Savings have to be made and, unfortunately, only so much can be cut from back office functions, middle management and joining up of services.
That means healthcare itself must take a hit and every area of spending will put forward a strong case for why it is in the public interest to be retained.
When you go beyond emergency care the priorities, such as obesity, elderly care or anti smoking campaigns, are hard to judge and the fairest way to choose is to put the options to those affected.
Whatever the decision on obesity – a problem that has reached epidemic levels – more work has to be done before it reaches the stage of going under the surgeon's knife. Children must be better educated about what to eat, and greater encouragement given to physical activity in schools. As with many health issues, tackling the problem early is often a cheaper way to help more people than the expensive surgery needed when it is too late.