The winter of media malcontents

9 Nov 00
When Nigel Crisp was handed the BBC survey of health authorities' readiness for the winter months he must have felt lucky to start his first day as English NHS chief executive with a good news story.

10 November 2000

In last week's survey, nine out of ten health authorities and health boards – 72 of the 81 responses from 123 across the UK – were 'very or fairly confident' that they were better placed than last year to deal with increased patient numbers over the winter months. Although 38% said they expected to cancel routine surgery to free beds for emergency cases, an equal number said they did not think this would be necessary.

For whatever reason – simple news judgement or a desire to fuel the argument – the BBC's interpretation of the survey data will have been enough to make Crisp choke on his morning cornflakes.

Like Christmas, the NHS 'winter crisis' seems to make its appearance earlier every year. Already by September eager newshounds were being dispatched to sniff out the runes of disaster in the hospitals.

Then the BBC chose to see the health authorities' responses as proof positive of the impending crisis. This in turn will reinforce the view of health service staff that any local difficulties in the coming months will be seized upon as evidence that the health service is about to implode.

Alastair Campbell, Number 10's spinmeister-general, was not the only one annoyed – he called the report on the Radio 4's Today programme an 'outrage'.

Acute hospitals are stretched all year round due to a combination of waiting list work, sickness absence and unfilled nursing vacancies. Winter merely exacerbates this problem. But carers insist that they are doing their best to minimise its effects.

The NHS and social services are working together to reduce bed blocking, more beds are in place and some hospitals increased the number of non-urgent operations during the summer and early autumn to compensate for a cut in waiting list work in the winter.

Pension top-ups have been offered to older staff to defer retirement until the spring and Department of Health hit-squads are ready to mobilise to deal with local problems. There are moves to employ up to 2,000 medically qualified refugees, though this may have little effect this year.

In advance of last week's concordat with the private sector, patients were already being booked into private facilities to have their operations, freeing precious capacity in the NHS.

A range of professionals agree preparations are well advanced. The British Medical Association says more effort than ever before has been put into winter planning.

'New funds have been made available and communication between all the services involved, from the ambulance service through the NHS to social services, has been improved,' says Dr Bill O'Neill, BMA Scottish secretary. 'Novel arrangements are being planned to address unnecessary admissions and delays in discharging patients.'

Barry Elliott, chairman of the Healthcare Financial Management Association, says money, often part of the problem in the past, will not be a major worry this year.

'We have received quite a lot of additional funding to enable us to cope, particularly in critical care. Also, our experience in the past few years, particularly that we gained from the millennium planning last year, means that we are better prepared than in previous years.'

Staffing is the nagging worry. Money can buy beds and drugs and cover the extra salaries but what if there are not enough nurses? There could be up to 15,000 nursing vacancies, many in intensive care, and this is one of the reasons why no-one in the NHS will predict a trouble-free winter.

'The biggest worry is in our ability to recruit staff to work on the additional intensive care beds,' Elliott says. 'Staffing difficulties do make problems inevitable. It is far and away our biggest problem.'

A further problem is social services' ability to take patients out of hospitals. At least a quarter of social services departments were forced to make cuts this year and they will rely on a cash injection from local health authorities, which have been given £150m to ease winter pressures with a direction to share it with social services where appropriate.

Moira Gibb, president of the Association of Directors of Social Services, says at the moment there is a 'mixed picture' on the sharing of cash but she is confident the money will get through. 'The message from Alan Milburn is that he will frown on places that don't operate as one system. Ignoring problems in another part of the system will not be seen as sensible management, but I think people are trying to make it a whole system.'

Everyone knows that there are wild-card factors that could yet skew the picture. Any further large-scale fuel protests could affect plans for community nurses and social services staff to look after vulnerable people in their own homes. A severe winter, predicted by some forecasters, would increase the services' workload as the elderly fall prey to flu and pneumonia.

But in spite of the scare stories, it seems NHS and social services staff are in general better prepared than they have been. But they will be keeping their fingers crossed that the severe weather over the past two weeks is not a sign of worse to come.


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