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Flu pandemic could kill off a generation of local managers

The fear in the Department of Health over swine flu is palpable.

Its leadership is worried that primary care trusts have become complacent. The modest numbers infected so far and the mildness of the symptoms have provided false assurance that we have been spared a major and deadly outbreak.

The propaganda from ministers and experts has exacerbated the problem. The soothing refrain is that Britain is better prepared than any other country in the world.

Britain has amassed huge stockpiles of antiviral drugs, and PCTs have been drafting plans to co-ordinate action with hospitals, councils, strategic health authorities and businesses.

But the DH fears many of these plans will fall apart in the face of a renewed and more virulent onslaught in the autumn. Last week, behind closed doors at a hastily arranged meeting hours before the World Health Organisation declared a pandemic, flu czar Ian Dalton ordered PCTs to test their plans to destruction.

Some PCTs will get it right, others will be lucky. Those who get it wrong and are unlucky will be exposed to the full force of public anger. The exemplary performance of the best PCTs will be used as a stick with which to beat the worst.

Local managers should be in no doubt about what they will endure if they fail. After five years of preparation, millions of pounds of investment, months of warning over swine flu and endless declarations that the country is ready, the public and local and national media will lynch you.

The political climate has rarely been more hostile to public servants, and NHS managers are always seen as a legitimate target. If you are deemed to be responsible for avoidable deaths they will dissect your pay packet, dissect your organisation and dissect you.

Readers' comments (8)

  • Richard,

    I don't agree with the above

    First, it is very difficult to define failure in such cases. What is failure for you? If you have 500 deaths instead of 200? Or 10,000 instead of 7,000?

    Second, the local managers should not be made scapegoats, not when they follow the ever-changing guidance from the top. Remember that the HPA algorithm re H1N1 has changed 6 times in one month. What does this tell you?

    Third, I don't believe that DH has fears in regards to the local plans. DH has and does receive regular assurance that plans are in place and ready so, honestly, I have no idea who is your source any why is so misleading.

    There is more to say but I will stop here, of course, I don't expect you to reconsider you article although it may be appropriate to do so.



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  • Richard Vize speaks the truth. The Public will not be considering the nuances of what failure means. For them the sight of closed wards, suspended GP surgeries, closed schools and reduced public transport will mean looking for someone to blame. The local NHS managers are a prime target; probably rightly so.

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  • Killing off a generation of NHS management might not be a bad thing really

    (Tongue firmly in cheek)

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  • Having been involved in a lot of Pandemic Flu planning recently, I would have to agree with the comment above that it is changing directives and information from the DH that is particularly challenging and may mean make or break for some PCTs who are working hard to ensure readiness.
    The DH seems to renege decision making when it feels like it, leaving things to 'local decision making', only to then change their mind a few days later.
    What concerns me is that Trusts are still waiting for the 'national' panedmic flu system which, as we still havent had it, we are planning to be without and have spent a lot of time, blood, sweat and tears creating alternatives for. If this system suddenly appears at the same time the situation deteriorates, it will potentially undo many of the local plans put in place to date, or change the decisions upon which these systems have been made and make PCTs fail due to no fault of their own.

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  • Hopefully "failure" will be judged by something other than simple numbers. PCTs would be well advised to consider carefully their engagement with general practice as without their help and involvement at an early stage then by any measure "failure" will be laid squarely at their door. Management of the issue by the "mushroom method" is not one of the workable options that unfortunately seems to be in use at the moment.

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  • Amusing piece! The truth is that viruses do not respect well-laid plans, cannot be lectured to and certainly do not respond to 'command and control' from the centre. Ultimately what happens will depend on luck more than anything else. Our modern high mobility and interaction society makes effective prevention of transmission without huge social and economic disruption unworkable. Tamiflu is not an antiviral in the same way that antibiotics work on bacteria.

    At the end of the day, it is the virulence of the virus that will count, not public health plans. At the moment, the virus seems relatively benign. If that changes, then the panic will sweep all before it.........

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  • From the GP magazine 'Pulse' :
    "Patients who believe they may have ‘swine flu should stay at home and take paracetamol’ and call their GP only if they need further advice, a London GP and Health Protection Agency board member said today.

    Speaking on BBC Radio Five Live, Dr Rosemary Leonard, a GP in Dulwich, south London, sought to reassure the public, describing the current swine flu virus as ‘an incredibly minor illness’.

    And despite the new HPA’s new London algorithm instructing GPs to treat all symptomatic patients in the capital with a course of antivirals, Dr Leonard said that in many cases, patients should simply stay at home.

    ‘All you need to do is stay at home, take paracetamol,’ she said. ‘If you need some advice, call your GP, but do not go to an A&E department.’

    ‘This isn’t the plague,’ she added. ‘In fact we now in our practice have a saying that if someone comes in and they’re really, really ill we say well they’re just too ill to have swine flu.’

    However Dr Leonard say the Health Protection Agency was concerned about patients who had fully recovered from swine flu being ‘ostracised’ because of their previous infection.

    ‘This has been happening very unfortunately since the beginning off the outbreak a few weeks ago. And all doctors who have seen cases of swine flu are just appalled by it.

    ‘Please, everybody else who is listening. If you know someone who has swine flu, once they are better, once the symptoms are gone, it takes a few days - they are not infectious anymore.’

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  • What is going on here? This relentless "manager bashing" is getting out of control both in the editorial of this newspaper and the comments, viz: Anonymous 19th June 12.35 above. Do you honestly think it is appropriate to blame NHS managers for "closed wards, suspended GP surgeries, closed schools and reduced public transport" in the event of a worsening flu pandemic?!! Last time I checked, nhs managers and staff were human beings, not super heros. Having been involved in the set up and running of an anti-viral collection centre myself last week with 24 hours notice, as a redeployed clinical middle manager with a day job to also do, I can assure you it was efficient, extremely well run and very gratefully received by members of the public who attended to collect their medicines. It was also very well supported by our Senior Management Team. Back off and have a little more faith for goodness sake.

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