Sunday, 14 January 2018

One Flu Over The Containing Nest

One of my childhood memories is of going to the local fish and chip shop, buying a portion of chips and a great big juicy gherkin to eat on the way home. The chips were always too hot to eat, and the vinegar from the gherkin always seemed to run down my arm. I’ve loved chips and gherkins ever since. And last week, I found myself standing in my local supermarket (actually its 21 miles away) looking at the pickle shelf with a view to replenishing my larder after the Christmas celebrations. As I stood there looking, I became aware of 2 women talking about flu.

I’m a researcher who has often drawn upon cultural anthropology as a way of trying to understand how people make sense of the world around them. I’m always keen to seize any opportunity to engage in an ethnographic experience. I felt a little like a participant-observer as I stayed where I was and listened to the conversation. Both the women appeared concerned over the growing number of news stories about flu. Neither of them wanted to have the flu vaccination, citing that it was ‘pointless, it doesn’t protect you against the flu so why bother’; they talked about ‘that girl’ who had died from flu and not only had she died, but she had done so in a hospital; and that ‘we always gets lots of flu at this time of the year’ so ‘if you are going to get it you will get it’.

It was a sad and somewhat poignant conversation to listen to. This year there has been a great deal more information provided about the need for a flu vaccination and protection this can provide. The health promoting message has been repeated for some time now. It’s never been easier to get a flu vaccination and yet there are still many people who for whatever reason have chosen not to do so. Unfortunately this group also includes health care professionals. The story about Bethany Walker, the 18 year old from Applecross in Scotland who was ‘that girl’ who died, was also linked to a story about why so many NHS staff in Scotland have not had the vaccination. As I write this blog, just some 40% of NHS staff in Scotland have been vaccinated. Back in England, and in the NHS Trust I am involved in, some 72% of staff have been given the flu vaccination. 

This year there has been a growing call for the flu vaccination to be made compulsory for all those working in health and social care settings. The outgoing NHS England’s National Medical Director, Sir Bruce Keogh, noted that ‘30% of people with the virus do not know they are carrying it, so NHS staff may not be aware they could be putting patients, colleagues and their own families at risk’. The debate over compulsory vaccination is likely to be very polarising and distracting. As far as I am aware unlike the US, here in the UK today there is no compulsory legal basis requiring people to be vaccinated against anything. Even the 1853 law requiring compulsory vaccination for small pox was discontinued in 1948. Despite a small outbreak in Glasgow in 1950, by 1978 the WHO announced that the smallpox virus had been eradicated globally.

Under the WHO Global Vaccine Action Plan, measles and rubella are targeted for elimination in 5 WHO regions by 2020. The UK achieved this in 2017. This was achieved by voluntary means with most parents embracing the need to have their children vaccinated against the potentially deadly childhood diseases of measles, mumps and rubella. The MMR vaccination was introduced in 1988. Apart from a fall in uptake in the late 1990s caused by the now discredited research by Andrew Wakefield, linking MMR to autism, voluntary vaccination uptake has been maintained at +90% levels.

At my NHS Trust, we had a 100% take up of this year’s flu vaccination by the Trust Board of Directors. Now our Medical Director was one of those getting his flu vaccination along with the rest of us, so I was surprised to hear him stand up and say he didn’t think it had worked to protect him! The occasion was at our Quality and Safety Committee, where he was giving a presentation regarding progress on our 7 Day Service (we are one of the national pilot sites). His comment referred to a bout of what he described as ‘man flu’ (a descriptor I really dislike!). This wasn’t flu as in the H3N2 ‘Aussie flu’ which affected some 170,000 people in Australia and which is beginning to spread across the UK at an exponential rate. But it was severe enough to make him feel really rough, not ill enough to go to A&E, or his GP, but ill enough to feel the need for care. Fortunately for him his wife provided for his care, in the form of keeping him warm, making sure he had plenty to drink, giving paracetamol, and making him rest. 

The word ‘fortunately’ was his word. He asked us to consider those without family support, particularly the elderly who might experience similar symptoms and have no one to provide them with care. If that care is not available to them and they pitch up at our A&E departments seeking some care, should we be at all surprised? Like many others, I believe that 7 Day Services should not just be about hospital care. However, we have a long way to go in ensuring the provision of effective integrated community based care is available to all. So for many people the hospital still provides a ‘containing nest’, which when they are poorly, is a safe place to be, even if it is not somewhere they really should, or even need to be. And if you have not had your flu vaccination yet, its not to late to do so.