NHS Boss Fired After Putting Patient’s Safety First

April 19, 2010

Telegraph.co.uk

By Laura Donnelly

Gary Walker was dismissed as the head of one of Britain’s largest hospital trusts over accusations that he had used bad language during meetings.

But he told The Sunday Telegraph that senior NHS figures wanted him out because he had refused to put waiting time targets above all other considerations.

Now he is standing against health minister Gillian Merron in the key marginal seat of Lincoln with a manifesto which says that Government diktats are “killing patients and destroying the NHS”.

Mr Walker said he was dismissed from United Lincolnshire Hospitals trust, in February, on trumped-up charges after he tried to blow the whistle on pressures placed on him by health authority bosses, which he said threatened patient safety.

Seven months earlier, Mr Walker had written to NHS chief executive David Nicholson setting out his concerns.

In the letter he said pressures on managers to ensure waiting targets were hit – regardless of how many patients arrived at Accident and Emergency departments – were jeopardising safety.

He said the NHS East Midlands strategic health authority (SHA) was subjecting him to the same kind of behaviour as caused the scandal at Stafford Hospital, where an investigation found hundreds of patients died amid a rush to hit waiting targets.

Mr Walker said he had been bullied by the authority’s bosses over the trust’s failure to meet Government demands as its eight hospitals struggled to cope with a sudden 30 per cent increase in arrivals to A&E in early 2009. He had been brought in to run the trust in 2006, following a scandal in which more than 1,000 of its patients fell victim to waiting list manipulation, when they were placed on a “suspended waiting list”.

The manager, who had worked in the NHS for more than 20 years, oversaw improvements in Lincoln, including a 40 per cent fall in infections.

But in early 2009, as Britain experienced the coldest winter for a decade, the trust experienced a massive rise in the number of patients arriving at A&E departments.

By April, emergency attendances had risen by 30 per cent in just 10 weeks. As the hospitals prioritised emergency patients, waiting times for operations on non-urgent patients grew. When Mr Walker discussed the situation with SHA bosses, he was told to leave quietly, and fabricate a story about why he was going, or his “career would be in tatters,” he alleged.

He protested that the priority should be to deal with the problem, and asked for funding for more wards, which took months to be agreed, he said.

In July, the trust’s chairman David Bowles quit, claiming he had been threatened with suspension, when he refused to commit hospitals to meeting the targets at any cost.

Soon after, Mr Walker went on sick leave. While he was off he was told he was under investigation by the trust, and in February, a new chairman sacked him after an employment panel concluded “on the balance of probabilities” that he had used foul and abusive language at formal meetings.

Mr Walker admitting swearing from time to time, but said he had never sworn directly at an employee or colleague. The panel said it was not possible to make such a distinction.

“I was sacked because I was a whistle-blower and they just wouldn’t stand for it,” he said. “The claims about swearing were laughable. I swear from time to time, like many people working in a stressful environment, but I have never sworn in a way that threatened anyone.”

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3 out of 5 Brits Do Not Believe the NHS is Doing a Good Job

April 15, 2010

Telegraph

By: Rebecca Smith

When asked to grade the NHS only 30 per cent gave it a score of very good or excellent, The Deloitte 2010 Survey of Health Care Consumers in the United Kingdom, found.

The NHS scored worse than the healthcare systems in Canada, France and Switzerland but better than Germany and America.

The wide ranging survey questioned at least 1,000 people in each of the six countries on subjects including personal health, comparing hospitals or doctors before being treated, satisfaction with hospital care and GP and extent of waste in the health service.

Fewer people in Britain were satisfied with their GP than in any of the other six countries with 65 per cent of people saying they were happy compared with over 70 per cent in all the other countries.

Those who are not satisfied said fewer delays, having an ability to email their physician, and improved conditions of the physical surroundings were their top priorities.

There was also a poor response when questioned about hospital care with 63 per cent saying they were satisfied with recent care. Satisfaction rates were higher in all the other countries except Canada, the survey revealed.

Dean Arnold, head of Deloitte’s global health care practice, said: “Currently, people tend to be happy with their local hospital, but not necessarily with the NHS as a whole.

“It would appear that consumers are able to depersonalise the NHS from the professionals they interact with. But the public will become more challenging and more demanding in the future as the possibility of choice becomes increasingly apparent.

“Individuals should be asking themselves – how good is my surgeon? What are the hospital’s readmission rates? Where can I receive better treatment? Location will no longer be the primary basis upon which to decide where to receive care and treatment, quality and outcomes will become the gold standard.

“A more informed and empowered public will in turn help make the NHS more effective and more efficient.”

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UK Hospitals Rated Worst Tried to Gag Whistleblowers

February 2, 2010

Guardian.co.uk

By Rajeev Syal

A hospital trust branded the worst in Britain by the NHS regulator actively discouraged staff from expressing fears about the safety of patients, an independent inquiry is expected to conclude.

Senior managers at Mid Staffordshire NHS Foundation Trust, where poor working conditions may have contributed to more than 1,000 deaths, will be accused of promoting a culture of secrecy, according to sources close to the inquiry.

The disclosure of a key finding of the report, expected to be released this week, comes as campaigners for patients who suffered neglect in Stafford and Cannock Chase hospitals call for a judicial review into the trust.

An official close to the inquiry told the Observer that it will conclude that staff were discouraged from bringing problems to the attention of managers and NHS authorities.

“Staff have known about the problems on the wards for many years, but there has been no means by which they can bring them up. Those who have tried to do so have been shot down. Some have been ordered to withdraw or hide their allegations,” the official said.

The inquiry was launched in September by the health secretary, Andy Burnham, following a Healthcare Commission investigation that delivered the most savage indictment of any NHS organisation in the commission’s five-year history. Its report condemned “appalling” standards of care at the trust’s hospitals in Stafford and Cannock, particularly involving emergency admissions, which may have contributed to up to 1,000 deaths between 2005 and 2008.

The inquiry, chaired by Robert Francis QC, has heard evidence from a number of members of staff that they had been actively encouraged to ignore serious problems in frontline services.

One senior Stafford hospital official was suspended last week after documents from the inquiry allegedly showed that she tried to cover up damning comments about the care given to a 20-year-old who died just hours after being sent home from the accident and emergency department.

Kate Levy, board secretary and head of legal services at Mid Staffordshire NHS Foundation Trust, is being investigated over allegations that she encouraged a doctor to rewrite a report into the death of John Moore-Robinson.

Staff in accident and emergency failed to spot that the telecommunications worker had a ruptured spleen following a mountain bike accident on Cannock Chase in April 2006. He died at his home in Coalville, Leicestershire, less than 24 hours after being sent home with painkillers.

A report by Ivan Phair, an A&E consultant, into his treatment said: “The premature death of Mr Moore-Robinson in my opinion was an avoidable situation. I feel that an independent expert would criticise the management afforded to him by the staff. There is a high probability that the level of care delivered to Mr Moore-Robinson was negligent.”

After reading the report, Levy wrote to Phair asking him to erase the comments. Her letter stated: “As reports are generally read out in full at the inquest, and press and family will be present, with a view to avoiding further distress to the family and adverse publicity I would wish to avoid stressing possible failures on the part of the trust.”

The report was not presented to the inquest. Mr Moore-Robinson’s parents only found out about Levy’s letters when copies were given to them by a lawyer at the inquiry.

Frank Robinson, the dead man’s father, told the Observer that there had been a “culture of cover-ups” at the hospital. “Nothing can distress us more than losing our son. So for this woman to claim that hearing the truth would distress us is a heartbreaking and cruel insult,” he said.

“This is a hospital trust out of control. The place needs to be overhauled.”

Staff have claimed that they have been intimidated into silence when they have raised concerns. Pradip Singh, a senior consultant who gave evidence to the inquiry, used the protection of the Commons all-party health committee last year to explain what went wrong at Stafford hospital after what he called a “savage reduction” in levels of nursing. “Over the years, many clinicians had noticed deterioration in the standards of patient care, which became particularly acute approximately three years ago when major cutbacks were made in staffing numbers. This included a savage reduction in the number of nursing staff,” he wrote.

Singh, a gastroenterologist, said that he and other consultants had complained to senior medical managers and the trust’s management, but those who complained had been ignored and branded as troublemakers. He said that a “palpable culture of intimidation” in the trust deterred others from speaking out publicly.

The culture of secrecy at the trust has been reinforced by a written “whistleblowers” policy that discouraged an open discussion of problems, according to one charity that made a submission to the inquiry.

Cathy James, deputy director of the charity Public Concern At Work, said she had found the written policy wanting. “In health, more than almost anywhere else, a closed culture will breed silence. Mid Staffs is a warning for all. I hope that this will push the other trusts to review their policies so that staff believe that it is safe and acceptable to speak up.”

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20% of Hospital Patients in UK Has Diabetes

January 26, 2010

Telegraph

by Laura Donnelly

Soaring obesity levels have triggered record levels of the condition, which increases the risks of heart and kidney failure, and can result in blindness, nerve damage and amputations.

The first ever diabetes audit of NHS hospitals has found that 20 per cent of patients on hospital wards are now suffering from the disease – twice the proportion previously estimated.

Doctors said the figures, which will be published officially later this year, showed the “terrifying burden” the epidemic is placing on Britain’s population and the crippling effect it is having on NHS resources.

Some patients were being treated for direct consequences of the condition, after uncontrolled blood sugar levels caused them to fall into a coma, or suffer kidney failure, ulcers, or nerve damage.

Others suffered heart attacks and strokes, the risk of which is increased fivefold by diabetes.

While the figures include diabetics admitted for ill-health unrelated to their condition, the audit is expected to show that these patients stayed in hospital far longer than others, in some cases, because of the extra risks posed by their condition and in others, because the diabetes was not properly managed.

Experts said the existing burden on Britain’s hospitals reflected the impact of increasingly unhealthy lifestyles.

Prof Anthony Barnett, clinical director for diabetes at Heart of England NHS Foundation trust, said: “The situation we are facing as a country is absolutely terrifying.

“The obesity rates get worse and worse, the numbers with diabetes keep mushrooming, and given that these people are prone to a whole range of other serious medical conditions, it has an enormous impact on NHS resources.”

Of the 2.6 million people in the UK with the condition, 2.3 million have type 2 diabetes, where nine out of ten cases are related to lifestyle causes, such as obesity, low exercise levels, smoking and alcohol use.

Cases of type 2 diabetes have doubled since 1996, in line with the rise of obesity. If rates of obesity continue to spiral, by 2025, treatment costs for more than 4 million diabetics could consume one quarter of the NHS budget, projections show.

The Government’s diabetes tsar Dr Rowan Hillson, who is leading the audit of 200 hospitals said all patients admitted to hospital with diabetes should be given access to specialist advice, whatever the reason for their admission, so that potentially lethal complications were not missed.

She said: “This is absolutely crucial; there is evidence that the appointment of specialist nurses can reduce re-admissions of patients with diabetes, as well as drug errors, and length of stay.”

Previous research by charity Diabetes UK has found that just half of diabetes patients reported being seen by a specialist nurse during their hospital stay.

Another study found 20 per cent of diabetes patients were not given their medication at the right time, while 30 per cent said staff had been unaware they suffered from the condition.

Research has shown that the number of people undergoing lower limb amputations because of ulcers caused by diabetes has doubled in the last decade.

Around 5,000 people a year undergo a lower limb amputation, when circulation problems caused by diabetes result in foot ulcers and sores which become infected.

Surgeons say as many as half of the operations could have been avoided if expert care was received sooner.

Vascular surgeon Prof Roger Greenhalgh, from Imperial College Healthcare trust, said: “The numbers of amputations are going up, and that is partly because of the increased prevalence of diabetes, but we are also finding too many cases are not referred to specialists early enough”.

Dr Hillson, a consultant at Hillingdon Hospital in London, said the best parts of the NHS referred all diabetics with foot problems to a team made up of several types of specialists, to ensure complex problems were not missed, but said this was not yet standard practice.

She said: “One of the complications of acute diabetes is foot problems that can lead to amputation and even death.

“We know an enormous amount can be done to prevent this, and that this can save limbs, but there is variable practice across the country,” she said.

Russ Harris, from Bournemouth, was diagnosed with type 2 diabetes, aged 61, in 1999.

The former salesman, who enjoyed a rich diet while on the road, working for a company which sold Danish pastries, was 19 stone when he suddenly lost five stone in just three months, and began to suffer thirst and frequent urination.

Since his diagnosis, he has been admitted to hospital several times for complications linked to diabetes, including major fluid retention, while renal problems have reduced his kidney function to one quarter.

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Obese Encouraged to Gain Weight to Qualify for Surgery

January 26, 2010

Guardian

by Owen Bowcott

Obese patients are being “effectively encouraged” to pile on the pounds to qualify for weight-loss operations on the NHS, the Royal College of Surgeons warns today.

The college claims lives are being put at risk as some health trusts require patients to reach higher body mass index (BMI) levels than others before they receive surgical treatments.

The postcode lottery means that access to NHS weight-loss surgery is “inconsistent, unethical and completely dependent on geographical location”, according to the college.

Last year 4,300 operations to reduce body weight were carried out on the NHS, but as many as 1 million people could meet the National Institute for Health and Clinical Excellence (Nice) criteria for being classed as having severe obesity.

Bariatric, or weight-loss, surgery is carried out after diets, drugs and lifestyle-altering interventions are seen to have failed. It is not generally recommended for children or young people.

“Constraints on NHS funding mean that in some areas NHS decision-makers are opting to ignore professional guidelines and are denying patients’ access to surgery,” the college maintains. “In others, patients who already meet the [Nice] criteria are forced to wait until either they become more obese or develop life-threatening illness like diabetes or stroke.”

According to the Nice guidelines, bariatric surgery is recommended for adults with a BMI of more than 40, who have other significant diseases (for example, type 2 diabetes) that could be improved if they lost weight, and who have tried but failed to lose weight using non-surgical techniques.

The college, which is holding a conference on the issue today, says hospitals are assessing patients referred from primary care trusts under different eligibility criteria, resulting in some patients with a BMI of 60 or greater being refused surgery while others with a BMI of 40 or less are undergoing operations.

“Nice guidelines are meant to signal the end of postcode lotteries yet local commissioning groups are choosing not to deliver on obesity surgery,” said the college’s director of education, Prof Mike Larvin. “In many regions the threshold criteria are being raised to save money in the short term, meaning patients are being denied life-saving and cost-effective treatments, and are effectively encouraged to eat more in order to gain a more risky operation further down the line.”

One bariatric surgeon, Peter ­Sedman, said: “There is absolutely no doubt that some patients more needy of surgical treatment than others are being denied it. I will treat the patient, my hospital will offer the service, but unless the patient moves house they will not be referred and if they are, the treatment is subsequently blocked.”

David Haslam, chair of the National Obesity Forum, said: “Bariatric surgery is amongst the most clinically effective and cost effective specialities in any field of medicine, preventing premature death and transforming lives, whilst saving vast amounts of money for the NHS and the economy.

“Even the most cynical taxpayer should support bariatric surgery, alongside clinicians, in opposing the unethical and immoral barriers to surgery imposed by NHS purse-string holders.”

The college is calling on the Department of Health to ensure all patients have equal access to treatment. It estimates that obesity problems cost the NHS £7.2bn a year.

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British Government Trying to Get Rid of Unused Swine Flu Vaccine

January 13, 2010

Daily Mail

By Christopher Booker

So the Government, as the Daily Mail has revealed, is trying to get rid of £1billion-worth of unwanted swine flu vaccine – because the deadly epidemic they were promising us all last year never materialised.

Several things are shocking about this revelation, not least the charge by the Council of Europe’s head of health that major drug companies might have leaned on the World Health Organisation (WHO) to stoke up last year’s scare by warning that swine flu could be a worldwide ‘pandemic’ killing tens of millions.

Certainly, those companies have made vast fortunes out of selling the vaccines which, at our expense, are now having to be flogged off at give-away prices.
The Government is trying to get rid of £1billion worth of the swine flu vaccine

Worthless: The Government is trying to get rid of £1bn worth of swine flu vaccine

But in a way most shocking of all is that this scandalous waste of public money – and the wild over-reaction which gave rise to it – was entirely predictable.

I can say this with confidence because I predicted it on this very page of the Daily Mail in April last year, just when our government, led by the Chief Medical Officer Sir Liam Donaldson, was cranking up the scare-machine to fever pitch by predicting that swine flu could be as bad as the Spanish flu epidemic of 1918 which killed 50million people worldwide.

Even then it was clear that governments all over the world, led by the WHO, were in the grip of a hysterical panic over swine flu.

Our own government was holding emergency meetings in its ‘crisis bunker’ off Whitehall.

The BBC Today programme wheeled on a WHO ‘expert’ to predict that 40 per cent of Britons would catch swine flu, while citing another unnamed ‘expert’ as predicting that up to 1.2million of us could die.
The Government set up several special NHS centres to deal with suspected swine flu cases

The Government set up NHS centres to deal with suspected swine flu cases

A similar panic had seized politicians in America, when just one child died after a family holiday in Mexico – even though this compared with the 36,000 Americans who die each year from more conventional strains of flu.

Yet eight months later it was being reported by scientists that swine flue is only a tenth as virulent as ordinary flu, and only one-100th as virulent as that Spanish flu at the end of World War I.

In other words, swine flu – just like the bird flu which we were told by a senior WHO official in 2005 was going to kill 150 million people worldwide (the true death toll turned out to be barely 200) – has predictably turned out to be yet another example of that all-too-familiar and very dangerous disease of our time, the ‘scare phenomenon’.

Three years ago, with a food safety expert, Dr Richard North, I wrote a book called Scared To Death, a detailed study showing how scare after scare in the past 20 years has rocketed through the headlines, costing us all billions, before it was eventually revealed that they had been blown up out of all proportion and, in many cases, had no real justification at all.
Leaflets were issued to highlight the danger of contracting swine flu

Leaflets were issued to highlight the danger of contracting swine flu

Based on years of research, we traced the history of a whole sequence of such panics, ranging from those over salmonella in eggs and BSE in beef to the Millennium Bug that was supposedly going to bring civilisation to a halt at midnight on December 31, 1999, as half the world’s computers crashed.

That particular panic cost an estimated $300billion before it was discovered that the countries which hadn’t spent fortunes on sorting out their computers fared no worse than those that had.

The purpose of our book was to show how consistently these scares follow an identifiable pattern.

They invariably begin with some misreading of the scientific evidence, which then gets picked up and inflated into some major threat to human health or well being.

But the tipping point of any scare, the moment when it begins to create serious damage, is when politicians and governments get involved, buying the exaggerated threat wholesale and responding with a deluge of measures which end up costing us all billions of pounds.
Priests in Mexico pray while wearing masks intended to prevent them from contracting swine flu

Priests in Mexico pray while wearing masks intended to prevent them from contracting swine flu

Do you remember our health minister Edwina Currie in 1988 setting off that panic over salmonella in eggs, which was supposedly going to kill thousands of people because the bacteria were somehow getting inside the eggs they ate for breakfast?

Few headlines greeted the government’s admission four years later that salmonella was not getting inside eggs after all and that whatever else had caused a temporary rise in salmonella poisoning, it wasn’t eggs.

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Unhealthy Health Workers Hurting Patient Care

November 23, 2009

The Times

by David Rose

Health trusts must do more to help doctors and nurses exercise and give up smoking and heavy drinking, says the Government.

NHS organisations will be expected to improve access to intervention programmes such as counselling or gyms as part of a drive to reduce sickness absence, which costs £1.5 billion a year.

The first national audit of staff habits has found that high rates of obesity, smoking, absenteeism and poor mental health were having a direct impact on the quality of patient care.

The Health Secretary is expected to accept all the recommendations of the final review, drawn up by Steve Boorman, a leading occupational health expert, in a written ministerial statement.

The review found that the scale of sickness absence in the NHS was equivalent to more than 45,000 NHS employees being absent from the workforce each year.

However, the Department of Health has suggested that health workers should be encouraged to set an example for patients and the general public when it came to promoting healthy lifestyles.

The review found that hospitals whose staff were in poorer health were less productive and had higher rates of patient mortality and superbug infection. More than three quarters of 11,000 staff polled acknowledged that the state of their health affected patient care.

Dr Boorman, a former GP and the chief medical adviser to Royal Mail, told The Times earlier this year that health awareness among NHS staff was “very inconsistent”. He said that a clear correlation had emerged between the performance of hospitals and staff health.

His recommendations include cutting smoking rates in the NHS, which are the same as in the general population, and providing more time or opportunities for staff to exercise.

Health workers with musculoskeletal and mental health conditions are also to be promised access to early interventions such as physiotherapy or counselling.

The review will call on trusts to appoint health and wellbeing leaders at board level to bring down rates of obesity, drinking and smoking, and on the Department of Health to devise and implement national standards and provide resources to ensure that these standards are given priority.

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Brain Reacts to and Affected by Hypnosis

November 17, 2009

BBC News

An imaging study of hypnotised participants showed decreased activity in the parts of the brain linked with daydreaming or letting the mind wander.

The same brain patterns were absent in people who had the tests but who were not susceptible to being hypnotised.

One psychologist said the study backed the theory that hypnosis “primes” the brain to be open to suggestion.

Hypnosis is increasingly being used to help people stop smoking or lose weight and advisers recently recommended its use on the NHS to treat irritable bowel syndrome.

It is not the first time researchers have tried to use imaging studies to monitor brain activity in people under hypnosis.

But the Hull team said these had been done while people had been asked to carry out tasks, so it was not clear whether the changes in the brain were due to the act of doing the task or an effect of hypnosis.

In the latest study, the team first tested how people responded to hypnosis and selected 10 individuals who were “highly suggestible” and seven people who did not really respond to the technique other than becoming more relaxed.

The participants were asked to do a task under hypnosis, such as listening to non-existent music, but unknown to them the brain activity was being monitored in the rest periods in between tasks, the team reported in the journal Consciousness and Cognition.

Default mode

In the “highly suggestible” group there was decreased activity in the part of the brain involved in daydreaming or letting the mind wander – also known as the “default mode” network.

One suggestion of how hypnosis works, supported by the results, is that shutting off this activity leaves the brain free to concentrate on other tasks.

Study leader Dr William McGeown, a lecturer in the department of psychology, said the results were unequivocal because they only occurred in the highly suggestible subjects.

“This shows that the changes were due to hypnosis and not just simple relaxation. “Our study shows hypnosis is real.”

Dr Michael Heap, a clinical forensic psychologist based in Sheffield, said the experiment was unique in showing brain patterns supporting the theory that hypnosis works by “priming” the subject to respond more effectively to suggestions.

“Importantly the data confirm that relaxation is not a critical factor.

“The limited data from this experiment suggest that this pattern of activity then dissipates (at least to some extent) once the subjects start to engage in the suggestions that follow.”

But he said the small study, which needed repeating in other populations, did not prove that people being hypnotised were in an actual “trance”.

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Dementia Drug Use Killing Many

November 13, 2009

BBC News

By Nick Triggle

Needless use of anti-psychotic drugs is widespread in dementia care and contributes to the death of many patients, an official review suggests.

About 180,000 patients a year are given the drugs in care homes, hospitals and their own homes to manage aggression.

But the expert review – commissioned by ministers – said the treatment was unnecessary in nearly 150,000 cases and was linked to 1,800 deaths.

The government in England has agreed to take steps to reduce use of the drugs.

These include:

* Improving access to other types of therapy, such as counselling
* Better monitoring of prescribing practices
* Guidance for families explaining what they can do if they are worried about drug use
* Specialist training in dementia for health and social care staff
* Appointment of a new national director for dementia to oversee the measures

The review – and the government pledge to take action – comes after long-running concerns about the use of anti-psychotic drugs.

Over the past 30 years, the NHS has increasingly turned to the treatment, which was originally aimed at people with schizophrenia, as it has struggled to cope with the rise in people with dementia.

‘Different mindset’

There are currently 700,000 people in the UK with the condition, but this is expected to rise to one million in the next 10 years because of the ageing population.

The review, led by King’s College London expert Professor Sube Banerjee, accepted that for some people anti-psychotic drugs would be necessary.

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Swine Flu fears grow as NHS staff shun vaccine

October 12, 2009

guardian.co.uk

Denis Campbell

The Department of Health has ordered NHS bosses across England to ensure that frontline staff get immunised against swine flu amid growing signs that many doctors and nurses intend to shun the vaccine.

Chief executives and boards who run hospitals, primary care trusts and strategic health authorities have been told to urgently maximise the number of workers having the jab. Leading DH figures including Sir Liam Donaldson, the chief medical officer, have written to them six times in the last five weeks stressing the need for action before the second wave of the pandemic causes major problems.

Ian Dalton, the NHS’s national director of flu resilience, last week warned that vaccination of nurses, doctors and other frontline staff was “absolutely critical” and that widespread take-up of the jabs “will help us to save lives”.

The DH’s letters stress that patients’ health could be put at risk and the NHS left seriously short-staffed through virus-related absenteeism if senior managers do not overcome “perceived obstacles” to the vaccination of workers. Swine flu’s threat is so great that the NHS must avoid only small numbers of personnel getting immunised, as usually happens with seasonal flu every winter, the letters add.

They stress that vulnerable patients could be endangered if staff decide not to heed repeated urgings from Donaldson and other senior figures to have the vaccine. There are growing signs that large numbers of workers will shun the jabs because they see them as unnecessary and potentially unsafe.

Dalton wrote to the chief executives of local NHS organisations in England on 10 September telling them: “We all know that uptake of the seasonal flu vaccine among NHS staff is traditionally low. It is an NHS board responsibility that we do not find ourselves in this position with the swine flu vaccine.”

But hospital chief executives have told the Guardian that they expect as few as 10%-20% of their staff to get vaccinated and cannot fulfil the DH’s demands because the jabs, which are due to begin within days, are entirely voluntary.

One chief executive of a busy urban hospital in one of the swine flu “hotspots” said: “At the moment in my hospital if nothing changes then it could be that 10%-20% of staff have the swine flu jab … Staff could have the virus and pass it on to patients, a proportion of whom will die, albeit a very small proportion.”

He added: “The other consequence is that if loads of staff go off with swine flu that will leave us short-staffed, which is dangerous to patients. That’s a bigger danger than transmission.”

Another hospital chief executive said: “Ideally it should be 100% of frontline staff having the swine flu vaccine. But it obviously isn’t going to be. I hope we’ll get at least the 50% we usually get for seasonal flu. This is important because although this strain of swine flu is mild in most people, if it’s contracted by someone with an underlying health condition that can be serious.”

One medical director at another hospital added: “The word on the street in NHS staff circles is that the vaccine is no good and you shouldn’t bother with it. Nurses in particular worry that there may be side-effects, that corners have been cut in producing the vaccine and that the generally mild nature of the virus means they don’t need to take it. As few as 10%-15% of doctors may have it because we doctors believe ourselves to be above such trivial things as infections.”

A poll by Nursing Times magazine last week showed that the proportion of nurses who do not intend to get vaccinated has risen from 31% in August to 47%, while those who definitely will has fallen from 35% to 23%.

Dame Christine Beasley, the chief nursing officer for England, responded by stressing that the vaccine is “as safe as a vaccine can be” and adding: “Nothing in life is risk-free. I can well understand people being worried. I can well understand people thinking it’s only a mild illness and why should I bother? I do understand all that, I think you wouldn’t be human if you didn’t think that.” Beasley wants directors of nursing to act as role models to allay concerns among frontline nurses.

Hospital chief executives say privately that Donaldson’s repeated reminders of the mild nature of swine flu’s effects in those who contract it, and recent claim that the UK is “tantalisingly close” to beating the virus, may be leading staff to believe that vaccination is not important.

The health department said: “Frontline healthcare workers will be absolutely crucial in the height of a pandemic – without them, patient care will suffer, and the NHS will be stretched. Getting the swine flu vaccine will protect them and their patients.”

It added: “All NHS organisations will be working hard to ensure that all eligible staff have the choice to protect themselves and their patients from swine flu by having the vaccine.”

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