How a minor dose of flu nearly felled the NHS

The lesson of this latest `crisis' is that the condition of the health service remains fragile
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The Independent Culture
I HAVE had flu. I know this because I experienced its defining symptom: an irresistible desire to lie down. When it happens there is no mistaking it. I took to my bed on New Year's Day, dosed myself with aspirin, paracetamol and regular tots of my mother-in- law's sloe gin and, in common with thousands of others, waited for the illness to pass.

You wonder why I am telling you this? Because there is a puzzle about the current flu outbreak which my own experience may help illuminate. According to the Royal College of General Practitioner's flu monitoring unit in Birmingham there is no epidemic. The numbers affected - fewer than than two in 1,000 people on yesterday's figures - are low by comparison with previous winters and will need to double before we have what is officially termed an epidemic.

If that is the case, why have half the people I know - or, at any rate, many more than one in a thousand of them - apparently been laid low by the bug? And why, more importantly, is the NHS struggling to cope, closing wards to all but emergency admissions, cancelling routine surgery and, ominously, hiring freezer lorries to provide temporarily expanded mortuary space?

The answer to the first question is the easiest. Figures recorded by the Royal College of General Practitioners' (RCGP) monitoring unit - the gold standard for flu watchers - are based on reports from 350 GPs in 90 practices in the UK covering 700,000 patients. Every patient who goes to see one of these GPs suffering from flu or a flu-like illness is reported to the monitoring unit and becomes a national statistic.

Thousands of sufferers - myself included - have not bothered their GPs for the very good reason that there is nothing they can do for flu that patients cannot do for themselves (drink plenty of fluids, go to bed, keep warm and take whatever over-the-counter remedy you prefer). The published figures therefore vastly underestimate the true incidence of the illness.

I suspect this disparity between the true level of illness and the published level has grown wider in recent years as public understanding of flu has improved. A viral illness such as flu cannot be shifted by antibiotics and, as more people recognise that GPs have nothing better to offer than TLC (tender loving care - and they tend to be short of that, too, at this time of year), they are increasingly dosing themselves at home rather than seeking help at the surgery. Thus while the RCGP unit declares this year's flu toll to be low, offices are denuded, paracetamol sales soar and homes echo to the sounds of groaning invalids begging for another Lemsip.

The more tricky question is why this low level of illness should be putting such an unwelcome stress on the NHS. The weather has beenwarm, the health service has had a generous cash injection to deal with winter pressures - pounds 159m so far, with a further pounds 50m in reserve - and the Government boasted some months ago that it was reopening or preventing the closure of 2,000 extra beds.

It poses the question of what would happen if there were a genuine epidemic, a prospect that seemed to worry Frank Dobson, the Health Secretary, on Tuesday when he acknowledged that it would be "very difficult to cope". Compared with this year's two in 1,000 people suffering from flu, the 1993 outbreak peaked at 30 per cent above this level and the 1989 epidemic at more than two-and-a-half times above it. In 1969, the year of the last global pandemic, the infection rate hit 10 per 1,000, implying that more than 500,000 people were falling victim each week.

Were such a pandemic to occur again, and scientists predict that a repetition is inevitable, on the evidence of this week's experience we would need a fleet of freezer lorries to join the one hired by the Norfolk and Norwich hospital to expand its mortuary space.

The causes of the current NHS "crisis" are complex. The first point for the sceptical observer to bear in mind is that it has occurred just as the NHS pay review bodies are finalising their reports for presentation to the Cabinet. Inflation-busting rises in excess of 5 per cent for nurses and doctors are being sought by the unions and a crisis in the NHS, especially if it can be linked to staff shortages, provides a useful lever to loosen ministerial purse-strings.

The second point is that the NHS is in fact performing rather well, as yesterday's announcement of a record fall in the waiting-list demonstrates, but it has become a victim of its own success. Thousands more patients have been treated and operations carried out, raising bed occupancy rates and putting increased stress on facilities. The result is an NHS that, while well funded, is running close to capacity. Thus it is efficient in terms of producing maximum bang for each buck, but has little flexibility to accommodate sudden increases in demand such as occurred at Christmas. A few elderly people going down with flu can soon clog up a casualty unit if beds are full and there is nowhere to move patients on to.

That said, there are genuine staffing problems, especially among nurses and associated staff such as physiotherapists. A buoyant economy and low unemployment have meant stiff competition among employers for the 18-year-old school-leavers whom the NHS normally recruits. Hospitals have been losing out to Marks & Spencer, and, nationally, the Royal College of Nursing claims that 8,000 posts are vacant.

There is anecdotal evidence that problems blamed on the flu outbreak were in fact caused by the way Christmas fell on a Friday this year. That meant GP surgeries stayed closed for a full four days, rather than the normal two of Christmas Day and Boxing Day. Deputising services were unable to cope and patients phoned 999 instead. St James's University Hospital in Leeds, where attendances at accident and emergency were 50 per cent up between Christmas and the New Year compared with the previous year, was back to normal this week. No flu outbreak was ever over so swiftly.

The lesson of this latest "crisis" is that the condition of the NHS remains fragile, despite the large sums invested and even larger sums to come over the next three years. Though improving, the slightest pressure could be enough to trigger a relapse. The right prescription is a steady infusion of funds, careful monitoring and a recognition that cutting waiting-lists must never be allowed to usurp its central function - to provide immediately a bed and care for every truly ill patient in their hour of need.