Money, money, money. If only it were the answer to all the National Health Service's ills. Were that true, this morning we should all be proposing a toast to the healthy future of our most-prized national treasure. After all, the Government has now thrown huge amounts of public money at the NHS. Last year the Chancellor announced in his March budget that spending on the NHS would rise by 6.1% a year over inflation for the next four years to £68.7bn in April 2003. And in yesterday's Pre-Budget Report he promised a further £1 billion next year. By rights then, all those who have made a career out of arguing that the NHS's failings could be put down to decades of Government under-funding should be looking forward to a happy retirement.

Alongside the Chancellor's statement, the interim findings of Derek Wanless's report into NHS funding also argues that tax funding is the fairest and most efficient way of paying for the service and warns that unless investment is increased substantially the NHS will crumble. But what the Chancellor and Mr Wanless fail to point out is that the real crisis facing the NHS is not so much a lack of state funding as the Government's total lack of vision for reforming the service and, in particular, the patient's inability to control how the money allocated to the NHS is actually spent.

Wanless concludes that a health service funded through taxation appears to be the most efficient way of delivering care. But that does not make the NHS necessarily the most effective at providing good quality care. The system is able to be efficient for a simple reason: because it resorts to rationing. Often we make people wait a long time for treatment, sometimes we do not offer them the best treatment available, occasionally we simply don't give them access to new drugs at all. And you only have to use the NHS, or listen to the stories of those who have, to know that a wholly tax-funded system run by Whitehall may be wonderful in theory but is actually atrocious in practice.

So why is the Government so dismissive of the alternatives? Countries like France, Germany and the Netherlands, which operate a system of social insurance, do spend more on health but should we automatically see this as a threat? It is only because British politicians have closed their eyes to introducing forms of funding other than taxation that we are denied the choice and speedy treatment that the French and Germans take for granted. Closing the gap between what they spend on health compared to what we spend using taxation alone would mean the sort of tax rises that most voters would not be prepared to accept.

Even if huge tax rises were feasible, it is difficult to see how simply pouring more taxpayers' money down the guzzling throat of the monopolistic NHS monster will be the answer to all our prayers. Government funding takes far longer to come on stream than more direct forms of payment. The extra £1 billion promised will not take effect until 2003 and even when it does arrive it will take months to actually trickle down to patients. Meanwhile, winter draws in and the NHS urgently needs help now.

Two years ago the health service was crippled by a flu outbreak that left some hospitals without a single emergency bed. Almost nothing has improved since then and in some areas, as the Government's own spokesmen admit, things have even got worse. Far more needs to be done to decentralise and depoliticise the NHS if we are not to see the horrors of Winter 1999 repeated all over again.

As Derek Wanless rightly points out, money is certainly needed. New and expensive technologies, the growing proportion of elderly patients, and the demands of a more consumerist society are all driving costs and workloads inexorably upwards. But tax rises alone are not the answer. Without greater leadership and vision from those in charge of the service, that money will almost instantly be swallowed up by bureaucracy or by managers responding to short-term targets and initiatives while those who need it most are forced to wait or seek costly private care.

Even the Government's own blueprint for reform, the NHS Plan, admits that "the current structure penalises success and rewards failure". So why do Tony Blair and Alan Milburn continue to persevere with that structure rather than trying to overhaul it? If a popular, left-wing Government elected on a mandate to overhaul public services cannot come up with anything better than a superficial handout and a promise to find more doctors and nurses, then the NHS - and all who depend on it - really do face a deathly future.

Helen Brown is Director of European Relations at The Institute for the Study of Civil Society, an independent think-tank.