By Rob Sissons, health correspondent, BBC East Midlands
The push to deliver efficiency savings is nothing new in the NHS but the modern day pressures makes the mission no easy task.
Spend on agency and bank staff is being examined for savings but there are limits to how much this can be targeted, as there is a need to maintain safe staffing levels and ensure that front-line clinical staff are not overburdened or suffer burnout.
Events can of course blow any savings plan off course and there are plenty of unknowns in the coming months.
How bad will winter be is one of the big questions bosses ask every year and the inevitable strain that puts on health services can force up spending.
Hospitals are planning for winter now in summer.
Another cost pressure will be if doctors and nurses resume strikes over pay. The British Medical Association is currently balloting junior doctors – now called resident doctors – over whether they wish to take industrial action, with the result expected in July.
The ambitious plan for new capital infrastructure in Nottingham, including a new A&E and cancer treatment facilities, has been put back to 2037, which leaves the trust having to deal with older facilities
It is grappling with the biggest NHS building, maintenance and repair backlog of any trust outside London.
That can lead to unexpected disruption. A recent inspection of an operating theatre roof recently revealed wiring problems that put it out of action, when there is pressure to use facilities as much as possible to bring down the waiting list backlog.
The savings targets have been set – but delivering them was never going to be straightforward in the complex world of healthcare.