The House of Lords Science and Technology Committee said that ministers had failed to offer reassurances that NHS services could deal with the predicted surge, when several million people may become ill.

It called for clarity on how intensive and critical care departments will cope with high patient numbers. It expressed concerns about NHS staff providing services outside their usual expertise if they are transferred around the country to the areas experiencing most demand.

The committee also criticised ministers for not setting up the National Pandemic Flu Service for England earlier in the year.

An interim service is now in operation to diagnose cases over the phone or internet and distribute drugs at pharmacies and health centres. But this was beset by problems when it launched last week, with the website crashing in the first few minutes.

The committee praised the Government’s actions in stockpiling antiviral drugs such as Tamiflu and entering into advance purchase agreements for a vaccine for the H1N1 flu strain, but said ministers needed to offer better guidance over who could have access to these treatments.

Swine flu is affecting about 100,000 people a week, and hundreds are being treated in hospital.

Lord Sutherland, the chairman of the committee, said that he was disappointed that tests to examine how the full range of health services would respond in a pandemic had not been carried our earlier.

“While the Government have got some things right in preparing for a flu pandemic, such as the stockpiling of antivirals, there are other areas where we appear to be under-prepared,” he said.

“We were surprised and disappointed that the Government had not undertaken ‘whole system’ testing of health services preparations for a flu pandemic before swine flu emerged.”

The peers said that the national swine flu helpline in England should also have been set up sooner and asked for assurances that it will cope with high demand this autumn.

Lord Jenkin of Roding, a former health secretary, who was asked to sit on the committee’s flu pandemic inquiry, told The Times earlier this year that ministers had said the hotline would be ready by April or May.

From:
http://www.timesonline.co.uk/tol/news/uk/health/Swine_flu/article6730118.ece

Dr Holden, the British Medical Association’s lead authority on pandemic flu, said he thought the thresholds for issuing Tamiflu had been set too low, a policy which he fears will come back to haunt the Department of Health if the H1N1 virus becomes resistant to Tamiflu.

The GP, based in Matlock, Derbyshire, helped draft the clinical algorithm used by operators on the National Pandemic Flu Service telephone line, but said doctors are being encouraged to dish out a “pill for every ill”.

Writing in Pulse mageazine, he also accused Andy Burnham, the Health Secretary, and Sir Liam Donaldson, the Chief Medical Officer, of giving different advice to GPs and the public.

“Both … have contradicted themselves by telling the public they can have Tamiflu if and when they want it, but at the same time telling GPs to use their clinical judgement.

“They are running with the hares and hunting with the hounds.

“People are finding it a bit hard to swallow that we are getting beaten up by the DH for antibiotics prescribing but that the same principle doesn’t seem to apply to the judicious use of Tamiflu.

“Personally I feel the flu line will help to relieve pressure on GPs but my concern is that the threshold for giving out Tamiflu will be set too low. For most people, given that is a mild illness the amount of medication being given out is overkill.”

As more courses of Tamiflu are distributed, GPs are seeing an increase in the number of patients who have experienced side-effects caused by the antiviral, including nausea, vomiting, diarrhoea and headaches.

“Every day GPs are saying they are seeing people with side effects from Tamiflu,” said Dr Holden. People are going for second and third consultations with their GP. It’s putting even more strain on the NHS.”

Swine-flu-could-become-resistant-to-Tamiflu-because-of-over-prescribing

Implementing the European Working Time Directive next Saturday, when the NHS is already under pressure with 100,000 new cases of swine flu being diagnosed in a week, is the ‘probably the worst time in living memory to do this’, the junior doctors’ campaign group RemedyUK said.

Junior doctors are the last group of NHS staff to come into the Directive this Saturday by cutting their working week from 56 hours to 48.

Experts have warned that the NHS is not ready for the change and there will be gaps left in rotas putting patients at risk.

John Black, president of the Royal College of Surgeons said if swine flu turns into a major crisis, the Government should show leadership and suspend the Directive.

He said: “We could have a one, two or three-stage serious pandemic. If that happens everybody of course will work whatever hours are necessary to keep the patients alive in a crisis.”

“I trust that if that happens the Government will not fudge it and they will actually say that the European Working Time Directive leaves no slack at all in the system and if there is a major crisis it should be suspended.”

Richard Marks, Head of Policy at Remedy, said: “Millions have been spent on staff call-centres using non-medical staff to diagnose and prescribe (for swine flu) but at the same time they are reducing doctors’ working week by one full day.

“It’s probably the worst time in living memory to do this.”

Doctors are likely to be in short supply during a flu outbreak as they are in the frontline of exposure to the virus and are at increased risk of falling ill themselves and may also have sick children to care for during the peak of a pandemic.

RemedyUK has called for the introduction of the Directive to be delayed until the uncertainties over how the flu outbreak are resolved.

Dr Matt Jameson Evans, chairman of Remedy, said: “Unfortunately we have a camel’s back situation and swine-flu is more of a sledge hammer than a straw.

“We already know most doctors are against EWTD, we just need the leadership to do the right thing here.”

Dr Andy Thornley, Chairman of the BMA’s Junior Doctor Committee said: “Clearly pandemic flu is going to place additional pressure on an NHS that is trying to adapt to the introduction of the 48-hour week for junior doctors.

“The government need to be much clearer in communicating how it plans to deal with these additional pressures as it is unacceptable that so little information is trickling down to junior doctors.

“It is also important that the NHS works hard to reduce unnecessary bureaucracy and inappropriate work so that junior doctors can do what they do best – treat their patients.

The Directive does not allow for wholesale suspension but if individual staff work longer than the 48-hour limit the time can be balanced out over the coming months.

A report due from the House of Lords Science and Technology Committee is expected to criticise ministers for not setting up the National Pandemic Flu Service in April.

From:
Cutting-doctors-hours-during-swine-flu-outbreak-is-unnecessary-risk-Government-is-warned

The report will attack the labour Government’s failure to keep its promise to set up a flu telephone helpline by April.

Labour Ministers will be held to account for the delay in setting up the national flu helpline and for giving confusing advice to vulnerable groups and NHS staff.

The report will be published as senior doctors hold an urgent meeting with Andy Burnham, the Health Secretary, in a last ditch attempt to persuade him to drop controversial European rules limiting the hours doctors can work, which are due to come into force on Saturday.

One doctor gave warning that the NHS was facing a “triple whammy” as it struggled with swine flu, the introduction of the European Union Working Time Directive and– four days later – the movement of more than 30,000 junior doctors between hospitals as part of the annual rotation of specialities.

Further concerns over Britain’s swine flu response are raised today by a Sunday Telegraph investigation, which has exposed major security lapses in the national flu pandemic service.

The flaws would allow fraudsters to obtain dozens of doses of Tamiflu – the main drug being issued to swine flu victims.

The Sunday Telegraph has also discovered that maternity units are planning to cancel home births and planned caesarean sections if the outbreak turns into a major epidemic.

Andrew Lansley, the shadow health secretary, said government planning failures had created a response to the pandemic that already appeared to be “riddled with problems”. He accused ministers of taking “an ad hoc approach” to a situation which needed careful planning.

This week’s report by the House of Lords science and technology select committee is the first to look into the Government’s preparedness for pandemic flu. It will attack its failure to keep its promise to set up a flu telephone helpline by April when the world was on the brink of a pandemic.

This newspaper disclosed in May that the delay was caused by the Treasury, which took seven months to sign off on the deal.

The hold-up meant the Government had to introduce a stopgap flu phoneline, introduced last week, manned by staff given just one day of training.

In the meantime, NHS Direct, which should have been running the service, has made hundreds of its highly trained staff redundant.

The Lords report will also question the adequacy of advice being issued to the public, in particular that offered to vulnerable groups such as expectant mothers. In evidence sessions, committee members described the lack of public advice for pregnant women as “extraordinary”.

The advice was only publicised last week, leading to further confusion when ministers appeared to distance themselves from recommendations they had previously endorsed.

Last night senior doctors said ministers must take urgent action to avert an impending crisis.

From Saturday, doctors will not be allowed to work more than 48 hours a week, under EU rules. The change has been fiercely resisted by many senior doctors who say it will put lives at risk.

It could mean that the NHS is short of doctors just as pressure on hospitals caused by the swine flu outbreak intensifies.

Britain’s top surgeon has urged ministers to suspend changes to working hours. John Black, the president of the Royal College of Surgeons, accused ministers of “having their heads in the sand”.

He said: “The courageous thing to do would be to step in and suspend the 48-hour limit for the whole of the NHS, once we come under pressure, but that would require political leadership. I don’t expect it to happen.”

Mr Black said despite warnings the Government had made no useful concessions over the rules which he says will put lives at risk, and “devastate” the training of health professionals. He will restate his plea for concessions over doctors’ hours in a meeting with Mr Burnham on Wednesday.

The weekly 48-hour limit for doctors is measured over a sixth-month period, allowing doctors to work extra hours some weeks, if they then cut back on others.

Doctors can opt out of the directive on a voluntary basis, but only individually, throwing rota planning into “chaos”, according to senior doctors. They want whole departments or specialities to be allowed to suspend the rules.

Both Mr Black, and John Heyworth, the president of the College of Emergency Medicine, said they did not expect the introduction of the working directive to have an immediate impact, but they fear it could cause shortages of doctors by September, when flu cases may soar. Mr Heyworth, an A&E; consultant at Southhampton General Hospital, said: “There is a triple whammy heading inexorably our way – the directive, doctor rotations, and swine flu, and the impact of all of this happening at once is unknown.”

He said doctors had explained their concerns to ministers about the changes to working hours “at great length”. Last night the Government defended the operation of its Pandemic Flu Service. It said that on the first day of the service, Thursday, it carried out more than 58,000 assessments, and almost 6,000 courses of antiviral drugs were collected in England.

From:
http://www.telegraph.co.uk/health/swine-flu/Swine-flu-ministers-blamed-for-chaos

Despite the steep rise in cases, there was a smaller increase in the numbers in hospital with the disease – up to 840 against 652 last week – and a rise of just 10 in the number in intensive care to 63. All strategic health auth­ority areas are classified as suffering from “exceptional influenza activity”. Some areas, including eastern districts of London, are hot spots.

But at 150 consultations per 100,000 population, the number of patients visiting the GP nationally remains below the rates seen in the last sizeable outbreak of flu like illness in 1999-2000 and the number of actual cases is far below the peak of the last flu pandemic in 1969-70.

Sir Liam Donaldson, the chief medical officer, said more detailed investigation of the deaths that have to date been attributed to swine flu had resulted in some new cases being counted in and others discounted, leaving the provisional total at 26.

The English figures were disclosed as Professor Hugh Pennington, a leading virologist at the University of Aberdeen, said that Scotland was “possibly through the worst” of the first phase of the virus as latest figures showed far lower GP consultation rates than in ­England.

The relatively small rise in those being admitted to hospital in England and an apparent drop in the GP consultation rate in some parts of the country provided a possible first hint that the initial wave of the infection might also be peaking in England, as it has in the US.

But Sir Liam warned against “reading too much” into those figures. If the data held for another week or so they might indicate a lull in the pandemic, “but I don’t think so yet”.

The infection remains mild in most people and continues disproportionately to affect children. Two thirds of those who have died had other severe underlying medical conditions, Sir Liam said, with only 16 per cent of the small number of deaths in otherwise healthy people.

“The bad thing would be if 100 per cent of the deaths were healthy people,” he said. With the current state of the virus, “the vast majority, even with an underlying condition, will get flu and recover well”.

The Federation of Small Businesses wrote on Thursday to Andy Burnham, the health secretary, calling for measures to help its members through the pandemic.

It wants routine inspections of businesses suspended in areas with high levels of infection and a simpler system for the smallest companies to reclaim statutory sick pay.

“A small firm employing only three people could expect to have all of its workforce off for up to two weeks this autumn,” John Wright, the federation’s national chairman, said.

Sir Liam said that school closures had not been ruled out for the autumn, but “it would be a huge step to close schools across the country”, with a considerable economic impact.

The pandemic flu service is intended to lift the burden from GPs and give swift access to anti virals. Patients whose replies to a list of questions indicate they may have swine flu will be given an access number and told where a relative or friend can, with suitable ID, collect their Tamiflu.

The Association of British Insurers said its members would accept the number as the equivalent of a medical diagnosis of flu for travel insurance claims.

Early callers to the swine flu hotline on Thursday afternoon were greeted with the slightly disconcerting question asking whether they were “conscious”, write FT reporters.

More worrying was the fact that the online version had already crashed after being swamped, though the telephone service seemed to be working well and call centre staff were responding promptly.

One potential sufferer with flu-type symptoms said the person taking his call appeared to be reading from a similar list of “do you have swine flu?” questions as seen online. The questions ranged from “do you have trouble speaking?” to “do you have a patch of purple dots underneath your skin?” and “can you bring your chin down to your chest?”

Callers are also told that if they misused the service they would be prosecuted.

No questions were asked of the caller whether he was part of an “at risk” group, such as asthmatics.

He described the process as similar to “ringing a bank or an insurance company”, with the call-centre worker “clearly not a medical professional”. The 2,000 operators will liaise with GPs to report problems. So far, the hotline is available only in England.

From:
http://www.ft.com/cms/s/0/909e04e0-7794-11de-9713-00144feabdc0,dwp_uuid=819fc44c-33e2-11de-9eea-00144feabdc0.html

While the pandemic has spread to nearly 200 countries, the UK has intrigued public health specialists by reporting to date the most cases outside Mexico and the US, with 100,000 new suspected infections in recent days and rising fast.

After recent incidents when British citizens have been detained in China, Brunei and Romania, the Foreign Office is warning visitors to its website that they could be screened on entry to a foreign country and even placed in quarantine if found to have swine flu like symptoms.

But with many countries across Europe and elsewhere yet to be significantly affected by the flu, and often with modest stockpiles of the medicine Tamiflu, those who do fall ill while abroad may face greater hurdles than normal in gaining swift access to treatment.

Some countries are simply putting up posters at ports of entry advising travellers to seek medical help if they have flu symptoms, but it says Romania is among those now specifically asking those arriving from the UK to fill in a medical questionnaire and placing those with symptoms in isolation in hospital for treatment.

The Association of British Travel Agents has also criticised overzealous imposition of screening of British travellers by foreign countries including Egypt and Turkey despite advice that it serves no purpose from the World Health Organisation.

Official advice warns those who have already fallen ill to defer their trips, while the airlines BA and Virgin have already indicated that they may prevent people from travelling if they have the symptoms.

After concerns that two travel insurers had said they would not cover cancellation costs for people contracting swine flu, the Association of British Insurers stressed this week that all would be reimbursed provided their condition had been recognised by the government’s new Pandemic Flu Service.

To date, at least 52 British students have been quarantined in China, 200 soldiers in Brunei and eight school children in Romania.

The Foreign and Commonwealth Office said that it was providing consular assistance to at least 160 British nationals in swine-flu quarantine in four countries: China, Singapore, India and Egypt.

“We are paying close attention to the welfare of Brits in quarantine. We are keeping in touch by phone with those in quarantine to check on their welfare; ensure they understand the procedures; and to pass messages to and from parents and relatives in the UK.”

From:
http://www.ft.com/cms/s/0/019983e0-7876-11de-bb06-00144feabdc0,dwp_uuid=819fc44c-33e2-11de-9eea-00144feabdc0.html

“With companies already hit by recession, the threat from swine flu is the last thing firms need,” said David Frost, director-general of the British Chambers of Commerce.

One research group, FirstCare, estimates the number of people off work because of colds, coughs and flu is three times higher than normal for the time of year.

The caution shown by companies such as Britvic could help explain part of the jump. The drinks maker said it was taking the “sensible approach” of asking staff to work from home if friends, family or anyone else they meet has swine flu.

However, BT, one of the country’s biggest employers, said it was not seeing “significant absentee rates at this stage”. Nevertheless, the telecommunications group is sending out regular bulletins to staff about the threat and has given “hygiene packs” to engineers, including alcohol wipes and face masks.

Ocado, the Waitrose owned online grocer, is issuing delivery drivers with hand sanitisers and wipes to reassure customers. Domino’s Pizza said in the event of a more serious outbreak it could leave orders at a customer’s front door to avoid contact. J. Sainsbury has bought masks for workers in case of a serious outbreak.

The BBC was criticised this week for buying 4,000 doses of the anti viral drug Tamiflu, and there is sensitivity among companies anxious not to be seen to hoard stocks, though several banks including Nomura and HSBC have supplies if needed.

Centrica, owner of British Gas, said: “Tamiflu is being provided for our employees who work in critical roles, for example those working on offshore platforms and service engineers who provide essential maintenance support in customers’ homes, to be taken only if they begin to display symptoms.”

Some companies– such as Google, Nomura and Goldman Sachs– are installing extra hand cleaning facilities, including alcohol wipes outside lifts and in staff canteens. Inter­Continental Hotels Group, owner of the Holiday Inn chain, has gone further by installing hand sanitisers for customers in hotel bathrooms and restaurants.

Honda, the carmaker, has introduced “enhanced cleaning” for all solid surfaces, including door handles, and issued staff with antiseptic handwash. BBH, a large advertising agency in London’s Soho, has “deep cleaned” the desks of infected staff.

Away from business but reflecting the general caution, students graduating at Sussex university were given alcohol gel on Friday before they went on stage to receive their certificate and shake hands with Sanjeev Bhaskar, the comedian and university chancellor.

“It seems like a good idea– he’s going to be shaking hands with 400 students,” said Tom Wills, president of the university’s student union.

From:
http://www.ft.com/cms/s/0/417576fa-7884-11de-bb06-00144feabdc0,dwp_uuid=819fc44c-33e2-11de-9eea-00144feabdc0.html?nclick_check=1

Mrs Blair started feeling unwell at the start of the week and received a diagnosis of swine flu on last week.

She was given a course of the antiviral Tamiflu and told to cancel all engagements until she recovers. Mrs Blair had been due today to pick up an honorary degree from Liverpool’s Hope University in recognition of her work as a human rights lawyer. A staff barbecue has also been cancelled as a precaution.

Data from a sample of GPs’ surgeries, seen by The Times, shows that up to 40,000 people complained to their doctor last week of “flu-like illness” in England and Wales, with a huge rise in the number of young children being affected.

The report shows that the highest rates of reported illness are in children aged five to 14, with 160 of every 100,000 in this age group reporting symptoms, followed by 114 per 100,000 in those aged up to four years old.

Overall, the rate of people complaining of symptoms increased to 73.4 cases for every 100,000 people in the week to Sunday, compared to 50.3 cases per 100,000 the week before.

This is a rise of 46 per cent and is equivalent to about 39,150 people across the country reporting symptoms compared to about 27,000 people who did so the previous week.

The figures, from the Royal College of GPs (RCGP), are based on a sample of 84 doctors’ surgeries across the country. Although they do not provide a total of confirmed cases of the H1N1 virus they are used by the Government as an official measure of how the outbreak is spreading.

The figures show the current outbreak is already worse than the seasonal flu experienced over Christmas and the New Year which was the worst for eight years. The winter flu outbreak hit a peak of 69 cases per 100,000 people across England and Wales. Doctors would normally expect to see fewer than 30 cases per 100,000 during the summer.

Separately, however, the RCGP criticised the Government’s response to the flu pandemic, accusing it of providing conflicting advice to both doctors and patients.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article6716158.ece

The Royal College of GPs is collecting feedback from family doctors on issues arising from the current outbreak, which has been linked to 17 deaths in the UK so far.

GPs have complained of poor out-of-hours planning, confusion over prescribing the antiviral drug Tamiflu and a lack of knowledge over how long patients should stay at home if they have the virus.

It comes after GPs saw a leap of almost 50 per cent in the last week in the numbers of people contacting them with fears they have swine flu.

Around 40,000 people a week in England and Wales are now complaining to their doctor of “flu-like illness”, with a huge rise in the number of young children being affected.

The figures, from the Royal College of GPs’ monitoring system, showed 50.3 people per 100,000 were reporting flu-like illness between June 29 and July 5.

But this leapt 46 per cent to 73.4 people per 100,000 between July 6 and 12.

In a submission to the House of Lords Science and Technology Committee, the College said it had an “excellent working relationship” with the Government’s chief flu adviser, Ian Dalton, and was “very pleased” with the responsiveness of health officials.

But it said issues were arising via feedback from GPs, including a “lack of information and conflicting advice” from both the Government and primary care trusts (PCTs).

Changes to the procedure for obtaining Tamiflu – such as patients obtaining the drugs from a flu centre rather than a GP surgery – “were not cascaded down to PCTs/GPs”.

The written evidence said: “Family doctors also noted that conflicting advice was being provided by different agencies.

“Some GPs raised concerns about the lack of support provided by their PCTs, such as no action plan to help primary care respond to the outbreak.”

Some out of hours doctors have complained that they are not being seen as the “major player in the flu plan operationally in their area”.

“They reported that they had received poor and inconsistent communication, including lengthy and verbose documents that were unworkable operationally.”

There was also anxiety among GPs about a lack of protective clothing and whether they should take Tamiflu preventatively with the aim of trying to protect their own families.

“Concerned family doctors have also been in contact seeking the latest recommendations on the protection of pregnant healthcare workers that might come into contact with possible swine flu patients. It appears guidance on this issue is not very clear.

“Family doctors have also informed the RCGP that they do not know when they should advise their patients to come out of isolation following an episode of H1N1 flu. In addition, there seems to be confusion around how long health workers need to stay off work following a presumed flu diagnosis.”

The weekly flu report from the College said flu was evident in all age groups “but remains highest in five to 14 age groups.”

The study said the highest number of cases was being seen in central England but the North had seen “a marked increase compared to previous weeks”.

There has been a small decrease in the number of cases being seen in London although the capital remains a major hot spot for the virus.

The rate of influenza-like illness is highest among those aged five to 14, at 159.57 per 100,000 population.

The next most affected group is youngsters and babies aged up to four, at 114.12 per 100,00 population.

This is followed by people aged 15 to 44, those aged 45 to 64 and then people aged 65 and over.

From:
http://www.independent.co.uk/gps-criticise-response-to-flu-pandemic

Nine per cent of the workforce will be sick by the end of August, say the latest official forecasts, and up to 12 per cent in September, when the peak of the first wave of the swine flu pandemic in the UK is expected.

Coupled with the large number of staff taking annual summer holidays, that could present considerable difficulties for employers who have already cut staff in the downturn.

The latest projections, due to be announced by Sir Liam Donaldson, the chief medical officer, suggest that 30 per cent of the population is likely to be infected with flu during this first wave of the pandemic, ahead of an expected second wave near the end of the year.

The data also suggest that between 0.1 per cent and 0.35 per cent of those infected will die from the flu. That could mean up to 350 deaths a day but the wide variation in the estimates shows the difficulty of collecting reliable figures at this relatively early stage in the pandemic.

The figures are slightly below forecasts released this week by Imperial College in London, and still reflect a relatively mild effect compared with previous flu pandemics.

However, epidemiologists have been concerned that those most affected are children and working-age adults, and although many of those who have died have had underlying health problems such as diabetes or asthma, up to a third appear healthy.

So far, just 17 deaths in the UK have been confirmed to have been caused by the H1N1 virus, although the Health Protection Agency is poised to publish more detailed statistics on infections calculated by a new method since it abandoned systematic testing of the virus this month.

The World Health Organisation said this week that yields from experimental batches of a vaccine to protect against H1N1 had proved disappointing, and European regulators are undecided about how many weeks they should take to study the safety of vaccines in volunteers before approving their widespread use.

But ministers have been told that there will be enough vaccine doses available by the end of this year to cover all those judged to be priority groups, including those with underlying health conditions.

From:
http://www.ft.com/cms/s/0/4fbbf3b4-7182-11de-a821-00144feabdc0.html?nclick_check=1

They say the sheer number of infections in the capital has led to the virus mutating into a unique form.

According to the Royal College of GPs, about 12,500 new infections are being reported to London GPs each week.

Wendy Barclay, professor of influenza virology at Imperial College, warned that authorities needed to keep a close eye on London’s infections as the virus could mutate into a faster-spreading or more harmful version.

“It is very important to keep a careful look for clusters of severe cases that might indicate that a mutated virus has arisen, which could be more virulent,” she said.

However, researchers admit they do not know when this could happen.

Dr Oliver Pybus, an evolutionary biologist at the University of Oxford, said: “Predicting how the virus will mutate is rather like trying to predict the weather in several months’ time – virtually impossible.

“The mutation rate of the flu virus is a million times faster than in animals, so it can change very quickly. London will have already developed its own strain of swine flu, even though at the moment it may not act any differently from the rest of the UK strains.

“However, the worry is that it could change, or that should a new, more dangerous version appear anywhere in the world, it will hit London first because of the number of travellers passing through.”

The warning comes as new research shows swine flu penetrates deeper into the lungs and can inflict more damage than ordinary seasonal flu.

Tests on animals showed that swine flu thrives all over the respiratory system, including the lungs, and causes lesions instead of staying in the head, as seasonal flu does.

Experts also believe swine flu is closely related to the 1918 pandemic strain, which killed up to 40 million. Blood tests show many survivors seem to have immunity to swine flu.

Commenting on the research, Professor Ian Jones from the University of Reading said: “It shows that the new virus is about five times more pathogenic than seasonal H1N1 but that, nonetheless, the major outcome is recovery.”

Experts have predicted half the UK population could contract swine flu this year and 150,000 could die — based on figures which suggest the H1N1 virus kills about 0.5 per cent of humans who catch it.

Virologist Nigel Dimmock, emeritus professor at the Department of Biological Sciences at Warwick University, said millions would fall ill.

He said: “It would be reasonable to assume that half the population will get flu this year. If that’s all swine flu, then that would be a hugely significant number of deaths.”

“The percentage of people killed who contract the virus is believed to be around 0.5 per cent. If half the population catch swine flu then that could mean 30 million times that percentage as a number of deaths — it’s an awful lot of people.

“Things are certainly not going to get any better by the end of the year. At the minute everyone is susceptible.”

The news comes after the recent deaths of the first victims of swine flu who were otherwise healthy.

Schoolgirl Chloe Buckley, six, from West Drayton, died on Thursday. She is believed to be the first child in Britain without underlying health problems to be killed by the virus, while
Dr Michael Day, 64, from Bedfordshire, was taken to hospital on Saturday and died the same day.

An unnamed patient from Essex was the other victim. The co-ordinated national response to the virus is now in the “treatment” phase, as opposed to “containment”, meaning experts believe the spread of the virus is unstoppable.

Health chiefs are now working to implement a plan to vaccinate at least 30 million people by the end of the year to minimise disruption to public services and industry with people taking time off work.

From:
www.thisislondon.co.uk/swine+flu+virus+has+mutated+in+London%2C+scientists+warn

The chance for patients to have 24-hour access to their doctor’s notes on password-protected websites will appeal to the middle classes and the “worried well” who already diagnose their ailments with the help of the internet.

But there is a welter of ethical and practical difficulties that could yet scupper the idea and must be considered by Francis Maude and his Tory policy implementation unit before the plan can be approved.

The most pressing issue is that almost nine million households in Britain do not have access to the internet. Health experts fear that such a move could penalise the most vulnerable in society. What disadvantage would this mean for the elderly, infirm and technologically inept? And who will store the medical records of those who do not take part?

More chillingly for some is the question of how commercial companies such as Microsoft and Google intend to make money from such ventures if, as seems likely, there are no government contracts on offer and it is left up to individual patients to chose to sign up to a number of free services. “Google is not magnanimous. It will no doubt sell that information at some point,” said a leading health analyst.

Suggestions that Google could display drug or other advertisements based on an individual’s health record, or sell anonymised data for drug trials, have been strenuously denied by the company in the US. Privacy campaigners are nevertheless likely to be concerned.

It has even caused friction within the Tories. The plan is part of a bigger “open source” IT project led by George Osborne’s team, but some staff working for Andrew Lansley, the Shadow Health Secretary, believe that there may still be a need for a central health database in the end. How else, they ask, would a hospital be able to access the medical record of a patient who comes into A&E; unconscious and unable to grant them online permission?

The chance for massive cost savings, however, are likely to outweigh these objections: it must seem a hugely attractive alternative to the longoverdue £12.4 billion NHS computer project that Tony Blair promised would provide electronic health records for up to 50 million patients. “You don’t need a massive central computer to do this. People can store their health records securely online; they can show them to whichever doctor they want,” David Cameron has said.

“But best of all, a web-based version of the Government’s bureaucratic scheme like Google Health or Microsoft Health Vault costs virtually nothing to run.”

Unlike in the US, the Tories say that NHS trusts will not be handing out contracts to Google or Microsoft, and that patients will be allowed to chose whether to take part.

“We can 100 per cent guarantee that we will not have a system where there is an exclusive deal on health records with one company,” said a Tory source. “We fully expect there to be multiple providers that will almost certainly be free to users.”

The health plan is a small but highly controversial part of a Conservative agenda to use data currently held by the Government to give consumers more choice, decentralise and, perhaps most importantly, cut costs.

The party points out that there are more than 100,000 public bodies in Britain that produce a huge range of information. It believes that there are significant benefits in publishing the data in standardised and open format, so that it can be plugged into online maps, websites and other applications.

The Tories have been struck by the innovative website theyworkforyou.com, run by the charity mysociety.org, which analyses and republishes data about MPs in a user-friendly manner in a process known as mashing. They want to do the same with the rest of the public sector.

“Some of our key reform policies, for example school reform, depend on this type of information being released to the public, and so enabling effective choice and accountability to be exercised,” said a recent Tory plan.

At the moment, only a fraction of this is available, but in an aggregated and anonymised format. Norwich Union, the Tories say, spent £5 million to develop a UK flood map, which was cheaper than trying to use existing government data.

Mr Lansley has already announced that in health, commercial websites will be able to bid for the data collected by the Department for Health, allowing them to publish ward-by-ward comparisons on everything from cleanliness to readmission rates.

Dr Foster Intelligence has been awarded a £12 million contract to provide NHS hospital league tables. The Tories say that if the underlying data were published, these league tables would be built by charities and companies without any cost to the taxpayer.

At the moment a small amount of data is provided for patients on the government website NHS Choices, but doctors have expressed concern at the way it is used to rank hospitals.

The Conservatives’ agenda does not come without risk. It will inevitably be associated with Steve Hilton, one of Mr Cameron’s principal advisers, who is married to Rachel Whetstone, the head of communications for Google.

According to The Register, the technology newspaper, Google and Microsoft have lobbied hard to get their hands on medical records in the US and elsewhere, and the broader “open source” project is likely to work in their favour.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6644802.ece

A spokesman for NHS London said no further details about the death would be released until the afternoon.

It comes after the first British patient without underlying health problems died on Friday after contracting swine flu.

Earlier in the day, it was disclosed that the swine flu virus sweeping the country had reached Downing Street. It is understood that Gordon Brown’s adviser on climate change, Michael Jacobs, has been infected.

It is thought that he may have contracted the virus during a recent visit to Mexico where the global outbreak originated.

He is not thought to have had any direct contact with the Prime Minister since developing the symptoms two weeks ago.

Nevertheless, Mr Jacobs was required to stay away from last week’s G8 summit in L’Aquila, in Italy, for fear that he could spread the infection to other delegations. Instead, he followed the negotiations by telephone.

A No 10 spokesman said last night: “There has been extensive preparation in Downing Street and across the Civil Service to minimise the spread of swine flu.

“The Cabinet Office has issued guidance to personnel managers in all departments and comprehensive information is available to civil servants on how to deal with suspected cases.”

Nearly 10,000 Britons have been confirmed with swine flu after it spread to the UK from Mexico. However, hundreds of thousands more people in the UK are thought to have the virus.

The total number of cases in the country are now being estimated rather than counted individually.

The UK has the third highest case total in the world after Mexico, which has 10,262 cases, and the US, which has at least 33,902.

From:
http://www.telegraph.co.uk/Swine-flu-death-toll-rises-to-16-in-Britain.html

More than three-quarters of the public – 77% – believe NHS funding should be protected in the face of future spending cuts, an opinion poll has found.

Other departments’ budgets should be sacrificed in order to preserve the health service, the British Medical Association survey heard. Four out of 10 people said they would be willing to pay higher taxes to sustain growth in NHS funding.

The poll questioned 1,071 people in five UK cities – London, Edinburgh, Belfast, Manchester and Cardiff – reflects fears that severe cutbacks are looming.

Nine out of 10 people suspect NHS services will be cut as a result of the recession, and almost as many believe waiting times for treatment will rise; 85% anticipate additional charges for NHS treatments.

The level of public support for the NHS at the expense of other departments is likely to be welcomed by the Conservative health spokesman, Andrew Lansley, who last month stirred controversy when he declared that a future Tory administration would protect the health service and target cuts elsewhere.

The poll, released on the eve of the BMA’s annual conference in Liverpool, gave conflicting evidence about privatisation. Nearly 60% said the private sector should be more involved in providing NHS services but almost half (47%) said there should be no further contracts for commercial companies.

The BMA chairman, Dr Hamish Meldrum, said: “These results show how anxious the public is about the effects of the recession on the health service, with a significant number saying taxes should increase to protect NHS funding. No one wants to see any cuts in the public sector but our poll reveals just how much society values their health service.

“Fear often goes hand in hand with economic slumps, with people worrying what will happen to them and their families in times of ill health. While we appreciate that the government needs to steer the country through this difficult economic period, we urge it not to do so at the expense of NHS funding.”

From:
http://www.guardian.co.uk/society/2009/jun/29/nhs-funding-cuts-survey-bma

Andy Burnham, health secretary, said he supported “in principle” a plan that would reward dentists for registering new patients.

The author of the report, Professor Jimmy Steele, said dentists would have “a significant chunk” of their annual income – possibly as much as 50 per cent – linked to the number of patients on their books.

“It’s an incentive to take more patients on,” he said. “We are saying there needs to be an incentive to take patients on and it’s also a useful performance measure.”

The Steele report was commissioned by Alan Johnson, the former health secretary, in response to growing public anger about the shortage of NHS dentists in many parts of the country.

Apart from recommending that dentists should earn more for taking on extra NHS patients, the report also proposes remedies for when dental work goes wrong. That could mean dentists being penalised for faulty work and having to carry out repair work at no extra charge to the NHS.

At present dentists can end up being paid twice by the NHS for carrying out faulty work: first for the initial treatment, then for putting right a mistake. “It’s a basic principle of quality and warranty,” said Prof Steele.

Mr Burnham said he wished to challenge the assumption that a previous government attempt to improve dentistry with a new contract in 2006 had “not worked for the public”.

It may not have resulted in the progress the labour Government had hoped for but there had been a “marked increase” in the number of patients getting access to an NHS dentist, he added.

“I recognise this is an area of unfinished business,” he went on. “We need to make sure the NHS is on the right path.”

But he insisted that the measures in the review were “certainly not about ripping up the 2006 reforms”.

According to the review, there has been too much focus since 2006 on paying dentists according to how much work they carry out.

A new way forward was for dentists to be paid according to three elements: registration of patients, quality of work and volume of activity.

Prof Steele also called for a new system of patient charges, replacing the current three band system with one of between five and 12 bands.

This was in response to some patients feeling they were not always getting value for money, he said.

From:
http://www.ft.com/cms/s/0/8f368184-5f77-11de-93d1-00144feabdc0.html

John Black, president of the Royal College of Surgeons, said the European Working Time Directive (EWTD) would be catastrophic for the NHS.

The EWTD, which fully comes into force on August 1, limits the number of hours doctors and surgeons can work each week to 48 but doctors and especially junior doctors often work longer hours than this.

Mr Black said reducing the hours of doctors and surgeons could lead to an increase in waiting lists and even hospitals shutting.

Writing in the Mail On Sunday he said: “Unless the Government comes to its senses the result will be catastrophic for the NHS with patient safety on a knife edge, surgeons not being properly trained, waiting lists going up again and even hospitals closing.

“We have already reached the point where patients’ health has been endangered. There is a serious risk of units in hospitals having to close to emergencies, with resulting chaos, not to mention the danger and inconvenience brought about by patients going long distances to a hospital that has enough staff to stay open.

“This is truly a nightmare, and I despair that the labour Government will not take action.”

Earlier this week research was published revealing that junior doctors were being asked to lie about their working hours to meet new the new European rules.

A survey of 31,360 junior doctors who were compliant “on paper” with new limits on their working week, found that one in 10 had been asked to submit that data even though the hours they worked were actually longer.

Of the 3,938 junior doctors who said their hours were not compliant “on paper”, 17% said they had been asked to submit hours that showed they were in line with the new rules.

From:
http://www.telegraph.co.uk/Working-hours-directive-will-put-lives-at-risk-in-hospital

The Conservatives, who have close links with Google, argue that developing a database would be unnecessarily expensive, and it would be more beneficial to hold the information on secure systems which already exist, such as Microsoft Healthvault or Google Health.

Patients would be given the choice of storing their records with private companies, although it is not yet clear what would happen to the notes of patients who do not consent.

The Tories estimate that if data were outsourced to sites such as these, the country would save half of the £1.65 billion it spends on IT annually.

Under the plans, which emerged at the weekend, medical staff with appropriate access would log on when necessary, although it does raise issues over security.

David Cameron, leader of the Conservatives, has previously singled out the “Electronic Patient Records system” as an example of the government’s wasteful spending.

Winning a contract for medical records would guarantee revenue for Google or Microsoft for years, while it would also help increase the use of their technology in healthcare.

The National Programme for IT, one of the biggest computer contracts in the world, is designed to link more than 30,000 GPs to nearly 300 hospitals.

Parliament’s public accounts committee however warned in January that if the scheme was not showing signs of moving forward by July, hospitals should have the option to ditch the plans.

The new system is designed to provide an online booking system, centralised medical records for 50 million patients, e-prescriptions and fast computer links.

But the MPs’ report found that progress was “very disappointing” with further delays expected. A revised completion target of 2014/15, already four years behind schedule, was “in doubt”, while the report also found the scheme was now costing taxpayers an estimated £12.7 billion.

http://www.telegraph.co.uk/Patient-records-should-be-given-to-Microsoft-or-Google-say-Tories

Health Direct raises one cheer for the proposals. At last- some common sense and recognition that the current project is hopelessly flawed and expensive.

However Microsoft and Google both have bad records for using personal data. The “Opt In” option for patients must be offered and respected.

The UK has moved past the stage of containing the swine flu outbreak and into the “treatment phase”, he said.

“The national focus will be on treating the increasing numbers affected by swine flu. We will move to this treatment phase across the UK with immediate effect.”

There are now 7,447 laboratory-confirmed cases in the UK, he said.

London and the West Midlands have already had sufficiently high numbers to move towards a policy of outbreak management, which saw people with swine flu clinically diagnosed rather than being confirmed by laboratory reports.

Mr Burnham said that last week saw a “considerable rise” in swine flu cases.

“There are now on average several hundred new cases every day,” he said.

“Our efforts during the containment phase have given us precious time to learn more about the virus. We have always known it would be impossible to contain the virus indefinitely and at some point we would need to move away from containment to treatment.”

He added: “We have now signed contracts to secure enough vaccine for the whole population.”

The first will become available next month, with 60 million doses available by the end of the year.

From:
http://www.telegraph.co.uk/Swine-flu-cases-in-Britain-could-top-100000-a-day.html

Official statistics will show around 200 serious mistakes and “near misses” by fertility doctors – the fifth consecutive year the figure has risen.

Experts have warned that the true number of errors is far higher than those reported.

They have also raised concerns about the standards of fertility clinics and the ability of the watchdog – the Human Embryology and Fertilisation Authority – to control the industry.

It follows a series of mistakes by staff at IVF clinics.

It recently emerged that a Cardiff fertility clinic implanted a couple’s last usable embryo into the wrong woman.

Last month, a London NHS hospital was forced to destroy three embryos after creating them with the wrong sperm.

In 2003-04 there were 15 mistakes for every 10,000 “cycles” of IVF.

But by 2006-07 there were 40 mistakes for each 10,000 cycles.

According to the HFEA, the rise in reported mistakes is a sign of increased vigilance rather than increased failure.

Josephine Quintavalle, from Comment on Reproductive Ethics, said: “There will be a lot more cases than people realise. You can’t rely on the goodness of people to own up to their mistakes.

“It’s incomprehensible how these things can happen – even the busiest clinics rarely deal with more than half a dozen patients each day.”

From:
Number-of-IVF-blunders-by-fertility-doctors-to-rise-for-fifth-consecutive-year

The Office of Government Commerce, a wing of the Treasury, was concerned about the labour government’s ability to take on such an enormous project from the beginning.

Over several years the OGC repeatedly raised issues of unrealistic timetables, unknown procurement risk and an inability to predict costs or value for money.

It questioned whether the labour government had enough qualified staff or an ability to manage large IT programmes. For example, it wrote that there was “no overall concept of affordability or ability to demonstrate value for money”.

The warnings now appear eerily prescient, given that the estimated cost of the project has since ballooned from £5bn to £13bn ($8bn to $21bn). The project is running four years late, prompting the Department of Health to warn that contracts could even be terminated if progress is not made by November.

Companies including CSC, Cerner and BT are involved in the mammoth task of letting half of patients book referral appointments online, setting up broadband connections within the NHS and delivering digital x-ray communication systems.

The OGC’s concerns came to light after the Tories obtained 31 of its reports through an FoI claim.

Nine of the reports gave “red” status to elements of the programme, implying that urgent remedial action was needed for the project to succeed.

“These reviews expose Labour’s incompetence over the NHS IT system,” said Stephen O’Brien, shadow health minister.

“It’s incredible that, right from the beginning, the government should have ignored these repeated warnings about problems.”

The information has only emerged now because the Department of Health previously blocked publication. Six reports, undertaken since 2006 are still being withheld.

From:
http://www.ft.com/cms/s/0/80bcc8c8-604b-11de-a09b-00144feabdc0.html

The stern warning comes from the Care Quality Commission, the main health regulator, less than a year before a system is introduced that will require all the trusts to register with it.

Registration will give the commission more leverage, since it will be able to dictate, for example, that trusts have to improve in specific areas. Cynthia Bower, commission chief executive, said:”We will not hesitate to place conditions upon trusts’ registration, as part of our new statutory powers.”

A CQC spokeswoman elaborated by saying that if trusts failed to meet the new registration requirements “we could issue an on-the-spot fine, take a trust to court and fine them an even greater amount, look at imposing new management, look at closing particular services. We could say, ‘you could no longer carry out heart surgery for this period’”.

The commission’s warning comes as it publishes a report on whether trusts are meeting existing standards, expected to form the basis of the yet-to-befinalised registration requirements. The study, based on self-reporting, found that in the year to March 2009 about half the 392 trusts were not meeting at least one of the 44 minimum standards it demanded.

The next step is for the commission to test their claims. Last year it dis-agreed with trusts in 28 per cent of cases it inspected, judging that the trusts’ own estimates that they were reaching a particular level were over-optimistic.

Fewer trusts than the year before thought they were meeting minimum levels on “learning from safety incidents”. More than previously thought they met decontamination standards, although 11 per cent thought they still did not.

The proportion of flagship foundation trusts declaring compliance with all 44 criteria dropped by 6 percentage points to 66 per cent, although it remained much higher than for other trusts.

From:
http://www.ft.com/cms/s/0/50720594-5b9f-11de-be3f-00144feabdc0.html?nclick_check=1