I don't think I heard the word 'NHS' more than once during the chancellor's emergency budget - for that is what it was - on Monday.

Nor read all but the occasional passing reference to "health spending doubled since 1997" in the fat pile of accompanying Treasury documents - let alone in media coverage next day.

But don't think the NHS has escaped unscathed as a result. This was scary stuff from which we will all be hit one way or another, senior consultants and NHS management as taxpayers, voters as patients and finance directors as budget planners braced for cuts.

What cuts? Surely, there was no mention in Alistair Darling's pre-Budget report statement - to give the event its proper title, misleading though it was this time - was there? No.

Mr Darling is famously a more plain spoken and honest man than many in his trade. And, as in his then-controversial interview in the summer (when he warned the world faced its biggest crisis for 60 years), the chancellor made a virtue out of frankness on Monday: we are in a big hole, global and domestic.

Where the cost will bite, sooner or later, on UK healthcare provision, came in his passing reference to reducing the planned real terms increase in public spending from 1.8 per cent to an official 1.2 per cent - though I have seen suggestions that it will actually be tighter than that, closer to 1 per cent.

Why? While some capital spending will be brought forward to stimulate jobs (I didn't hear the words "PFI hospitals") capital spending will be frozen from 2010-11 when the chancellor hopes the recession will be over (a BIG hope that is). It will be part of Treasury efforts to recoup the money - that short term fiscal stimulus - it is deploying to reverse the downward economic spiral.

Smart moves

In medical terms it is like applying a£20bn electric shock to a faltering heart beat. It sometimes works, sometimes not, but as the Keynesian economist JK Galbraith once explained, no one knows what's going to happen next: the difference is that smart people realise this, others don't.

So don't trust those who claim to know the future at present. They are probably the same people who claimed that "history ended" when the Berlin Wall collapsed or celebrated the triumph of capitalism when the West embarked on a reckless expansion funded by Asian savings and low interest rates.

If we are struggling to stay cheerful (we are, aren't we, it's the only way) we might draw comfort from Mr Darling's reminder that net public sector investment - mending those holes in school and hospital roofs - did rise from 0.6 per cent of GDP in 1997 to 2 per cent.

Much of the money was well spent and, if it has proved impossible to sustain at that level, we were expecting a squeeze, were we not? Sir Derek Wanless urged us all to get fitter to render the NHS affordable. Patricia Hewitt hammered those trust budget overspends.

And do many NHS managers not believe that real efficiency gains will be easier when times get tougher?

Sober assessment

So the party's over (again) and we shall see what happens next. I don't share the widely asserted view that the Darling pre-Budget report marked "the end of New Labour" or even the death knell of the government. Tony Blair and Gordon Brown were always pragmatists in macroeconomic matters (do what works) and were also trying to redistribute tax revenues towards the poorest whenever they thought Middle Britain wouldn't notice.

Changing circumstances have simply allowed Mr Darling to do it more openly and hit the better off more openly too. Unison and Old Labour MPs were delighted. But don't imagine wary Brown has changed, nice though it is to see a loyal, decent union like Unison having something to cheer.

"A serious package for serious times," Unison said in a distinctly optimistic statement. But on the day of the pre-Budget report the Bush administration part nationalised the Citigroup bank, and we can expect President Obama to do the same pump-priming as Britain is doing.

Yes, rising debt levels are scary, but it is absurd to say, as some pundits do, the crisis is either worse or more expensive than two world wars. We will survive, but it will be rough. Doing nothing was not an option: caution is the new recklessness.