Everyone knows that the country's health services are facing a tough time due to budgetary constraints.

However, health spending has to be a priority, and providing the best possible service for the money available is the trick which we entrust to those in power.

In the Bradford district, that means the Health and Wellbeing Board, the Bradford Council body which has an overview of the public health, GP groups and other health services across the area.

But a peer review of the board, by an equivalent team from another authority, has said that Bradford isn't facing up to the tough decisions that have to be made in the face of dwindling budgets.

The review says that the Health and Wellbeing Board needs to focus on fewer priorities and this seems to make sense - it is better to get the most important things right rather than spreading itself too thinly and risking failing at many things.

It also needs to make sure that the general public knows exactly what the role of the Health and Wellbeing Board actually is and what its relationship is to the greater NHS network.

But the greatest issue raised by the peer review is that the board does not appear to be treating with enough urgency the fact that changes might have to be made to the district's health services in the face of shrinking public spending budgets.

There are going to have to be tough decisions made, and that is why the board is in place. Shrinking away from them, or putting their heads in the sand as a storm approaches, is simply not an option.