The Best Prepared Country for Flu in the world - a possible oops?

One of us was driving en route for a little late lunch (all our lunches are late) last Friday at about 14.00hrs and heard during the journey a Radio 4 news bulletin as we flipped the channels to help pass the huge distances involved in home visiting in Northernshire. A similar article appeared in one of the national papers too.

Swine flu seems to have died a death here in Northernshire, perhaps because the media have found, or been fed, other “stories” to concentrate on.

In informal discussions in the mess we did speculate if there might still be a few slight “increases” due although these speculations may have gone before we publish.

The start of the final Test Match and of the football season for the “I don’t feel well, boss. I have some Tamiflu do you really want me to come in . . .?” crowd might just cause a few slight blips of “swine flu”independent of media hype but related to sporting fixtures.

The news item says that so many doses of Tamiflu have been given out which, dear reader, DOES NOT equate to GENUINE swine flu cases. Estimates put the diagnostic (in)accuracy of swine flu as between 1 in 4 to 1 in 10 of prescriptions being given to patients who ring them who actually have swine flu. Based on our own personal experiences of patients not better after the magic wand of Tamiflu has been waved suggest that almost all of the swine flu line diagnoses are wrong.

This will of course be of great comfort to someone given Tamiflu with meningitis as if they tossed a coin they would have a better chance of getting the right diagnosis (using the coin) not the Swine Flu Panic Line. Heads you live, tails you die.

But still we all know that call centres and protocols are the way forward in medicine here in the UK as they are cheap, far better than (any form of) learning from (any) experience. In fact to use the newly discovered American expression this is true “Socialized Medicine” aka the current NHS.

No wonder the Americans who can afford private medicine are worried. They are like the British who cannot afford private medicine who are worried also. They know how crap the NHS can be. And is. Given a choice of seeing a doctor or ringing a call centre operative to make a diagnosis without seeing you, who do you think some of the most affluent and educated people in the world would opt for even if it meant paying a bit more?

You can see the first British moon landing being done by a gerbil with a protocol from a call centre in Watford rather than a highly trained astronaut who also happened to be a pilot. We believe the later was done by the Americans we doubt the British could do anything like it so the call centre, and the gerbil, will have to do, comrades. This is after all what the NHS does best care on the cheap.You may be able to fly a supersonic jet comrade doctor but the Department of Health insists you throw a paper airplane for your patients and call it world class aviation. They are so much cheaper than real aircraft or treatments.

Oh we must mention this.

A colleague has been asked to provide a note for a patient asked for by the patient’s employer to say he does not have swine flu. This is because another worker has been given Tamiflu and the patient’s boss does not want to run the risk of catching Tamiflu, sorry, swine flu, from any of his co-workers.

Nice little earner for any doctors here especially as we can’t test for swine flu if they wish to play this silly game for this particular employer. Will the airlines or the coach companies or railways be next? We have been asked to provide this type of letter for other severe life threatening illnesses like chickenpox by travel agents.

Remember this is the United Kingdom the worst prepared but best panicked country in the world to deal with a mostly mild viral illness.

Praise be the Party and all its plans. How could the “best prepared country in the world” have got it so wrong just like a lot of other but easily fixable things wrong in the NHS? No wonder the Americans are worried. If “socialized medicine” comes in the USA the UK could face a brain drain of NHS managers.

Would we be prepared and able to cope? Probably.

How have we managed without them thus far?

The NHS Flu Pandemic Plan vs reality

Anyone who watched Sir Liam Donaldson and the new health minister, Andy Burnham, yesterday afternoon would have been “impressed” at how far on the United Kingdom is in its preparation to counter swine flu (according to them).

GPs will now diagnose swine flu using a checklist and there will be Tamiflu distribution points (TamDPs in grunt speak? Sounds a bit like damned MPs?). We await with (no) interest further details as the medical press are saying that Primary Care Trusts or the local Politburos will take over in a military style command structure to direct GPs in the event of a pandemic.

Excellent idea! Appoint people who cannot provide decent health care to a population that is predominantly well to a position of a General to command an army in the midst of a crisis?

Vicky Pollard does D-day ? Whatever.

But we digress. This post is about the reality on the ground. We have already posted about the availability of Tamiflu (June 16) but this is what is happening here in Northernshire.

A local GP has been having a phantom pregnancy of swine flu for the last 2 weeks having had it themselves for this long. They saw an unwell child with a fever and diagnosed swine flu in the wee child. They then rang the Health Protection Agency to ask what to do.

An hour later they got through and were told to go to the local A&E department to get swabs. They got the last one issued as the local A&E had all but run out of swabs and were refusing to issue them to GPs. The patient and family were confined to barracks to prevent spread of the flu and then the practice waited for the swab results under the impression that it would take 48 hours.

This was over a week ago. No swab results but daily phone calls from the confined to barracks parent whose child was better 24 hours after seeing the GP asking if they could leave the house? The answer was no until the swab result came back. You can imagine the angst here.

If the swabs came back positive would Tamiflu be issued given our experience thus far? Or would there have to be an urgent convening of the local Soviet of Tamiflu Guardians (next week) to decide if they could afford to issue any Tamiflu and to whom?

Now we as far as we know have no confirmed cases of Swine flu in our part of Northernshire but if the checklist for GPs goes along the lines of:

1) Do you feel poorly?
2) Has anyone you know, or yourself, been to a Spanish speaking country in the last 12 months?

Can we see what will follow next?

We are now entering the “treatment” phase. Given that virtually every patient with a cold or sore throat has self diagnosed themselves with “flu” before they even see a GP could we have a run on Tamiflu akin to what happened when the Northern Rock building Society was rumoured to be in a bit of bother?

Praise be to the Party and its Plans. With all its Prudent management of the UK economy we know we are in safe hands during the flu pandemic. The grunts on the ground will just have to cope as best we can.

Still we can practise using the Department of Health’s NHS Flu pandemic game here (they have been such busy boys and girls here haven’t they?) or a more interactive game here. Thanks to Dr Grumble for these little gems.

Big Brother is Watching You the Flu Pandemic

Comrades, this evening we here at ND Central were asked to prescribe Tamiflu for a very important person who was venturing forth to shores foreign and had read the BNF, the British National Formulary, the prescriber’s bible, about how it was prescribable on the NHS.

Now most of us at ND do not read the NHS Spamalot email service because it is pure management spam, and so full of sh*t* that the local sewage farm, that does so much better at protecting public health than do we, would not cope if all the NHS email spam was funnelled there instead of into NHS doctors’ email boxes.

We rely on an old grunt trick called listening to people. If the media shows queues of people outside schools with confirmed cases of swine flu getting Tamiflu and online and local pharmacies tell you can’t get it then what do you conclude?

That the Party and all their wonderful managers have control of it for the benefit of the People? No one has told us this we drew our own conclusions but then there is a “Flu Plan” which we are not privy to as we haven’t bothered to read it.

So enter stage right our illustrious important person. We duly explained all of our current limited understanding of this and explained that we were happy to issue them with a prescription but they might not get it.

5 minutes later the local idiot PCT comrade pharmaceutical commissar advisor was on the line telling us what naughty boys and girls we had been.

Which bit of the NHS Tamiflu Con had we missed?

Of course fellow resistance fighters if there is to be a campaign of passive resistance following the unfortunate first death from swine flu and every GP started issuing Tamiflu prescriptions “just in case” would the comrade commissar pharmaceutical advisers be able to cope with the first influx of real work they have ever had to deal with? Life or death decisions after a 3 year degree course and failure to make it in retail pharmacy?

If swine flu does take a hold this winter and this behaviour is repeated what will be the consequences? Remember this was a highly educated “just in case” going to a high risk area as opposed to a “I am going on holiday and I might catch something can I have . . .”?

Praise be to the Party for it is truly Big Brother if you dare to prescribe Tamiflu.

No doubt every member of the Party has been issued with their own personal numbered pack of Tamiflu carried with them at all times together with their gas mask and ID cards in the bunkers just in case. What would happen in a real flu pandemic if the Five a Day co-ordinator went down with a cold, sorry flu? Anarchy on the streets?

We haven’t been issued with such packs and according to the British National Formulary it is still prescribable on the NHS except in Northernshire. You have been warned comrades. Wait ‘til the brown stuff hits the fan to see who the chosen few will be . . .