National pandemic service: A leap of faith
There are a lot of anxious people at the Department of Health today. At lunchtime, there will be an important change in the way H1N1 swine flu is managed in England.
The National Pandemic Flu Service is planned to go live (see the BBC's Q&A here). There will be a unique phone number for people with symptoms to go through an assessment and, where appropriate, to get a unique authorisation number for a course of antivirals.
The focus of the service, however, is online. I've been told by officials that the recommended route for those with internet access will be the website rather than the phone line.
It's the first time that a health service has offered prescription medicine online to anyone who can answer a checklist.
The oseltamivir (Tamiflu) - and the zanamivir (Relenza) for pregnant women - will be free; there will not even be the usual prescription charge. This leap of faith is pretty big.
• Firstly, can members of the public be trusted not to abuse the system by trying to get antivirals when they don't need them? More on that later.
• Secondly, will the website and phone line be able to cope with the demand?
The Department of Health kindly allowed me to access the online system yesterday afternoon before it went live. I should stress that it was a simulation, and I did not end up with any antivirals. But I was able to see exactly how it works.
It is essentially a tick-box symptom checker. The first questions are designed to weed out those who may need urgent medical attention for another condition. Then you are asked to tick a box if you - or the person you are caring for - has a fever plus two or more flu-like symptoms from a list. There are a few other questions designed to weed out those for whom antivirals would not be appropriate.
I went through the online assessment - purely as an exercise - and it took me about three minutes to get a course of antivirals approved. I was given a long, unique authorisation code for a "flu friend" to take to the nearest collection point.
I gave my work address and postcode in Shepherds Bush to find where I could pick up my phantom prescription. Up popped Wormwood Scrubs prison pharmacy, which is helpfully open 24 hours a day - but only, I imagine, for inmates. Oops. I was told that such glitches will have been removed by the time the service goes live.
There will be safeguards to reduce the risk of misuse. You will have to give a name, address and date of birth. Your "flu friend" will have to bring proof of ID for themselves and you. And the system will keep a record of everyone who has used it.
Ministers and officials know that a minority of the "worried well" may try to get antivirals in advance for when they or family members fall ill. Given that some have been paying more than £100 to get drugs privately online, there will surely be some misuse of the system. The question is: how much misuse?
The UK is acknowledged to be one of the best prepared countries for this pandemic. It has enough antivirals stockpiled for half the population, and that will rise to 80% in the future. That means there is more than enough to go round for those who need it.
The online and telephone service is not there for people to stockpile antivirals to take abroad on holiday in case they get ill. And remember that, like all medicines, Tamiflu can have side-effects. The most common is nausea. Most people who get H1N1 swine flu will get over the infection without the need for antivirals. The medical advice is that common painkillers, plenty of fluids and bed rest will be perfectly adequate for most.
So the National Pandemic Flu Service in England is intended for the sick, not for the healthy.