Brown's NHS revolution threatened

Tony Blair and Gordon Brown face a major obstacle to their ambitious and expensive plans to reform the NHS - a huge shortage of staff.

The Government has promised to recruit 15,000 extra GPs and doctors, 35,000 more nurses and 30,000 other staff but health service workers and their unions, already angry over low pay, say their jobs will be made even more unattractive by rises in National Insurance.

Figures this week showed the number of jobless is now very low, and there are grave doubts as to how the vacancies proclaimed by Health Secretary Alan Milburn can be filled.

The recruitment problem has been an enduring headache for the Government, and health service managers have had to travel abroad to find doctors and nurses. In London, nearly one in three nurses comes from overseas and most hospitals rely on agency nurses to keep the wards open - at a cost to the NHS of an extra £2 billion a year.

But this is only one of a series of complaints now mushrooming around the Budget, which saw Gordon Brown put a penny on NI contributions for both employers and employees, as well as freeze personal allowances.

Mr Blair and Mr Brown's effort to sell the Budget hit problems when they were challenged by a consultant at the Chelsea and Westminster hospital over the increases in NI contributions for health workers and the NHS itself, which will have to pay an extra £200million a year.

Peta Longstaff, an accident and emergency specialist, told the Chancellor, in the full glare of TV cameras: "It sounds a bit of an own goal if we're paying for our own service."

Mr Brown replied: " I would not have asked people to pay more tax unless if was absolutely necessary."

Derek Wanless, the man who wrote the report for the Chancellor which recommended the huge increases in NHS spending, today reiterated his concerns about whether the service can change in the way it needs to, in order to justify the spending rise.

The former chief executive of NatWest said the future of the NHS was clouded by "uncertainty", and said ministers faced a considerable challenge in making them work. "There is potentially a huge problem from a political point of view about being seen to deliver," he said in an interview with The Times.

He also issued a timely warning that it would be foolish to pour money into the NHS "too fast" because it could lead to prices across the health system being pushed up.

In an attempt to sell the proposals to voters, Mr Blair has written to all Labour MPs, urging them to campaign for the Budget this weekend.

The £8.5 billion tax increase does not mean a return to the "tax and spend" policies of Old Labour, he said.

He wrote: "This is a New Labour Budget, because it builds on the platform of hard-won economic stability that has delivered low inflation and mortgage rates and record high employment."

But Tory leader Iain Duncan Smith warned that Mr Brown would "tax, tax and tax again." He told members of the London Chamber of Commerce: " All of this is merely a downpayment on future tax rises."

Meanwhile, it was revealed today that family doctors are to be offered one of the biggest shake-ups of their working lives since the NHS was founded in a bid to stop them quitting.

The changes unveiled by the British Medical Association include allowing GPs work as salaried doctors or to become self-employed by working as "independent contractors", and giving them more control over their workload and improved career development opportunities.

There was growing anger among business leaders today as they calculated that firms will have to pay an additional £6.2 billion to the Government in taxes as a result of this week's Budget. It emerged that British business will be paying three-quarters of the £8.3 billion rise in taxes, mainly through higher National Insurance contributions. Firms which employ the most staff will be hit the hardest.

Hospitals will get payments by results
Parents hit by NI cost for nannies
Hand signals a pointer to pressure