Another new year, another clutch of 'NHS in crisis' headlines bespatters the national newspapers. The pattern is a classic, if not quite perennial, one: widespread outbreaks of flu lead to more patients presenting in accident and emergency departments, while on the wards the same outbreaks lead to elderly people blocking beds and more staff off sick.

The immediate result is patients waiting on trolleys in A&E. The delayed result is more patients waiting longer on lists for elective treatment. Both are disastrous PR for the NHS and the government. This year, the underlying shortage of nurses - worse than 12 months ago - is the most depressing and dangerous element.

Ministers are adept at short-term solutions to comparatively short-term problems, as the 'winter pressures' measures show. They are less resolute when major action is needed - witness the endless shilly-shallying over pay. The nurse shortage is at the heart of winter crises, and pay is at the heart of the nurse shortage. These PR problems will not be susceptible to easy and superficial PR solutions.

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