Public health leaders bel­ieve the NHS reforms have left eme­rgency plans ‘confused’, posing a ‘real risk’ that no-one will take command in a future public health emergency.

A review led by former CMO for England Sir Liam Donaldson found there were 30% more deaths from flu in the year after the swine flu pandemic than during the outbreak itself.

The UK, Greece and Ireland were the only European countries where deaths rose. Sir Liam’s team concluded that the DH’s ‘laissez-faire’ attitude to flu contributed to this rise.

It said the reaction to the 2009/10 pandemic was ‘highly assertive’ but that efforts were ‘insufficient’ after health sec­retary Andrew Lansley took office in 2010.

Cancellation of the annual flu campaign and a failure to warn that the pandemic virus would circulate and affect younger people led to a ‘worrying’ fall in awareness, the review said.

Sir Liam’s conclusions
DH policies may have led to a 30% rise in deaths in 2010/11 compared with 2009/10. Swine flu deaths jumped from 361 in 2009/10, the pandemic year, to 474 in 2010/11. Critical care admissions rose from 1,700 to 2,200, and hospital admissions from 7,879 to 8,797. In all other European countries, except the UK, Greece and Ireland, deaths and emergency admissions fell in 2010/11.

‘The differences in the government response over the two years were striking and likely to have contributed to the inc­reased impact of the disease in the second year,’ Sir Liam and his team concluded.

Faculty of Public Health pre­sident Professor Lindsey Davies said: ‘It is a source of great concern that lives may have been lost because people were not reminded of the risks of flu and how to avoid getting it.’

She said there was growing worry among public health off­icials over the government’s reluctance to give local auth­orities clear responsibility for tackling local epidemics and emergencies.

‘The latest advice from the DH is as confusing as ever and there is a real risk that no-one will take responsibility for getting things done,’ she said.

Professor Lindsey Davies: 'The advice from the DH is confusing and there is a risk that no-one will take responsibility for getting things done' (Photograph: N Clarke)

RCGP immunisation lead Dr George Kassianos said the lack of an awareness campaign in the year after the pandemic reinforced the message of a ‘mild’ flu in that year.

‘Influenza has never been "mild",’ he said. ‘It makes people ill, can cause severe complications and ultimately it can kill.’

Dr Paul Rutter of Imperial College London, who worked on the review, said awareness campaigns were important.

‘We had them for 15 years as a core public health message,’ he said. ‘A lot of the public health community were baffled to see it dropped.’

But Professor David Salisbury, DH director of immunisation, refuted claims of complacency. ‘We know flu is an unpredictable virus that can kill so we take it seriously every year,’ he said.

Professor Salisbury said eff­orts were made to increase anti­viral use once the seriousness of the 2010/11 flu season became clear. ‘Thanks to robust early planning, the NHS coped well with the pressures of flu last year.’

RCGP health protection lead Dr Maureen Baker said lessons must be learned. 'This paper suggests that we might reasonably expect more flu outbreaks with serious effects on younger patients over the next few years.’

• Eurosurveillance Online 2012