SCOTLAND’S hospitals could be pushed to breaking point this winter amid warnings health boards may struggle to cope with an expansion of the flu vaccine programme under the continued threat of Covid.

NHS Lanarkshire has red flagged its immunisations roll out as ‘very high risk’ in official documents, with others boards raising similar concerns about capacity, funding and safety.

The Scottish Government is considering making the flu vaccine available to more adults this year in preparation for a possible second wave of the coronavirus.

One health board said it is working on the presumption that all those over 55 will be offered the jab.

The Scottish Government has said it will outline changes to the eligibility criteria when it has confidence there are adequate supplies of the vaccine to deliver the planned expansion.

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NHS Lanarkshire, which oversees a patient population of around 563,185, says it may not be able to fully deliver this year’s programme and warns that Covid-related anxiety could lead to a surge in demand for the flu jab.

The board also raises concerns about staffing and suitable spaces for GPs and other health professionals to vaccinate safely within social distancing constraints and suggests the appointment system may require to be “outsourced.”

It adds: “These factors have the potential to adversely impact on population health and avoidance of hospital admissions during the winter period.”

Labour’s health spokeswoman Monica Lennon said she is seeking an urgent response from Health Secretary Jeane Freeman to ensure boards are prepared for the worst case scenario of a double pandemic.

Currently, people with a health condition, those over 65 years old, pregnant women, healthcare workers and carers are eligible for the vaccine in Scotland - along with primary school children and children with a health condition, who will be offered the vaccine from six months of age.

NHS Lothian has said it is anticipating a 10% increase in demand for vaccines which could require “significant” extra funding while Glasgow’s health board said it is considering how it can increase delivery at GP practices, clinics and pharmacies amid the “new challenge” of Covid.

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A spokeswoman for NHS Western Isles said: “NHS Western Isles has been working under the presumption that eligible groups for influenza vaccination will be extended and are planning for all those over 55 and all health and social care staff to be vaccinated.

“The programme presents challenges in terms of widened extent, additional costs for delivery and accommodation but we are planning for the additional safety and staffing measures needed.”

Andrew Buist, chairman of BMA's Scottish GP Committee said GPs do have concerns about how flu vaccines will be delivered.

He said: "It is clear that the usual approach of general practice delivering the majority of flu vaccinations will not be possible under the present circumstances.

"There needs to be an all hands on deck, carefully managed, realistic and targeted approach to deliver the programme."

Covid is caused by infection with a new coronavirus (called SARS-CoV-2) and flu is caused by infection with influenza viruses.

Because some of the symptoms of flu and Covid are similar, experts say it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis.

According to some research in the United States it is possible to get both at the same time but the likelihood of it happening is still unknown.

Lisa Heidinger, a virologist based in Glasgow, said health boards will face a number of practical challenges in delivering the flu vaccine this year to an extended population, particularly if cases of Covid begin to rise and in the absence of a vaccine.

Ms Heiginger said: “There has been a lot of research done that shows a possible link between the mortality rate of Covid during influenza season.

“There is also the added issue that those that receive the influenza vaccination are also mainly those in the high risk/vulnerable category.

“So vaccinating them would have to expose them on some level to a healthcare setting. Whether a nurse visits them or they attend in person, that exposure is still there.

“The fact that it is projected that there may be a second spike at this time that could in itself hinder the vaccinations leading to a possible dual outbreak due to lack of protection of the vulnerable.

“Not to mention the strain to the NHS with both on their hands.”

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Influenza (Flu) and Covid-19 are both contagious respiratory illnesses, but they are caused by different viruses.

Scottish Labour Health Spokeswoman Monica Lennon said she is urgently seeking answers from the government.

She said: “NHS Lanarkshire’s cry for help on flu preparedness is extremely alarming.

“We must be prepared for the worst-case scenario, including a double pandemic, and these board papers are a massive wake-up call to Scottish Ministers to live up to their responsibilities.

“We need an update in Parliament from the Health Secretary about the preparedness of NHS Lanarkshire and health boards around the country to cope with flu pressures, a potential second wave of COVID-19 and other health needs, including thousands of delayed operations."

Dr Tim Allison, NHS Highland’s Director of Public Health said the board is putting plans in place in recognition of the “challenges of delivering the influenza vaccine” this year.

A spokeswoman for the Scottish Government said: “Planning is underway with Public Health Scotland and NHS health boards for this year’s seasonal flu vaccination and we are committed to supporting boards to ensure they can deliver it.

“We will set out how we will expand free eligibility for the 2020-2021 seasonal flu vaccine, when we have confidence that there is adequate supplies of vaccines in order to deliver on any commitments we make.

"These options will be driven by the best clinical evidence available.”