Health Check: An epidemic of politics has broken out

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The Independent Culture
MY EX-WIFE called me last week to ask how I was after a recent bout of flu. She had read in the papers that over 3,000 people had died of the illness in one week and she felt she should have shown more concern. No wonder the NHS was in crisis, she said, it was obviously a serious epidemic.

I reassured her that the Grim Reaper had passed me by on this occasion, and that 3,000 deaths in a week was not, in fact, excessive. Over 600,000, mostly elderly, people die each year - more than 10,000 a week - and they have to die of something. It is true there are more deaths in the winter than the summer - an extra 25,000 on average and up to 40,000 in a bad year - but this year's toll was not out of the ordinary.

Yet I am sure that this figure of 3,000-plus deaths, combined with tales of casualty departments turning patients away and people dying on trolleys, will have caused alarm. It may even have contributed to the excessive pressure on the ambulance service, which saw 999 calls double, many from people who may have felt they were dying but actually needed little more than a hot water bottle and a drink.

Thus is talk of a crisis in the NHS self-creating. This year's version appears to have started in the North-west, where casualty departments came under pressure between Christmas and New Year, partly because GP surgeries were closed for four days as a result of the way the holiday spanned a weekend.

From this local difficulty a national "crisis" was spun, helped along the way by claims from medical organisations about the shortage of nurses and intensive-care beds. Yet in London, where casualty departments were besieged by journalists eager to record the latest NHS convulsion, doctors reported nothing doing. It was business as usual.

Even Frank Dobson, the Health Secretary, agreed there was a crisis and warned it could get worse if the weather deteriorated. To old NHS hands, who remember real crises such as that of 1987 which triggered the Tory NHS market reforms, this was a surprising admission. But what option did Mr Dobson have? If he had denied it he would have caused uproar. By acknowledging it, he strengthened his own case for more NHS funds when the recommendations on doctors and nurses pay come before the Cabinet this month.

Here, it seems to me, is the lesson of these events. Ask the members of any organisation under pressure where the problems are and they will point to lack of resources, equipment and staff. They would be mad to do otherwise. As Enoch Powell observed in 1962, the NHS presents the unique spectacle of an organisation that is continually run down by all those who work in it, because that is the best way of ensuring it obtains extra funds. All that has changed is that the spectacle is no longer unique.

There is no doubt that the NHS is under great pressure, created by the normal winter demands combined with the Government drive to cut down waiting lists. But to call it a crisis devalues the term. What we need is a new definition to distinguish the normal winter pressures from the extraordinary ones.

The Department of Health achieved this with flu some years ago, raising the threshold for an epidemic from 100 to 400 cases per 100,000 (the current level is 272), to avoid the ludicrous situation in which every year was an epidemic year. I suggest we could similarly redefine "NHS crisis" in terms of a new threshold of patients waiting on trolleys, being shunted between intensive care units and so on.

But I fear it is unlikely to be taken up. The temptation to join in the politics of protest is too strong.

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