In their personal lives people do not think that our economic difficulties are a short-term blip. People recognise that they are much more likely to be facing even more difficult times in a decade than we are today. We are in for hard times for some time to come.
So let's seriously work through what this might mean for the NHS.
Danger facing the NHS
The main danger for the NHS does not come from these economic realities. It comes from those who may feel that these economic realities do not have a severe impact upon the NHS.
Time is ticking and for every few weeks that we fail to recognise the long-term impact on the NHS of these economics, the NHS will be endangered. The country is fully committed to the principle of a health service free at the point of need with equal access for all paid out of national taxation. But very, very few people comprehend the economic side of that political bargain.
The nation can wish the principle of a health service but it will not be able to wish the economics to maintain that set of principles through the sorts of increase in resources we have become used to.
New economic reality
If we fail to understand how this new economic reality will impinge upon the NHS and make a coherent plan for it, bits of the NHS will drop off and its comprehensiveness for all will be compromised.
But what does this mean in concrete terms?
For 60 years the value equation for the NHS has been straightforward. The source of value for the NHS has come from clinical staff, their kit and drugs. If we wanted more healthcare then we had to increase the amount that we spent on those three elements of value creation.
If we wanted more healthcare then we needed more staff; more kit; more drugs.
Now we want more healthcare for the ageing population and we can't afford the more staff or more kit or more drugs that will provide that.
We must learn to use the staff, kit and drugs that we have much more wisely, not just for the period of the Nicholson challenge, but for the decades to come.
Delivering a significant improvement in healthcare outcomes for the same resource will be tough, but recognising that as the only game in town will be a good start.
And let's be clear about the other side of that coin. Those people who allow endemic inefficiency to continue are enemies of the NHS and if they have their way, the NHS will fail.
- Paul Corrigan is a management consultant and former special adviser to Tony Blair. More at www.pauldcorrigan.com/blog