THE die is cast. An extra £1.8 billion will come to the NHS in Wales over the next five years, paid for by a one per cent rise in National Insur-ance contributions.

Gordon Brown, pictured, five years into his Chancellorship of the Exchequer, has finally taken the plunge and committed New Labour to a rise in direct taxation.

It was a move widely anticipated and one for which the ground has been prepared months in advance.

The government has been hinting that it might take this step for some time, encouraged by public reaction which indicated that people were prepared to put up with the financial pain, as long as the gain - improvements to the NHS - followed.

And here is the rub. It is important not to underestimate the political gamble New Labour has taken with this Budget.

The extra cash has been hailed as a kiss of life for an ailing NHS.

But the powers-that-be will want to ensure that it is not the kiss of death for New Labour. They will want tangible evidence of a return on the electorate's investment before the next General Election.

In Wales, there are Assembly elections next year. Reductions in waiting times are gradually being achieved in target areas such as cardiac, orthopaedic and cataract surgery and these will no doubt be used as examples that Labour's approach to the NHS in Wales is working.

But waiting lists and times generally remain stubbornly high, and there are plenty of other problems that must be addressed in the NHS in Wales, many of which will take years to realise.

In common with the rest of the United Kingdom, there are not enough GPs in Wales.

There are 100 vacancies in Wales and the situation is particularly acute in Blaenau Gwent and the upper Rhymney Valley.

There are not enough surgeons, and nurses. Gwent, like other parts of Wales, cannot cope with the demands made on orthopaedics and other specialities without sending patients out of the area or to the private sector for treatment.

Gwent has nearly 200 nurse vacancies and may have to go abroad to recruit for the second time in little more than a year.

There are not enough radiologists, physio- and occupational therapists and other professions allied to medicine.

There are increasing emergency pressures, high levels of bedblockers, not enough facilities in which to carry out operations.

These problems will take time and patience to solve. Quick fixes, such as waiting list initiatives, have a role to play in improving the lot of patients, but there has to be a long-term vision and short- term political gain must not be allowed to obscure this.

Last week's Budget has been dubbed a Budget for the NHS. People have been prepared to swallow the taxation pill on the back of promises of much shorter waiting times and lists, better hospitals, more doctors and nurses.

But the NHS has been used as a political punchbag since it was formed in 1948 and there is little reason to believe, and little evidence to indicate, that it will not continue be so used.

The figures are impressive - £128 million over and above the spending already an-nounced for the NHS in Wales in 2003/04, rising to a possible extra £1.8bn on forecast levels for 2007/08.

Such amounts of cash rightly come with conditions, and proposals to monitor the effectiveness of the spending are being finalised.

But the biggest fear - uttered by many in the NHS in Gwent, Wales and beyond - is that the political desire for quick results to boost the government's and the Welsh Assembly government's chances of re-election, will manifest itself in short-termism.