The gap is widening between front line staff and managers.

Delegates at last month’s RCN congress in Liverpool sent out a clear message that the NHS should remain free at the point of delivery (News June 25). A resolution calling for a fixed fee of £10 to be introduced for GP appointments was rejected by 91 per cent of delegates. Speakers said that introducing a charge could deter many people from seeking medical attention and be another nail in the coffin of the NHS. The NHS has generally come out well on access to treatment, although there has been some recent slippage with outpatient waiting lists, delays in emergency departments and getting appointments with GPs. Harsh choices will have to be made as further budget cuts are in the pipeline, and there will need to be a tighter rationing of care, treatment and expensive medication. In this stark scenario of rationing and cutbacks, the campaign for safe staffing levels and pay rises for nurses, healthcare assistants and care workers is going to be even more of an uphill struggle.