As a season, winter is a distinctly mixed bag. There’s the promise of Christmas; the roasting of chestnuts; and the excitement, at least initially, of snow. There is also the depressing effect of short days; cold temperatures that precipitate heart attacks and strokes; and the surge in viral infections, some of which, like flu, can be life-threatening. These adverse health impacts inevitably lead to a sharp increase in demand for acute medical care, and when the NHS and the social care system have little or no spare capacity a “winter crisis” ensues, with normal services knocked over in the attempt to cope.
According to the respected health think tank the King’s Fund, this year’s winter crisis could be the most severe ever seen. The calling of a general election and the subsequent cancellation of the autumn Budget has meant that for the first time in years there is no additional funding earmarked to help expand short-term capacity. Even if there were, it is unlikely that sufficient staff could be found. A decade of austerity and the Brexit-related loss of EU workers have left the NHS in England short of around 40,000 nurses and 10,000 doctors. The government’s mishandling of NHS pensions reform has created a uniquely damaging situation in which our remaining senior staff stand to lose substantial sums of money if they work additional shifts. We should brace ourselves for a bad flu season, if the recent experience in Australia is anything to go by. And, most worryingly, in 2019 the NHS did not make the recovery in performance that it normally does over the summer months.
A whole host of measures – A&E targets; total bed numbers; waiting times for surgery and appointments; bed occupancy rates – have been unremittingly dire throughout the year. But figures can be sterile. The sight of an old friend, an A&E nurse with over 30 years’ experience, in tears as she finally resigned from the job she loved, stays with me. Explaining herself, she gestured to the heaving waiting room, the queue snaking right to the doors, the ambulances backed up outside: “It’s July,” she said. “It’s unrelenting.” In The Lion, the Witch and the Wardrobe, CS Lewis conjured up an imaginary land where it is perpetually winter. The Tories have turned the NHS into the Narnia Health Service.
Winter crises are a political choice. The independent fact-checking charity Full Fact searched mentions of the term in the press from 1993 onwards. There was a spike in citations around the turn of the millennium in the early years of the New Labour government. But from 2003 onwards, as the sustained above-inflation NHS funding increases pursued by Tony Blair and Gordon Brown gradually bore fruit, mentions of winter crises virtually disappeared. Increased rates of flu vaccination undoubtedly helped – in the 1990s fewer than 40 per cent of eligible patients were being immunised, compared with more than 70 per cent today. But the chief factors are bed numbers and staff, and since 2013, media mentions of winter crises have been at blizzard proportions every year.
It is a strange experience, writing this column before polling day, yet realising it will be read after the result of the election is known. I have been scrutinising opinion polls with the obsessiveness of a fortune-teller handed cupfuls of tea leaves, hoping against hope that we elect a progressive government serious about funding public services.
Even though at time of writing that hope seems forlorn, I have a more enduring one. In CS Lewis’s Narnia, the permafrost is finally thawed by the return of Aslan the lion, aided by the courage of the Pevensie children. There is argument as to whether Aneurin Bevan, the founder of the NHS, actually said the words often attributed to him: “The NHS will last as long as there’s folk with faith left to fight for it.” To me, their provenance is irrelevant. The NHS is one of the greatest things about our country. My fervent hope is that the faith to fight for it will endure, whatever the outcome of our present political turmoil.