Another crisis in the NHS. What a relief. Or so it seemed to me last week, getting off the plane at Gatwick after several days’ exposure to the US media’s obsessive coverage of Michael Jordan’s third and “final” retirement from basketball. In Britain if it’s January it’s winter health crisis time. The stories may be predictable and the headlines familiar, but at least they have more substance than endless analyses of one rather tall athlete’s ball control and bank balance.
So, thankful for this small mercy, I sat down with a pile of cuttings. Checking that they were dated 1999, and not ’98 or ’97, I read of the “Agony of doctors at breaking point” (Daily Mail), of how a “Hospital has to turn away ambulance in ’flu crisis” (Birmingham Post), and of why “Critically ill patients face desperate hunt for bed” (Daily Mail again). After reading upwards of 50 such headlines, I thought I’d seen one of everything. But no; the Mirror of 12 January devoted its front page to a picture of baby Jake alongside a pithy description of his recent plight: “Doctors started Jake’s birth, then stopped. They’d run out of beds.” And, just in case you’d failed to appreciate the awfulness of Jake’s experience, the paper helpfully flagged its piece “The most shocking NHS crisis story yet.”
Something has gone wrong with the script. This is the age of New Labour, and things weren’t supposed to be like this. Wasn’t the annual winter health crisis due to become history? Yes, of course it was. Back in November, Frank Dobson was doing the rounds to remind us of this very intention. As the Guardian leader writer of 4 January pointed out, “Just two months ago he announced an extra £250 million to avoid a winter crisis, pointing to the success which last year’s special winter fund had achieved. He boldly explained that his new approach meant ‘the NHS is better able to cope with the winter than ever before.’” The Guardian might have added that our prescient health secretary was careful to qualify his remarks with disclaimers about what might happen in the event of a major flu epidemic.
I suppose some people may have believed that merely electing a new government would indeed effect a magical transformation. But it was always hard to see how, and the evidence of doubts confirmed has now been displayed on the pages of every newspaper. This is not to say that anything is worse than it was. Anne Widdecombe may have shocked Guardian readers (12 January) with the startling claim that ministers had been “putting political priorities above the immediate needs of the health service,” but academic observers take a sanguine view.
Professor Chris Ham, director of the Health Services Management Centre at the University of Birmingham, says he mostly reads the Guardian and Independent. “What I’ve been seeing in those papers seems to me quite fair. It’s a bit superficial, but you’d expect that.” A crisis, then? Well, not really. “It’s been more difficult this year than in some previous years. It’s not just money, it’s more fundamental. There are shortages of staff in some areas, and there’s very little slack in the system. So to that extent you might say that some parts of the NHS have been in crisis. The way I’d put it, using medical terminology, is that we’ve got an acute on top of a chronic problem, and what the papers pick up on is the acute problem.”
And don’t they just. Flu has had the most coverage. The Times of 5 January offered a whole page of science, epidemiology, and home remedies. The London Evening Standard of the same day was one of several papers reporting that “Flu victims are putting London’s health service under unprecedented strain by dialling 999 and asking to be rushed to hospital.” Meningitis put in an appearance (“Just how many more must die?” demanded the Express on 6 January), but shortages in intensive care beds soon displaced it as the issue of the moment. Easily the most grotesque story was the affair of the hospital morgue in a freezer lorry: “A CRISIS-HIT hospital has hired a refrigerated truck as an overflow MORTUARY,” reported the Daily Star on 6 January. 
Among what Chris Ham refers to as the underlying chronic problems of the NHS, the shortage of nurses generated many stories. The Daily Star (11 January) managed to find one who had abandoned the bedpan in favour of “Page 3” work: “Says Emma Connolly RGN, ‘I’m not interested in pornography, which is why I turned to the Daily Star and its sexy, tasteful shots.’” For more cerebral readers, Melanie Phillips used the pages of the following day’s Daily Mail to argue her case that one of the reasons why we have a nursing shortage is that the profession has taken a wrong turning: “A while ago, nurses decided they wanted to become more like doctors. Their leaders decided nursing had to gain higher status by becoming more professionalised. So during the Eighties, nurse training was transferred from the hospitals to the universities, where it was turned into an academic subject. As a result, it has driven away people who would make excellent nurses but have no academic bent. Conversely, why should people who are degree material choose such a low-paid job?”
For the Royal College of Nursing, Christine Hancock got swiftly to the point as she saw it. “A good pay rise would boost numbers immediately,” she assured the Guardian of 12 January. You can’t blame Christine Hancock for using the occasion offered by an acute problem to remind us of her chronic complaint. And, of course, she wasn’t the only opportunist around. Junior doctors also seized the day. “The excessive workload combined with the long hours already worked by these doctors has meant that patients may now be at risk in some regions,” according to a BMA press release titled “Winter pressures impact on junior doctors” (11 January).
So everyone, including the media, sees the annual winter crisis as an opportunity to argue a case. Does it matter? John Appleby, director of the health systems programme at the King’s Fund, thinks it does. He says there have been some particular problems this year but doesn’t believe they add up to a crisis. What it does add up is a mountain of bad publicity for the NHS, and this depresses him. “A lot of what’s published is just anecdotal,” he says. “But this begins to inspire stories about the need for major alterations to the NHS on the grounds that it’s about to implode. So people start to say, ‘Let’s look at alternative healthcare systems, including different ways of funding health care.’ I do find these stories worrying.”
John Appleby’s fear is that what starts with tales of nurses becoming models and bodies stored in freezer trucks could fuel a campaign to rethink the entire health system on the false premise that its condition is already terminal. In fact, most editorials published in national dailies during the January “crisis” were supportive of the NHS. The Independent on Sunday (“NHS crisis? What crisis?” 10 January) argued that “What is presented to the public as an unprecedented crisis in the health service is little more than one of the inevitable small oscillations in the provision of health care to a population of 60 million. That people are so easily panicked into believing that collapse is at hand is the consequence of a lack of true perspective.”
The Daily Mail came closest to raising serious doubts. Its editorial of 7 January finished by suggesting that “so long as the NHS is funded exclusively out of taxation, it will continue to be starved of cash. We need an urgent and fundamental debate about the future of the nation’s health.”
The King’s Fund takes the potential impact of all this reporting seriously enough to be commissioning an analysis of the media coverage of this year’s winter health crisis. John Appleby hopes it will find out how well the stories match up with the reality of data on ambulance calls, numbers of intensive care beds in use, staff absences, and the like. Until we have such a study, we won’t really know whether baby Jake’s unfortunate birth and nurse Emma’s modelling ambitions are genuine straws in the wind or simply sideshows.