There is no shortage of ideas to help the NHS weather the gathering financial storm: this was the main message from today's breakfast debate at The King's Fund, which brought together perspectives from commissioning and strategic planning in the NHS.
Speakers identified many opportunities to save money, many of them familiar: stop doing procedures that produce no benefit for the patient, stop procedures in hospitals that could be done in community settings for less, avoid duplication of specialist services and infrastructure, don't waste valuable clinical staff time in the community on form filling that could be done by someone else, enable patients to take more care of themselves, and make better use of under-used NHS land and buildings.
Taken together these would result in significant change for hospital and community services.
Many of the means to achieve this are also familiar: better leadership, PCTs coming together to pool expertise and commissioning clout, using financial incentives to drive costs down, and using the innovation and resources of the voluntary and private sector.
The quality of NHS care does not have to be a casualty of a financial crisis. Indeed, a crisis may help to focus minds on clinical improvement and effectiveness in a way that a period of plenty does not.
But two big questions remain – will what we know now be enough to save money on the scale needed to meet rising demand with lower (or no) growth? And will change happen fast enough?
Many of the changes described above have been attempted in some parts of the NHS, but they can be politically fraught and can take a considerable amount of time where public and staff buy-in is needed. Local NHS leaders are learning how valuable it is to have local doctors on side to help persuade the public, but the process can be hampered by a lack of honesty from national politicians about the scale of the financial crisis and its implications for the NHS.
The public needs to be open to change rather than resist it at every turn and honesty from national politicians can help to set the tone of public debate.
But honesty seems elusive entering an election period, with Conservative pledges to resist reconfigurations and Labour's tendency to duck when it comes to talking about cuts in staff or services.
The media also has a role to play: changes to local services are treated with suspicion or even derision (remember the outcry over the PCT that tried to restrict hip and knee operations for obese patients?). This must change if the tax-paying public is to be engaged and involved with the decisions that need to be made.