The National Health Service (NHS) in the UK has come in for increasing criticism over the past few years, both from within and without the system. Newspaper reports tell of neglected patients and money-grubbing GPs, and concerns about a target-driven culture, privitasation and staffing levels create an impression of a system at breaking point. Yet, the NHS is a cherished institution about which many feel passionately defensive. One of the drivers of morale in a beleaguered NHS is the gratitude that patients express in a myriad of ways, almost all of which are informal. Whereas there are numerous systems in place for making a complaint, the ways in which people say ‘thank you’ are often ‘under the wire’ and rarely receive formal recognition.