Ian Dalton's swine flu update - a whole-system approach

What should NHS staff be focusing their efforts on?

We are beginning to see the weekly numbers of new cases decreasing slightly with the latest figures down again from the previous reported figures of 53,000 to 46,000 as at 26 November. While this is positive news, there are still a relatively high proportion of patients in hospital and critical care, and the worrying trend of deaths as a result of swine flu continues with the biggest week on week increase so far.

There are further signs of increased pressure within the system, particularly on A&E and ambulance services. The NHS experiences additional pressure on its services each year, but while we are well placed to manage these we cannot be complacent, as we may be facing our toughest winter for many years. All organisations will need to continue to work together to ensure a whole-system approach to managing winter and pandemic flu pressures, responding flexibly to regional and local variation in demand. Only in this way can we continue to maintain services as effectively as possible on behalf of our patients.    

The vaccination programme is well under way, with 8 million doses having been distributed across England. We therefore have sufficient stock to vaccinate everyone in the priority groups, and GPs are now able to re-order the vaccine, via their PCTs, to continue to deliver the programme.

Completing the vaccination of all of the initial priority groups – public and health and social care staff – remains our highest clinical priority, as it is the best way people can protect themselves, their patients, their families and their colleagues from swine flu. Once the priority groups are complete GPs can begin to offer the vaccine to all healthy children over six months and under five years of age. Now that the programme has begun we must maintain the momentum, with all NHS organisations doing as much as they can to achieve a high take-up of the vaccine in order to protect and save lives.

The next steps

You will be aware that there has been some media coverage around the swine flu vaccine over the last few weeks, particularly around the safety of the vaccine and whether pregnant women should have the vaccine. Given that pregnant women are particularly vulnerable to complications should they get swine flu, the Department of Health strongly recommends that pregnant women should have the vaccine.  Ultimately, whether to have the vaccine or not is a personal choice, but it is important that healthcare staff have the right information available to provide to their patients about the vaccine, how it will protect them and how it has been tested to ensure safety. Please be reminded of the information that is available to support the vaccination campaign on the Department’s website, including an information leaflet and Q&A at www.dh.gov.uk/swinefluvaccinetools.

I am aware that there have been a number of instances of pregnant women requesting the (Baxter) Celvapan vaccine when they have been offered the (GSK) Pandemrix vaccine. The JCVI recommended that pregnant women should be given Pandemrix since a one-dose schedule with this vaccine gives excellent protection against the virus.  It therefore gives much more rapid protection than would be afforded by the two-dose Celvapan schedule. Expert scientific advice is clear that thiomersal-containing vaccines, such as Pandemrix, do not present a risk to pregnant women or their babies. However, as it is better to be vaccinated than not at all, and, if a pregnant woman does not wish to receive Pandemrix, despite receiving clear advice about the more rapid protection this would offer, PCTs should ensure that there are arrangements in place for her to be able to receive Celvapan, and that GPs are aware of these.

Progress to date

We are still collating and validating vaccination uptake data from across the NHS and hope to be in a position to share those figures very shortly. However, early anecdotal evidence that I have gathered from colleagues around the service shows that there are some excellent examples of the staff vaccination programme working well, with promising indications of high uptake, particularly among staff in critical care, paediatrics and intensive care.

All the latest information on the current numbers of flu-like illnesses, GP consultation rates, hospitalisations and deaths can be found on the HPA website.

The most up-to-date clinical information and guidance can be found on the Department of Health website at www.dh.gov.uk/swineflu.