Over the 40 plus years of my medical career there has been progressive evolution of clinical services. The management of cardiac surgery, stroke rehabilitation, transplantation, joint replacement and IVF have all developed at the behest of medical science. The costs of these services have been added to the “bread and butter” responsibilities of trauma, obstetrics, cancer and emergency surgery, and the management of medical disorders such as pneumonia and heart attacks. While paediatric workload has diminished thanks to better obstetric care, there has been a necessary explosion of services in geriatric medicine and mental health care.

In 1997 the NHS employed nearly 1 million people. It now employs 1.35 million. The cost of the service represents 9 per cent of GDP, an increase of 3 percentage points in real terms since the Millburn/Blair takeover of policy. However, the electorate has been short-changed.