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If you are taking out £15-20 billion from a service like the NHS, it is foolhardy to expect this to be achieved whilst improving quality. It is all well and good to point to examples in business where technology improvements and lean processes improve productivity and efficiency. But changing a sluggish service the size and complexity of the NHS along this path, within a few years, whilst improving quality of services is totally unrealistic.

Of course there will be pockets where this is achieved, and no doubt done very well. However, this is unlikely to be the norm and I fear that the disruptive changes which we will undoubtably see over the next few years could be detrimental to patient care.

Whilst the public sector is in recession, we should be aiming to at least maintain current quality whilst reducing the budget. Then in a few years when emerging from the recession, there will be a (more) stable service to build on, rather than one which has been decimated by short term-ist changes.

Perhaps this is because there is not a politician in the land who is willing to put their head above the parapet and give realistic expectations instead of telling the public what they want to hear.