Openness and transparency are also at the heart of the matter in relation to health budgets.
A report published by Audit Scotland has revealed three health boards needed Government bail-outs of £1 million to £4m last year, with nine boards having underlying budget deficits.
However the public wouldn't have known as this wasn't clearly shown in their accounts.
Growing financial pressures, including rising prescription drug bills and the costs of reorganising acute care, are thought to be among the reasons why NHS Forth Valley, NHS Fife and NHS Orkney struggled to make ends meet. Like ordinary households, health boards also face rising fuel and food costs.
But they are also facing tight budgets which mean they say they will need to make a total of £272m in savings this year.
This they are already doing. The problem is that in the areas where the biggest savings can be made, limits are being reached.
Some of the boards with the cleanest finances are those such as NHS Greater Glasgow, which are eliminating the most staff posts, but whether this is desirable or the best way of planning for the future is not debated.
Boards could allow more nursing posts to be lost through natural wastage. There are other ways to reduce costs – restricting access to the medicines patients need, or closing hospitals and centralising services. None of these are politically popular, but if they have to happen, boards and politicians alike should be honest and open about it.
That is not the case when, as the Royal College of Nursing pointed out, even Scotland's official auditing body couldn't clearly track how money was being shifted around the system.
If decisions and deficits are concealed, and bail-outs are giving a false impression that boards are breaking even, it benefits no-one.
It helps conspire in the illusion that we can continue to avoid difficult decisions about what matters most, how cuts are managed and what is being sacrificed.
The RCN and the British Medical Association are right to call for a sensible public debate about what the NHS can afford to do.
A long-term approach is also essential. The Audit Scotland report warns the requirement for boards to balance their budgets annually is encouraging a "short-term view" and implies criticism of the Scottish Government for insisting on it.
The demand that boards break even each year is fine in principle. But the principle is not being adhered to in reality – when boards which have been bailed out are being held to a repayment schedule to address the deficits – ironically forcing more savings in years to come.
The Government should look again at this policy, if it is indeed the enemy of planning and is preventing a sensible long-term view of NHS finances.
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