At the beginning of the summer it looked as if we could be on the brink of a major health epidemic that could bring the country to its knees. A huge machine went to work preparing for the impending cataclysm. Six months later the swine flu epidemic has been a bit of a damp squib, and the medical profession looks as if it has been ‘crying wolf’ yet again.

Millions of pounds were spent on vaccines and antivirals and a great deal of anxiety has been generated. So was this incompetence? And, are we going to point the finger of blame at someone?

The retrospectoscope is a great and wonderful tool. Looking back to the summer there was a very real threat of a new strain of a virus, which had the potential to spread rapidly across the world. Attempts at containment were unlikely to succeed. In addition, there was evidence from South America showing that this new virus had the potential to be highly virulent, and worst case scenarios suggested that up to 65,000 people could have died.

Those responsible for planning services across the country are in an unenviable opinion. If they under react and under plan then they risk leaving the country vulnerable to a great plague that will cause untold misery and grief. If they over react then they will be accused of unnecessarily crying wolf and wasting money. And if they look indecisive then they appear weak.

Swine flu has been a global problem and the planners in this country will have looked carefully at what the rest of the world was doing. And it looks like everyone else got it about as wrong as we did. Well actually some of them got it even more wrong. The French, for example, bought 94 million doses of vaccine - more than the population of the country - and they only used 5m of them.  Now they are desperately trying to unload their excess stock.

And figures published in Le Monde showed that some other parts of Western Europe bought enough vaccine to immunise their whole population twice over. The US and Canada also bought considerably more than they have used, with Canada recently donating 5m surplus doses to Mexico.

There are some that think we have drawn a line under this too quickly. Flu epidemics come in threes, and we still haven’t seen the end of it. The WHO is still warning that it will be a year before the crisis is over. So maybe before we rush to put our excess vaccines onto eBay we should just wait a little longer. 

Doctors are naturally cautious and I think most of us think that the government largely got it right. It is far better to slightly overreact rather than the opposite. I think the majority of taxpayers would agree with this too.

However the green-ink conspiracy theorists have been on the case and are pointing their fingers at the drug companies. They are suggesting that some of the independent experts sitting on WHO committees have financial links with the pharmaceutical industry. And one blog posting goes further and points the finger at an individual. 

Should we believe the conspiracy theorists? Probably not. The allegations may well turn out to be totally without merit or validity. Whenever a mistake is made then there is always someone ready to leap forward and claim that there is a conspiracy at work. But, with such large sums of money at stake, we do need to be reassured about what went on.

One of the many worries about a swine flu pandemic is the effect it would have on the case mix inside hospitals. If we were overrun with seriously ill children then traditional paediatric ITU services could be swamped. There has been plenty of warning over this, plenty of constructive thought and a good deal of local planning.

The net result will involve a major rearrangement of how health care staff are deployed if the worst-case scenarios come true - hospitals might consider cancelling non-urgent surgery and moving staff around in order to cope with the changing patterns of disease. Even staff not directly affected by swine flu may be affected by repercussions of this. The exact way that this will pan out in practice is not yet known.

Earlier in the year the GMC issued some fairly sensible advice on this. It states that doctors may be asked to work outside their normal scope of practice, and some doctors who have retired, or who are not working in the profession, may be asked to return to work. They strongly encourage doctors to respond positively to such requests.

“Doctors need to feel confident that they are working within agreed standards and principles of practice, and will not be subject to criticism because of the difficult decisions they are forced to make, or the standards of care provided during a pandemic,” it says.

The GMC guidance goes on to explicitly state that: “In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence, and the availability of other options for care. In a pandemic, this means that you may work outside your normal field of practice, either in providing care to patients with influenza, or patients with other conditions.”

However the Nursing and Midwifery Council have taken a contrary view, which is encapsulated in the cliched phrase: “We’re not happy”. In their website guidance on swine flu, modified earlier this month, they write that: “All nurses and midwives are expected to practise within their competency level…If faced with any aspect of practice that is either outside their area of registration or beyond their competency level, they must seek supervision or advice from a competent practitioner…Nurses and midwives are able to extend their scope of practice, within the healthcare legal framework, but must ensure that they have the knowledge and skills to do so in a competent manner. If competency levels are not adequate, support and supervision must be sought from a competent practitioner.”

This guidance makes it clear that nurses who are forced by circumstances to work outside their comfort zone cannot expect any support from their regulators if they get into trouble. In the meantime they have written to 90,000 nurses who are out of practice, asking them if they would like to return to work to “address any potential staffing shortages which may occur in the event of a surge in the swine flu pandemic.”

The mixed messages that this is sending out are confusing.

Most nurses I talk to are very aware of the possible clinical problems. If the brown stuff started to hit the fan then they would do what seemed most appropriate at the time. As individuals they would want to do their level best and do what needed to be done. The disconnection between the nurses on the ground and their regulators needs to be explained.

To me this issue highlights a major cultural difference between doctors and nurses and their attitude to risk and diversity.

Read MPS advice on swine flu practice.