This is a time for cool heads.
That was the comment from professor Andrew Kerslake, director of the Institute of Public Care at Oxford Brookes University and one of the speakers at this year's National Commissioning Conference in Birmingham.
Kerslake was talking about personal budgets - but his comments apply to managers facing difficult times across the whole public sector. "This is not a time for personal budget zealots," said Kerslake. "This is a time for cool heads and for thinking through the implications of what needs implementing."
A conference on commissioning may seem a specialised forum, but a number of themes have emerged over these two days of discussion that will chime with leaders across all public services.
The first is, of course, the economic crisis. That goes without saying - and one of the grave difficulties in dealing with the implications of budget cuts is the level of present uncertainty about where those cuts will fall and how big, precisely, they will be.
What is clear, however, is the discrepancy between senior public managers, who are keen to get on with some strategic planning about services in the future, and their feeling that politicians, on all sides, are holding back from such planning.
Professor Peter Smith, professor of economics, at the centre for health economics at York University, expressed the feeling of many with his comments that politicians are being "absolutely abject in not being able to spell out the ramifications of the spending constraints".
Another major theme is the continuing difficulty of working across public sector boundaries. Time and again, instances come up of the practical difficulties involved, even where there would be clear gains.
Last week, Professor Chris Ham, professor of health policy and management at Birmingham University, pointed out that a fundamental change is required to the incentives facing NHS foundation trusts.
"Instead of being paid to treat more patients in hospitals, they should benefit when they support people to remain independent, thereby avoiding the need for admission," he wrote in the Guardian.
That sentiment was echoed at the commissioning conference. "Health trusts have done a lot of decommissioning," said professor Sube Banerjee, professor of mental health and ageing at the institute of psychiatry, Kings College London, who worked on the first-ever national dementia strategy for England, published in February.
"But the places where you can get money from decommissioning services are not the same as the places where you then want to put the money, for example, moving money from acute services to dementia. It's very complex when you work across those boundaries," she says
Similarly, even where there is a clear cost-effective case for new services, such as the early diagnosis of dementia, which could save local health trusts money, that requires up-front spending. It is happening in some areas, but will the appetite for investing to save survive hard times?
• Jane Dudman is blogging live from the conference today
