As if the impending onset of winter pressures (following so soon after summer pressures) were not enough, there comes widespread flooding and the prospect of more fuel protests. Without doubt, the next few weeks promise to be a busy time for health service managers everywhere. Apart from implementing the NHS plan - against the background of an approaching election, with all the heightened anxieties that can bring - they may have to cope with queues in casualty, bed-blocking in acute wards, disruption or damage caused by the floods and the myriad problems a petrol shortage would bring. Well, no one ever said life as an NHS manager would be easy.
So it is with a certain sense of trepidation that we draw our readers' attention to a policy area which most will probably have neglected, perhaps paying it occasional lipservice before passing on to what undoubtedly seem like far more urgent matters. We refer to the NHS's responsibility to the environment.
Unsurprisingly, the service has been slow to take note of, and adapt to, environmental concerns. Every few years the issue suddenly comes into vogue as ministers launch a new initiative, but then it seems to fade again just as suddenly without much having changed in the interim. More often it takes an emergency to stimulate more fruitful reflection. Just such a situation exists now, and a useful starting point for reflection is a modest but fascinating research project in the North West.
This found that during the last fuel protest, pollution levels dropped noticeably, admissions to accident and emergency departments declined, while deaths and serious injuries from road accidents fell by 58 per cent. In short, we were afforded a brief glimpse of what life could be like with less traffic on the roads: there would be rapid and significant health gain.
Yet how many acute trusts have 'green' transport plans? How many NHS organisations permanently operate car-sharing schemes or encourage staff to cycle to work? How many can honestly say their waste management is as efficient as it could be?
How many are still building massive car parks?
It would be glib to suppose there are never powerful reasons for trusts' tardiness in adopting green policies: in particular, Britain will need a revolution in public transport before car-use will decline. The NHS cannot bring that about; all the more reason for it to forge effective partnerships. When managers are of necessity consumed with the immediate and local, it is hard to shift attention to the long-term and global. Many green initiatives seem small-scale and piecemeal, and lack convincing evidence they will do any good. But the North West study should act as a reminder that they can. And the floods should act as a reminder of the consequences of doing nothing.