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Talk about stealing the Tories clothes. Chancellor Alastair Darling announced that the inheritance tax threshold is being doubled to £600,000 and foreign millionaires will be forced to stump up a few quid to the Exchequer - all part of the pre-Budget report/Comprehensive Spending Review. Dr David Nicholl wonders if the cash that goes to the Health Service should be managed by someone who actually knows what they're doing. Is he mad?

Yesterday saw the launch of the comprehensive spending review (CSR). Although all the focus in the last few weeks has been on the Brown 'will he, won't he' have an election, the results of this review will have a much greater consequence than even an election, after all, this is only the second CSR that New Labour has had.

What were the results of the 1997 CSR were? When Gordon Brown, as Chancellor, announced the results in 1998, this lead to huge investments in public services. If we look at Health, this year the government will be investing an estimated £91 billion in the NHS- that is double what was spent 10 years ago, a truly jaw dropping figure.

Yet, if we skip back 10 years, it was almost inevitable that ANY government would have had to invest in the NHS as no-one had invested in it for years. In 1997, we spent less than almost any Western country on health as a proportion of GDP (gross domestic product). Now in 2007, the UK spends as much as any comparable country.

Even now Darling has committed to increasing the rate of spending by 4% in real terms - although this is a smaller rate of growth than we've become used to, and this will have a significant effect on the way the NHS is run. Not least, because not only will the rate of growth reduce, but also much tighter financial controls will be in place, yet the cost of drugs and new treatments will rise significantly.

So why is it that we expect a mere politician to run the NHS, when it is the World's third biggest employer after the Chinese army and the Indian railways, with 1.3 million employees? Just look at how many Health ministers we have had in 10 years, Frank Dobson, Alan Milburn, John Reid, Patricia Hewitt and most recently Alan Johnson- none of them with any significant experience of healthcare.

As an employee, I have a suggestion - that if we are going to spend this much money on healthcare, that we do have much more rigour about what healthcare workers do, and that should start at the very top.

Why not have a similar system to the US for ministerial appointments? For example, the government in power would appoint only Ministers that have to been voted on by Parliament. Such ministers would not even need to be a politician, they could be an expert in their particular field, but they would still be held to account by Parliament.

With my system running similar to Congressional hearings in the US, there would be inherently much more stability in individual departments with an improved level of Parliamentary scrutiny. This way the government could actually do something very unique- they could actually appoint a Health Minister who knew something about health and they would be accountable!

I mean, what muppet actually thought appointing someone like John Reid or Patricia Hewitt was a good idea - and then to put them in charge of £90 billion?

Running healthcare, just like running the economy, Gordon, relies on stability, and not on some ministerial scandal to force someone with no previous experience into the job. Yet with our tit-for-tat politics there is no political party which seems to be prepared to really challenge the status quo. But if the people in charge are making such huge decisions with vast sums of our money, don't we deserve better? "

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