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Swine Flu

Volume 496: debated on Monday 20 July 2009

Motion made, and Question proposed, That this House do now adjourn.—(Mrs. Hodgson.)

I am pleased to have secured this debate on what is an extremely pressing issue—even at this late hour. I have been trying to secure a debate for some weeks in order to raise concerns about our preparedness for swine flu. I had hoped to secure a more general debate so that colleagues could also contribute. I believe that the Government should have arranged for a debate in their own time, as these are very important issues, so it is pity that they were unable to do so.

Despite today’s statement, there are still some issues that I would like to put to the Minister, reflecting comments made to me since the Secretary of State’s update. We are experiencing the first global flu pandemic for 40 years. I commend front-line NHS staff and others in the health care sector. The UK death toll currently stands at 29, but the number is increasing. Each death has been a tragedy for friends and family, so I am sure that the Minister will join me in sending condolences to them all at what is an extremely difficult time.

I did not call this debate to whip up public anxiety or panic. All I want to do is try to get reassurance on a number of key issues, not least because of the extra pressures and costs placed on the NHS and the predicted drop in economic output as factories, offices and businesses cope with a reduced work force. The public, I believe, have a right to be as well informed as possible and I fear that conflicting advice and information from various sources have become a big problem.

The Secretary of State clarified advice for expectant mothers this afternoon, which was welcome. However, confusion still remains in other areas. To what extent are the Government liaising with the medical profession, charities and the media to ensure a consistent message?

Despite the fact that the UK initially adopted a containment strategy, it has the fifth highest number of cases of swine flu in the world. Does the Minister accept that this is because our containment strategy was not as effective as it could have been? Many of those who should have been given antiviral drugs—because they were infected or had come into close contact with someone who was infected—did not receive this treatment.

At the start of July, the number of confirmed cases of swine flu exceeded the number of doses of antivirals administered by more than 1,000. Does the Minister agree that if a proper containment strategy had been in place, the number of people receiving antivirals would have been far higher? Why were those with “suspected” swine flu not targeted alongside those “confirmed” with the illness? The Government also indicated that they would contain the virus by giving antiviral drugs to those who had been in contact with a swine flu victim. Yet figures from the start of this month show that antivirals had been given out to fewer than two confirmed contacts of each victim. Can the Minister explain how this demonstrates a rigorous containment strategy?

The Minister might argue that this strategy could have been pursued only for a limited period of time, and it is now necessary to move towards a strategy of “treatment”, as the Government have done, but the World Health Organisation in a briefing note published only seven days ago states that all countries should, as part of their pandemic vaccination strategy,

“reduce transmission of the pandemic virus within communities.”

Does the Minister believe the Government are heeding that advice?

I want to move on to discuss the concept of a national pandemic flu line. The Secretary of State said today that a flu line has become necessary only very recently. In their “A national framework for responding to an influenza pandemic”, the Government said a flu line should be ready when the World Health Organisation raised its alert to level 5:

“During Phase 5, response plans must be ready for instant implementation and activated when required... the national flu line will be established”.

When the WHO raised its alert to level 5 at the end of April, the then Health Secretary stated that a flu line would not be up and running until October. Will the Minister explain why the Government decided to ignore their own national framework? Does she accept that that has hampered the health care sector’s ability to distribute antiviral drugs and information efficiently?

We are now told that a national pandemic flu service will be established by the end of this week. The service will include a website and call centres, but will only be an interim service. When will a full service be rolled out and how will it be different? The Secretary of State confirmed today that all Members would be given details about antiviral collection points in their constituencies this week. Will the Minister answer the question posed by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) about whether maximum distances to collection points will be agreed? That is hugely important in rural constituencies such as South-West Norfolk, and other constituencies across the country where vast distances must be travelled to attend hospital or a clinic, or even to visit a doctor. Will the Minister reassure me that the distribution strategy will not put unnecessary pressure on hard-pressed pharmaceutical wholesalers?

I also want to mention criticisms from health care professionals. GPs have made it clear that delays to the flu line have resulted in those with symptoms turning up at their local surgery instead of remaining at home, thus going against public health advice. They also say that the pressure put on surgeries by the “worried well” results in patients with serious health conditions finding it difficult to get appointments. Does the Minister recognise those extra pressures on local GPs’ surgeries and community health centres?

A company specialising in respiratory medicines has also highlighted the likelihood of swine flu aggravating underlying health conditions, such as asthma. What contingency plans are in place to take account of increased demands for medical devices such as inhalers? What extra resources are being made available to NHS staff, who might face increased demands from patients suffering from other existing health conditions?

The Royal College of General Practitioners has accused the Government of giving conflicting advice to doctors and patients. GPs say that there has been a lot of confusion over prescribing Tamiflu, and there is a lack of clarity about how long a patient should be advised to remain at home after contracting the virus. Does the Minister agree that it is vital that the Government and the health care sector share a common approach?

On the vaccination programme, the Secretary of State suggested today that we could begin receiving supplies from August, yet the WHO has said that a fully licensed vaccine might not be available until the end of the year. Will the Minister confirm that the first doses of vaccine will have been fully tested? It is vital that we start a debate about what criteria will be applied for prioritising certain vulnerable groups for early vaccination. That debate needs to start now, in a sensitive and considered manner, well before vaccination is made available, so that the public are clear about who will receive initial doses. How will decisions on priority groups be reached? Who will be consulted, and does the Minister accept that time might be running out for such consideration?

I now turn to forward planning. Sadly, experts agree that we have not seen the worst of swine flu. More people are expected to become infected. The death toll, alas, is expected to rise, and we should not underestimate the threat of a more virulent strain developing as the virus possibly mutates. The onset of autumn and winter will bring conditions that are far more conducive to the spread of the virus. Some experts have suggested that we should have sent more people to Mexico or the United States earlier, to gain vital information about the virulence and impact of swine flu. Does the Minister accept that point? Will we be sending people to, for example, Australia—which is in the midst of its flu season—to gain a better understanding of the way the virus may affect the United Kingdom during our winter?

There are other countries with lower death rates than the UK from which we can learn. In the context of the global nature of swine flu, I understand that some airlines have called for GPs to “certify” people swine flu-free before they fly. The British Medical Association is anxious for GPs not to have to bear any further burden, and to be able to spend time treating people rather than form filling. Can the Minister confirm that the latter will not become a requirement for them?

The chief medical officer for England has issued figures relating to a “worst-case scenario”, which suggest that if 30 per cent. of the population contracted swine flu it could lead to some 65,000 deaths. He has stressed that those figures relate to a worst-case scenario, but even the Health Secretary’s figure of 100,000 new cases a day by the end of August are cause for much concern throughout the House and our constituencies, and hence throughout the country. That number of cases could lead to around 1,500 hospitalisations a day, yet the Society of Critical Care Medicine says that the UK has the lowest number of critical care beds per 100,000 people in western Europe and north America. Although the matter was raised today by my hon. Friend the Member for South Cambridgeshire, he received no specific answers to his queries. What is being done to offset the potential pressures? What criteria are the Government applying to the cancellation of elective operations? Will hospital trusts be allowed to make their own decisions on the basis of local conditions?

I am aware that biocides have been developed to kill the swine flu virus through hand gels, sprays, diffusers and wipes, and that many other countries across the world are using those products in their fight to contain the pandemic. I understand that some can be effective for up to a fortnight on treated surfaces, and that a hand gel will still be effective after two hours. Organisations could be required to use biocides. To combat MRSA we have all been required on occasion to use handwashes and wipes when visiting hospitals, and when there is an outbreak of foot and mouth disease we are required to put our boots and vehicles through anti-bacterial washes. What consideration has been given to the establishment of a campaign for public awareness of such products, or to ensuring that they are used in public areas such as schools and the transport network? In his advice to expectant mothers this afternoon, the Secretary of State cited good hand hygiene first. In the light of that, does the Minister accept the points that I have made about the wider use of licensed biocides?

We are in uncertain territory. The Home Secretary has said that the threat from swine flu could be worse than that from terrorism in terms of its impact on communities. As I emphasised at the start of my speech, I do not intend to cause undue panic, but the Government must be clearer about their plans. Delays to vital measures such as the national flu line have only served to reinforce the view that they may be under-prepared. People’s lives depend on a robust and carefully thought-out strategy to deal with this pandemic, and I hope that the Minister can give me the assurances that my constituents and the public demand.

I know the Minister well, and I know that she will respond to me in good faith. If there are points that I have made tonight to which she cannot respond in the limited time available, I ask her—in good faith—to respond to them in writing before the House adjourns for the summer recess tomorrow. If she will do that, I shall at least be able to pass her responses to colleagues so that they can return to their constituencies in the knowledge that the Government have addressed these serious issues.

I congratulate the hon. Member for South-West Norfolk (Christopher Fraser) on securing the debate on what is an important matter. I certainly undertake to answer any questions that I am unable to answer in the limited time I have available. I will endeavour to do as much as possible before the House rises. I am sure that he will understand that it might be difficult to meet his request, but I will get the answers to him as quickly as possible.

I agree with the hon. Gentleman about the need to reassure the general public. They are understandably concerned as cases of swine flu increase. I hope that he therefore welcomes the statement made today by the Secretary of State for Health, which dealt with a large number of the issues about which we have just heard. While recent weeks have seen a considerable acceleration in the rate of spread, it is important that I take the opportunity to stress that the basic nature of the virus has not changed. Swine flu has not become more dangerous. To give some perspective—I know that the hon. Gentleman agrees with me about the need to give perspective—as with seasonal flu, it remains a mild and self-limiting illness for the overwhelming majority of people, although it can be severe in a few cases. Of course, I again offer my condolences to the families and friends of those who have lost loved ones.

The basic hygiene advice to people is exactly the same today as it was some months ago, and it is worth reiterating. To help to limit the spread, people should sneeze into a tissue. They should dispose of it properly and wash their hands. To reduce the chances of catching the virus, people should wash their hands regularly. If they have flu-like symptoms, they should stay at home, check their symptoms on www.nhs.uk, or through the swine flu information line and then ring their doctor if necessary.

Soap and water is good enough, we believe. A leaflet has gone out to every household and information is available on the website. In areas where there has been a particular concentration of cases, extra and considerable efforts have been made in terms of communications. To answer the hon. Gentleman, hand gels are useful where it is not possible to get to a place to use soap and water but over and above that we regard that as a matter for individuals and not something that we are promoting.

I turn to the issue of NHS preparedness. Our health service has been preparing for a pandemic for many years, and the World Health Organisation has said that this country’s preparations are among the best in the world. I summarise by saying that we prepare for the worst and we hope for the best. Our early efforts to contain swine flu by isolating cases, offering Tamiflu as a preventive method and shutting schools where necessary gave us a precious window of time to learn more about the virus, about which little was known, and to fine tune our preparations.

We stockpiled antivirals, so that we have enough to treat half the population, and will be increasing that to cover 80 per cent. in due course. We ordered more than 15 million additional courses of antibiotics to treat complications and they will be delivered over the coming months, as will the 226 million extra face masks and 34 million extra respirators that we have ordered to protect health and social care staff. We took major strides towards developing a vaccine, about which I will seek to give some reassurance.

The House will already know that the Department of Health has signed contracts with 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. I assure the House that we will take all necessary steps to ensure that the vaccine is appropriately tested.

It is interesting to note that, in preparing for a pandemic, appropriate trials to assess safety and the immune responses have been carried out on vaccines very similar to the swine flu vaccine. Those vaccines have been shown to have a good safety profile. Over 40,000 doses of the said vaccines, on which the swine flu vaccines are based, have been given without any safety concerns. There is no suggestion that the UK would use a vaccine without careful consideration of safety issues. We have one of the most successful immunisation programmes in the world and we intend to keep it that way. We are now planning the vaccination programme so we can start administering vaccines to priority groups including NHS and social care staff as soon as we get the green light to proceed, and we will continue to take the best independent scientific advice on all vaccination questions.

The hon. Gentleman asked how the decision on who gets the vaccine first will be made. As I have said, administering the vaccines will need to be prioritised, and we will make a decision when we know more about the risk profile. A decision on prioritisation of groups of the population will be taken on the basis of which groups are being most affected by the virus, when the vaccine arrives, and how best to protect the capacity of the national health service. Therefore, there are a range of factors to be taken into account.

I am very grateful to the Minister for her clear answers to my questions. When decisions on prioritisation are taken, will local considerations be taken into account, so that the practitioners on the ground locally will have the final say?

We have to ensure consistency across the country, so we will act on the best medical and scientific evidence that we have got.

The Secretary of State outlined earlier how we would keep colleagues in the House informed on these matters during the recess, and I shall come on to that now. The Secretary of State confirmed earlier that, following our request, strategic health authorities will provide weekly briefings for MPs coinciding with the Health Protection Agency’s national updates. They will cover the kinds of information that the hon. Gentleman requested, which are important to all Members as constituency MPs. The information will include the numbers of diagnosed and confirmed cases and of hospitalisations, updates on antiviral collection points, and local information on any clusters or other specific developments. There will also be a hotline number to the local SHA so that Members have a direct line to express any concerns, make any inquiries and establish what the position is locally. Local arrangements will vary across the country—the hon. Gentleman talked about his constituency being particularly rural—so this local contact is extremely important. I can also assure the House that the civil contingencies committee will meet weekly during the summer months and Ministers and officials will be in close contact and in dialogue with their counterparts in the devolved Administrations to ensure a consistent UK-wide approach.

The hon. Gentleman raised the important issue of the national pandemic flu service. We have always been clear that it would be virtually impossible to limit the spread of swine flu indefinitely, and in recent weeks it has become apparent that it is no longer effective to continue intensive efforts simply to contain the virus. As a result, we switched our emphasis to treating the increasing numbers getting the virus. I also wish to echo the comments of the hon. Gentleman and of my right hon. Friend the Secretary of State earlier by thanking all health workers both on the front line and behind the scenes who have been dealing with the increasing numbers of people with swine flu.

The national health service is coping extremely well and we should pay tribute to its ability to respond to times such as this. As the number of cases continues to grow, we will need to give extra support, so the national pandemic flu service will be instrumental in taking the strain off doctors’ surgeries. When we took the decision to move from containment to treatment, we were clear that the service should be brought into play as soon as it was needed on the ground, so I should stress once again that the technology to launch the flu service has now been available for some time. We have been anticipating and waiting for the point when we saw a significant spread across many areas of the country before it became worth while and sensible to launch the service nationally.

What we have seen in recent days is exactly that eventuality, for which we have been planning and working. A significant acceleration in the spread has taken place, with 55,000 new cases of swine flu reported last week and an equivalent increase in pressure on front-line services. To give an illustration, on 8 July just six primary care trusts reported exceptional levels of flu-like illness, whereas one week later, on 15 July, the figure had increased to 110. It was at that point that the Secretary of State took the decision to activate the national pandemic flu service—the decision was based on demand, not on the availability of technology. This means that the service will go live in England by the end of this week, subject to testing, and will be accompanied by a major public information campaign.

After the launch, people will no longer need to ring their general practitioner if they suspect they have swine flu. Instead, they will be able either to 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. As I said earlier, hon. and right hon. Members will receive information on the location and number of collection points as part of a weekly update through their strategic health authority.

Does the Minister accept that many people who feel vulnerable will naturally and instinctively wish to go to see their GP, rather than go online or make a telephone call? With respect, those services have historically not been as successful as they have been set out to be in the past. Added pressure will be put on GPs because people will instinctively still call them first.

That tendency is understood, which is why it is so important that this service has been fully tested and will work. It is important to remember that GPs themselves are asking for this, as are the SHAs and the PCTs; everyone across the NHS is saying, “This will help us.” I know that the hon. Gentleman knows that if someone has the virus they should not go to their doctor’s surgery, because they should be staying at home—I am sure that he promotes that approach in his constituency, as I do in mine. That is a very important, but I certainly agree about the need to reassure and give full communication.

The hon. Gentleman asked about the differences between the interim and the full service. An enhanced national pandemic flu service, based on the original flu line design, is still planned to be available by October. The key differences between the interim and the enhanced service are the following: the enhanced service will have increased functionality to provide greater verification of patients’ identity against the database; it will have an automated interactive voice response function, in addition to call centre handlers; it will allow authorised health care professionals to authorise an antiviral to a patient directly, without completing the full IT assessment process; and it will have an enhanced clinical algorithm, which will include separate pathways—separate ways forward—for adults and for children, with greater flexibility to alter the assessment process.

The hon. Gentleman asked about international work, and I can confirm that the Health Protection Agency and the Department of Health are in regular contact with colleagues around the world and with international organisations, such as the World Health Organisation, to ensure that we learn all the necessary lessons about how countries are responding to the pandemic and, indeed, to pass on our own good practice and share.

Containment did not fail—

House adjourned without Question put (Standing Order No. 9(7)).