Leading article: We must pay up to prevent the decline of our health service

ON THE face of it, winter seems to have cast the National Health Service back into a near-constant state of collapse. Over the weekend, incredibly, there were just 20 intensive care beds available in the whole of England; as a result, a number of distressing stories have emerged, from pensioners left on trolleys in corridors to patients being treated in ambulances because of lack of hospital space.

There is an outbreak of flu putting extra pressure on resources, but there is such an outbreak every few years, and the NHS ought to be able to cope. Neither is this outbreak particularly bad; the number of flu cases was much higher in 1995. The fact that the NHS is struggling is evidence of a deeper malaise. Most noticeably, a lack of nurses means that many beds that are physically available cannot be used to treat patients.

Overall, Britain has one of the most efficient health sectors in the world. The very fact that it operates at the limit of its abilities shows that it is using its resources to the full. For every penny we spend on health, we get better value for money than almost any other country. Labour has also copied the Tories by increasing spending in real terms, with the summer's Comprehensive Spending Review granting the NHS an extremely generous pounds 21bn over three years.

The British public has at successive elections shown itself reluctant to pay more in taxes, and alternative social insurance systems may do no better. Even in the US, where citizens clamour for the best-quality products from every industry, "managed health care" is the fashion. Americans found that their economy was not strong enough to sustain uncontrolled health spending.

The NHS does not usually fail to treat those who are acutely ill. Its worst failings show up elsewhere, in the shoddiness of treatment of the chronically ill, whether that means the condition of the crumbling buildings or the wait to be treated. It is a scandal that patients are still subjected to the indignities of mixed-sex wards. Old buildings, even at such world- renowned centres as Great Ormond Street, Harefield and the Royal Marsden, cost more to run, more to heat, and are less accommodating to new practices and efficient delivery of care than newer hospitals.

These problems may get worse. Cost inflation in health services, which have continually to match the advent of new drugs and life-saving technology, runs far above that in the rest of the economy. This makes it impossible to keep up with demand without increasing the numbers of trained staff and advanced facilities. The present shortage of useful bed space - flu epidemic or no flu epidemic - is a sign that the time for this has come. New Labour speaks of hard choices; this will be one of them.

Much more spending is necessary in these specific areas. We may not be able to buy all that we would like; but we can afford basic and decent standards of health care. We can afford to pay more to nurses, whose pay and status are ridiculously low given the vital job that they do, and the need to attract people to the profession. We can update our hospital stock to give more dignity to patients, especially the old and chronically ill, who have to spend long periods in depressing surroundings. Britain spends less per capita than other developed nations on health care; there is room for extra spending.

If voters are telling the truth when informing pollsters they want to spend more on the NHS, they will have to meet the costs. Higher income or consumption taxes, public-private partnerships which put off the cost to some later date, or more state-based insurance payments, are all options. None of them, though, disguise the real challenge: pay more, or watch public investment in the NHS wasted for lack of decent facilities and adequate staffing.