While politicians have been quibbling over the size and the semantics of the public sector spending cuts to come, the NHS is quietly starting to get on with them.

Strategic health authorities and individual NHS employers are starting to plan to cut costs by reducing staff, whether through redundancies or by offering more flexible working options, such as a three day week.

A primary care trust could save nearly £7m in five years by investing £3.1m in measures to reduce obesity, smoking and excessive drinking

The latter appears to have worked well in the private sector, where the effects of the economic crisis were felt sooner, and the relative speed with which the UK is emerging from the downturn compared with previous recessions has been attributed to both employers’ and employees’ willingness to be flexible.

If the NHS is to follow suit, there is little time to waste. Any national negotiations over flexible working and job guarantees must be conducted efficiently and with a minimum of posturing from any of the parties involved.

And, as ministers and shadow ministers vie to put a figure on - or not put a figure on - the amount that must be saved to pay back the deficits, it’s good to see the NHS and local government coming through with figures on the second P in QIPP - prevention - alongside the necessary focus on efficiency and productivity.

It is notoriously difficult to quantify the savings from health interventions, but an independent report has this week reckoned that a primary care trust could save nearly £7m in five years by investing £3.1m in measures to reduce obesity, smoking and excessive drinking. Similarly, Dr Foster Intelligence estimates a PCT can save £1.7m each year by preventing unnecessary admissions for patients with long term conditions.

Multiplied 152 times, those are significant savings, and not ones that necessarily cost jobs.

It’s crunch time, but job cuts are not the only way to save the NHS money