Defend Our NHS report : Theresa May’s launch of the NHS Long Term Plan should fool no-one

 

Dear friends of the NHS

Please read and share widely.

This email is based on press releases by Merseyside KONP and national KONP/Health Campaigns Together (to whom thanks) and information from the Defend Our NHS team.  The photograph is from the Guardian web site and the cartoon from the Times.

On Monday Theresa May was welcomed to Liverpool by Merseyside KONP, Save Liverpool Women’s Hospital campaign, Defend Our NHS and a hundred protestors who gave her a very clear message on her plan.

alder hey

Protestors know the reality – and how things are getting worse. At Arrowe Park Hospital bed occupancy has been 99.3% against a safe level of 85%. And last year ambulances had to wait more than an hour to hand over their patient to the hospital 2,477 times, up from just 80 in 2013/14.

The Royal Liverpool Hospital has been on ‘Red Alert’ at least 25 times since 1 December. Bed occupancy is 92.3%, In December, 495 ambulances waited over 30 minutes to discharge their patients, and 135 of these waited over 60 minutes. Last week, some patients waited over 3 hours to be seen in A&E, and some in A&E waited 24 hours for a hospital bed.

In Liverpool a major problem is that the half-built Carillion PFI hospital was designed with fewer beds; capacity at the Royal was cut to match the plans. The Trust justified the cuts, claiming that Care in the Community would reduce demand.

And in Wirral the CCG’s proposals to slash services at walk-in centres will compound the problem.

May’s plan, written by NHS England Chief Exec Simon Stevens*, will replicate this all over England, shifting resources out of hospital, promoting digital technology (with the secretary of state Matt ‘Appcock’ anxious to replace GP consultations) and telling patients to look after themselves.

Rationing

Last winter, former Health Secretary Jeremy Hunt suddenly postponed all elective (planned) operations to ease the pressure on hospitals. Now, an NHS England document Preparing for 2019/20 Operational Planning and Contracting intends to ensure that ‘as much of [sic] inpatient elective activity occurs in the first half of the year, before winter’.

The document also includes a rationing plan for 17 NHS treatments no longer to be commissioned by CCGs. Trusts are also urged to ‘grow their external (non-NHS) income’ and ‘work towards securing the benchmarked potential for commercial income growth’. Hence the ward at Clatterbridge Hospital recently handed over to Four Seasons Health.

Trusts must set up systems to raise money by charging patients for treatment (‘overseas visitor cost recovery’) – a policy recently denounced by several medical Royal Colleges because of its impact on individual and public health.

Long term agenda

The 44 discredited Sustainability and Transformation Plans, re-branded as Integrated Care Systems, will hold the regional budgets to control NHS Trusts. ‘Planning assumptions’ in each STP area are to be agreed by 14 January. Neither the STPs, nor the ICSs, nor the Long Term Plan have been mandated by an Act of Parliament, let alone by patients or health workers. Yet, despite protests and clear evidence of the dangers, Wirral Council has charged at full speed into the STP and an ‘integrated’ partnership with the local clinical commissioning group. (We will be writing again soon about the ongoing legal challenge to this.)

The private sector could gain control of individual ICSs through long term contracts to manage the entire health system within one region.

Real integration of health and social care can only take place when the profit motive is taken out, with care fully-staffed and resourced, publicly accountable, funded through general taxation, and provided free at the point of need.

point of need

John Lister, editor of Health Campaigns Together said:

All of the main lines of what has been published or leaked about the Plan are a depressing re-run of previous plans and gimmicks: the only novel proposals are for more central control and less accountability, for trusts to run more like and with private businesses seeking profits, and to raise money by undermining the principles and values of the NHS through charging overseas visitors – a government policy widely condemned by NHS professional staff and campaigners as discriminatory and a step backwards from prevention and public health.

There is no reason to believe this plan, with even less local accountability and no serious plans for public consultation, will prove any more acceptable to the public or successful in implementation than the secretive STPs in 2016 or other previous failed efforts.

Campaigners have yet to see anything to recommend the new plans, or any indication NHS England is willing to come to grips with the crisis fuelled by chronic austerity limits on funding – or demand an end to chaos and fragmentation of the Health & Social Care Act.”

Dr Tony O’Sullivan, KONP Co-chair and retired consultant paediatrician, said:

The government has cut £7bn to social care and has underfunded the NHS by £20bn in annual funding over the last 9 years. There is no plan to repair the damage done. Platitudes about prevention and better health are exposed by the £1bn cuts to the public health budget responsible for prevention.

After 9 years undermining mental health, the ‘extra’ now committed is not new money but comes from elsewhere within NHS funding. Theresa May’s assertion that the NHS has never received higher funding is simply not true in relation to NHS funding required to meet need.

Over 210,000 vacancies in NHS and social care and unacceptable stress carried by staff, dangerous waits for A&E, cancer care and surgery, all tell the true story. And the fact that private health providers get 50% of their funds from treating patients diverted from an NHS deprived of the resources to treat them itself exposes the policy direction of government. We cannot accept this situation.’

Watch out for some further analysis of the NHS Long Term Plan which we’ll share by email to this list and on our Facebook page.

DONHS on Facebook

* Mr Stevens’ previous job? “His responsibilities include leading UnitedHealth’s strategy for, and engagement with, national health reform, ensuring its businesses are positioned for changes in the market and regulatory environment.”

 

Wirral and the NHS: WHOOPS Apocalypse!

Whoops

The latest news from Defend Our NHS Wirral includes news of  not to be missed upcoming meetings starting on Monday. We didn’t know what the WHOOPS acronym stood for but if was about preventing an an apocalypse of the NHS we were all for it.

We’ve since found the answer :

WHOOPS = Wallasey Hands Off Our Public Services
Apocalypse = Wirral Council + NHSE (know locally as the CCG!)

 

Dear friends of the NHS

You’ll soon receive an invitation to the DONHS Christmas party in Birkenhead.

Meanwhile there’s work to be done!

We need to save our Wirral walk-in centres! Make the CCG (Wirral Clinical Commissioning Group) change their plans. 90% of Wirral GPs (your doctors) think the proposals don’t make sense.

How can we make a difference?

o       WALLASEY: MONDAY!!! Special Meeting, Adult Care and Health Overview and Scrutiny Committee Monday, 12th November 2018 6.00 p.m. Committee Room 1 – Wallasey Town Hall – Wirral councillors discuss the walk-in crisis.

o       BIRKENHEAD:  CCG: Tuesday 13th November 1:00pm: Birkenhead Town Hall.

o        BIRKENHEAD: CCG: Tuesday 13th November 6:30pm: Birkenhead Park Cricket Club.

o       LISCARD: Wednesday 21st November 7.00pm: Public meeting: DONHS and WHOOPS discuss the threat to public services including the walk-in centres: St Albans Centre, St Albans Road.

o       WALLASEY: Tuesday, 27th November 2018 4.00 pm: Wirral councillors discuss the mess they’ve got us into!!! Call-In, Adult Care and Health Overview and Scrutiny Committee: Wallasey Town Hall.

o       WALLASEY: CCG: Thursday 6th December 6:30pm: Wallasey Town Hall.

o        BIRKENHEAD: all campaigners and local doctors: Saturday 8th December: SEE FACEBOOK AND EMAILS FOR DETAILS: meeting from 10:00am at the Miriam Medical Centre (with coffee provided by the Centre) to discuss our campaigns and action on 11th December (below). Ending with soup and sandwiches AND a march into Birkenhead town centre.

o        BIRKENHEAD: CCG: Tuesday 11th December: 6:30pm : Birkenhead Town Hall. THE PETITIONS WILL BE HANDED IN.

https://www.facebook.com/groups/defendournhs/

DEFEND OUR NHS WIRRAL

#DefendOurNHS

Facebook and Twitter: Defend Our NHS

Email: defendournhswirral@gmail.com

 

Wirral’s NHS crisis : petition to save five walk-in centres and other news from Defend Our NHS

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Dear friends

There are four things we would like to bring to your attention. As usual we would be grateful if you could take action and also share this message with your contacts.

Make no mistake: in the past week Wirral’s NHS crisis has turned into an emergency. The proposal from the local branch of NHS England (the clinical commissioning group/CCG) to close all five of Wirral’s walk-in clinics is shocking.

It is a further nail in Wirral’s NHS coffin and follows the phoney logic of the CCG and Wirral Council’s ‘integration’ of health and care, and their move to ‘place-based care’ (whatever that means*).

Our well-attended public meeting (with GPs and other health and care professionals speaking and in the audience) in Birkenhead last week discussed this and launched an immediate campaign to SAVE OUR WALK-IN CENTRES.

Please support these four actions:

  1. Read, share and display the attached leaflet. Thousands of these are being distributed around Wirral with the support of local GPs who, like us, believe that the proposed closures are idiotic.
  2. Try to attend and spread the word about the meetings and events listed on the leaflet. In particular we urge your attendance on: Tuesday 16th October: a lobby of Wirral’s new joint commissioning body meeting (the Council and the CCG): gather from 1.00pm outside and then inside Birkenhead Town Hall. Thursday 18th October: Defend Our NHS public meeting from 7.00pm also in Birkenhead Town Hall to discuss the GP and walk-in crises.
  3. Sign and share the petition which is gathering signatures all over Wirral. It is attached for printing and further use but also on-line at https://www.change.org/p/defend-our-nhs-save-our-wirral-walk-in-centres
  4. Support the judicial review which will challenge the legality of the national and local plans for NHS ‘integration’ if we can raise the funds. Find out more at: https://www.crowdjustice.com/case/justice4nhs-stage5-courtofappeal/

Thank you and best wishes on behalf of Defend Our NHS

https://www.facebook.com/groups/defendournhs/

* You may have more luck than us. We have yet to find a councillor who can answer the questions in this test in their own words. The questions originated in Calderdale which is experiencing the same mayhem as we are in Wirral: http://www.energyroyd.org.uk/archives/16190

Petition sheet Oct 2018Screen Shot 2018-10-08 at 14.13.15

Defend Our NHS meeting – Feedback and footage

Feedback from last night’s Defend Our NHS  Wirral meeting at Birkenhead Town Hall.. Footage below available on DONHS Facebook page.

Interesting developments from last night’s Defend Our NHS meeting . Our first speaker was local GP Dr Abhi Mantgani whose practice is home to one of the centres under threat. He noted how up to 90 thousand patients attend Wirral walk-in centres every year. Their closure can in no way be categorised as more convenient or less confusing.
The meeting agreed to support a mass cross Wirral campaign to stop the closures, to urge Wirral councillors to stand up for their constituents, and noted that rearranging the deckchairs on the Titanic was not any way to defend our NHS .
There will be a further protest meeting in the very near future.
Time and time again members of the audience noted the gulf between Labour Party policy nationally and locally, and the Councll leader’s apparent willingness to implement Tory policies on health. The audience wanted a Council which stood up for the NHS and its voters.
Happy days.

Defend Our NHS : Heads Up On Pop Up

Our Birth Rights and Wrongs story caused quite a stir . Fortunately there are people better informed than us to to tell you about the pop up /pop out birthing centre in Seacombe.  So we are giving you the heads up about a public meeting organised by our friends Defend Our NHS and to also tell you to watch BBC1 North West Tonight tomorrow night which will feature a report about the opening of the centre and hopefully featuring a well informed ,dissenting voice facilitated by Wirral Leaks.

Dear Friends of the NHS

  1. Please find attached a leaflet for our next public meeting which will discuss the controversy surrounding the new Seacombe ‘pop-up’ Birthing Centre*. Please attend if you can – and share this information widely.
  • Wednesday 28th March at 7.00pm in St Paul’s Church Hall, Church Road, Seacombe, CH44 7BA.
  • Guest speakers: Felicity Dowling from the Save Liverpool Women’s Hospital campaign and Stephanie Miller, retired local midwife.
  1. We had another successful open meeting last week. Those present discussed the outcomes of the previous meeting, which had agreed a set of local and national concerns about the NHS as well as what we could do about them collectively and individually. The results of our deliberations will be available as a file on our Facebook page – and we’ll see the results over the coming months as we continue the fight to defend OUR health service. It all depends on YOU.
  2. Defend Our NHS was represented at the recent second meeting of campaign groups from around the Cheshire and Merseyside STP ‘footprint’. We shared information about how our services are being ‘slashed, trashed and privatised’ and how some councils are collaborating in this.
  3. One thing all local groups are determined to do is celebrate the NHS’s 70th birthday – and ensure it continues in good health. Some of our supporters will be attending the massive march in London on 30th June; on the same day many of us will be holding a ‘picnic in the park’: an NHS birthday party with fun for all the family. More details soon.

Best wishes on behalf of Defend Our NHS

Email: defendournhswirral@gmail.com

Facebook: https://www.facebook.com/groups/defendournhs/

Twitter: @DefendourNHS

* The centre will be opened by this week, at the invitation of Wirral Council and Wirral Clinical Commissioning Group, by Conservative Baroness Cumberlege. We wonder if Wirral Council (which has voted to oppose the privatisation of the NHS) has read this: http://socialinvestigations.blogspot.co.uk/2012/12/the-case-of-baroness-cumberlege-why.html

Seacombe pop up 9

 

Defend Our NHS : fight-back time!

DONHS

DONHS : action meeting 2 March 

With all the bad news emanating from our local NHS we are pleased to post the latest missive from local people who are trying to defend our  great institution rather than see its demise as a career opportunity!

Dear friends of the NHS

Defend Our NHS: action meeting!

The public meeting on Friday (March 2) was a big success. There was a good turn-out despite the awful weather, our speakers were excellent, and the meeting joined in enthusiastically to shape our strategy for forthcoming weeks and months,

We asked – and attendees answered – three questions:

  1. What is your main concern about the NHS?
  2. What should WE ALL do about our concerns?
  3. Will YOU actively join our campaign?

Now it’s YOUR chance to join in the fight to stop the awful local and national damaging changes to our NHS as it is ‘slashed, trashed and privatised’.

How? Come to our next PUBLIC MEETING: Friday 16TH March from 7.00pm at The Welcome Centre, 43 Hamilton Street, CH41 5AA, Birkenhead.

Meanwhile THIS THURSDAY Wirral Clinical Commissioning Group is holding a ‘public engagement’ event at Heswall Hall, Heswall (8th March 2018 from6.30pm).

You might want to ask them: 1) why they are supporting a ‘pop-up’ maternity centre in Seacombe when so much medical evidence is against the idea; 2) why are they continuing to implement local changes to the NHS when WIRRAL COUNCIL HAS VOTED TO OPPOSE THEM.

Is it right that, in 2018 in one of the richest countries in the world, we have headlines like this one in the Liverpool Echo last week about Arrowe Park?

“Nurses ‘forced to wear COATS’ and patients left ‘freezing’ as hospital heating breaks. Staff gave out blankets – fears pregnant mums and young children were also affected.”

YOU can join us to fight to restore a decent NATIONAL HEALTH SERVICE.

Best wishes on behalf of Defend Our NHS

defendournhswirral@gmail.com 

https://www.facebook.com/groups/defendournhs/

https://twitter.com/DefendourNHS

 

Defend Our NHS: thanks, alerts, invitations, birthdays – and congratulations

Supporting NHS 70
Dear friends of the NHS
First , thanks to everyone who contributed to funding the judicial reviews of the government’s and NHS England’s damaging changes to our health service. You’ll be pleased to know that the funding appeals for the reviews – both of which DONHS is supporting have reached their targets. The case will be heard in Leeds High Court on Tuesday 24th April.
Meanwhile we continue to show our support for the NHS and its staff in other ways. There will be a day of protest all over the country on Saturday 3rd February. A march in London will be mirrored by events right across England.
We urge supporters in Wirral to join us outside  Arrowe Park Hospital from 1.00pm. Show that you  : value hospitals like Arrowe Park and Clatterbridge ; support NHS staff: nurses,doctors,midwives,paramedics and others; and believe in a free,comprehensive ,universal National Health Service . Or if you just want to know more about the crisis in our NHS and the answers to it. Come and join us! Details at: https://www.facebook.com/events/157164351576903/ 
The Liverpool protest will be a day earlier on Friday 2nd February . Details at :
Our next public meeting  (your MP and councillors have been invited) will be on Friday 2nd March in Birkenhead from 7.00pm. The venue is : The Welcome Centre 43 Hamilton Street, Birkenhead, CH41 5AA
The NHS will be 70 this year
To celebrate – and to show our support for the service and all who work with it – we will be holding not one but two parties ! The first will be on Saturday 30th June in Vale Park, New Brighton.
The second will be a social and public meeting in Birkenhead, 5th July
There is another significant birthday this year. The NHS is 70. Defend Our NHS is 7! This group was  was founded exactly seven years ago this month. We’ve grown  – and perhaps to recognise  what has been achieved we won an award ! Take a look at : 
https://wirralleaks.wordpress.com/2018/01/11/the-leaky-awards-2017-the-grand-finale/  

Best wishes on behalf of Defend Our NHS

Further information : Leaflet Jan 18 v3 DRAFT

 

 

 

A New Year Message from ‘Defend Our NHS’

 

999

Dear Friends,

Happy 2018!

Thank you for signing – if you have – the petition to STOP the new plans to dismantle our NHS. https://you.38degrees.org.uk/petitions/stop-the-plans-to-dismantle-our-nhs

If you haven’t, please do!

Now NHS campaigners have got together with the University of Brighton and the NHS Support Federation to bring you this short survey about NHS changes in YOUR area. The results of the petition will be sent to your local decision makers.

This is a chance for you to make your views known at a local area level at last, whether the council or NHS have asked you or not!!! (Certainly, if you live in Wirral – like many other places, the Council and CCG have been conniving in total secrecy to dismantle our NHS and implement the so-called STP, while hypocritically claiming opposition. Nobody, except those in the conspiracy and those attempting to expose it, are aware.)

A tip would be to strongly disagree with the statements which indicate some sort of cut AND that prioritise financial savings over patient care.

https://healthcheck.nhsfunding.info/survey/

Please take a few minutes to fill it in. Carl Walker from the School of Applied Social Science, University of Brighton, says: “I’d be grateful if you could share as widely as possible to friends around the country. We are aiming for 10,000 people around the UK to complete it. Thanks

https://healthcheck.nhsfunding.info/survey/

And remember to share the petition, which is an important indicator of the public’s feeling towards this completely unacceptable, top-down reorganisation involving £22bn of cuts, to the NHS. ONE BILLION in Cheshire and Merseyside alone (as recommended by the infamous PWC).

https://you.38degrees.org.uk/petitions/stop-the-plans-to-dismantle-our-nhs

Here’s to a successful 2018. On 23rd December the lawyers for the campaign group 999 Call for the NHS told them that “a judge had considered our papers and those of NHS England… and granted permission for our JUDICIAL REVIEW to go ahead – some time after 16th February 2018! ”

Another good reason to sign and share this: https://you.38degrees.org.uk/petitions/stop-the-plans-to-dismantle-our-nhs

Happy New Year everyone and THANK YOU!

Best wishes on behalf of Defend Our NHS

Advent Farewell 20 – Brother, Can You Spare A Dime?

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Now we’re with  post -war Labour Prime  Minister Clement Atlee when it comes to charity . We think it is indeed a ‘‘cold grey loveless thing”.

Having said that we are not suggesting be Scrooge-like this yuletide rather that if you can spare some money this Christmas and as we’re talking about the creeping Americanisation of the NHS we perhaps should be asking ” Brother Can You Spare A  Dime” for a campaign to defend the NHS. Details are set out below by Defend Our NHS campaigner Kevin Donovan :

Dear friends

Sorry to bother you… There’s no pressure to contribute and no need to reply , but the value of our NHS really is a cause close to my heart. As many of you know I’ve been involved in a campaign to defend the NHS (DONHS) for almost seven years . There are currently two legal moves planned to contest changes which are damaging our health services. One still needs funds and I’ve just pledged to the case : https://www.crowdjustice.com/case/jr4nhs-round2/.  

DONHS is supporting both challenges. The other is   999 judicial review

There are many calls on your time and money but a contribution to this would make all the difference .

If you need to know more please get in touch or have a look at our campaign’s Facebook page: https://www.facebook.com/groups/defendournhs/

Kind regards – and Happy Christmas!

Kevin   

 

Good Health In Bad Hands

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Apologies for the delay in publishing this but it landed in our spam. This is feedback from the Defend Our NHS (DONHS) Wirral meeting that we previously plugged. 

In the mean time it seems that local politicians have been belatedly gegging in on the action , most particularly in relation to the now ‘temporary’ closure of Eastham NHS Walk-in centre. This week’s Adult Care Health Overview and Scrutiny Committee was a humdinger with NHS head honchoes – Simon Banks ( NHS Wirral Clinical Commissioning Group) and Karen Howell ( Wirral Community NHS Foundation Trust) getting a good mauling.

Acting chair  Cllr Moira ‘Matron’ McLaughlin took the opportunity to say that it was “important that the decision-makers are held to account.” Yes, those words actually came out of her mouth. My, how we laughed. And then we cried such bitter tears.

She also took the opportunity to plug a prospective Labour councillor who had organised (yet another) petition.  We note that campaigning for next year’s local elections has already started then !

However more concerning for us was an issue that received  zero press coverage and caused considerably less outrage among councillors and that was the closure of  Thorn Heys, an NHS respite service for people with learning disabilities and mental health needs.  Somebody remind us what was that Wirral Plan ‘pledge’ about ‘protecting the most vulnerable’ again?

What is most apparent is that ‘partnership’ working between Wirral Council and its NHS counterparts is not what it should be – the power struggles and the safeguarding of ever diminishing budgets was there for all to see – although of course some highly paid public servants and consultants still seem to be doing okay out of it ! As ever the only people to suffer are those who pay for what appears the deliberate (?) and ongoing (mis)managed decline of a once great institution !

Dear friends of the NHS

Are you angry? The packed audience at our public meeting on Thursday were angry. But they were also full of ideas for the fight back to defend our NHS. There was a spirited and constructive discussion after superb inputs from national campaigner Steve Carne and from a number of local campaigns on our own patch.

Why are people angry? Read the list below* and then come back here.

Are you angry yet? You should be. And if you are you can do something! This is what Thursday’s meeting decided. You can do some or all the following now.

  1. Let us have email addresses of others who might want to join the fight.
  2. Read AND act upon AND share the ‘to do’ list (in the ‘Files’ section on our Facebook page and attached to this message):https://www.facebook.com/groups/defendournhs/files/
  3. Come along to the many NHS meetings and protests (some on the ‘to do’ list but starting with the Eastham event on Monday detailed below). Some important events are shown. PLEASE COME!
  4. Shadow Health Secretary, Jonathan Ashworth will be in Eastham to meet with members and people affected by the closure.
    If you are available, and if you know anyone who is concerned about the closure, please bring them along.
    When? Monday September 11, 2017 at 11am – 1pm. Where? St David’s united reform church Eastham Wirral ch62 9dg
  5. STOP THE STP! Wirral Council has the power – and has already said it opposes the STP. Why doesn’t it do it? Wednesday 13th September 6.00pm at Wallasey Town Hall. Let’s make this the biggest lobby ever! Arrive early! http://democracy.wirral.gov.uk/ieListDocuments.aspx?CId=819&MId=6118&Ver=4
  6. Attend the Wirral CCG AGM @Tranmere Rovers 28th September from 1.00pmhttps://www.wirralccg.nhs.uk/news/wirral-ccgs-annual-general-meeting-2017/ It’s the CCG which has the local purse strings and makes the cuts.
  7. Share your experiences on Facebook or by email.

Thanks and best wishes on behalf of Defend Our NHS

…………………………………………………………………………………………

* That list:

  • The closure at short notice last week of the Eastham NHS walk-in centre.
  • The simultaneously announced end of the Eastham-Arrowe Park bus service.
  • The ‘pilot’ closure of the Clatterbridge dermatology ward.
  • A further near ONE BILLION POUNDS of cuts in the pipeline for Cheshire & Merseyside.
  • The payment of £300,000 to Price Waterhouse Cooper to compile the list of cuts to be made locally.
  • The payment across England of £21 MILLION POUNDS to firms like PwC for similar ‘work’.
  • The news that PwC and other ‘tax management’ outfits are being given the job of organising NHS service commissioning.
  • All this part of the 44 awful ‘sustainability and transformation partnerships’ (STP) including one here in Cheshire & Merseyside.
  • The STPs and everything else above comes from the brain of the head of NHS England Simon Stevens who now effectively controls the whole of our NHS. (Jeremy Hunt has washed his hands, Pontius Pilate-style.)
  • The revelation that Simon Stevens came to the NHS from US health ‘corporation’ United Healthcare.
  • The revelations of the anti-patient and anti-doctor business behaviour of United while Stevens was a boss.
  • EVERY local council has rejected the STP. Wirral Council has the power to stop the STP in its tracks and voiced its opposition last December – BUT it took the leader of the Council, Phil Davies, EIGHT MONTHS to write the letter to Jeremy Hunt.
  • Meanwhile the cuts have got worse, the waiting lists longer, the appointments harder to get, the adverts for American-style health services appear on GP notice boards – yet wonderful NHS staff continue to offer a fantastic service despite all this and despite years of effective pay cuts.