I had an odd experience at the weekend. Reading the Commons health select committee’s depressing report on patient safety, I kept thinking of the more visible drama now being played out over public expenditure and pay.

The MPs’ report begins by recalling Hippocrates’ celebrated advice to doctors 24 centuries ago: first do no harm. They also quote frank admissions that until recently medics usually did much more harm than good, like bloodletting. A cautionary tale there for anyone seeking to rescue the world’s economies from the excesses of a banking sector eager to resume business as usual.

Governments, including Britain’s, were too reluctant to say “you’ve all drunk enough” and close the bar.

But what should we make of the latest artillery exchange? Gordon Brown and David Cameron trade statistics to prove each other’s remedies would fail Hippocrates’ test. They could both be right; Cameron by squeezing public spending too hard before the economy is safely out of recession (it is not); Brown by failing to admit that cuts must eventually come – as Cabinet colleagues openly admit.

Despite signs of recovery, most indicators are still getting worse. Higher unemployment means more jobless benefits and borrowing, putting extra pressure on budgets. Everyone knows that, though Brown is characteristically less than frank.

That patient safety report (MPs are alarmed by slow safety progress, incidentally) offers advice. When a patient is harmed the NHS must be “totally honest… give a full explanation, apologise unequivocally” and promise not to do it again, it says. Do it, prime minister.

So former health secretary Alan Johnson’s assumption of only a few weeks ago that his 2008-11 pay deal with health unions will not be unpicked is now looking optimistic.

There is a lesson here for Andrew Lansley too. Remarks during an HSJ interview which attracted attention last week were intended to underline the wholesome message that a Cameron government would not overrule NHS pay reviews or negotiation. That is a bit optimistic too, though Cameron endorsed it on radio.

More significant here is Audit Commission chief Steve Bundred’s proposal for a public sector pay freeze (or “severe restraint”) which had Unison’s Dave Prentis and other union leaders squealing that their members have suffered enough – and it is not their fault.

Maybe, but don’t expect sympathy when private firms are cutting pay (to avoid redundancies) or offering staff half pay holidays. Chancellor Alistair Darling, his authority increased since Brown failed to sack him, mildly observes that public sector pay and conditions can’t ignore the wider market. Correct.

So when chief medical officer Sir Liam Donaldson’s £3.4m pension pot (£97,000 a year) gets into the tabloids, along with those BBC suits, it is a sign of growing pressure on public managers’ pay and their pensions too.

I am with Jon Restell, who has urged optimism and courage on NHS managers. No one knows how the crisis will unfold. A W-shaped recession? A slow recovery? High inflation again?

The markets which have to finance Treasury borrowing are banking on a Tory election win next year and tighter measures to balance the budget. Yet when the German government recently decided to make balanced budgets a legal requirement, some financial pundits howled with dismay: a formula for making things worse (like 1931).

Cameron’s cash crunching plans (“just speculation at this stage,” say sources) to bring in Microsoft or Google to replace the NHS’s overcentralised IT database should be viewed as part of his vision of the “post bureaucratic age.” First do no harm?