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© ncarucarWhat if the sickness is being carried up from the Gulf of Mexico?
Health secretary Andrew Lansley is coming under pressure to get a grip on the winter flu outbreak, amid warnings that millions more people need to be vaccinated in order to prevent a mounting death toll.

Lansley was accused of a U-turn as he reinstated a public health advertising campaign after he was warned by government advisers of the need to improve immunisation rates which are at their lowest this winter for many years.

The Joint Committee on Vaccination and Immunisation (JCVI), the government's advisers on vaccines to prevent serious illness, said 16 million Britons are at serious risk from flu. The committee said a greater uptake of the jab was vital among groups including pregnant women, those with breathing conditions such as asthma, and people with diabetes or heart, liver or kidney disease.

Lansley has reinstated the national Catch It, Bin It, Kill It advertising campaign. It had been discontinued despite helping educate the public to adopt good hygiene habits during last year's H1N1 swine flu epidemic at a cost of just £609,000.

He has been criticised for not instigating the campaign to urge everyone at risk to get a seasonal flu jab from their GP, for ending the Catch It publicity drive, and for not ensuring that all under-fives were offered the vaccine.

But the JCVI ruled out the need to add under-fives to the list of those needing routine vaccination, saying there was not enough evidence to justify recommending the move.

There were 12 more deaths in the last week from flu, bringing the total this winter to 39, the Health Protection Agency (HPA) said today. Thirty-six were killed by H1N1 swine flu, which is the most virulent of the two main flu strains currently circulating. The others died after contracting Influenza B, the other strain. All except one of the 39 were under 65 and four were under five, which underlines H1N1's dominance of this winter's flu, as it mainly affects groups other than the elderly.

Significantly, 23 of the fatalities belonged to one of the clinical "at risk" groups whose health is at potentially serious risk if they get infected. And only two had received a winter flu jab recently, despite their vulnerable health status, the HPA confirmed.

Lansley's radical plans to restructure the NHS in England are also under fresh scrutiny. Writing in the Guardian, Conservative MP and ex-GP Sarah Wollaston warns that they run the risk of ending with the NHS in England being privatised inadvertently. Critics, including some doctors and the main health unions, have already claimed that the reforms will end in a privatised NHS.

Wollaston, a member of the Commons health select committee, is the first Tory MP to raise such public and serious concerns about the health service shake-up.

British Medical Association chairman Dr Hamish Meldrum, the leader of the UK's doctors, said he agreed with Wollaston's fears that Lansley's shake-up would lead to the NHS being privatised. "She is right. That is our analysis. It brings that reality a lot closer," he said.

He shared her concern about "private cherry-pickers", adding: "In the past these providers have tended to be given the most profitable parts of the NHS and left the NHS with the most difficult areas, such as acute and emergency care."

With experts predicting the next few days will bring the peak of this winter's flu season there were signs that the NHS is under growing pressure. The number of people receiving critical care in hospital, mainly because their breathing has been badly affected by flu, leapt from 460 to 738 in the last week - a rise of over 50%. Arrowe Park hospital, in Merseyside, has banned visitors to try to keep patients clear of flu.

The JCVI held a teleconference after the Department of Health (DH) asked them to review whether the existing vaccination policy, which has been subjected to serious criticism in recent days, needed to change. They said: "It would be hoped that influenza circulation will have subsided within a month. The greatest gain will be achieved in increasing vaccine uptake in the clinical risk groups." These groups total some 16m in the UK.

Lansley's Labour counterpart, John Healey, said: "I welcome Andrew Lansley's U-turn on the use of a public advertising campaign to help tackle the flu crisis. The health secretary made a serious misjudgment when he axed the annual autumn advertising campaign to help public understanding of this flu and boost vaccinations for those most at risk.

"At a time when the NHS is stretched and playing catch up, the decision he has taken today is better late than never."

"With Britain about to go back to school and work after the Christmas and New Year break, I welcome Andrew Lansley's change of mind on public advertising to back up the efforts of doctors, nurses and midwives to boost flu-jab protection for the groups most at risk and to advise people on how to deal with those in the family who have flu."

Lansley is about to overhaul both the NHS and public health budgets which will see GPs commission £80bn of healthcare. Wollaston writes: "I received an email this week asking me to stop the privatisation of the NHS. The coalition is not privatising the NHS, but it is in danger of failing to make that clear."

She predicts that her former profession may be dissuaded from commissioning care and in that instant will increasingly hand the process over to private providers, who are better able to navigate the new system. Because of this she says that GPs are unlikely to relish the role Lansley is carving out for them and she points to parts of the country where clinical excellence is being achieved "without the need for a revolution".