With even the chancellor having to admit his forecast was woefully wide of the mark, the NHS could be forgiven for basing its financial planning on sunny spells rather than torrential rain.

But primary care trusts must now face up to the need for sharp revisions to their funding assumptions for the next few years.

“It is a peculiarity of British politics that there are few experiences more painful than being beaten with a shroud”

There will not be clarity on the NHS’s financial future until after the general election. Until then the Department of Health is caught in a bind; even floating indicative funding figures for the next two to three years runs the triple risks of establishing a new baseline for negotiations with the Treasury, triggering an outbreak of shroud-waving as clinicians and managers make dire predictions about the effect on patients, and giving the opposition something with which to beat the government; it is a peculiarity of British politics that there are few experiences more painful than being beaten with a shroud.

But a realistic assessment of funding prospects is essential for effective planning. The best PCTs will already be starting to redesign services for two years’ time which strip out the waste of unnecessary operations, move more care into the community, drive closer collaboration with social services and apply lean principles. Down the road their providers should be building unprecedented collaboration between clinicians and managers to deliver savings by improving quality, safety and patient experience.

But the key will be commissioning. The funding squeeze will be the most challenging test of individual PCTs and the world class commissioning programme as a whole.

Some weaker PCTs might be broken by it. But if it allows the NHS to see the forthcoming turbulence as an opportunity to improve services rather than simply cut them, it would vindicate the wisdom of moving power away from providers.

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