A rough old trade is politics, as most MPs can confirm. All the same, I felt a bit sorry for Andrew Lansley the other week when he was beaten up for saying 'on many counts recession can be good for us'.

Labour politicians, who are not all gaffe-free either, whipped themselves up into a state of phoney indignation about the unemployed and homeless.

Yet we all know what the Tory health spokesman meant, albeit said incautiously: that people have less scope in a recession to eat, smoke or drink their way into hospital.

Sure enough, Saturday's Financial Times reported that wine sales are dropping for the first time in decades, plonk as well as the City bankers' fine wines, though the paper also reported that it is a good time to get a Porsche for just£90,000 - that's£40,000 off for any Unison member readers, who may not monitor it closely.

The moral is that recessions treat different people differently, the theme of this week's column. Sure enough Mr Lansley, who is determined to cross the finishing line and become health secretary himself, was back in the fray on Monday protesting that the new King's Fund report shows that Labour "simply hasn't done enough" on booze, fags and obesity.

NHS debt

Ahead of the health secretary's announcement of the NHS operating framework and financial allocations for 2009-11, Mr Lansley also weighed in to attack NHS London's plan to write off£579m debt by 2011, accumulated by a minority (11) of its 38 acute hospital trusts and five out of 31 PCTs.

"Writing off debt is no substitute for resolving problems through rigorous financial planning, as many other PCTs across the country have been forced to do. Under no circumstances should measures be implemented that would encourage financial irresponsibility in the future," he declared.

Interesting if true? So I checked it out. But first, those financial allocations, significantly issued for two years instead of one, to ease uncertainty and head off panicky cuts - beds and staff - which may rebound on the service as they did after the big 1984-85 squeeze. "Steady as she goes," is Alan Johnson's message.

In reality it is going to be tight. Alistair Darling's pre-Budget report spoke of£5bn worth of efficiency savings, about£2bn of which may have to come out of the NHS.

Ministers will still argue that the 5 per cent over two years promised in the last comprehensive spending review is still there - and keeps the NHS ahead of what may be fast falling inflation. "Look at the cutbacks and massive uncertainties in the private sector", they will remind NHS staff.

London's plans

We shall see. But what about London, whose five strategic health authorities merged into NHS London in 2006? SHA officials are keen that a small group of primary care trust chief executives get the credit ("we're very proud of them") for the debt write-off scheme, a "once in a lifetime" chance to tackle the problem and allow trusts to co-operate in implementing Healthcare for London. It might even help them become foundations.

As all irritated non-Londoners know, the capital is both richer and more divided by inequalities: most of the indebted acute trusts are on the poorer, east side of the city. The bail-out will require the richer PCTs to chip in to help their brethren.

How? By forgoing 1.3 per cent of their planned 5 per cent budget increases, except those five PCTs still struggling with their own debts; also by saying goodbye to a£304m surplus previously topsliced.

Why play PCT Robin Hood? Officials explain that, whereas a struggling NHS executive in Southampton may not feel Oxford's pain across the region - or Cornwall feel Devon's - London's NHS chiefs know they are in this together.

"They may also be sharper operators," whispers one.

PCT boards will be asked to OK this during December. A few may say "no" and go their own way, though it may be tough alone. Redistributed investment will be disproportionate and sector-based and decisions will be localised.

And to answer the Andrew Lansley question, yes, debtors will be under the cosh to put their financial house in order. What with Alan Johnson, Alistair Darling and co, several coshes actually.