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Swine Flu Update

Volume 493: debated on Friday 12 June 2009

With permission, Madam Deputy Speaker, I should like to make a statement on the A(H1N1) virus, commonly known as swine flu.

Yesterday evening, the World Health Organisation raised its pandemic alert status to phase 6. The criteria for making this declaration are based on the geographic spread of the virus and not its severity. There is now clear evidence of sustained community transmission in countries outside north America, which means that we are facing the first pandemic for more than 40 years. Across the world, nearly 30,000 cases have been confirmed in 74 different countries. As of today, there have been 909 confirmed cases in the UK. There have been 144 reported deaths in six countries, but none in the UK.

Yesterday’s announcement means that it is even more important that the global community works together to limit the impact of swine flu. Over the last few years, the UK has supported the UN system, including the World Health Organisation, in pandemic preparedness and response capacity. We will continue to support the World Health Organisation and its partners in the crucial months that lie ahead.

In response to this particular outbreak, we have also now set aside a further £6 million in additional help for the international response. The WHO declaration does not, of itself, trigger any material change in our domestic preparations, which have been under way for several weeks now and are at an advanced stage.

The Department of Health is continuing to work with other Government Departments, health protection officers and other health care professionals to slow the spread of the virus. That work includes our strategy of giving antiviral drugs for the treatment of those with symptoms and prophylactically to those who have potentially been exposed to the virus, and, where appropriate, closing affected schools. As our knowledge about the virus has increased, we have been able to refine our strategy to be in line with the best public health assessments.

At discussions at the Civil Contingencies Committee this week, we were able to update our strategy to respond to the latest advice. That includes the use of clinical diagnosis rather than laboratory testing alone where there is a high probability that cases are positive and the more targeted use of antiviral prophylaxis, which is where antivirals are provided on a preventive basis to contacts considered most at risk of contracting the virus. In practice, that will include mainly household or household-like contacts, or, in a school context, those at surrounding desks, for example.

We have been monitoring our domestic response continually. The formal declaration of a pandemic should not affect people’s day-to-day business and it does not affect our assessment of how the virus is behaving in this country. It is important to stress that the majority of cases in the UK so far have not been severe, with those catching the virus making a full and fast recovery—though a small minority of cases have been more serious.

As I said, the Health Protection Agency reported 909 confirmed cases of swine flu in the UK. Twenty-eight people are known to have been hospitalised and the majority have already made a full recovery. Nearly all those people had previous underlying conditions. We now have enough antivirals to treat half the UK population, with orders to increase that to 80 per cent. We also have orders for 226 million facemasks, 34 million respirators and 15.2 million courses of antibiotics, which will be delivered within the coming months.

The free swine flu information line, along with the nationwide leaflet, TV and advertising campaign, has kept the general public well informed about the steps they can take to protect themselves and limit spread. However, we recognised from the outset that we would be unlikely to prevent a widespread outbreak indefinitely. In recent days, there have been significant increases in the daily number of cases in certain parts of the UK, most notably Scotland, where Health Protection Scotland has concluded that sustained community transmission appears to be taking place. This is characterised by an increased number of sporadic cases—that is, cases with no identifiable link with other confirmed cases.

Those increases come as no surprise and are in line with what we know from similar outbreaks, but it remains the case that, at some point, we will need to move our focus away from limiting the spread of a localised virus towards mitigating the effects of a widespread virus. I want to be clear: that point has not yet been reached. We continue to monitor the situation carefully, and any decision to move to mitigation will be based on the best public health, clinical and scientific advice.

There is always a careful balance to be struck between benefit and risk when offering any drugs to healthy people. The extra knowledge that we have gained during the last six weeks of containment means that we can now refine our approach. The Health Protection Agency will be using all its expertise and clinical judgment to look even more carefully at the circumstances behind local outbreaks before deciding who should be given antivirals.

The single most effective way to limit the impact of any future epidemic is the successful development and distribution of a vaccine. Significant progress has already been made, including the identification of virus prototypes, which are so important in the production of the vaccine.

The declaration of phase 6 is highly significant because it means that manufacturers will now be expected to meet the contractual obligations of advance purchase agreements for vaccine that countries, including ourselves, had already agreed in the event of phase 6 being declared. We are already speaking to manufacturers to agree what this means for our own plans for full country coverage of pandemic-specific vaccine, should it be required. We have advance purchase agreements that enable the UK to purchase up to 132 million doses of pandemic-specific vaccine—enough for two doses for 100 per cent. of the population, should that be necessary. On current projections, we expect the first deliveries of the pandemic vaccine to arrive in the autumn.

Current indications are that seasonal flu vaccine production is well advanced and is expected to be completed in the next few weeks with the requested UK quantities being delivered at the usual time. The WHO does not expect switching to pandemic flu vaccine production to have an impact on seasonal flu vaccine production.

The final important thing to stress is that people should continue to follow our advice on good hand hygiene, and the “catch it, bin it, kill it” messages. They should cover their noses and mouths with tissues when they cough and sneeze, throw the tissue away, and wash their hands. People who have flu-like symptoms should not panic, but should stay at home and check their symptoms using the online symptom checker or the swine flu information line. If people are still concerned, they should call their GP or NHS Direct.

The WHO’s announcement is an important signal that all countries should now ready themselves to deal with increased flu cases. The UK has been preparing for this for years. We are recognised by the WHO as one of the best prepared countries in the world, so we are in a very strong position to respond to the global pandemic we now face.

I commend this statement to the House.

I am sure that the House will be grateful to the Secretary of State for giving us an update in the light of the World Health Organisation’s announcement yesterday about the move to pandemic phase 6 status.

In addition to thanking the Secretary of State, may I extend through him our thanks to all the staff in the Department of Health, the Health Protection Agency and the NHS across the country for the way they have responded to the spread of this virus? I reflect, as the Secretary of State perhaps has, on the fact that preparation turned out to be very important and useful. The spread of the virus in this country, relative to the spread in some other countries, has been limited. The containment strategy has clearly had a substantial beneficial effect, not least because in Scotland the schools are breaking up for the holidays and because we will shortly be seeing the school holidays in England. There was a risk that if the virus had spread rapidly it could have had a big impact on the public examination system, but it did not have as big an impact as it might have done. The containment strategy worked well, from that point of view. We should convey our thanks to all the staff involved.

I entirely endorse what the Secretary of State had to say about the desirability of maintaining a containment strategy while we can do so, and agree that it is perfectly reasonable to do so with more limited use of antiviral drugs, if we can do that. We do not want to medicate people if it is not necessary. Clearly in Scotland, and perhaps soon in England, we may need to move to a mitigation strategy rather than a containment strategy, and in that context, and bearing in mind the risks of a substantial recurrence of the virus in the autumn—in our flu season—the need for preparation is even greater now that we are in a pandemic phase. We will increasingly see additional cases coming into this country from overseas, as well as community transmission in this country. To that end, may I ask the Secretary of State a number of further questions about the preparations that we undertake in this country?

The Secretary of State will have observed that Professor Neil Ferguson’s report the other day suggested the desirability of surveillance in hospitals of young adults who present with respiratory illness, as the virus seems not to attack the elderly particularly, and to attack young adults especially. Does he propose that the Department and the NHS encourage that surveillance?

The Secretary of State has talked about the current strategy of restricting the use of antivirals to close contacts. He will know that our view is that we should, in the mitigation phase, continue to pursue what is called a household prophylaxis strategy—that is, we think that close contacts of people who are confirmed or suspected of having the virus should be offered antivirals. In that context, he will know that the phase 6 alert from the WHO, under the contingency plan, should trigger the national pandemic flu line, which is not the same thing as the free swine flu information line. People should be able to ring the pandemic flu line to have their diagnosis confirmed, to have a prescription for antiviral drugs confirmed, to be given a unique number, and to be told where their collection point is.

On that flu line, in papers supplied only a few months ago to the House of Lords Science and Technology Committee, the Department of Health said:

“Signing the contract in December”—

that is, December 2008—

“should mean that the National Flu Line Service system is available for use in the event of a pandemic by April/May 2009.”

The Secretary of State knows that that is not the case, and that the national flu line is not available, even though it is due. Will he explain why? In addition, the national flu line should link to the distribution of antivirals through collection points. The same document said:

“In line with the NHS Operating Framework, the target date for identification of Antiviral Collection Points is the end of December 2008.”

So by now, primary care trusts across the country should know where those collection points are, but clearly they do not. There appears to be continuing uncertainty and confusion among community pharmacies about whether they should, or should not, be the antiviral collection points. Will the Secretary of State confirm that in many cases they should be? Community pharmacies that currently seem uncertain about whether they should be a collection point, and resistant to the thought, should be. We are not talking about people with flu symptoms visiting their local pharmacies; clearly they should not do that. We are talking about flu friends visiting local pharmacies.

Will the Secretary of State ensure that we have a further debate about the issue of school closures in the autumn? If the virus continues to be relatively modest in its severity, there will be an argument that school closures may be an excessive response, but there is also an argument that if there is a very large number of cases, and if schools look like they are places where the virus will spread rapidly, there would be a risk that if we did not close schools for a short period where cases were confirmed, we would overwhelm local health service facilities.

On health care facilities, can the Secretary of State say what measures have been taken to extend critical care capacity for the coming flu season? What has been done to make available teams trained in the use of non-invasive ventilatory support? The document from the Department on surge capacity suggests that in the case of this virus, such a strategy might be desirable. Can he say further, or let us know later—

Order. May I ask the shadow Secretary of State to begin to draw his comments to a close, because we are interrupting discussion on private Members’ Bills, and there are quite a few Members hoping to catch my eye?

I have just a couple of questions to ask, if I may, about critical capacity. Under what circumstances might elective work in hospitals be stopped, and what has happened to the concept of enhanced rest centres, which were to have helped to offset the pressure in the acute sector? Finally, what more can we do to help developing countries, in addition to providing £6 million for that purpose? What would happen, for example, if the virus were to reach South Africa in its current flu season? It is a developing country that has a serious problem with the risk of HIV immune-compromised patients, but its medical system would have the capacity to deliver antivirals rapidly to patients if the country had access to sufficient antivirals; many developing countries do not have that capacity. Can we contrive to assist southern Africa, for example, in responding to the outbreak?

I thank the shadow Health Secretary for the measured tone of his comments, and the help that he has given us today to ensure that together we can give a reassuring message to the public, as we should. I strongly agree with him that we in the House should today send our thanks to staff in my Department—the Department of Health—and the Health Protection Agency, and to front-line NHS, public health and local government staff, who are working on the ground to ensure that we are in a strong position to deal with the outbreak.

As the shadow Health Secretary knows, we have been preparing for years. I was pleased with his acknowledgment that the containment measures that we have worked to put in place have had an effect. That in itself has given us more time to improve our preparedness for the spread of the disease. He said that we should maintain the containment strategy, and I should like to confirm that that is our intention. Nothing is changed by the WHO’s declaration; we continue to follow the plans that we have laid out. However, obviously it is important to keep that under review. There will come a point when we have to move from the containment to the mitigation phase, as he acknowledged, but we are not there yet. We keep the matter under review, and we would update the House at such a point.

The Civil Contingencies Committee will consider the matter next week, including what the trigger points might be for moving from the containment phase to a mitigation phase, and what arrangements are needed to ensure successful distribution and treatment in that phase. Those are matters that we will consider next week with colleagues from Scotland, Wales and Northern Ireland. Of course we will update the shadow Health Secretary and the House when we have more information to give. On the decision taken this week about flexibility, I should just say that it is important to allow flexibility to the experts on the ground where clusters have developed. That was very much the message from Scotland. We agreed to that flexibility this week, and we think it is the sensible thing to have done in the circumstances.

The shadow Health Secretary asked me about the work of Professor Neil Ferguson and, in particular, the surveillance of young people in hospitals. I want to reassure him that we recognise the importance of that. As he will know, Professor Ferguson is on the Strategic Advisory Group of Experts, or SAGE. Obviously, his advice is being fed in directly to us on matters such as the one we are discussing. The hon. Gentleman also asked about restricting the use of antivirals to close contacts. I think he asked that question in the context of the mitigation phase of the spread of the disease. I want to assure him that that is precisely the kind of thing the committee will consider next week. The balance has to be struck between a flexible response that is practical for health professionals, including public health professionals on the ground, and taking sensible and precautionary steps to prevent the spread of the disease. But we think the important thing is to give public health professionals the flexibility that they need on the ground to make those judgments. We will consider the matter in more detail next week and I will update the hon. Gentleman at that point.

The shadow Health Secretary asked about the national pandemic flu service. As I indicated in my statement, that will be up and running by the autumn. We have put in place interim services to give the public the information that they need. We have well developed plans for such a service which, as I said, will be in place by the autumn, and it will be able to deal with the demand, as necessary.

The hon. Gentleman suggested that there was some uncertainty and that PCTs did not know where collection points were. May I assure him that work is continuing to refine plans to set up the collection points, should they be necessary? Ian Dalton, director of NHS Flu Resilience, has worked in close partnership with PCTs on this. The hon. Gentleman also asked about the role of pharmacists. Again, that is an issue we will consider next week, and I will update him on that.

It is important for the public who are listening to this debate not to get a sense that there is about to be a widespread plan for school closures. I am sure the shadow Health Secretary would agree that it is business as usual and that life must go on. Obviously there may be circumstances in which the HPA considers it necessary to require or advise school closures because that may help with local containment of the disease. It is properly a decision taken at a local level on the advice of the HPA, but at all times it is the head teacher and the board of governors of any school who should listen to that advice and take the necessary action. However, it is important to keep the issue in proportion and avoid overreaction.

The hon. Gentleman’s two final points were about critical care capacity and other measures in the national health service to deal with any expected pressure on NHS services as we work our way through. I want to assure him that I had a conversation with David Nicholson, the chief executive of the NHS, very soon after coming into office, in order to be assured that and understand how the NHS is ready to cope. It is important to say that the NHS has been preparing for this moment for a long time, and it was an important part of the operating framework which was sent out to the NHS last year. The plans are in place and we will ensure that the capacity is in place where it is needed. I am grateful to the hon. Gentleman for raising that point.

Lastly, of course we need to work through the WHO to ensure that we assist developing countries to manage the spread of the disease. I mentioned the £6 million that we have allocated for this purpose. The hon. Gentleman was right to mention southern Africa and the obligations that we have to help across the developing world. We take those incredibly seriously, and we will update the House as we have more information on precisely what practical steps we will take to make that happen.

I, too, thank the Secretary of State for making the statement today. In the context of the World Health Organisation decision to raise the alert status, it was important that the House be made aware of the Government’s position. I raised the issue of a pandemic and our preparations for it in a debate five or six years ago, at which time we were inadequately prepared. Enormous progress has since been made, and I give credit to the Government for their response to the current situation.

Given that the Government have, I think, been acting appropriately, does the Secretary of State share my concern that there might still be a lack of public understanding of some of the consequences? The media have generally been helpful, but there were elements of alarmist reporting in the early stages and, more recently, perhaps of complacency. The most important thing that the Secretary of State has to do is to increase public understanding of what is an appropriate response. He mentioned the closure of schools. That is often an important component of the response, particularly in terms of containment, because it removes a potent incubator population from the local community rather than any particular threat to the children at the school.

Does the Secretary of State foresee any difficulties if and when he feels it appropriate to move from the strategy of containment to the strategy of mitigation? Questions will inevitably be asked—“Why are we no longer being given Tamiflu when, last week, that was the response?” He needs to think through how he gets that information across. He must be clear about the level of prophylaxis and the distribution of antivirals if we move to a mitigation stage.

For instance, are we still going to concentrate on health care professionals in the wider sense—all those who work in close proximity to patients? I speak as a former optician. I realise that I would be likely to be in some danger of spreading the disease, were I working in close proximity to the face of someone who was affected.

What is the Secretary of State’s epidemiological assessment for the UK? Is he expecting a rapid increase over the coming weeks, or that when we reach the period for seasonal flu outbreaks in the autumn, we are likely to see a rapid escalation in the incidence of community infection in this country? In that context, are there any dangers inherent in the combination of swine flu and seasonal flu? How will the professionals know how to respond appropriately? Will they be aware which immunisation they should give, for instance, and will they be aware of the circumstances in which they should give a double immunisation, if appropriate?

Lastly, there was a reference in the statement to using clinical diagnosis to a greater extent, rather than laboratory testing. That is, of course, sensible but it raises questions about getting an accurate picture of the levels of infection. Is any differential diagnosis now available between swine flu and seasonal flu?

I pay tribute to the hon. Gentleman for his foresight in bringing the issue to the House all those years ago. I mean that genuinely. It was important that colleagues with a scientific background and understanding of these matters raised public awareness and the public debate, and I am grateful for his acceptance that the Department for Health, the Health Protection Agency and others responded and significantly upped their game. As a former Health Minister coming back, I know that the subject occupied a great deal of my time two years ago, so I can assure him that the importance of the issue was internalised a long time ago.

The hon. Gentleman mentioned the media. Perhaps I can do something that not many Members of the House have felt inclined to do for some time, and thank colleagues in the media for the balanced, fair and accurate way in which they have put over to the public information about the outbreak. That has characterised the vast majority of the media coverage so far. All of us, in all parts of the House, want that to continue through the rest of the year. It is important that we give a clear message to the public that things carry as normal.

The hon. Gentleman asked about the move from containment to mitigation and the issues that might arise about public messaging. I understand his point. Along the trajectory of this outbreak, there will be points where careful thought will have to be given to public messaging. Of course, there is a balance to be struck between the practicality on the ground for health staff carrying out the strategy, and the successful containment of the disease. The clear consensus of the committee this week was that we should give that flexibility to the Health Protection Agency.

The hon. Gentleman says that people might draw a distinction based on whether they can get an antiviral in one part of the country but not another. It is important to point out that there are dangers in over-prescribing and in giving medication to healthy people. That also has to be a consideration as we try to get the balance right.

The hon. Gentleman asked me to speculate on the projection of the disease, but it is important that I do not get into what can only be speculation at this stage. Obviously, there are scenarios for the development of the condition, which could take different paths, one of which he mentioned. There are also other potential scenarios. I assure him that the relevant scientific advice is being given to the committee. We need to plan for all scenarios, and that is what we will continue to do. The strategy has been described as “hope for the best, plan for the worst”. We will continue to plan for the worst at all times and make sure that robust plans are in place. I assure the hon. Gentleman on that point.

What the hon. Gentleman said about clinical diagnosis rather than lab testing was very much in tune with what I said earlier about flexibility for health staff. That is a sensible and practical step to take at this moment. At all times, we want to preserve an accurate picture of how the disease is spreading in the country. We have plans in place to ensure that.

Order. I ask hon. Members to ask just one single, concise question. If responses are brief, all Members present might be successful in catching my eye. I am ever-mindful that we have interrupted private Members’ business.

Across Whitehall and in many parts of the economy a great deal of planning has taken place because of fears of an outbreak of avian flu. I thank the Secretary of State for his calm and well informed statement and I am grateful to his Opposition counterparts for their approach. Will the Secretary of State assure the House, as I expect he can, that what we learn from swine flu will be fed into the longer-term planning for a more serious outbreak of avian flu, which we still expect to happen one day?

I thank my right hon. Friend for his important question. The information that we are gathering now is important not only for the immediate challenge that we face but, more generally, in preparing the country for any challenges in the future. That is why we have to strike a balance between practicality on the ground and accuracy. That takes me to the point raised by the hon. Member for Somerton and Frome (Mr. Heath). There is some discussion about the hospitalisation rate for the condition. The figure given by the World Health Organisation is 7.5 per cent., but it could be higher because of under-reporting in other parts of the world. It is important that at all times we try to get as accurate a picture as possible, not only to help in the here and now but to leave information that will be useful to future generations in dealing with any similar or worse conditions.

I congratulate the Secretary of State on his promotion to the top of the greasy pole at the Department of Health. I warn him, however, that if his party changes leader in October, his tenure might turn out to have been short.

Sadly, the Secretary of State has said nothing today about travel, although most of the country are thinking about going away, including many people in Hinckley, Burbage and Market Bosworth in my Leicestershire constituency. What advice is he giving? So far, we have had only two cases in Leicestershire, but there is real concern. Finally, is he trying to reach young people through YouTube and Facebook?

I am grateful for the hon. Gentleman’s congratulations and I look forward to discussing complementary therapies with him at great length in the coming weeks.

The advice on travel has been clear throughout: there are no border closures and no restrictions on travel. The World Health Organisation reiterated that yesterday; I did not reiterate it again because I did not want to imply that there might be a problem. There is not a problem; there are no restrictions on travel at all.

I understand that the Health Protection Agency, whose headquarters are based in my constituency, is encouraging the testing of people who have flu-like systems but have not travelled to one of the high-risk countries. Will my right hon. Friend confirm that all primary care trusts in London are able to run the required algorithm and that GPs have sufficient swab-taking supplies in their practices? Barnet, my PCT, has that facility. Its area has had seven cases; the first case in Barnet occurred in my constituency. It is important that all PCTs should be able to run that algorithm.

I can give my hon. Friend that assurance and I will write to him with further details on that point.

Will the Secretary of State consider preparing for to issue of a written statement on Monday? It could answer some of the detailed questions to which I am not sure the House has heard the answers this morning. What is the telephone number, either now or then, that someone should ring if they believe that someone in their household might have one of these respiratory conditions?

I would grateful if the hon. Gentleman said what he has not heard that he wants to hear. I answered the shadow Health Secretary’s questions. If the hon. Member for Worthing, West (Peter Bottomley) want answers to specific questions, I would be grateful if he submitted them to me today in writing. I shall make sure that he gets an immediate response. The swine flu information line is 08001513513.

I welcome my right hon. Friend to his new post. As he is new to it, he might not know that one of the early outbreaks of swine flu took place in Finsbury in my constituency, when a young Australian man came back from Mexico. However, the outbreak has been contained because of that man’s responsible behaviour and the prompt action of the local medical staff. Will my right hon. Friend join me in thanking them for their prompt and appropriate behaviour?

The most admirable thing about our national health service is how, at moments such as this, committed people up and down the country move into action and work hard to protect the public. That is a great thing. The shadow Health Secretary was right to raise that point; we would all wish to thank those people. We will be calling on them in the coming months, but as always they will be there for us and up to the task.

If there is a large increase in the number of people infected by swine flu, as we seem now to be anticipating, the national flu pandemic service will be the only means of distributing antiviral drugs. Why is that service not already up and running, as was intended? What has gone wrong with the BT contract? Will the Secretary of State give a clear explanation? What does he mean by “the autumn”?

We have put in hand plans for a national service that can deal effectively with the mitigation phase of the condition, as and when it is reached. A detailed business case for the service has been prepared. That, of course, has to be tested to ensure that it delivers proper value for money and that the system being developed does the job that we want it to do. That work is now well in hand, and as I said in my statement, the service will be up and running by the autumn.

It has been suggested that widespread prophylactic use of antivirals could lead to the development of resistance to those antivirals in the virus itself. Is that factor being taken into consideration in planning the use of antivirals?

The hon. Gentleman makes a good point. That is a consideration. The decision taken this week on restricting the use of antivirals prophylactically is mainly because of the practicalities of doing it for health staff. However, he makes the important point that overuse of medicines among the healthy population is never sensible.

I thank the Secretary of State for his courtesy in coming to the House so promptly after yesterday’s statement by the WHO—perhaps that will spread like a contagion among his colleagues, so that they too make rapid statements. Are any special measures being taken for those who have a lot of contact with people coming in from overseas, such as those who work at Luton airport, or those in my constituency at Yarl’s Wood, who deal so promptly with a lot of asylum seekers coming into and out of detention?

I do not believe that any particular measures are being taken for immigration staff at the moment; I will seek to get the hon. Gentleman a fuller explanation of why that is the case.

The Secretary of State has now admitted that he cannot prevent a widespread outbreak of swine flu. Why is it not better to have that widespread outbreak in the summer rather than putting it off until the winter?

My family love me, but there is a limit to what I can do, four days into the job. I am doing my best, as is everybody else, to ensure that the country is prepared. It makes sense to contain the condition as much as possible to give us time to put the necessary systems in place on the ground to take the country through this particular moment. [Interruption.] I am still slightly taken aback by the hon. Gentleman’s question.

The Secretary of State only touched on the impact of school closures and said that that will be a local decision. However, many people will be worried about the possible effect of school closures on parents and the knock-on effects on businesses. What assessment have the Government made of that possibility, and what discussions has he had about it with other Government Departments?

Obviously, we are working closely with other Government Departments to get our advice right on this point. School closures continue to be discussed by the civil contingencies committee, and we will update the hon. Gentleman and the House as necessary. Although more serious in a minority of cases, it is important to reiterate that in the vast majority of cases this has been a mild condition, and people have made a very speedy and full recovery. It will be important not to raise heightened concern about widespread school closures. Where they are necessary to prevent the spread of the disease within a particular area, let us leave that to the professionals and the experts. If they wish to give advice to school governors and head teachers, that is how these things should properly be done. It is not necessary at this stage to have a national policy on school closures, or whatever the hon. Gentleman seems to be pointing towards. Let us deal with this calmly as we go along, but at all times taking the steps advised by the experts.

On a point of order, Madam Deputy Speaker. May I point out that Front Benchers took 31 minutes to make their opening statements and ask questions, so you inevitably had to curtail the few Back Benchers who are present in our questions? I understand that, but will you and Mr. Speaker look into whether Front-Bench contributions should be formally time limited?

I can inform the hon. Gentleman that they are time limited, for that very reason, and that is why I intervened. That is even more important today, because it is a day for Back Benchers to bring their Bills before the House.