We can have little surprise at the news that the Oxford Radcliffe Hospitals NHS Trust will have to find big savings next year. The state of the public purse means few public services will escape the pain whatever the politicians promise us in the run-up to the General Election.

The national debt is huge and the notion that we can find the savings we need without hitting the big frontline spending areas has no logic.

The Oxford Radcliffe trust has managed to more or less achieve the £44m it said it had to find in this financial year and it appears to have been done without overt damage to the service that it provides.

We say ‘overt damage’ because these figures are large and cannot be achieved without any pain at all. The unions suggest that many posts have not been filled as they have become vacant. This can work for a while but does put increasing pressure on services.

The big concern is the cumulative effect. The trust says it is going to have to find £45m on top of the £44m it had to find this year. It is obvious that finding this second sum will be harder than finding the first £44m.

The trust says that savings will be made by treating fewer people in hospital and treating them at home or at the GP surgery instead.

Like many of the spending cuts we hear about from the politicians, these ‘efficiency savings’ are presumed but not necessarily deliverable.

The fear must be that bigger and bigger savings in the health service will be funded by a return to unacceptably long waiting times for hospital procedures.