BBC Social Affairs Correspondent Niall Dickson: "Health service in crisis"

Over the weekend only 20 intensive care beds were available in the whole of England.

Hospitals, ambulance services and doctors in Leicestershire, Warwickshire, Staffordshire and the West Midlands are struggling to cope with the crisis, which shows no sign of relenting.

The Walsall Manor Hospital had to turn away emergencies for 90 minutes on Sunday, while other hospitals in the region have had to cancel operations.

A 'flu epidemic which kept 45,000 people in their beds over Christmas and New Year according to the national influenza monitoring unit, has been blamed for the intense strain on health services in the Midlands.

'Not exceptional'

But Dr Douglas Fleming, of the Royal College of General Practitioners' 'flu monitoring unit, said: "There are a lot of people across the country who have 'flu, but the overall level at the moment has not reached exceptional levels for this time of year."

BBC Social Affairs Editor Niall Dickson reports on the crisis from Selly Oak Hospital in Birmingham

He said it was extremely unlikely it would become a nationwide epidemic.

Hospital managers said they were prepared for an onslaught of extra cases, but the national shortage of nurses had pushed services to breaking point.

Tim Jones is policy manager of the NHS Confederation, which represents hospital managers.

Correspondent Andy Newman: "For a 90-minute period even emergencies were turned away"

He said the demand was not unprecedented and there were beds available.

However, he added: "The factor we have this year that hasn't been a factor before is nurse staffing - we do seem to have a shortage of qualified nurses.

"There are emergency beds available but they can't be opened because we do not have the nurses."

The 'flu outbreak is making a bad situation worse. On 27 December about 80 cases per 100,000 people were being recorded each week.

That compares with the last serious flu outbreak, in 1995, which saw 230 cases per 100,000 a week. A major epidemic in the 1960s caused 1,180 cases per 100,000.

Bug comes from Australia

Doctors say the classic symptoms of the virus, called H3N2 Sydney flu after the city where it originated, are aches and pains.

Sufferers are advised simply to retire to their beds until they feel better.

Major employers such as Jaguar in Coventry fear an increase in absenteeism

Monday sees a mass return to work after the Christmas and New Year break and big employers in the Midlands, such as Jaguar, Rover, GKN, Cadbury's, Walkers and Wedgwood, fear thousands of workers will call in sick with the 'flu.

There are fears that the bug is heading south.

The pressure group London Health Emergency says the capital's health services may not be able to cope.

The group's Campaigns Director, Geoff Martin, says: "The start of 1999 will be grim indeed for both patients and the dwindling band of front line staff fighting to hold the services together."

Shadow Health Secretary Ann Widdecombe said the Government was responsible for the winter difficulties in the NHS through a combination of policy mistakes and inaction.

If the winter pressure cash had been allocated in September rather than November, that would have given hospitals time to prepare and hire extra staff, she said. The focus on getting waiting lists down had also meant that insufficient resources were available to cover emergencies.

The British Medical Association has urged people not to over-burden their GPs.

BMA spokesman Fay Wilson gave this advice to people suffering 'flu symptoms: "Don't go straight to hospital, because they can't cope.