The UK response to swine flu was “proportionate and effective”, an independent review has concluded.

However, its recommendations for handling future pandemics highlight some areas where the UK and devolved governments could improve based on their experience of swine flu, said Dame Deirdre Hine, who led the review.

She said there should have been “break clauses” in contracts with pharmaceutical companies for flu vaccines so, when less was needed than anticipated, governments could have paid less.

The review calculated £1bn was spent on pharmaceuticals, including antivirals, vaccine and antibiotics, in preparation and response to swine flu. The total cost of preparing and responding for swine flu was £1.2bn, with the remaining £2m spent on equipment, communications and infrastructure.

Dame Dierdre said she did not believe governments were swayed by pharmaceutical companies to increase their response and buy more drugs. She said: “I have no suspicion of that at all.”

The review also recommended preparedness plans should have more flexibility to be changed depending on the severity of the pandemic.

It said the government should publish predictions of the most likely spread and severity. For swine flu it only published “reasonable worst case” scenarios, which were interpreted as what was likely to happen, the review said.

Dame Dierdre, a former chief medical officer for Wales, said critical care came under pressure during the pandemic because there was not enough capacity. If the flu had been worse there would have been a significant shortfall. She recommended the health service do further work on “surge capacity”, particularly in paediatric critical care.

Dame Dierdre also said ministers had told her they would rather be accused of over reacting to swine flu than have failed to prepare enough. She said: “I talked to each of the ministers in turn and the primary driver of their decisions was feeling they had to do the best for the population.”

She said “more than one” minister told her “they personally would prefer to be criticised for doing too much rather than the alternative, where there could have been unnecessary deaths from doing too little”.