Baroness Hine yesterday published her independent report into the swine flu (h1N1) outbreak in 2009 and praised the overall response as being very satisfactory despite some £20m worth of vaccine being procured and not used.

My own experience as one of the professionals hired to manage the outbreak and later plan and execute a mass vaccinations programme for 300,000 citizens indicates that despite this high praise, there are lessons to learn – which is why I’ve carefully titled this post because I do not think the lessons will be learned – yet.

My 3 key observations:

1. The NHS had to invent a logistics chain from scratch to distribute both the vaccine (cold chain) and associated consumables (needles etc) from a central hub or hubs through to the end users (mainly nurses in primary and secondary care settings).  This despite the fact that the NHS has been running for many years and been through 5 years of supposed planning and testing in order to evidence compliance with it’s statutory responsibilities under the Civil Contingencies Act 2004.  The entire logistics organization o health could be and should be consolidated and streamlined (like the army, navy and air force have done in the Defence Logistics Organization (now D&ES)) which would improve efficiency and doubtless save a few £billion – really!
2. The medical profession appear to be the most undisciplined bunch I’ve come across in terms of following policy and instructions.  Every man jack of them seems to have a different opinion and they appear to instantly polarise when presented with an expert opinion on something.  This significantly undermined the take-up of vaccine within the health community as senior and relatively junior staff told anyone who would listen “I’m not having it – I don;t think it’s safe, it’s being rushed through, we don;t trust the CMO” etc.  I had one senior member of staff in charge of vaccinating an entire PCT who was pregnant with twins and fought against the jab for weeks; influencing colleagues against it by her misguided leadership – then suddenly panicked nad rolled up her sleeve when a couple of pregnant women lost their unborn babies and die.  Had this virus been more virulent her goos would have been truly cooked – of course I’m used to dealing with weaponised biological agents so maybe my decision threshold is sharper!
3. Warning and informing the public was both excellent and hopeless.  On the one hand we had the carefully crafted films and leaflets (once they finally got out) and the BBC news coverage with the excellent Fergus Walsh.  On the other hand we had utter indecision and an abject failure to TELL health professionals what they MUST do in order to protect the public.  This lack of clear leadership totally undermined the mass vaccinations programme; slowing take-up and compounding the negativity radiated by the heretical “health professionals” who put their uninformed (in most cases) opinion against the CMO and SHA advice; thereby undermining public confidence.  In the PCT that I worked the Chief Executive and Board Members consistently avoided the entire subject of pandemic – fiddling whilst Rome burned – and the Consultant in charge of infection control dithered and faffed about ordering hundreds of thousands of pounds worth of equipment and storing it instead of issuing it!  Again, had this been a more virulent outbreak, thousands would have lost their lives through their inaction.

In summary, the headlines of the report do not due justice to the reality that there is much work still to do in health before it can proclaim itself agile to opportunities and resilient to disruption.  Hopefully, some of the lessons identified might transfer into good practice – butI’m not so sure.

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