Nick Hoile: The tide is beginning to turn on Covid. Ministers should act now to prevent a winter flu crisis.

17 Feb

Nick Hoile is a health policy specialist and a Senior Director at MHP Communications.

After making it through the most gruelling January in its history, there is a light at the end of the tunnel for the NHS. The number of people in hospital with Coronavirus is slowly falling, as the lockdown pays off by reducing transmission and the vaccination programme now reaching over 500,000 people a day. With spring around the corner, ministers will surely be tempted to move the story on from “winter pressures” and focus on the Government’s recovery strategy.

But winter is always coming, and it pays to be prepared. Despite dire predictions, there was no “twindemic” of Covid and seasonal flu this year. In fact, the number of people suffering from flu fell by more than 95 per cent compared to the previous year. Social distancing, mask wearing, hand washing, lockdowns, and an enhanced influenza vaccination programme all contributed to reduced transmission. Next year, we may not be so lucky.

Seasonal flu has the potential to come back with a vengeance, as Coronavirus restrictions lift and the public begins to “tune out” after 18 months of persistent public health messaging. Ministers and health systems leaders may struggle to find the bandwidth to focus on flu, as they work flat out to deal with the backlog of patients waiting for routine care, implement new NHS legislation, and establish new public health structures.

If Sir Simon Stevens moves on from NHS England this year, as he is expected to do, we may enter the next flu season with new NHS leadership in place. The result could be a “perfect storm” for the NHS, with swamped GP practices, full hospitals and longer waits for care causing a severe headache for the Government. It would be an open goal for Labour’s effective shadow health team.

So, what can ministers do to avoid a health and political crisis next flu season? Thankfully, they already have one of the most powerful tools for protecting public health and reducing pressure on the NHS at their disposal: seasonal flu vaccines. There are several steps ministers should consider now to help ensure the vaccines reach people at risk of flu and its complications.

First, they should build on the success of the 2020/21 flu vaccination programme – the most effective there has ever been. The successful rollout of a national “call and recall” system, which encouraged people to get vaccinated, should be fine-tuned, and the expansion of the programme to include people aged 50 and over should be retained for another year which evidence is collected on its impact.

Second, ministers should seize the opportunity of the new NHS legislation to establish clear leadership and accountability for vaccination programmes. As a result of the Lansley reforms introduced by the Health & Social Care Act 2012, responsibility for flu vaccination is currently spread across several different NHS and public health organisations. Against this backdrop, it is no surprise that England has consistently missed the World Health Organization’s target for flu vaccination uptake among over 65s and at-risk groups in recent years.

A more rational structure, with clear safeguards to prevent vaccine programmes falling in and out of fashion once politicians have a stronger grip on the NHS, would undoubtedly focus minds. As Nadhim Zahawi’s appointment as minister with responsibility for the rollout of the Covid vaccine has shown, accountability is often critical to the successful rollout of government programmes.

Third, the NHS’s complex system of payments and incentives to drive uptake of the flu vaccine should be reformed as part of the Government’s planned vaccines strategy for England. Providing flu vaccination clinics can be lucrative for GP practices – and rightly so, given their importance. However, this can cause GP practices to compete, rather than collaborate, with other health services like community pharmacies, which may be more convenient for some patients to visit.

A review into payment systems has already been conducted, and the emphasis on collaboration rather than competition in the forthcoming NHS legislation sounds like a step in the right direction.

In addition to fostering collaboration, the payment system could also be adjusted to provide a greater reward for vaccinating “at-risk” groups of working age adults with conditions like cancer or diabetes that make them particularly vulnerable to flu.

These groups have historically been harder to reach than the over 65s. In 2020/21 only 52 per cent of “at-risk” groups took up the offer of a flu vaccine, compared to 81 per cent of the over 65s. These numbers need to increase if we are to protect the vulnerable and reduce pressure on the NHS next flu season.

Fourth, there is an opportunity for ministers to do more to encourage best practice sharing across the NHS. The uptake of the flu vaccine can vary significantly across the country, with local areas facing different challenges based on their geography and demographics.

The size and scale of the NHS means that, whatever the challenge, there will always be one local area that has developed an innovative solution. In advance of the next flu season, the National Immunisation Network annual meeting could be relaunched and expanded in light of the forthcoming health reforms and new vaccine infrastructure.

Fifth, ministers should consider running a large-scale public information campaigns to raise awareness of seasonal flu. After eighteen months of public health messages about viruses, hand washing, and vaccines, ennui may have set into the public mind.

Some at-risks groups may conclude that, when compared to Covid, seasonal flu is nothing to worry about. A hard-hitting campaign that helps people understand how serious flu can be, with a focus on working age adults who are particularly vulnerable, may help change this mindset.

With a concerted effort now, ministers can help prevent a resurgence of flu next season and cement the UK’s reputation for world-leading vaccination programmes. There is no need to be caught off guard.

Lastly, every one of us can do our bit to save lives and protect the NHS. If you’re contacted by your GP this autumn and offered a flu vaccine – say yes.