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Published: 16/01/2003, Volume II3, No. 5838 Page 11 12

Is the winter crisis a thing of the past? Having reached mid-January, A&E directors might be forgiven for an outbreak of restrained new year optimism. Laura Donnelly reports

'This time last year was a nightmare. This is traditionally the worst week of the year.'

So says a relaxed-sounding David Cheesman, director of emergency care at Whipps Cross University Hospital trust, arguably one of the NHS organisations to feature most regularly in the winter whirlwind of media crisis stories.

And this year? Mr Cheesman is keeping everything crossed. Like many other managers, the endof-year targets - just 10 weeks away - are weighing heavily on his mind.

Those working in accident and emergency departments are aware that targets like the four-hour admission or discharge are more than challenging.

The March milestone - that 90 per cent of patients will be admitted or discharged within four hours - is still 'a long way off ', admits Mr Cheesman. Last week, Whipps Cross achieved 64 per cent.

In recent years, the hospital has been seen struggling desperately with the extra pressure of winter.

Publicly, it probably hit rock bottom in the winter of 1998-99, twhen the Daily Mail used images of Whipps Cross A&E department to illustrate a 'thirdworld NHS'.

But this year - for once - the hospital is feeling faintly optimistic.

Mr Cheesman tells HSJ: 'I came in this morning and we had 30 beds empty.We have got more empty beds now than we had in the middle of summer.'

The situation is not perfect - a few operations have been cancelled, he says - but 'this is without a doubt a much better winter for us than normal'.

The cold snap and icy roads increased the number of trauma patients with fractures and such like, but, says Mr Cheesman, 'we can patch them up and send them on'.

It is medical patients with respiratory and viral problems who cause the real problems.

And - so far - these have been largely absent.

Which is not to say that Whipps Cross has had it easy.

Having suffered badly from the Norwalk-like virus this summer - with 15 wards closed - the socalled 'winter vomiting bug' returned in December.

Five wards were closed, but the episode was dealt with just in time: the wards were re-opened the weekend before Christmas.

'By Christmas eve, we had 100 empty beds, ' says Mr Cheesman.

What made the difference? He believes that close working with social services has been key:

packages of care were available throughout the Christmas period, speeding up discharge.

Whipps Cross has also increased the number of services and transport available at weekends, and extended the hours of its discharge lounge.

But as the rest of the world enjoyed the lull between Christmas and new year, Whipps Cross was playing out 'a highrisk strategy' in an attempt to improve its performance on A&E targets.

On 30 December, a ward was closed down so that a temporary emergency medical centre could be opened on 2 January.

'We did plan to open it in May, but because of the four-hour target we have opened it early. It was a high-risk strategy, ' admits Mr Cheesman.

A ward will provide the temporary facility until the real centre is open.

Making such major changes at a difficult time of year may look like a desperate measure - especially when the trust is struggling to staff it.

Mr Cheesman says: 'Whipps Cross has a poor record in terms of A&E, so we have got a long way to go. It wouldn't be possible for us to achieve the targets without this.'

The temporary centre, he says, has been 'done on a shoestring.'And while diligent senior staff are keeping it open, Mr Cheesman admits that when the bill comes in the trust may struggle.

'The key issue is nursing staff.We have got a lot of senior staff working long hours - grade Fs, Gs and Hs working weekends. It is going to cost more, it will be expensive - but It is the only way we can hope to meet targets.'

Few in the NHS would pretend that the absence of winter crisis stories is purely a victory for sound planning.

Other factors come into play - chief among them the absence of flu in recent weeks. Latest figures from the Public Health Laboratory Service show that the rate of flu per 100,000 of the population was down to just 11.9 cases for the week ending 29 December. That compares to a normal seasonal level of between 50 and 200 cases and epidemic levels, defined as 400 cases and over.

And how does one define a winter crisis? Traditionally, January is the month where the media pack hunts down that winter story. But for the last two years, a somewhat desperate press has settled for a story that just happened to take place in winter - last year it was Rose Addis, the 94year-old patient whose family claimed she was abandoned at Whittington Hospital. The year before it was bodies in the chapel at Bedford Hospital.

In fact, the last winter with any authentic hallmarks of a winter crisis was the one before . That was the millennium winter when shortages of intensive care beds - at one point there were no ITU beds left in the capital - provided a backdrop to the second year of the Daily Mail's continued campaigns about a third-world NHS.

Seventy-three-year-old Mavis Skeet's operation for throat cancer was cancelled for the fourth time in five weeks because of bed shortages at Leeds General Infirmary.

Under pressure, prime minister Tony Blair told journalist David Frost in an infamous TV interview in January 2001 that he would bring NHS spending up to EU levels, in a statement which led irrevocably to the NHS plan and radical reform of the service.

That surely was a winter crisis.

Except that the NHS millennium executive team's report on that winter suggests, as the King's Fund summarised, 'that most NHS staff felt that while the NHS was under pressure, they did not perceive it as being in crisis'.

Mark Purcell is a public relations consultant who has been working with London trusts for the past four winters.

He feels the government has been pretty lucky: 'Every year there has been a winter story but I feel that the Department of Health has been very lucky - because there hasn't really been a winter since 1997.'

And some of that is down to timing. He believes that had the viral infection which affected the capital ahead of Christmas come at the same time as the current cold snap, the results could have been 'absolutely catastrophic'.

For Mr Purcell, the key winter pressure is staff: and keeping them fit and working.He believes that the government's biggest victory in terms of planning is persuading staff to have a flu jab.

'I think the jabs have been fantastically successful. Real winter pressures are not about media stories; they are about all the nurses being knocked out with the flu.'