Patients face a bitter pill

As such, hospital managers and the Department of Health (DoH) should ensure patients have a say in the changes. The programme of cost savings must be a revolution by consent rather than a new raft of top-down edicts from the corridors of Whitehall and local concerns must also be recognised.

Any doctor or nurse can tell you that the profile of public health in deprived South Yorkshire towns is different to the concerns of rural North Yorkshire. Neither should be neglected.

There are many areas of care which deserve support but clearly the scale of work done by cancer, geriatric, maternity and mental health staff is among the most important.

These are, perhaps, the departments with which people are most likely to come into contact over the course of their lives and where a cut-price service could do most harm.

Protection of key areas can be achieved if the NHS is encouraged to slim down its bloated bureaucracy. A hospital trust cannot run without some managers and targets but executive pay, which soared under Labour, must berestrained. Procurement too could be simplified and cheapened; the NHS is Europe's largest employer and should use its size to drive efficiency rather than to tolerate waste.

Ministers must also understand that their planned re-organisation of the NHS could create more expense and uncertainty.

The coalition, then, is at a crossroads. It has been left with no choice other than to make savings yet it must not put at risk the improvements in public healthcare achieved under Labour, such as the fall in waiting times for operations and appointments with consultants.

The cuts will inevitably be quick but they must not be cruel.