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Swine Flu Update

Volume 496: debated on Monday 20 July 2009

With permission, Mr. Speaker, I would like to make a statement on the AH1Nl swine flu pandemic. I wish to do three things today: to update the House on the spread of the virus, to provide additional details about the launch of the national pandemic flu service, and to set out how Members in all parts of the House will be kept informed during the summer recess.

In recent weeks, we have discovered a great deal more about the swine flu virus. While it has spread quickly, the virus has not become more dangerous. For the vast majority, swine flu remains a mild and self-limiting illness—and let me be clear: our advice to the public about dealing with it has not changed. However, as the number of cases rises, it is understandable that people are becoming more concerned, and all organisations have a role to play in providing reassuring, consistent and clear advice.

First, I wish to deal directly with advice to pregnant women, which, again, has not changed since the outbreak began. The chief medical officer says that most pregnant women with swine flu will get only mild symptoms, but pregnancy brings a higher risk of complications. Bearing these risks in mind, at present mothers-to-be are advised to continue normal activities such as going to work, travelling on public transport, and attending events and family gatherings. However, they are advised to take the following steps to reduce their risk of infection and complications: first, to observe good hand hygiene, with frequent use of soap and water; secondly, wherever possible, to avoid contact with someone who is known or suspected to have swine flu; and thirdly, if they have flu-like symptoms, to make early contact with a general practitioner, who may advise treatment with antiviral drugs. If in doubt, pregnant women should seek advice, and if they think they have symptoms, they need to contact their GP as soon as possible for antiviral treatment. The chief medical officer will be reissuing this advice later today.

I also understand that families with small children have concerns. The key characteristic of swine flu is fever. The first thing that parents should do is check whether their child has a temperature at or over 38° C. They should then contact the national pandemic flu service, once it has launched, or their GP, if their child has a high temperature and any one of the following symptoms: tiredness, headache, sore throat, shortness of breath, loss of appetite, vomiting and diarrhoea, aching muscles, or limb and joint pain.

Since my last statement to the House, the daily reported figures from the Health Protection Agency have been replaced by weekly estimates based on the numbers reporting flu-like illness to their GPs. The latest figures published on Thursday show how the number of cases has grown, with 55,000 new cases of swine flu reported last week alone. There were 652 people in hospital, 53 of whom were in critical care. There had been 26 deaths in England.

The figures also confirm that the virus has now taken hold around the country, rather than in isolated pockets, and show how quickly this has happened. On 8 July, just six primary care trusts reported exceptional levels of flu-like illness. By 15 July, this had increased to 110 PCTs—hence our immediate decision last week to activate the national pandemic flu service. The latest figures show that nine out of 10 NHS regions are now showing exceptional levels of flu-like illness, based on GP consultations.

GPs are on the front line in this pandemic. They are coping admirably with the increased work load, and I am sure that the House will want to extend its thanks to them, to their staff and to everybody working so hard throughout the health service, the Health Protection Agency and the Department of Health. All professionals deserve our full support, and the best way to do this is to find new ways to relieve pressure on the front line.

The technology to launch the national pandemic flu service has been available for some time, but given the latest HPA figures, and drawing on advice from the field, we have now reached a point where the service is required. I can therefore confirm that the service will go live in England by the end of this week, subject to testing. It will be accompanied by a major public information campaign. After the launch, people will no longer need to ring their GP: they can either answer questions online via the new website or ring the call centre service, where trained staff will be able to assess them over the phone. If swine flu is confirmed, they will then get an authorisation number, which their flu friend can use to pick up antivirals from local antiviral collection points. I will ensure that all Members receive information on the location and number of collection points in their area before the launch of the service later this week.

In Scotland, Wales and Northern Ireland, the situation is different. We have not seen the same rate of spread, and, as a result, the service will not be in operation in those countries this week, but they may choose to opt in at a later date. People in those regions should, therefore, continue checking their symptoms on the NHS website, or via the swine flu information line, and then call their GP for diagnosis over the phone.

The Government must be as open as possible about the potential scale of the threat, so that organisations in the public and private sectors can plan effectively. Last week’s planning assumptions set out reasonable “worst case scenarios” for them to plan against. We published a range of figures covering the numbers who could get swine flu; experience complications, and be hospitalised or die. The assumptions also cover the number who could be absent from work because they or their family get swine flu.

Let me stress again that those are worst case scenarios, not predictions—and we need the media to play their part in reporting them as such. For the NHS, the assumptions mean that it can now step up its preparations to cope with a sudden surge in swine flu cases, and it already has detailed plans in place. Similarly, infrastructure providers and other essential operators, such as food suppliers and electricity, gas and water companies, already have continuity plans to maintain services. However, organisations of all kinds should now establish plans to reduce the threat that swine flu poses to the economy.

The Government have published guidance documents on continuity planning, and we have also set up a new business advisory network for flu to provide a single source of information and advice. Full details are available on the business link website—

Let me now update the House on vaccines. The Department of Health has already signed contracts with two manufacturers to supply enough vaccine for the whole population. According to their delivery schedules, we should begin receiving supplies from August, with enough becoming available for at least 30 million people by the end of the year. Clearly, we want the vaccine to be available as soon as possible, but we cannot compromise on safety. We will take all necessary steps to ensure that the vaccine is appropriately tested.

We are also now planning the vaccination programme so that we can start administering vaccines to priority groups, including NHS and social care staff, as soon as we get the green light to proceed. We will continue to take the best independent scientific advice on all questions about vaccination.

Finally, I recognise that hon. Members must be updated during the parliamentary recess. I have therefore asked strategic health authorities to provide weekly briefings for MPs coinciding with the HPA’s national updates. They will cover local information on the number of diagnosed and confirmed cases and hospitalisations, as well as updates on antiviral collection points, local information on any clusters or other specific developments, and a hotline number for hon. Members to use to contact their local strategic health authority.

In addition, the civil contingencies committee will meet weekly, and Ministers and officials will be in close contact throughout the summer months to respond to emerging issues. This evening, there will be a briefing session open to all Members with the chief medical officer.

I am also grateful to the hon. Members for South Cambridgeshire (Mr. Lansley) and for North Norfolk (Norman Lamb) for the constructive conversations that we have had. I will of course keep Conservative and Liberal Democrat Front Benchers updated over the summer, and we will continue regular discussions with Health Ministers in Scotland, Wales and Northern Ireland to ensure a consistent UK-wide response.

In conclusion, concern has risen and there is increasing pressure on services, but there is no change to the advice or to Government plans. It is because we have planned carefully for this eventuality that we have large quantities of antivirals, a national pandemic flu service about to launch, and a vaccine on the way. That constitutes a solid base on which to deal with future challenges. I commend the statement to the House.

The House will be grateful to the Secretary of State for his further update on the flu pandemic response. I am sure that hon. Members also wish to offer our condolences to the families of those who have died as a result of contracting the H1N1 virus. Again, I join the Secretary of State in expressing our gratitude to all the NHS staff, particularly in primary care, for their response to the growing pressures arising from the virus.

The House will know that we supported the containment strategy and the shift to a treatment-only policy. In time, it will be important to understand how effective the containment strategy was in practice. There is some evidence to suggest that a significant number of people who might have been given antiviral treatment while the containment strategy was being pursued, or given prophylactic access to antiviral drugs, did not in fact receive it. Will the Secretary of State agree to a review of that in due course, although obviously not at this stage?

It is clear that there is still a considerable degree of confusion about what people should and should not do about this flu. Publishing planning assumptions and preparing for the worst is one thing, but we really do need the Government more effectively to explain that, up to now, we are not experiencing the worst-case scenario, and that we can therefore take a “business as usual” approach, except for those who have symptoms or contract this influenza. Can the Secretary of State confirm that from later this week, everyone who needs to will be able to access diagnosis and antiviral treatment via the pandemic flu line? Will he say what are the maximum distances to what he describes as local antiviral collection points? Can he explain why pharmacists are being used in some areas but not in others? Why cannot they be used more generally for now, while the numbers involved remain limited?

Over the weekend, conflicting advice was issued to expectant mothers. Consistent and accurate advice is paramount in a situation in which we are trying to maintain public confidence, so can the Secretary of State tell the House what steps he is taking to ensure that the chief medical officer liaises with the royal colleges and other associations to achieve consistency and clarity of advice to the public?

An interim solution for the national pandemic flu line is to be put in place. We know that the Treasury delayed until December signing the contract for a full solution with BT. Even so, this March, the Secretary of State’s Department said that it could be available by April or May. It should, according to the plan, have been activated in mid-June, when the pandemic alert was declared, but it was not. To that extent, it is a month late. It is clear that much of the confusion that we have seen in that month could have been avoided if the Government had delivered the pandemic flu line on time. BT says that it did all that was asked of it. Who and what caused the delay?

The Secretary of State still maintains that vaccination could begin by September. There is a great deal of public interest in a potential new vaccine, so it is vital that the Government set out clearly the process for licensing and implementation. Clearly, the fact that a vaccine has been manufactured does not mean that it has been licensed by the European Medicines Agency, the EMEA. We do not yet know whether the EMEA will be able to fast-track licensing based on the mock-up dossier, or whether it will need additional clinical data. We do know that in 1976, the US authorities began a vaccination programme with an unlicensed vaccine that had damaging side-effects. Can the Secretary of State therefore confirm that it is the Government’s intention to proceed only with a licensed vaccine?

I have asked the Secretary of State and his predecessors several times for a debate on vaccine prioritisation. Will he publish the advice on the criteria for that, and on the benefit of vaccinating young adults compared with vaccinating the elderly, who appear to have some acquired immunity? Can he tell us how many people aged 55-plus are estimated to have contracted the virus? Of course, we need also to know who he anticipates will fall into the at-risk category groups for vaccination, coming immediately after health and social care workers.

We have to plan for many more hospitalisations over coming weeks. The planning assumptions are for a clinical attack rate of up to 30 per cent. Will the Secretary of State now publish the modelling that forms the evidence base for that assumption? What is the basis for his belief that up to 50 per cent. of children may contract this influenza?

We know that the UK has the smallest number of critical care beds in relation to population of any major health system. May I ask the Secretary of State again what criteria he thinks should be applied to the cancellation of elective operations, and what plans the Government have to train additional NHS staff in the use of non-invasive ventilatory support?

Finally, last Thursday Margaret Chan of the World Health Organisation warned of the threat that developing countries face and their disadvantage in placing orders for a finite supply of vaccines. What more do the Government intend to do to ensure that access to vaccination reaches the most at-risk groups in developing countries?

I thank the hon. Gentleman for his remarks, and I agree with him: I am sure that we would all wish to pass on our condolences to those who have, sadly, seen a loved one die in the current outbreak. I also want to put on record again my thanks to the staff of the national health service, particularly those working at primary care level. I visited the antiviral collection point in Tower Hamlets this morning. Obviously, there has been some very real pressure on staff on the front line, who are dealing with lots of cases. In that part of the country, where staff have dealt with some of the highest levels of pressure, they have coped admirably well. We all owe them a great deal of thanks, as we plan to deal with the further challenges ahead.

Let me go through the issues that the hon. Gentleman raised; I shall take each one in turn. He asked me first about the policy of containment, and asked whether I would commission a review. I am confident—this is backed up by the advice from experts in the Department—that the containment policy worked well. It allowed us more time and breathing space, and it provided high-quality information, with which we were able to assess the early development of the virus. It is right to say, of course, that there came a point when it was hard to sustain the procedures of the containment policy in areas that were experiencing great pressure. He will recall that we relieved that pressure by allowing the outbreak management phase to commence. Let me just say to him that we will come back to the issue and look again at it—now is not the time to do that—but the early feeling is that the containment period worked well, and bought us time, which helped us to plan.

The hon. Gentleman asked me about the planning assumptions. I hope that he will agree with my judgment that in this day and age, it is right to share with the public, business and public services the information that is given to the Department and Ministers about the likely effects of the virus, in terms of the spread of disease, hospitalisations and the deaths that sadly occur. I have taken the judgment that we should continue with that policy of openness, but we will at all times explain it and put it in the right context. As he will have heard, in all my statements I have stressed the “business as usual” message at all times, as have the Minister of State, Department of Health, my hon. Friend the Member for Lincoln (Gillian Merron), and Professor Sir Liam Donaldson. I can do so again for the hon. Member for South Cambridgeshire (Mr. Lansley) today; indeed, I did so in my statement. That is always the context.

The hon. Gentleman asked me about antiviral collection points and the steps being taken to ensure that they are accessible to people all over the country. He asked whether there should be maximum distances. Obviously, those are matters for every primary care trust. I said in my statement that I have asked that all Members be given information on the local collection points in their constituencies. We will make sure that that information is given before the national pandemic flu service launches. It is possible that pharmacies could play a greater role in developing that network, and I am open to the possibility that any Member, from any part of the House, may bump into me in the next few days and say, “We haven’t got enough collection points; some people will find it a long distance to travel.” Let us have that discussion, and respond to concerns, as we go along. We are confident that from the latter part of this week, we can stand up a service that will significantly relieve pressure on primary care and enable us to get medication to people who need it quickly.

The hon. Gentleman asked me about the advice for pregnant mothers, which he said was confusing. Let me say again that our advice has not changed. I cannot make that clear enough. The front page of a newspaper stated that one voluntary body had said that people should not plan for a pregnancy—should postpone pregnancy, in effect—and there was a response to that from the Royal College of General Practitioners. I would be grateful if he would listen to this point: comment has been made on the advice prepared a long time ago for H5N1, bird flu, which, as I think he knows, would have been a more serious virus. It is important that care is taken to ensure that the statements that are made relate to the current advice. As I say, that advice has not changed.

The Royal College of General Practitioners and the Royal College of Obstetricians and Gynaecologists have played a superb role over the past few weeks, and I am sure that they will continue to do so. Both organisations have given clear advice today and in the past week, and of course we will continue to liaise with them to ensure that they can continue to play that role.

The hon. Gentleman said that the national pandemic flu service was “a month late”, and asked who had caused the delays. This brings us to the heart of some of the information that the Liberal Democrats were putting out this weekend. I am afraid that they were trying to score a political point when none was justified. As I have explained, when I came into the Department, the clear advice to me was that it would be justified to stand up a new national network—with all the resource, energy and time that that would take—when we had simultaneous outbreaks in many parts of the country and there was not only pressure in two or three places but more sustained pressure across the country.

I want to refer the hon. Gentleman back to the numbers that I quoted in my statement. I will read them to him again, because they illuminate this point. I said: “On 8 July, just six primary care trusts reported exceptional levels of flu-like illness.” One week later, that figure had increased to 110. On that day, 15 July, I took the decision—which was endorsed by Cobra—to activate the national pandemic flu service. We could have done it earlier, had the circumstances justified that. I have been clear since I came into the Department that the service could have been activated, should that have proved necessary. The change in the facts on the ground last week justified the activation of the service, and I do not believe that it is right to build a story about long delays and infighting. That has not been the case, and the decision was not technology-driven; it was driven by pressure on the ground.

The hon. Gentleman asked about a vaccine. There is a difficult discussion to be had about putting in place a prioritisation programme for vaccination that deals with higher-risk groups and health and social care staff at the same time. I believe that that can be done. Given that such a decision will be taken in the next week, or longer ahead, after the House has risen, I undertake to share that information in advance with the Members on both Front Benches, so that they can have an input into the decision.

The hon. Gentleman asked about a licensed vaccine. I repeat what I said in my statement: we obviously want to ensure that any vaccine is properly and thoroughly tested. A process was put in place for H5N1 but, as we are dealing with a mild virus, the circumstances are now different. The balance of risk attached to pursuing an unlicensed product is obviously much changed, given that this is a mild virus. I know that the hon. Gentleman understands these complexities. For me, the important thing is to get in place the necessary assurances on the vaccine as quickly as possible, so that we can move ahead with a prioritised vaccination programme, come the autumn.

The hon. Gentleman asked about critical care. We have taken great steps, not just recently but over a long period of time, strategic health authority by strategic heath authority and primary care trust by primary care trust, to ensure that there is sufficient critical care capacity in all parts of England to enable the NHS to cope. The publication of the planning assumptions last week gave further information to help local health services to plan for the expected levels of demand. Of course we will continue to do that at all stages, and to endeavour at all stages to give full answers and all information so that the hon. Gentleman and all other hon. Members can make informed judgments on these important matters.

I thank the Secretary of State for providing a copy of an early draft of his statement. I also add my thanks to health workers who are working on the front line and behind the scenes. I want to start by asking about the advice to pregnant mothers. Why, if the advice has not changed, did the National Childbirth Trust say that it was acting on departmental advice? Why was the website changed so late in the day?

The right hon. Gentleman talked about patients being advised to contact the national pandemic flu service. They have previously been putting quite a strain on our GPs’ services. Will he explain the six-month delay in getting Treasury approval for the hotline? The freedom of information request made it quite clear that there had been a significant delay in signing it off, which could have resulted in an undue work load on our GPs.

I tabled a parliamentary question on collection points earlier this month, in which I asked

“how many primary care trusts had designated influenza treatment distribution centres on 1 July 2009.”—[Official Report, 13 July 2009; Vol. 496, c. 174W.]

The answer, which I am sure the Secretary of State will be interested to hear, was that the information is “not collected centrally”. That does not inspire confidence at all. Who is in charge? Does the Department have a handle on what PCTs are doing, or is it all delegated to a different level?

There have been worrying reports in the newspapers about whether children can receive the vaccine before the final trial results are available. The right hon. Gentleman has tried to reassure us today, but will he explain why manufacturers have been exempted from liability for certain side-effects arising from the vaccines? No decision appears to have been made about the prioritisation of vaccines, yet SAGE—the Strategic Advisory Group of Experts—discussed the matter and made recommendations on 7 July. If that advice was available on 7 July, why has the Department not acted on it, and why are we still waiting for decisions to be made?

Finally, hospital staff are likely to be catered for, but what about care workers? My hon. Friend the Member for North Norfolk (Norman Lamb) has been advised by a care home that the PCT said it did not have the resources to give Tamiflu to care workers in the private sector, who would have to pay. Given that those workers are at the front line, and given the crossover between NHS and social care, will the Secretary of State address that? Will he also clarify what quantities of antivirals are left and explain why so few discussions with pharmaceutical wholesalers about the wider distribution of these products have been held?

In replying to the hon. Lady, I will endeavour to respond to any points from the hon. Member for South Cambridgeshire (Mr. Lansley) that I have not answered.

The hon. Lady began by asking about the advice to pregnant women. I repeat that the advice has not changed. The Department has given very clear advice since the beginning—[Interruption.] Let me be absolutely clear to the hon. Lady in answering her question, which is very important to many people. Advice was given over the weekend that was based on planning for H5N1, so that clearly was not and is not relevant in this case. The advice was subsequently withdrawn by the organisation concerned.

In those circumstances, it is important to ensure good liaison and sharing of advice, ensuring that different organisations can give their own advice—there is more than one voice in this debate and there is international experience to draw on. At all times, however, we want to give the clearest possible advice, and where further advice or clarification is necessary, we will always provide it. As I said in my statement, the chief medical officer will reissue existing advice, bringing together all the latest information, which I hope will provide some reassurance to the hon. Lady. I do not think that what she said particularly helps in this situation. It is important to recognise that people need clear advice, so we must not and should not invent confusion where there is none.

On the hon. Lady’s claims about a six-month delay, it is important to recognise that the national pandemic flu service is the first of its kind in the world. I am sure that if there were any problems or glitches, Members of all parties would not hesitate to say that it was outrageous and would criticise us for launching a service that had not been properly tested. The service, which is innovative and provides a different approach, will significantly relieve pressure on the primary care front line. Our decision was not technology-driven or, indeed, driven by delays in government. The service has been available for commissioning for some time. With pressure increasing simultaneously in different parts of the country last week, I judged it the right moment to bring this service into being. If we had done that any sooner, however, it could have been a distraction to staff dealing with the early effects of the outbreak in their areas.

The hon. Lady made a fair point about PCTs and about data on antiviral collection points not being collected centrally. I undertook this week to supply all Members with information on local antiviral collection points before the launch of the new service. She is perfectly entitled to hold me to that commitment.

SAGE has discussed vaccines and has made recommendations to Ministers. The Cobra civil contingencies committee first discussed the matter at last week’s meeting. We recognised that further time might be necessary to consider the higher-risk groups and the order of priority for receiving the vaccine. We must ensure that we strike the right balance in respect of health and social care workers. Of course, that must be linked to schedules for the delivery of vaccine. The issues are complicated and interlinked, but I commit myself to sharing important information with the hon. Members for South Cambridgeshire and for North Norfolk (Norman Lamb) over the summer.

The hon. Lady made an important point about private care home workers: such front-line staff must be able to do their job, thereby relieving pressure on the national health service. That point has been relayed to me by various people in recent weeks, and it is not lost on me. We will come to a final decision on the matter soon. The aim of giving vaccine to health and social care workers is to ensure that essential services can operate, and that extra pressure is not put on already overstretched services. That principle will guide our approach to issuing vaccine.

Order. May I say to the House that, at 32 minutes, the statement and Front-Bench exchanges took considerably longer than I would have wanted or expected? I say politely to representatives of the Front Bench that it is almost invariably an unalloyed joy for me to hear them, but it is better for them to leave me hearing less and wanting more, rather than hearing more and wanting less. At least 15 Back Benchers are seeking to put a question, and I want to accommodate them all, so the usual rule applies: short questions and short answers.

Will my right hon. Friend the Secretary of State give us his assessment of how local parts of the NHS are dealing with the distribution of antiviral drugs? I would not want that question to be interpreted as being in any way critical of what has happened so far, as I commend him, his ministerial colleagues and everyone in the Department and the national health service for their contingency planning and for the implementation of contingency plans, as endorsed by that responsible BBC correspondent Mr. Fergus Walsh, whatever some other people might say.

I thank my right hon. Friend. Mr. Walsh has indeed done a superb job in providing balanced coverage to the public, and we pay tribute to him: if coverage is not so well and carefully done, pressure can be put on NHS services as a result of people worrying unnecessarily.

Let me outline what is happening in Camden: three chemists have extended opening hours; three antiviral collection points will be in place later this week, and I shall ensure my right hon. Friend has the details. I am told that there is a flu car for those without flu friends, so there is a local distribution system for people who might find it hard to get antivirals, and 350 courses of antivirals have been issued to date. The local response varies: some PCTs are putting in plans to respond to the requests of their local community, but in Camden, as he can clearly see, a detailed local operation is already in place.

We are now in the holiday season and a lot of people will be going abroad, so what advice does the Secretary of State have for airlines and travellers, especially as nine youngsters have been diagnosed with swine flu in China? Should not those considering going abroad ensure that they have proper insurance: the European health insurance card if they are going to Europe, and proper paid-for insurance if they are going to other countries?

The hon. Gentleman raises an important point, as people will be about to travel. It is important that people take the same precautions when travelling as they would when at home. As I have said several times today, it is very important that people travelling within Europe—not just one member of the family, but all family members—have the European health insurance card, as that entitles people to necessary medical treatment, including for swine flu, across the European Union. I hope that the hon. Gentleman will encourage his constituents to ensure that they take that card on holiday. We recommend that if people have swine flu, they do not travel until their symptoms have stopped. We also recommend that people check the Foreign Office website for advice on travel to particular countries. If he wants more detail, I can write to him, but he is correct that people will want clear information on this important matter.

The Department, the Secretary of State and his predecessor have handled the swine flu outbreak very sensibly. While I accept that the outbreak has had tragic consequences for a few people, it is still mild and self-limiting. Is it not incumbent on all of us, both Members of Parliament and the media, to ensure that any reporting takes place on that basis, and that people are not panicked into believing there is something in the country that is worse than what we have—and are controlling—at the moment?

I thank my right hon. Friend for his kind remarks. The Department has been well served by a number of Ministers, because—as my right hon. Friend will know in his capacity as Chair of the Health Committee—it has planned for this eventuality for a considerable time.

I agree with my right hon. Friend that everyone—including Members of Parliament and any representative of the media who speaks on a public platform—has a responsibility to deal with this in a calm and measured way following the advice that has been issued. Any unnecessary concern out there could put extra pressure on the NHS front line, and I do not think that anyone would want that. We will rise to the challenge. The NHS has always been a wonderfully resilient organisation, and it will deal with this issue, but let us not make things more difficult for the valuable staff who are in front-line positions.

I, too, wish to express my condolences to the families of those who have died from swine flu.

What discussions have taken place about the contribution that the Treasury will make to dealing with the swine flu pandemic, and with the burden that will fall on the devolved Governments in the United Kingdom? Does he agree that, regardless of the statistics on people who are presenting with swine flu symptoms, Northern Ireland, Wales and Scotland should offer the same service, given that we call this a national pandemic flu service?

I strongly agree with the hon. Lady’s second point. We continue to have regular discussions with the four health Ministers, and Michael McGimpsey has been of great assistance in helping us to co-ordinate our response across the United Kingdom. All Ministers—in Scotland, Wales, Northern Ireland and England—agree that the right response is a UK-wide response, and that will continue.

We do not yet know the full cost of the pressure that the outbreak will place on services. We do not know the full cost of the vaccination programme, because we do not yet know how long the outbreak will last. As far as is possible, we must deal with that pressure within existing budgets and resources; but any extra requests for funding would be dealt with in the usual way, according to existing Treasury arrangements.

I thank my right hon. Friend for his statement. I am sure he agrees, however, that concern has grown over the definition of pregnant women and the under-fives as vulnerable groups. That is certainly the case in my constituency. Can he reassure my constituents that that vulnerability does not mean that they are more likely than not to contract swine flu? It is certain that in the case of pregnant women there will be no dangers to the unborn child, and it is certain that the treatment for the under-fives is entirely effective.

My hon. Friend has made an important point. Some younger people have not encountered this kind of virus before, while some older people have. However, it is not the case that anyone is necessarily more at risk of developing the virus than others; it is a question of people’s ability to withstand it after contracting it. That is an important distinction, and I am grateful to my hon. Friend for giving me an opportunity to clarify it.

Further to the question from my hon. Friend the Member for Ribble Valley (Mr. Evans) about travelling, may I point out that the Secretary of State has said nothing about information at airports and ports? Is he issuing leaflets? What about the arrangements for incoming as well as outgoing passengers? What information will be provided, and will any health officers be available?

We have not introduced screening at United Kingdom airports, but I take the hon. Gentleman’s point about information. I will follow it up, and check that good information is provided at ports of entry. I am grateful to him for bringing the issue to my attention.

The FCO website states:

“Medical screening for the Swine Flu virus… has been introduced… at several airports for passengers arriving on international flights.”

That includes airports in China, although obviously practice differs elsewhere. In relation to China, the guidance states:

“The Chinese government continues to place great emphasis on screening and surveillance, rapid detection, quarantine and treatment.”

Obviously, we know about the situation with the young children, which emerged over the weekend. We will provide support to them as necessary, but it is for all countries to deal with the outbreak as they see fit.

This global pandemic is affecting our country in our summer months, and it is anticipated that the situation may get worse as we work towards the winter months. Obviously, however, many countries in the southern hemisphere are experiencing the pandemic during their winter months. How closely are we monitoring the levels of infection in countries in the southern hemisphere, so that we can learn from the trends as we work towards our winter months?

My hon. Friend makes an important point. I can assure him that the international figures are monitored. At the risk of sounding overly critical, I think that our surveillance systems are better than those in many other countries, so we must exercise some caution in directly comparing the figures from one country with the figures from another. However, we keep a close eye on those figures. Obviously, one of the things about this virus is that it is spreading here during the summer months, which people would not always expect.

May I raise again the issue of constituents travelling overseas? Can the Secretary of State assure me that they will be able to contact the national pandemic hotline even if they are overseas, and that there will be some facility to direct them to where they should go, as language and other barriers might mean that they cannot access treatment when they need it?

I do not think that people can contact the service from overseas, but that is why I made an important distinction in my statement about people who are travelling. They should take all the necessary precautions, including purchasing over-the-counter medications, heeding the advice on the Foreign Office website and considering whether they should also have, if they are travelling within the European Union, a European Union health insurance card. The hon. Lady has raised an important point. I will see whether there is more we can do to provide reassurance. I would not want us today, when we are launching a new service for Britain, to be distracted by another issue, but if I can provide further reassurance or a better and more detailed answer in next 24 or 48 hours I will do that.

During the school term, it was easy to decide which schools had to close because there were outbreaks among the children. Is the Secretary of State talking to local education authorities about what will happen in September when the children return, because some schools might not wish to reopen?

The decision will have to be taken locally according to advice from public health officials. It is always the responsibility of the head teacher and chair of governors, and it would be premature to suggest that there should be widespread school closures. The majority of schools in England have broken up for the summer or are about to do so. We hope that that will have a beneficial impact on the spread of the virus, although we cannot be sure about that. We keep all these matters under discussion, and the Under-Secretary of State for Children, Schools and Families, my hon. Friend the Member for Kingston upon Hull, North (Ms Johnson), regularly attends our Cobra meetings. We will update advice to schools if and when that is appropriate.

Thank you, Mr. Deputy Speaker—[Hon. Members: “Mr. Speaker.”] I do apologise, Mr. Speaker, for whatever I said. Despite the Secretary of State's welcome assurances about keeping hon. Members in touch, does he agree that it is incomprehensible and further undermines the reputation of this House that, in the face of this and other crises, we break up tomorrow until 12 October, without any inkling of a recall to scrutinise the Government's actions?

I think that the arrangements I have put in place, and which I have explained in my statement today, will give hon. Members on both sides of the House, especially the Front-Bench teams, access to the information they need. We will issue a local hotline number, which will not be in the public domain, so that Members of Parliament can pursue any concerns over the summer months. It is very important that everybody keeps this virus in perspective. Parliament needs to keep it in perspective too, and if the situation changes I am sure that there will be conversations through the usual channels, but at this stage it is business as usual. It is important, however, that we have in place systems to make sure that people are properly updated over the summer months.

I think the Secretary of State missed the point made by the hon. Member for Ribble Valley (Mr. Evans) and others about people travelling abroad. A constituent of mine who was on holiday in Sharm el Sheikh in Egypt could not leave the country and was incarcerated—I intend no disrespect—in an Egyptian national health service hospital, where he could not get any consular advice. Over the next few weeks, this scenario—involving, perhaps, people who, rightly or wrongly, have not arranged sufficient travel insurance—is likely to escalate enormously, putting enormous strain on the Foreign and Commonwealth Office. There need to be amber lights flashing to the FCO and the travel and insurance industries to make sure that a potentially large number of people are not incarcerated outside the European Union in grotty hospitals.

May I say three things to my hon. Friend? First, before they travel people should check the arrangements for dealing with swine flu in each country. Secondly, they should have appropriate insurance in place, should that be necessary. Thirdly, of course we will ensure with colleagues in the Foreign Office that there is appropriate consular advice and support for anybody who finds themselves in a difficult position. Those three things are absolutely vital—and for people travelling within Europe, the European health insurance card is, of course, a crucial document, and nobody should go on holiday without one.

The Secretary of State said he envisaged receiving supplies of the vaccinations by August and that he was prioritising vulnerable groups and vital NHS front-line staff. I am the husband of a wife who is seven months pregnant and due in September, so will he tell me whether he is considering putting women who are in the later stages of pregnancy in any of those vulnerable groups? What steps is he putting in place for hospital maternity units, because the babies of women who have recently given birth are particularly vulnerable?

On the latter point, hospitals have, of course, sophisticated systems for ensuring the safety of the ward environment. On the hon. Gentleman’s first point, I can assure him that pregnant women are within the priority groups of those considered at higher risk. SAGE has given Ministers the conclusions on those groups. We have had our first discussion of them, but I can confirm that women in pregnancy are included. As and when appropriate—and not before too long, I hope—we will make public who is in those groups. The hon. Member for Romsey (Sandra Gidley) asked that we do that, and I have no problem with it. We want at all stages to be open about the advice that we are receiving, but we must look at the vaccination programme alongside the operational requirements to ensure that health care staff and social care staff are vaccinated. These are the issues, alongside the delivery schedule for the vaccine, that we are currently balancing.

Does the research confirm whether people can get swine flu twice and whether antivirals and Tamiflu injections are of any benefit in preventing a second bout of swine flu? What work is being done to ensure that a vaccination for swine flu does not counter the normal vaccinations that are given to so many people in this country for winter flu, and on whether those two injections have any effect on each other?

Order. The hon. Member for Portsmouth, South (Mr. Hancock) slipped in three questions, but I feel sure that the Secretary of State will furnish us with just one answer.

Perhaps I will write to the hon. Gentleman to cover all those issues, but if he was asking whether people can get the vaccine or antivirals twice, I can say that the national pandemic flu service has an authorisation code that is meant to stop precisely that problem, so that the antivirals can go around to everybody.

May I take the Secretary of State back to a statistic he gave us earlier orally but which does not seem to appear in the written version of his statement? I think he said that there are currently 652 people in hospital with swine flu, of whom 53 are in critical care. That seems like a rather high proportion. How does that compare with other, more conventional forms of influenza, and does it mean that we are not getting people to hospital fast enough?

No, I do not think that it means that at all. We can give the hon. Gentleman figures on the hospitalisation rate if he would find them useful. It is important for me to say that we are at the early stage of a new virus, and although we want to give the House the figures as openly as possible as we receive them, this is a developing situation and I do not believe that he should read too much into them at this stage. We have given him the figures, they are being updated every week and people can make their own judgments on them.

At the previous statement on swine flu, the Minister had no answer to the question about what is being done about people getting cross-infected on a plane flying into this country. We have this strange situation where the Government seem to have done nothing to discourage people from flying into the country, while airlines are turning people away and preventing them from flying out of it with swine flu. What is the Government’s rationale for that? What threshold would there be before they did something to discourage people from flying in and infecting people on the plane?

I do not know whether the hon. Gentleman thinks that we should stop incoming flights—perhaps he does. From the beginning, the advice from the World Health Organisation was that, given what we knew about this virus, it would not be justifiable to place restrictions on international travel. That was the clear position at the start and I have not seen any WHO advice to change it. Obviously we pay close attention to what the WHO says at all times.

There has been a lot of talk about the FCO website and tourism abroad, but I am interested in what is happening to tourism in Britain. We are very much open for business, yet we see headlines such as today’s “Holidaymakers face travel ban as swine flu sweeps country”. What conversations has the Secretary of State had with the tourism Minister to ensure that such headlines are placed in context and that the message goes out that Britain is very much open for business?

I think that I just gave that message in answer to the hon. Member for Birmingham, Yardley (John Hemming). Britain is very much open for business and, as I say, it is business as usual for the vast majority of people. The Department for Culture, Media and Sport has a representative who attends the Cobra civil contingencies committee, and I am sure that in terms of business continuity we will continue to listen carefully to what he or she says. As I mentioned in my statement, we are developing strong networks for business, in order to give it the advice that it needs. That is being led by the Cabinet Office and it will be useful to tourism, as well as to other businesses.

I am wearing my all-party group on diabetes hat here. Will all diabetics have access to the vaccine, or will a distinction be drawn between people with diabetes that is controlled by diet and exercise and other people with diabetes?

At this stage, I do not want to give all the information about the vaccination programme piece by piece. I gave an answer to the hon. Member for Lancaster and Wyre (Mr. Wallace) because there has been a lot of focus of women in pregnancy and giving further information on that is justified. We will say more in due course. Obviously we are purchasing enough vaccine to vaccinate the whole country, although not all that vaccine will arrive in this calendar year. Thus, we are putting forward a programme of priority vaccination for the autumn, about which we will say more in due course.

This morning, I rang a travel insurance medical hotline to seek advice about swine flu, but before I got through to someone I heard a pre-recorded message saying, “We can give you no advice about swine flu.” What advice is the Secretary of State giving the travel insurance industry? If I go abroad with a slight temperature would I invalidate my travel insurance were I to get swine flu?

That is a matter for the insurers; it is not necessarily a matter for me. I have said clearly throughout this statement that people should carefully check the FCO website and other advice before they travel, and they should not travel if they have symptoms. That advice is clear and if the hon. Gentleman has a query about his insurance policy, he should raise it with his insurer.

The Secretary of State is correct to say that swine flu is important and serious, but we must keep a sense of perspective, because the truth is that over the next six to 12 months many more of our constituents will develop cancer and heart disease and die from those illnesses. Will he join me in urging the media to report the illness of swine flu responsibly, thereby avoiding mass hysteria?

It is important to acknowledge—as the hon. Gentleman did—that accurate, balanced and calm reporting of this virus is necessary. If that tone is not struck, it puts pressure on the NHS and limits its ability to cope with the daily pressures, which continue, as the hon. Gentleman rightly says. The launch of the national pandemic flu service will take pressure off the health service by creating an alternative route for access to medication, and that will go a long way to helping to relieve pressure on the front line. We all have a responsibility to face up to the challenges as they come up, to deal with them as best we can, and to explain them as calmly and concisely as we can, which will help the whole country get through this challenge.

In conclusion, may I say that the NHS will get through this challenge, because it is wonderfully resilient? It has faced many challenges before and will face this one in the same way.