Why has the predicted winter crisis failed to materialise?

Princess Margaret Hospital in Swindon was running at almost full capacity last week. The 600-bed hospital started Wednesday morning with nine free beds, having admitted 38 emergency cases the previous day.

But compared with the start of January 1997, things were positively quiet.

'At this time last year, we were closed to all but emergencies and life- threatening conditions,' says Swindon and Marlborough Hospital trust spokesman Ian Keeber. 'We were facing 80 emergency admissions a day.

'Up to 25 per cent of the nurses expected on shift were ringing in sick with flu.

'It got to the point where all our beds were full, we had 10 people on trolleys in accident and emergency and another 20 on their way to us. Things are tight this year, but nowhere near as bad. Thank goodness.'

Swindon's experience mirrors that of hospitals around the country.

Liz Slinn, clinical services manager at Southampton General Hospital, remembers ambulances 'queuing down the road' last January while flu-hit staff coped with 50 medical emergency admissions a day, and intensive care was forced to refuse or transfer some admissions at peak periods.

This year, staff sickness is down, the hospital is dealing with about 35 medical emergency admissions a day and there have been fewer problems in ITU although intensive care and children's services have been under pressure.

A spokesperson for Queen's Medical Centre in Nottingham groans just thinking about last winter. Pressures peaked on 28 and 29 December, when 500 people passed through A&E; 120 emergencies were admitted in 24 hours.

This year, the centre has admitted no more than 74 emergencies a day and is generally 'busy, but nothing like last year'.

The first two weeks of 1997 saw problems throughout the country hit a peak.

This year, though, NHS Executive regional offices report, for example: 'Things do not seem too bad at the moment' (West Midlands); 'Tertiary centres are under pressure but coping well' (Anglia and Oxford); and even 'We are seeing pressure down across the region' (North and West).

Which prompts the question - whatever happened to the great winter crisis of 1997-98?

Regional offices and frontline managers say it has not materialised for two reasons.

First, there has been no repeat of the cold spell that helped to fill A&E departments last year.

And second, there has been no repeat of the flu outbreak that hit staff just as it increased emergency admissions.

The Royal Meteorological Society's weather log for December 1996 reports a 'very cold spell' from 21-31 December. The cold snap continued until 10 January, with 'day-time maxima below 0oC in most places' and as low as -15.2oC at night.

December 1997, by contrast, was 'very mild' with only 'a little bit of snow on the 2nd' and January 1998 has been 'very wet and windy, but fairly mild'.

The Public Health Laboratory Service says the number of cases of flu and flu-like illness rose rapidly in the final weeks of December 1996 and peaked at 200 cases per 100,000 population in the first two weeks of January 1997.

This year, cases have stayed at 'background levels' of less than 50 per 100,000 population all winter (see table).

But managers are still reluctant to say there won't be a winter crisis this year. Regional offices point out that activity levels did not return to normal until March last year so there is still time for one.

'We are keeping our eyes on the weather forecast and the progress of poultry flu,' says one region. 'If snow sweeps across the country or London goes down with flu, things could change very quickly,' says another.

Hospitals are also better prepared this year, and have benefitted from the government's injection of pounds300m winter pressures money in November.

Front-line managers are convinced that the government could not have saved this cash without

seeing more problems than

are being reported now.

Bucking the general trend, Joan Rumsey, patient and nursing services director at Northampton General Hospital, says 'there has not been a lot of difference between this year and last year.

'We have had quite a lot of money put into social services, which we hoped would help to release more beds,' she says.

'Social services have done a really great job and are moving about four patients a week.

'But the number of people we need to move has still gone up to 16 or 17 a week, from 15 last year. If the money had not been spent, we would have had another four on top of that and would be under even more pressure.'

Last Wednesday, Northampton General had 16 patients waiting for beds in A&E, and 60 medical 'outliers' in surgical beds.

Mike Lavender, consultant in public health medicine for Newcastle and North Tyneside health authority, says the government's money was 'timely' and usefully spent on measures to improve discharge, prevent admission in the first place and increase capacity.

Last year, Newcastle hospitals had difficulty finding beds for patients in hard-pressed A&E units, and at one point ran out of beds for women altogether.

This year, the Royal Victoria Infirmary, which has opened an observation ward for patients who do not need admission, says it is 'under considerable pressure' but 'coping'.

Last year, it ended up with a backlog of 18-month waiters.

This year, it has spent time and money keeping waiting lists down and has just 63 long-waiters to clear by March. So 'even if it turns icy or we get a flu outbreak, we should get through the winter without everything going haywire'.

Meanwhile, there is good news for the NHS. The Met Office is forecasting a period of 'exceptionally mild weather' ahead.