Flu has arrived early, fuelling NHS winter concerns

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We all know the kind of awkward guests who turn up early and then overstay their welcome, especially at Christmas. Well, this year, unfortunately, Performance Watch can reveal flu has turned up ahead of schedule.

Official data indicates hospital flu admissions are already climbing — distinctly earlier than they normally do — which has been noted at senior levels nationally in the NHS. Senior clinicians told HSJ they had noted rising numbers of more severe cases, suggesting the flu season has arrived early.

Public Health England confirmed to HSJ that flu had arrived “slightly earlier than average [but] we wouldn’t consider this outside the normal range”. This contrasts with last winter, however, when it was later than average.

PHE head of flu Jamie Lopez Bernal said: “Flu is now circulating and is starting to increase in the community, particularly in the north of England. Current evidence suggests that the main circulating strain of flu is well matched to this year’s vaccine — if you are eligible, get your vaccine from GP or Pharmacist to ensure you are protected.”

Some have identified the early arrival as a potentially alarming sign that the UK flu season might follow that of Australia, which also came early.

With the proviso that other continents are not always a good predictor of what the UK can expect, the King’s Fund’s chief analyst Siva Anandaciva says in a blog this week that senior clinicians are anxious “about the prospects of the punishing early and severe flu season in Australia being mirrored in the UK and putting further strain on services”.

One worrying potential consequence of this would be flu peaking early around Christmas time — adding to pressure on what are already over-full hospitals at a time when staffing and capacity is normally running lower.

The early arrival of flu was viewed by NHS Providers as “a worrying sign that the predictions of a difficult winter may already be a reality”.

And this sounds like a sensible reading. But at this stage the most severe concerns can only be speculative. A senior national figure cautioned it was too early to draw firm conclusions in terms of the length and severity of the flu season.

“There’s no reason to think that because it’s come early it will last longer. It may well arrive early and then leave early. But it’s something we need to monitor,” the source added.

The only significant lever left to pull to try and ensure the UK is as best prepared as it can be, is to make sure as many people get vaccinated as possible, especially those in high-risk groups.

Royal College of Nursing professional lead for public health Helen Donovan told HSJ: “Our message would be that it’s not too late to get vaccinated — and that goes for nurses and other clinicians as well as the public.

“There is a well-documented 43,500 vacancy rate in the nursing workforce and winter will already be hugely challenging. All frontline staff can help stop flu viruses spreading by making sure they are vaccinated.”

The good news on the vaccination programme, as noted by Dr Lopez Bernal, is that the vaccine appears to contain the right strands of the virus. The bad news is, however, that the children’s vaccination programme suffered a major setback after distribution of the vaccine was delayed.

Officials did, however, manage to restart the distribution of the vaccine for the programme, which covers around one million children, last month. But senior public health directors have raised concerns to HSJ about the need to play catch-up. The latest figures show vaccination rates among children are still below last year.

The system is already under extreme pressure, recording unprecedentedly low performance against core targets, and struggling with a workforce and capacity significantly short of what is required by demand.

It’s not a question of whether winter will be tough — it’s a question of how tough, at what point in time, and the severity of the flu season could have major bearing on this.

Everyone will be crossing their fingers that it’s a lighter flu season like we saw last year, rather than the 2017-18 winter, which was the worst year for “seasonal flu” in a decade.