Leading Article: Here comes the winter health crisis

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The Independent Culture
YESTERDAY, THE depressing prospect of the yearly "winter crisis in the NHS" came round again, seemingly as inevitable as the early appearance of Christmas lights in our high streets. More elderly people and children fall ill in the winter, and need emergency beds. A survey by the NHS Confederation, the body that represents Health Service managers, has shown that three quarters of hospitals surveyed reported they may have problems finding enough accident and emergency beds to meet that demand.

There is a degree of political motivation behind NHS managers' calls for more resources; it is in their interests to put pressure on governments. But managers are right to demand more; Britain spends far less on health care than France or the USA, even as a proportion of its national wealth. Coming on the day that figures showed that breast cancer victims have far less chance of survival here than in the US, we ought to join their pleas for more cash.

The government, as Frank Dobson pointed out yesterday, has acted to mitigate the winter beds problem. More money is being spent: there have been imaginative attempts to earmark some money purely to deal with this problem, and to bolster social services' provision of community care programmes to act as a first line of defence. Gordon Brown has promised that the extra money he pledged this summer in the Comprehensive Spending Review will not be cut. If that promise stands even as the economy slows, the NHS as a whole will not collapse.

But that money will not arrive until the spring; until then, hospitals will have to cope as best they can with limited extra funds. And there is even more to the yearly round of warnings than the generalised problem of under-funding. The NHS has real structural problems, which will not all be solved by spending more. Some of these are being exacerbated by ministers, whose obsession with their "early promise" to reduced waiting lists by 100,000 is plain wrong.

In trying to treat all patients equally to reduce the numbers waiting overall, treatment of those most acutely in need is being delayed, and priorities distorted. If elderly people with broken hips soon have to be shunted into corridors while beds are taken up with less urgent cases, we will know who has made that problem worse.

New Labour's extra money for the NHS is only just enough to keep the service running. If private medicine continues to expand, attracting more money from those willing and able to pay more to protect their families, the NHS may still seem to be falling behind. It may not be able to stand up to the competition, since governments cannot keep up with private hospitals' access to capital.

In this respect the attitude of NHS consultants, who often treat patients simply as machines who require tinkering to make them work, is crucial. If the NHS is to be seen as a success by its patients, it will have to change shape. In short, it will have to be humanised, a process glaringly absent from the "managerial revolution" of the past few years. The opening of the public inquiry into the Bristol surgeons struck off after the discovery of high numbers of fatalities among their child patients is a reminder that the top ranks of NHS medics can seem dangerously aloof and arrogant.

Ministers can raid the reserve to tide themselves over the immediate problem. They can provide extra funds for specific problems. But the long- term challenge for New Labour is whether it can stick to its plans to spend more on health care. In the meantime, it will have to sustain the good start it made with the appointment of the first Minister for Public Health, Tessa Jowell. Can they divert meaningful resources to health education? Can they establish working links between hospitals, too often centralised monoliths, and the social services? If they can, the impact of cold and depression in winter would be softened. There should not be the yearly drudge of reading about the strain in our hospitals; and government has it in its power to end it.

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