Leading article: The case for co-operation

The Royal College of Nursing's annual conference begins today on a note of warning – both for the nursing profession and the next government. The general secretary of the nurses' union, Dr Peter Carter, has expressed fears that the quality of care for patients will suffer because of the forthcoming squeeze on public spending. Dr Carter argues that it is "pie in the sky" to think that £20bn savings (the target set by the NHS chief executive Sir David Nicholson) can be achieved by 2014 through increased productivity alone. "The reality", he argues, "is that plans are being drawn up to take money out of the NHS, and it will be disastrous for the future."

Such comments suggest that the union is gearing up for a political battle over cuts after the next election. This might be seen as rather surprising, given that the Conservatives and Labour have pledged to ring-fence health spending (with the Tories even promising that it will rise above the level of inflation). The Liberal Demo-crats have not matched these funding promises, but have pledged to protect frontline services, to be paid for by imposing savings on management.

In one sense Dr Carter is right. Cutting management is unlikely to be enough for the NHS to meet its financial targets. And politicians of all parties are being disingenuous by implying that it will. But while the politicians are being less than up-front about the scale of the task facing the NHS, the health unions themselves must be careful not to neglect the bigger picture.

The NHS budget has almost doubled in real terms over 10 years. That spending has unquestionably delivered improvements in healthcare. Yet productivity has lagged. And those flows of cash will slow dramatically, no matter which party goes on to form the next government.

This is the central challenge facing the NHS: to preserve and improve services with fewer resources than the service has grown used to receiving. The health unions should be putting their heads together with NHS managers and politicians to come up with ways to deliver services more efficiently. The generous guarantees on funding they have already received (in comparison with almost every other government department) merely strengthen the case for co-operation.

If the unions fear that the axe will fall on inappropriate areas they need to come up with constructive proposals on how money can be saved without harming patient care. If the unions decide simply to go into political opposition after the next election, then Dr Carter's worst fears are certain to be fulfilled.