Hine calls for evaluation of flu line

A review of the UK’s response to the swine flu oubreak has urged the Department of Health to commission an independent evaluation of the “highly innovative” National Pandemic Flu Service.

The review, chaired by former chief medical officer for Wales Dame Deidre Hine, concluded that the government’s response to the pandemic had been “proportionate and effective” – but makes 28 recommendations to improve planning and delivery for the future.

Dr Hine’s report, The 2009 Influenza Pandemic, reveals that the pandemic cost the UK £1.2 billion, of which £1 billion was spent on drugs. Half of the rest – £93m – was spent on the NPFS; £28m to establish the service and £66m to run it.

The review concluded that the NPFS was “a highly innovative scheme” which had reduced primary care pressure at a time when it was most needed.

The report recommends that it should be evaluated to incorporate lessons into future planning. It says the evaluation should cover value for money, risk analysis and potential for wider application.

The web and telephone based NPFS was a key part of the government’s strategy for dealing with pandemics. Its intention was to enable people to stay at home, to have their symptoms assessed and for antivirals to be authorised if necessary.

The review said a contract to supply the NPFS with NHS Direct and BT had been signed in December 2008 but the development of the system was not complete at the start of the outbreak.

As a result NHJS Direct and BT developed an interim system which supported a ‘treat all’ approach only as the ‘at risk’ algorithm was still being developed.

The system was launched on 23 July after influenza-like illness consultations in GP surgeries rose rapidly. NHS Direct came under severe pressure, with less than 10% of calls answered in less than 60 seconds and 50% of all callers hanging up before their call was answered.

Between in launch and 11 February this year, when the NPFS was stood down, the service completed 2.7m assessments and 1.1m courses of antiviral treatment were distributed.

Dame Deidre’s report said the “overwhelming majority” of these antivirals were collected within 48 hours, showing that the service ensured that those requiring medicine were able to access it rapidly.

The report said a number of those interviewed for the review felt the introduction of the NPFS was essential to relieve the pressure on primary care in England, which could have otherwise collapsed in some areas.

It added: “Despite some initial reservations about the efficacy of a telephone-based triage system, most interviewees felt that it was successful in achieving the aim of reducing primary care pressure and ensuring rapid access to antiviral treatment.”

The report says there was in general a high level of public awareness and understanding of pandemic influenza and that the government’s communications strategy was successful.

However, it also recommends that the government consider making more use of social networking and digital technology to reach specific sections of the public.

Other recommendations include a call for the government to seek greater flexibility over the quantities of antivirals purchased. Dame Deidre’s review revealed that the unexpectedly mild nature of the pandemic meant the government was tied into buying many more doses of vaccine that the country needed.

Health secretary Andrew Lansley welcomed the report and said its recommendations would be taken into consideration as part of future planning.