IN all the acres of print devoted to political predictions for 2018, every commentator has missed what those in the crystal ball and cross my palm with silver game like to call the bleedin’ obvious.

To wit: that every minister with a connection to the NHS will at some point, most likely next January, have to apologise for a service that looks far from being in fine fettle.

After a steady drip of bad headlines and news bulletins over the festive period showing A&E departments so crowded the staff had to battle their way between trolleys like commuters rushing for a train, the apologies began.

First to go down with a case of the sorries was Jeremy Hunt, England’s Health Secretary. “This is absolutely not what I want,” he said of the decision to postpone non-urgent operations till the end of January in response to the crisis.

Next was Theresa May, whose apology began, as is customary, with a declaration that “record” levels of investment were going into the service. “I know it’s difficult,” she added. “I know it’s frustrating. I know it’s disappointing for people and I apologise.”

Scotland had to wait a few more days in the apologies triage area before Mr Hunt’s counterpart, Shona Robison, and her boss, Nicola Sturgeon, emerged. The First Minister went slightly further in the Prime Minister in saying she would apologise “unreservedly, not just during the winter but at any time of the year, to any patient who is not seen as quickly as we would want them to be seen in the NHS or who doesn’t get the treatment that they have a right to expect”.

She concluded with her own now traditional (and controversial) coda: that while things were not ideal in Scotland, it was worse in England. When the A&E waiting times were published yesterday, it looked bad enough in Scotland: 78% people seen within the four hour guideline when the target is 95%.

Ministerial mea culpas have become so predictable at this time of the year one is tempted to tell the respective civil services to type up the January 2019 press releases now. What ails the NHS this winter, after all, is what has ailed it in previous years: flu, an increasing number of elderly and vulnerable patients needing to be admitted to hospital and to stay there for longer, doctors’ surgeries being closed for the festive period, and, in Scotland, a plague of icy pavements and car parks leading to a surge in broken bones.

All of which makes one wonder if complaining about the NHS has become about as futile an exercise as moaning about the common cold and protesting at the delay in finding a cure. Should we simply now accept that there are three certainties in life: death, taxes, and having a rotten time if you need the NHS over Christmas and New Year?

Except it is not that easy, or that simple. Nothing is with the NHS. Ministers are fond of talking about extraordinary pressures when trouble hits, as if the NHS was a well-oiled, smoothly running machine the rest of the year. If it was, it would be able to cope better with seasonal spikes in demand. There would be some negative impact, certainly, but overall the system would be able to manage. Instead, what we have is an NHS that is just about coping most of the time, and when pressure increases even slightly the gaskets start to blow.

Patients recognise the myriad pressures on the service. From the teenager waiting in A&E to the “bed blocking” pensioner – or as I like to call them, hard working people who have paid into the system all their lives and deserve better – we are all health economists now. Yet still the gap remains between what we think the NHS should deliver and what it can. Has it got to the point where our unrealistic expectations have become a large part of what ails the NHS?

Like many people of a certain age and stage in life, I have spent more time in A&E and on other hospital wards in recent years than I care to recollect. Late night dashes to casualty, looking after someone in long term care, having a relative waiting for an operation, who among us has not got the T-shirt and the worry lines?

Stick around for long enough in those situations and one sees not just the best and worst of the NHS, but the best and worst in humanity as well. No one with enough experience of the NHS believes that all nurses are angels, doctors have all the answers, and every dreadful wrong can be righted. It is a service for humans, by humans, and as such it is inevitably flawed. Perhaps the day will come when a problem can be sorted just by picking up the phone and ordering a better consultant or nurse bot from IT, but it is not here yet.

But what does being more realistic about the NHS involve? When the system works as it should, it still seems like the miracle that was promised in 1945. It remains truly humbling to witness that great, lumbering, Heath Robinson of a machine crank into life and deliver patients safely to the other side of whatever accident or illness has befallen them. We know the old place could do with more money, that the percentage of GDP spent on healthcare in the UK is less than Germany or Canada, that expenditure per capita is relatively low. Yet we also know that it is not just about money. If it was, Gordon Brown’s billions for the NHS would have done the trick. Making the NHS work better involves, for one thing, taking tough decisions that may not go down well with staff, such as introducing seven day working across the professions. It also means more of us taking responsibility for our continued good health where and when we can, whether that be booking a flu jab or exercising.

Being more realistic about the NHS does not mean opening the door to further privatisation. That is merely slapping a sticking plaster on a gaping wound, covering up a fundamental problem underneath. Nor does it mean accepting that things will never get any better. Above all, being realistic means politicians saying sorry when it is merited, but doing something about it so that the same old problems do not keep happening at the same time every year. The NHS is for all our lives, every day of the year, and not just for Christmas.