The Budget joke I liked best was not the one about the tax haven deal with Lord Ashcroft’s Belize. It was that Alistair Darling had offered money to fill potholes in our roads after the long, hard winter, but not the black holes in the public finances after the even crueller recession.

Mean, but funny. It’s not quite true either. Neither Labour, Tories nor saintly Lib Dems have been very explicit so far about how they would rein in spending and increase the tax take. But we’re getting there slowly.

“Back office costs” has suddenly replaced “NHS bureaucracy” as a buzz word panacea

The unflashy-but-shrewd chancellor got a good press overall for what was widely called the first post-Brown budget. “You are in danger of becoming a national treasure,” Peter Mandelson apparently teased Darling.

City analysts and Fleet Street remained cross about the lack of tax-and-spend detail. Yet more will trickle out under the pressure of events. We got a bit more on the even more implausible Tory plans this week too.

Meanwhile the flood of emailed statements to NHS managers in the wake of the Budget included more about health secretary Andy Burnham’s offer to find one third of the promised efficiency savings - £4.35bn out of £11bn a year by 2013 - while allegedly protecting frontline services, at least for now.

It gives us some indication as to where ministerial attention will be focused, whoever wins power: £1.5bn from the cost of procurement; a modest £100m from that money pit the NHS IT programme; £60m from cutting energy consumption; up to £555m from cutting staff sickness and absence (see right).

I love those precise figures. Why not £556m? And “back office costs” has suddenly replaced “NHS bureaucracy” as a buzz word panacea for cost-cutting Tories as well as Labour.

Darling’s deputy, Liam Byrne, was duly mocked on TV over NHS sickness. How could they possibly save that much? By better procedures and by sacking persistent offenders, he gamely insisted.

Coincidence or not, from next Tuesday those of us who seek a doctor’s sick note may get a “fit note” which would (in theory) discourage malingering and ease the pathway back into work via changed duties or altered hours.

Who says so? Health and work “tsar” Dame Carol Black, who recommended the change back in 2008. Who knows, she might be right. It must be irritating for managers to get fresh guidance on “commercial skills for the NHS” and an update of the “PCT procurement guide”, but this is a Battle of Britain moment: no time for reflex cynicism, all shoulders to the wheel.

The DH’s new post-Budget “patient choice statement” is to be read in tandem with those above; regrettably the guidance does not state whether tea or coffee is the preferred beverage while reading, nor what type of biscuit. There you go again, Mike, reflex cynicism.

But does the statement contain evidence of Handy Andy’s retreat from the Burnham Doctrine that the NHS is the “preferred provider”? I think it might.

Thus: “Where existing NHS services are delivering a good standard of care for patients, there is no need to look to the market. But there is no compromise over poor quality care. Independent and third sector organisations will continue to make a value contribution…” writes Mr Burnham.

Yet the media too points several ways at once. The Sunday Telegraph’s ambulance campaign, thoughtful last week over 999 priorities, complains this week that crews are being given up to £38 for every casualty they keep out of hospital.

That makes sense in the Darling World of Cuts, doesn’t it? We have a long way to go and drastic steps like charging for NHS services cannot be ruled out - whatever Andy B or Lansley says now.

Topics