How well will the half-full glass sustain the NHS through the winter? Prime minister Tony Blair was unsurprisingly at pains to stress the fullness rather than the emptiness of the service's tumbler of resources when he launched the winter plan at the beginning of this week. And indeed, those resources are in the throes of being gradually replenished rather than drained. But his pre-election damage-limitation impulse ensured plenty of spin was devoted to playing up the persistent likelihood of problems, the better to defuse them when they happen.
What are the chances they will happen? The media are already on hyper-alert for the first glimmer of a 'winter crisis', the definition of which will accordingly be expanded to embrace comparatively trivial incidents that might otherwise have passed unnoticed. It proved such a rich seam for stories in January this year, and provoked so far-reaching a mega-response from the government, that unprecedented media scrutiny was always guaranteed for 2000-01. Several national newspapers are recklessly campaigning for the NHS to be abandoned, so the winter will provide them with a battery of easy potshots, while the fact that the prime minister has personally staked so much on the outcome, so close to an election, heightens the suspense to screaming pitch. To that extent, the 'winter crisis' will be a self-fulfilling prophecy.
This time last year the chief medical officer declared the NHS 'better prepared than ever' for the winter, with 100 more intensive care and high-dependency beds, fewer vacant nursing posts, a public awareness campaign about flu and over 1 million additional doses of vaccine; local winter planning groups involving social services had become part of the landscape. Armageddon still loomed. This year's plan includes yet more flu vaccine and public information, even better disseminated good practice and enhanced partnership working, as well as NHS Direct able to handle twice as many calls. Putting aside the inevitable media-generated doom and gloom, will all of that make the difference?
Possibly - if the winter and its associated flu viruses are mild ones: remember how 1997-98 passed relatively trouble-free. Probably not, if the weather is severe, and definitely not if the next - and now overdue - flu pandemic should strike; in that eventuality, the virus could prove one of the most politically influential in history.
Given currently available resources, managers appear to have done all that is humanly possible to prepare for the winter. The remaining gaps are those which can only be filled over time. Ministers need to remember this if the worst comes to the worst. They have come a long way from the sticking plaster and 'woe betide' attitudes of a few years ago, and seem refreshingly realistic about the NHS's capacity to cope. Let's hope it is more than mere pre-election posturing.