Last week’s revelation by HSJ of the pain the NHS might have to endure to achieve savings in the order of £20bn by 2014 dominated the national media.

But the ensuing debate over the report by consultancy McKinsey on what a saving of this size might mean for the health service did little to enlighten the public about the choices facing ministers, let alone managers.

Do not be distracted by political fog about rejecting the report or finding the savings in the NHS bureaucracy

The atavistic reaction to anything involving management consultants allowed many commentators and virtually every politician to miss the point. This was not a fiendish private sector plot to decimate the NHS workforce; this was a report revealing the brutal reality of the true cost to the NHS of the collapse of the banking system.

It is not, as health minister Mike O’Brien implied, a question of accepting or rejecting the McKinsey report. It is a question of facing up to the issues it raises.

There are pointless operations being carried out. There are wild variations in the numbers of patients seen by comparable doctors and nurses. Estate management is often poor. Bed blocking is still wasting large chunks of hospital capacity. Administration systems, not least around basics such as bookings, are too slow. These are just some of the issues managers are tackling as the public sector recession looms.

What starts to emerge from the debate in this week’s HSJ about the future for the NHS is a service of a markedly different shape from today. For example, scenarios for sharp reductions in hospital income in London are revealed. Although circumstances for the capital’s providers are particularly tough, this nonetheless gives a taste of what each region must address.

Fewer, larger providers integrated with community healthcare may be part of the new landscape. But there is a risk that consolidation of the hospital sector is driven by financial failure - trusts being too slow to restructure while trying to grow their way out of recession at the same time as primary care trusts are clamping down on demand.

Do not be distracted by political fog about rejecting the report or finding the savings in the NHS bureaucracy. Politicians can afford to obfuscate until after polling day. Managers cannot.