Without sounding overly biblical, but with the credit crunch in mind, is the NHS facing lean times after years of fat expenditure?
The bumper harvest years of NHS investment are certainly slowing down, although this was always the government's intention.The peak of investment was designed to bring results such as the 18-week target for hospital treatment, more equity in access, care closer to home and increased community health provision.
Major advances have been made with services and targets, but we all know there is never such a thing as a quick fix where health, and particularly public health, is concerned. Of course, cash backing makes a difference, but it takes time to fix broken hearts and to change people's lifestyles and expectations.
In East Lancashire, we are making headway with our public health initiative to save a million years of life. And along with our NHS colleagues elsewhere in the country, we will aim to keep the momentum going, despite the economic climate.
On the budgetary front, we always knew the 9 or 10 per cent growth in expenditure over the past three years would be reduced to between 4.5 and 5.5 per cent over the next three years or so. Naturally, we anticipated this, although none of us really foresaw the full-blown credit crunch that has come our way.
None of us are immune. The rise in energy costs increases the cost of running our new health centres and hospitals. Our plans to use the sale of NHS-owned land to fund new developments are also affected. A 15 per cent drop in house prices can mean a 40 per cent decrease in land value.
And, of course, we must all be prepared for a potential increase in demand for our frontline services, as the stresses and strains of the economic recession affect people directly. We must be ready to help our staff and our patients through this.
All this makes it tougher to deliver what we want, when we want. But the trick is to keep your eye on the longer-term aim and get there as soon as is practicable, given the economic climate.
We all have responsibilities to our local populations and to local enterprises. We have a duty to help businesses in our area by paying our bills promptly. Cash flow can make or break a good small business.
As for our own organisation, we will continue aiming to maintain and increase the quality of services delivered. Our strategic plan makes our goals clear: to increase life expectancy, improve quality of life and enhance the quality of services provided.
Maybe we will have to tailor our plans due to lower growth and maybe we will have to implement some changes later rather than sooner. However, in line with all NHS organisations in this difficult time, we will aim to protect patients and frontline services and see the job through.
Naturally, we will encourage the public to look after themselves better and to access services appropriately and responsibly. And that goes for us too.