Details of potential problems faced by the NHS in adapting to the raised intensity of the swine flu pandemic are set out in a leaked memo seen by The Times. The recent surge in cases, particularly in hotspots such as the West Midlands and London, prompted Andy Burnham, the Health Secretary, last week to announce the beginning of the “treatment phase” for the illness.

But the document, sent by a senior executive responsible for emergency planning, warns that box-ticking bureaucracy could impede key policies such as the rapid distribution of anti-viral drugs.

The treatment phase, involving people with flu-like symptoms being assessed over the phone via a national flu line, was intended to take the pressure off local GPs and hospitals.

The memo criticises the Government’s “muddled thinking” in advising health authorities how to implement this crucial phase.

Among the concerns are:

• That the scheduled national flu line is still not in place;

• That many trusts will be forced to set up local call centres to cope with the demand for Tamiflu, and distribute the anti-viral drugs from the same centres;

• That the use of vouchers to ensure only legitimate patients get them could be “a complete waste of time” when existing prescriptions would do just as well.

Sir Liam Donaldson, the Chief Medical Officer, indicated yesterday that a National Pandemic Flu Service, as the national call centre will be known, would be introduced on the basis of a surge in cases in the worst-affected areas around the country, and on how badly services are overwhelmed.

In the memo, the health trust executive concludes that the way the national flu line fits into the system “is anyone’s guess!!”, adding that the current ‘treatment phase’ instructions were “frankly all … a total fudge” and a “very confusing picture”.

Andrew Lansley, the Shadow Health Secretary, said it was “deeply concerning that some NHS staff did not have confidence in the Government’s plans to handle the outbreak.

“We need to ensure that every measure possible is taken to optimise our preparedness. It’s a pity that the Government delayed the implementation of a national flu line, which would have helped with the distribution of drugs and information”.

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