NHS austerity

Attention will now focus on how the huge structural changes, which the NHS chief executive Sir David Nicholson has joked are so big they can be seen from space, are put into place.

Prime Minister David Cameron will hope the changes, notably giving GPs powers to decide how to spend £65bn of NHS cash, will be implemented without further re-toxifying the Conservatives whose claim that the health service is safe in their hands hangs in the balance.

But their real problem is that the reforms could become conflated in the public mind with the more serious challenge facing the NHS of saving £20bn by the General Election.

Today’s Yorkshire Post analysis of NHS finances in the region shows for the most part that the most punishing savings targets ever set for the health service have been met in the last 12 months.

Yet this is only the first year of four in the savings programme and already signs of strain are emerging.

What lies ahead, if real and lasting savings are to be made, are massive changes likely to far more directly impact on patients than legislation.

Across the region, major reviews of services are already underway. Hospitals face being radically reshaped, with the potential closure of much-cherished services as care is moved into the community. All this must be achieved as demand for care due to the ageing population rises inexorably.

The decisions required will undoubtedly by difficult and controversial. Ministers may feel battered and bruised after the rocky passage of their Bill. But their real challenge lies ahead.