Emergency plans for dealing with a predicted surge in swine flu are muddled and contradictory, a leaked memo from the health service warns.

As the number of people falling ill in London and the West Midlands nears epidemic levels, officials believe that some measures to distribute drugs and relieve pressure on hospitals and GPs are “a complete waste of time”.

Correspondence between senior personnel seen by The Times raises concerns about the NHS’s readiness to deal with the hundreds of thousands of cases expected in the coming months.

Fourteen deaths have now been linked to swine flu. Britain has the third highest number of confirmed cases after the United States and Mexico. About 27,000 contacted GPs last week reporting flu-like symptoms.

Andy Burnham, the Health Secretary, said last week that Britain had moved into the “treatment phase” of its pandemic plan, signalling that the virus was spreading uncontrollably.

The memo sent by a trust executive responsible for emergency planning to other senior personnel criticises the Government’s “muddled thinking” on some key issues. The new phase involves people obtaining diagnoses via a national call centre, but this does not yet exist and trusts have developed their own call centre arrangements.

The memo also suggested that the creation of “Tamiflu vouchers” would hamper the rapid distribution of antiviral drugs. The job could be done just as easily with existing prescription forms, said the official.

Sir Liam Donaldson, the Chief Medical Officer, said that the virus was affecting young people mainly and could be fatal, but that many of those who died had underlying health problems. The Department of Health said that the NHS was “coping well” because most cases were mild. Sir Liam admitted that he did not know exactly how many people had the virus because many would stay at home rather than contact their GP. Britain has enough antiviral drugs to treat 80 per cent of the population.

Peter Holden, of the British Medical Association, who has been involved in drawing up the pandemic plans, said: “There is not confusion, but with an organisation as large as the NHS you will have some problems with people getting the wrong end of the stick.”

He admitted, however, that the use of Tamiflu vouchers did seem to be “a needless waste of money when prescriptions could do the same job”.

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