Health managers are reporting financial difficulties, which could make it more difficult to free up beds this winter. But, Patricia Hewitt, the Health Secretary, has made it clear that she will not go to the Treasury to bail out the trusts.

Management teams are being sent into struggling hospitals, but there are fears that a prolonged cold spell will increase the pressure for beds.

Any problems with funding are likely to be exacerbated by cold weather because it causes a surge in influenza, hypothermia and heart attacks.

And families could face further problems this winter after British Gas engineers voted to go on strike.

Fresh snow in the next month could be the harbinger of a harsh winter of the severity that occurs only once in every 10 years or, what would be worse, a "one in 50" winter - the last of which was in 1962.

"Having such a cold snowy spell over much of the UK this early is certainly unusual but it is too early to confirm our predictions for the winter as a whole," the Met Office said.

The blizzards come at a bad time for consumers, who have been hit by price rises of about 14 per cent for gas and electricity since September. More rises are likely and there has been gloomy talk that soaring demand could result in power to homes being cut off, although National Grid last night reassured customers that this was unlikely.

However, if demand does surge during further cold snaps, supplies could be switched off to businesses.

The British Gas engineers voted to take industrial action over pensions as the company warned that it was experiencing its busiest November for call-outs.

Nearly 6,000 technicians who service and repair boilers that power heating in homes voted by four to one to walk out in the run-up to Christmas.

GMB shop stewards meeting on Tuesday are expected to set strike dates within the next four weeks unless the company changes a plan to close the final salary pension scheme to new entrants.

Brian Strutton, national officer of the GMB, said: "The engineers have shown by this huge vote that they are determined to protect their pension. They had exactly the same agreement two years ago when British Gas/Centrica and its engineers reached a deal to increase their contributions, which the company is now breaking. This is a bad time of year for a dispute in the gas industry and the last thing GMB members working as gas engineers want is to leave customers with no heating and hot water."

In the NHS, the Government has avoided a winter crisis in recent years by introducing tighter controls to prevent bed-blocking by elderly patients.

Management teams are being sent into struggling hospitals, amid fears that a prolonged cold spell will increase pressure for beds and could lead to rationing.

In the first overt sign of rationing since Labour's extra investment in the NHS, primary care trusts in Suffolk announced last week that patients will no longer be considered for hip and knee replacements at Ipswich Hospital if they are badly obese.

Brian Keeble, director of public health, said: "We cannot pretend that this wasn't stimulated by the pressing financial problems of the NHS in East Suffolk."

Frank Dobson, the former health secretary, said: "It's a mess and ministers need to get a grip on this urgently, not least because the NHS is pouring money into the private sector rather than NHS hospitals."

Cost of a cold snap


Freezing temperatures and price rises will lead to soaring fuel bills this winter. Many suppliers have increased prices already by up to 14 per cent. Cold weather will steeply increase usage. However, the energy industry is confident that, although storms may knock down individual pylons, there will be enough power to heat and power homes.


The death rate always rises in winter. The Office for National Statistics said between 24,000 and 49,000 extra deaths had occurred during the winter months in recent years. A major cause is infections caused by flu. The Met Office said that an extra 8,000 deaths were expected for every 1C that the temperature fell below the winter average.


Schools are often one of the first casualties of a cold snap. There are no hard and fast guidelines telling heads when to close schools - it is left up to their discretion. John Dunford, general secretary of the Secondary Heads Association, said a decision to close was often made not because of pupils' needs but because teachers have to travel further.


The London Chamber of Commerce says staff absenteeism is the most serious problem businesses face in bad weather. It costs working hours and has serious safety implications if personnel are missing. The second most serious problem is disruption to transport - cancelled flights, closed motorways and delayed trains.