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All the clinical indications are that swine flu is a comparatively mild disease, but with the numbers of people infected rising rapidly and the Government predicting up to 100,000 new cases a day by the autumn the implications for the NHS are serious. On 2nd July the Department of Health issued ‘Swine flu epidemic - from containment to treatment - guidance for the NHS' which sets out the steps all healthcare providers should be taking to prepare for what may be to come.

All NHS organisations should have contingency plans in place to deal with the epidemic, and the new guidance asks all Trusts to appoint a lead director to oversee the plans. These plans will be tested in September by Strategic Health Authority/Health Protection Agency organised resilience testing.

Clinical audit staff need to prepare for a situation where carrying out a normal clinical audit programme might be severely hampered by staff absences, infection risks and travel restrictions. 

• NHS Employers have worked with the Department of Health to produce Human Resources guidance on the likely impact of the epidemic. Their recommendations include agreeing local protocols to deal with staff who are absent, either because they have flu or have caring responsibilities, and carrying out skills assessments in order to plan for redeployment of staff if normal working is suspended. 
• Any clinical audit staff who work in patient areas should be aware of infection controls and risks, and staff should be aware of the particular advice which has been given regarding swine flu (see the NHS Choices website). They should certainly be aware of their own Trust's policy and procedures on dealing with patients with confirmed or suspected swine flu.
• While close contact can spread the virus, there is little evidence that cancelling public gatherings would control the spread of infection. However clinical audit teams might have to review their local situation in deciding whether to carry out work which involves regular travel between different hospital sites or healthcare settings.

Trusts (and clinical audit teams) should plan for any additional work which might be necessary in order to prepare for, monitor and learn from the current epidemic. All trusts should be carrying out readiness assessments as part of their preparations, and Trust Boards will require regular updates on the situation in their organisations.

There is still a great deal of uncertainty in how the current epidemic will develop, and all NHS organisations will need to monitor the situation both locally and nationally to ensure they continue to be able to provide appropriate levels of care.

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