Has swine flu been handled well?

By Sue Mitchell Producer, Planning For Pandemic

The Health Protection Agency has been overseeing the launch of nine regional Flu Response Centres to deal with the swine flu pandemic.

Using mainly HPA staff, the centres have dealt with thousands of calls from health professionals and managed all aspects of containment, from swabbing to treatment and contact tracing.

The East Midlands Flu Response Centre is supported by HPA public health consultant, Dr Philip Monk, who detailed his experiences in a unique audio diary for Radio Four over a week, beginning with the region's first significant outbreak, among students at Nottingham University on 21 June.

His team works taking swabs, dispensing anti-virals and - most importantly in the early days - buying crucial time for the NHS to adapt plans drawn up for bird flu.

In some areas our flu response centres worked well but in others perhaps we should have moved faster Professor Nigel Lightfoot Health Protection Agency

But by 25 June staff were finding it hard to cope.

Dr Monk said: "We haven't got enough phone lines, we've only got 15 incoming numbers and we're getting irate people because they've had to wait a long time to get through.

"And we're getting tired and getting stressed, so it's all getting a bit tetchy and a bit irritable and there's no let-up in this."

Could do better

Professor Nigel Lightfoot, chief advisor at the HPA and head of the Pandemic Influenza Programme, has admitted to the BBC that more could have been done to properly resource the nine local response centres.

He said: "In some areas our flu response centres worked well but in others perhaps we should have moved faster in the staff, the resources, that were put in there and that is one thing we would do differently - just put more staff in.

And looking at the crude figures, those countries that neighbour us in Northern Europe - who one would imagine would have had similar number of cases - don't seem to have had quite as many as we have Dr Richard Slack East Midlands HPA

"Lessons are being collected from the operation of the flu response centres and will be implemented if we ever have to do it again."

The phone lines are manned 12 hours a day, seven days a week but Professor Lightfoot says problems have also occurred because so many people used lines intended for health care professionals.

He said HPA representatives should have been dispatched overseas as soon as the new strain of virus was identified.

"We probably should have sent more people earlier to Mexico, sent some people to the US, to learn what was happening and we will be sending someone to Australia because Australia is in the winter season so they're experiencing what we might experience come October."

Defence of containment

But Professor Lightfoot defended UK attempts to contain the spread of swine flu through effective diagnosis and treatment, contact tracing and measures to limit exposure, like school closures.

"We wanted to delay the big spread, so that all our plans came into operation.

"And we wanted to learn more about what was happening to people, what the illness was like.

"We had to set out to try to contain it and we did achieve a delay.

"We were actually understanding the numbers, watching what was happening and we did the studies."

The containment policy was abandoned earlier this month when it became clear that too many people were infected for intense testing and treatment to work.

With more than 10,000 cases, Britain is the worst hit country in Europe and the fourth worst hit in the world, behind the US, Canada and Australia.

Announcing the change, Health Minister Andy Burnham predicted the UK could see over 100,000 cases a day by the end of August.

European comparisons

The Regional Microbiologist for the East Midlands HPA, Dr Richard Slack, criticised the policy.

"I'm not sure how well the containment phase has worked," he said.

I think we're going to have a very difficult time figuring out where we go next Dr Phillip Monk Public health consultant

"I think if you look at it on a simple epidemiological count, the number of cases has increased exponentially.

"If containment had really been effective then we would get a relatively flat curve.

"And looking at the crude figures, those countries that neighbour us in Northern Europe - who one would imagine would have had similar number of cases - don't seem to have had quite as many as we have.

"So what we've done in terms of anti-viral prophylaxis and containment does not appear to have had much effect."

Dr Slack, has questioned whether pandemic planning was good enough, particularly given how difficult it has been to recruit NHS volunteers.

"Nationally the HPA has said that they'll be able to deliver on a lot of things that we have not been resourced to be able to do.

"Here in the Flu Response Centre, our own staff are working very long hours, seven days a week, without seeing an end to this and I wonder, if the HPA had said earlier on that we needed much more help, whether that would have made it easier.

"When it actually hits you and you've got to get those plans to work, you have a very short time to train staff up."

And Dr Monk fears that the NHS has not readied itself properly.

"It is apparent that at the moment the local NHS aren't quite ready yet.

"Although they've been warned and warned that this was coming - it's suddenly crept up on them faster than they had expected.

"I think we're going to have a very difficult time figuring out where we go next."

• Planning For Pandemic will be broadcast on Monday, 20 July, at 1100 BST on BBC Radio 4. Or you can listen to it for seven days after that at BBC iPlayer.

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