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Independents' Day

Swine flu is a global problem, so why are local responses so varied?

NHS chiefs continue to see the swine flu threat as real – and are frantically trying to figure out what to do about it.

By Steve Nowottny

NHS chiefs continue to see the swine flu threat as real – and are frantically trying to figure out what to do about it.

So has the swine flu threat passed? Can it really be only a week ago that the World Health Organisation said a pandemic was imminent and warned ‘all of humanity is under threat'.

Certainly, as more details of the H1N1 virus' virulence – or apparent lack of it – emerge, the threat seems less immediate. And the national media seem divided, split between amping up the threat to public schools' exam timetables on the one hand, and accusing a ‘global coalition of scientists, doom-merchants and drugs profiteers' of having made the whole thing up on the other.

But make no mistake. NHS chiefs and public health experts continue to see the threat as real – and are frantically trying to figure out what to do about it.

Alan Johnson yesterday appointed Ian Dalton, chief executive of NHS North East, to the newly created position of National Director for NHS Flu Resilience – or ‘flu tsar'. The Health Protection Agency continues to work flat out, and locally PCTs have dropped everything as they try to figure out what is to be done.

Over the past couple of days, I've been speaking to numerous PCTs, asking them specific questions about their preparedness – what their policy is on facemasks and viral swabs, whether they've drawn up plans to contact retired doctors and so on. And what's immediately clear is the extent to which different policies are in place in different parts of the country.

On facemasks, for example, NHS Bury has been very proactive – GPs have already received 48 per practice, with a further 90 going to the out-of-hours service. Contrast that approach with Derbyshire County PCT, which has decided there will be widespread distribution only in the event a pandemic is declared.

On swabbing, GPs in West Sussex, for example, have been given a stock of swabs and guidance on how and when to do so, whereas in Hammersmith and Fulham, testing of suspected swine flu cases has been made the responsibility of the local district nursing service.

There is clearly a 'postcode lottery' effect at work here, and while a local approach may be appropriate for some health challenges, GPs could be forgiven for asking why such divergent approaches are being taken to what after all is a global threat.

But even more alarming were the large number of PCTs who refused to give any details at all of what steps they are actually taking, and issued instead only bland 'keep calm and carry on' style public service messages insisting everything is under control. NHS East Lancashire's considered response to our six detailed questions – questions GPs are asking and desperate to get answers to – was the following.

‘The PCT and GPs are prepared and in a state of readiness should the need arise.'

The message from this part of the NHS hierarchy is clear then. Swine flu hasn't gone away, but everything is under control. Now let us get on with figuring out how to handle it.

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