The crises of winters past

Bed and staff shortages have taken their toll on the NHS

This year's winter crisis in the NHS is worse than other years because of the added factor of nursing shortages, according to health managers.

But it is by no means the only time hospitals have been facing crises in the last 10 years as demand for emergency treatment has surged.

It was the crisis of winter 1987/88 which sparked the then Conservative government to reform the health service.

It saw hospitals around the country closing beds in order to balance their budgets after years of extremely tight financial settlements, combined with growing demand and spiralling technology costs.

There were also other factors involved in the crisis, including a shortage of specialist nurses.

The reforms, implemented in 1991 and cushioned by an extra injection of cash, introduced the idea of an internal NHS market.

Innovation

The reforms were designed to spur innovation and improve a health service, which was seen as inefficient and overly rigid, without substantially increasing the health budget.

But by winter 1995/96, some A&Es were closed because of patient demand and a lack of beds and many patients had to be ferried between hospitals.

By the following winter, the government was faced with headlines suggesting the NHS was near collapse.

Beds were closed and routine surgery cancelled. Some hospitals only accepted 999 calls and many people were left on trolleys in casualty departments.

The problems were the result of many factors, including huge projected deficits in many NHS hospitals, a flu outbreak, a cold winter and social service cuts which led to bed blocking.

Labour's first winter in power was relatively mild and there were no serious flu outbreaks.

Extra cash

This year, it is a different story, despite £250m in extra winter money.

Stephen Thornton, chief executive of the NHS Confederation, said that people would also expect there to be no problems because of the extra £21bn for the NHS announced by the government in the summer.

But he said this would not kick in until April.

The NHS Confederation says a survey of acute hospitals found that the main reason for the rise in emergency admissions this winter was bed availability and nurse staffing.

The Royal College of General Practitioners' flu monitoring unit says the flu outbreak in 1998/99 is similar to that two years ago in terms of the pattern of cases.

But managers say staffing problems have got worse since 1996/97.

A spokeswoman for the NHS Confederation said this was "the new factor" affecting the crisis.

Epidemic

The last major flu epidemic in the UK was in 1968 when Hong Kong or Mao flu hit the NHS.

Hospitals were put on red alert and several saw as many as 10% of nurses struck down with the flu.

Children and young adults were the most affected group, although the elderly were more likely to die as a result of the virus, which was relatively mild.

At its height, London hospitals had up to 300 emergency admissions a day.

The epidemic was nowhere as serious, however, as the 1957/58 bout of Asian flu which killed 8,320 Britons.