As he set up the National Health Service in 1948, Aneurin Bevan observed: "We never shall have all we need. Expectation will always exceed capacity." And he told the Royal College of Nursing: "Every mistake you make, I shall bleed for." Those two statements - as true today as they were half a century ago - should be pinned to the office wall of Alan Milburn and of any subsequent Health Secretary for as long as the NHS survives. Whatever the truth of Rose Addis's treatment at north London's Whittington Hospital, certain fundamental laws apply. Put a service under ministerial control and the smallest mishap can lead to a major political row. Provide a scarce service completely free of charge and, in the absence of rationing by price, some other form of rationing - waiting, in the case of the NHS - must apply. On the first morning of the NHS, some doctors, expecting a tumultuous rush for free treatment, barricaded themselves in their offices. Patients, showing a better grasp of economics than their grandchildren half a century later, simply formed an orderly queue.

What has changed most since the NHS was founded is the willingness of patients, and particularly middle-class patients, to tolerate such exigencies. They want choice; they want comfort; above all, they want rapid treatment, time being the most precious of all commodities to the 21st-century consumer. But queues have become more, not less, important in the NHS, and they must play a central part in the online debate that the NS launches this month (details, page 34). Until the mid-1970s, governments planned staffing, equipment and other resources for the health service according to estimates of need, and found the money accordingly. Then, under pressure from the IMF and subsequently from the drive to hold down taxation, they imposed cash limits. In effect, the ball was tossed into the patients' court; only when the public clamour for better healthcare becomes politically intolerable do governments increase the cash available. Crisis is thus built into NHS planning. And since most people have no way of judging the quality of treatment except through how long they have to wait for it, the queue has moved into the political front line. The length and duration of queues, and the level of public anger with them, are the only cost-benefit analysis that governments can apply to the performance of the health service as a whole.

It is, above all, in the accident and emergency departments that the middle classes - who do not see the inside of prisons or social security offices, and who rarely use public transport - confront the disparity between private affluence and public squalor. But they willed it, in four general elections. Every hour of waiting, every brusque encounter with harassed staff, every unwashed bloodstain on the floor is a price they pay for Tory tax cuts. And doctors' frustration with the growth of managerialism in the NHS and with the fussy bureaucratic monitoring (see Colin Cooper and Theodore Dalrymple, page 29) stems from the same source. To meet cash limits, ministers and NHS managers explore ever more complex ways of identifying priorities and making money stretch further.

It is easily forgotten, two years after Tony Blair announced from a television sofa that he would bring health spending up to the EU average, how long it took public and politicians to recognise the extent of NHS underfunding. Yet to look at the figures now (see pages 32-33) is to be astonished. Britain ranks 18th among OECD countries in spending on health, and even Spain and Portugal have about twice as many practising physicians per thousand population. The inescapable conclusion is that, whatever is wrong with Britain's NHS, nothing can be put right until the availability of cash is improved. To attempt new reforms - no matter how much think-tank and policy-unit ingenuity has gone into crafting them, and no matter how dazzling the arguments for private management or local autonomy - simply puts more strain on an already overstretched service; it is like demanding that a starving family first redesign its kitchen.

But that should not rule out a debate on how to fund the NHS. International studies of health services, like last month's from the King's Fund, conclude that "the key issue for improving the NHS is not source of funding". They are wrong. It may be true, in a narrow economic sense, that general taxation is the best way of paying for a comprehensive, socially just service. But if general taxation yields inadequate funds, it becomes the worst way. If the Continental model of social insurance - which, in practice, may be no different from a hypothecated or earmarked tax - commands greater public acceptance, then, whatever the objections on grounds of principle or efficiency, we should make it work here. Until ministers have the courage to confront that question, the health service is likely to remain in crisis.

Hypnosis and the Jubilee

Readers of the New Statesman may plan to take a dismissive attitude towards the Golden Jubilee. This would be a mistake. The authorities are clearly afraid of something. You may think that a street party can be held more or less spontaneously. Go to the goldenjubilee.gov.uk website, however, and you are instructed to consult the local council, the Highways Authority and the Safety Advisory Group. You need a Traffic Regulation Order and Public Liability Insurance. If food is involved, go to the environmental health officer for "basic training". Fireworks? Get permission from the Civil Aviation Authority. Music? Off to the Performing Right Society. Hypnotism? (Yes, hypnotism.) Get a licence. The NS hereby incites civil disobedience. Ignore the rules, and get out and party. Then turn the event (using hypnosis, if necessary) into an anti-globalisation rally, an anti-car demo or a republican uprising. That's what officialdom must be afraid of; it knows something about the public mood that we don't.

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