Attempts by health officials to cut costs on flu vaccines have fuelled the NHS winter crisis, senior doctors have warned.
Health service documents suggest GPs were put under pressure to save around £3 per jab by buying vaccines which do not protect against one of the key strains in circulation.
Dr Nick Scriven, president of the Society of Acute Medicine, said around half of flu cases being treated in hospital might have been avoided, if a more comprensive jab had been chosen.
It comes amid rising levels of influenza across the country, which could reach epidemic levels if current trends continue.
Half of cases in hospital are suffering from A strains, the most deadly of which is a strain dubbed “Aussie flu”, because it fuelled Australia’s worst flu season in two decades.
But half are B strains - and the vast majority of cases this year involve a strain called B-Yamagata - known as “Japanese flu” - which is not covered by the vaccines most patients have received.
Two types of vaccine were available to British doctors this winter.
Quadrivalent vaccines, sold to the NHS for around £8, offer protection against two types of influenza A, including the strain A (H3N2), known as “Aussie flu,” and two types of B strain, including B-Yamagata.
Trivalent vaccines, which cost the NHS around £5, protect against both the main A strains, but only protect against a second B strain, which has proved to be rare this year.
NHS England last night insisted it had issued no national advice to GPs about which vaccines to buy.
But documents seen by Health Service Journal show that three clinical commissioning groups (CCGs) reported being told by NHS England’s regional outposts to “select the product with the lowest purchase price to the NHS and not purchase the quadrivalent vaccine for adults.”
— NHS Choices (@NHSChoices) January 11, 2018
The World Health Organisation says that the B-Yamagata strain made up 86 per cent of the B cases in circulation, while Public Health England’s laboratory reports show nine in 10 confirmed cases are B-Yamagata.
Dr Scriven said “Not using the quadrivalent vaccine has increased the risk of flu admissions. Half of the flu cases we are getting are the A strain, half are the B. It’s probably about half the cases that are coming into hospital that may have been prevented.”
Governing body papers, published in October by West Kent CCG, show NHS England South had emphasised the “cost effectiveness” of the vaccines in correspondence to GPs.
The papers state: “The quadrivalent vaccine has a higher cost than the trivalent vaccine and this would add significant cost pressures to the prescribing budget across the South East.”
“The advice from the national team is that there is minimal evidence of cost effectiveness. In the absence of robust evidence to prove superiority, the local CCGs and NHS England South (South East) are advising that prescribers should select the product with the lowest purchase price to the NHS and not purchase the quadrivalent vaccine for adults.”
Documents published by Barking, Havering and Redbridge CCGs and North Hampshire CCG in spring 2017 also said NHS England’s regional outposts had advised against use of the more expensive vaccine.
At least nine more CCGs ordered GPs to opt for the cheaper jab.
Guidance from Public Health England (PHE) published last month said that the quadrivalent vaccine was “likely to be cost effective compared with the trivalent vaccine” and suggested it should be considered for adults in at risk groups, such as pregnant women, and might benefit healthcare workers.
However, vaccines were ordered far earlier in the year, ahead of distribution in September.
An NHS England spokesman said PHE was responsible for advising on flu protection and CCGs were responsible for advice issued in their area.
An MP told the Commons that 20 patients have died because of ambulance delays this winter, while a service refused to declare an emergency.
Labour's Clive Lewis said NHS managers wanted to move East of England Ambulance Service Trust to its highest state of emergency on 19 December, and to seek help from elsewhere, yet did not declare an incident until 31 December.
"I've been informed during this period that 20 people died in incidents where ambulances arrived late,” he told the Commons.