NHS: Respiratory Syncytial Virus Infections

Baroness Ritchie of Downpatrick Excerpts

Thursday 9th June 2022 Grand Committee

Asked by

[Baroness Ritchie of Downpatrick]

To ask Her Majesty’s Government what assessment they have made of the cost to the NHS associated with managing Respiratory Syncytial Virus infections.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank the Minister and the Front-Bench speakers in this important debate, particularly as we emerge from Covid-19 and given the other respiratory viruses that are live in the community. I declare a personal interest: as an infant, I had pneumonia, which was one of these deep-seated respiratory viruses. I am talking about 64 years ago, but the viruses were all put in the family of pneumonia. Out of that emerged bronchiolitis.

Several questions are raised about this issue. The first is: what is respiratory syncytial virus infection? It is a leading cause of severe lower respiratory tract infections among young children and infants. An RSV infection usually causes mild and self-limiting symptoms in children and adults, which resolve within a couple of weeks. Symptoms can include a runny nose, fever and persistent cough—something that most of us can identify with. However, modelling suggests that the virus is responsible for 50% to 90% of hospitalisations among young children due to bronchiolitis, which is a common lower respiratory tract infection predominantly affecting babies and children under two years old. Up to 40% of hospitalisations are due to pneumonia.

So why the concern about RSV now? In late 2021 and early 2022, modelling predicted that RSV levels may double compared to a normal year, with a 100% increase in cases in young infants and a 40% increase in overall infections expected. As a result of the Covid-19 pandemic, the 2021-22 RSV season may be longer, with spikes in infection expected sooner than usual. There was a significant reduction in respiratory viruses during Covid-19 lockdowns, which limited infant exposure to RSV and thus impacted overall immunity. As the restrictions eased, it became apparent that there had been a significant rise in RSV cases and admissions.

Most hospital admissions for RSV in the UK occur in babies who are otherwise healthy. Despite the risk to all infants, studies suggest that 88% of pregnant women and 66% of midwives have no or little awareness of RSV. There are now widespread concerns in the medical community around the impact of RSV on an already stretched health service in the coming months and the cost to the health service of managing RSV infections—hence the subject of this debate.

In an average season in the UK, RSV is estimated to be responsible for more than 450,000 GP visits in children and adolescents, 125,000 cases of ear infection and 416,000 prescriptions of antibiotics. On secondary care, the Academy of Medical Sciences said:

“A lethal triple mix of COVID-19, influenza, and the respiratory virus Respiratory Syncytial Virus (RSV), could push an already depleted NHS to breaking point this winter unless we act now”.


With RSV, there is a cost to the health system, including £48.2 million for secondary care and hospitalisations. There is a direct cost of £65 million, with £15.7 million being spent in primary care on GP consultations. There is also a socioeconomic cost from the direct financial losses of the family and carers of children diagnosed with RSV. These estimated costs are just over £14 million in productivity losses every year. In addition, RSV in children under the age of five is estimated to cost an accumulated total of almost £1.5 million from the out-of-pocket costs incurred to families.

We have to ask what should be done to alleviate the burden on the NHS and to provide relief to infants and young families. In the wake of the Covid-19 pandemic and the nature of RSV infections, what consideration have the Minister and the Department of Health given to this matter? What assessment have the Minister and the department, working with the NHS, undertaken on those costs, bed blocking and the impacts on primary and secondary care? What is the impact on hospital and workforce capacity and waiting lists? What consideration have the Minister and the department given to ensuring that RSV infections could be treated in the community and in homes?

There are other questions to which I would like answers. What steps is the Department of Health and Social Care taking or planning to take to reduce the costs of managing RSV for the NHS, families and the economy, particularly with the overprescription of antibiotics leading to problems with resistance? What is the proper treatment? What discussions have taken place with medical professionals and clinicians to ensure that infants and young children receive the best treatment for full recovery? What learnings from the Covid-19 pandemic is the Department of Health and Social Care considering implementing for other respiratory viruses, such as RSV?

In conclusion, the bottom line is to ask what plans are being made and what funding has been set aside to ensure that protection against respiratory viruses remains a health priority for the upcoming season this autumn and into the winter and that there is better management to deal with them. What new policies are being forged to address RSV infections and to cope with the demands on the NHS? We must not forget that not only the infected child feels the burden of RSV; their families, carers and the health service are also impacted. The seasonal and contagious nature of this infectious disease has raised wider concerns over the possible impact on healthcare capacity, which has been re-emphasised during the Covid-19 pandemic, particularly when the NHS has been overburdened and overstretched.

I look forward to the developing debate and the answers that the Minister can provide. I like to think that this will be the first stage of an opportunity to give this subject a greater level of debate in your Lordships’ House, as it will become much more acute and apparent as we emerge from the Covid-19 pandemic and approach this autumn’s influenza and RSV season.