Editor's blog Monday 26 April 2010: Sharpening the scalpels and battleaxes

Good evening. You will find another new instalment of Maynard Doctrine here, in which the good Professor addresses himself to the impact of slowing spending on the NHS budget.

I don't say "the likely impact" because almost nobody I've spoken to over the past couple of years seriously believes promises that the NHS budget will be protected. For all the warnings from ministers against conducting mini-spending reviews, the smarter ones have been modelling real-terms reductions.

Not by enough - too many people have been looking at scenarios between 6 and 9%, instead of the more probable higher figure.

And not enough people - I don't think even half - have been even doing the modelling. Micawberish denial, or plain stupidity? I'm not sure.

But basically, we have an imaginary future, where the new administration discovers The Magical Money Tree Where Cash Grows For Free, and so all shall be well, and all manner of things shall be well.

And then there is the fact that the question for the workforce needs to be, 'if you earn over £20,000 a year, which do you want: job cuts or wage cuts?'.

This website was launched in the summer of 2008, when it was wholly apparent that public spending - and thus the NHS - was heading for serious trouble. Watching the service's attempts to react has been mid-way between comical and pitiful.

If you've ever witnessed a high-speed car accident, you will recognise this bit: the horrible certainty that you cannot do anything to prevent what is coming. Scant consolation that it hasn't actually hit yet.

Hoping the airbag is working - which has been the official response to what we know and have been saying for nearly two years is coming - inspires little in the way of faith or hope. It makes you wonder about the charity, too.

The penny is now dropping more widely.