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House of Lords Hansard
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02 July 2009
Volume 712

Statement

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My Lords, I should like to repeat a Statement made in another place.

“With permission, Mr. Speaker, I would like to make a Statement on the A(H1N1) swine flu pandemic. As of today, there are 7,447 laboratory-confirmed cases of swine flu in the UK, of whom a significant number have been hospitalised. Three people have sadly died, all of whom had underlying health problems.

Since the first UK case was confirmed on 27 April, health protection officers, NHS staff from across the UK, and Department of Health officials have been leading the fight to contain the virus. Last week, we started to see a considerable rise in swine flu cases, and the emergence of hotspot areas in London, the West Midlands and Scotland. Since then, cases have continued to rise significantly. There are now, on average, several hundred new cases a day.

This creates challenges on the ground and pressure on services, but the response from the health community has been tremendous. I hope the House will join me in putting on record once again our sincere thanks to the staff in the Health Protection Agency and the NHS, general practitioners and all those who work in primary care. Our efforts during the containment phase have given us precious time to learn more about the virus, to build up antiviral and antibiotic stockpiles, and to develop a vaccine.

We have always known it would be impossible to contain the virus indefinitely, and that at some point we would need to move away from containment to treating the increasing numbers falling ill. That is why last week I announced the move to the outbreak management phase. This gave hotspot areas, where there is sustained community-based transmission, more flexibility to deal with the virus.

Scientists now expect to see rapid rises in the number of cases. Cases are doubling every week and we could see more than 100,000 cases per day by the end of August, although I stress this is a projection only. As cases continue to rise, we have reached the next step in our management of the disease. Our national focus should be on treating the increasing numbers affected by swine flu. Based on experts’ recommendations, and with the agreement of Health Ministers across all four Administrations, I can today tell the House that we will now move to this treatment phase across the UK. This will mean that in England the Health Protection Agency will take a step back and primary care will take the lead in diagnosing and distributing antivirals.

There will be an immediate end to contact tracing and prophylaxis in all regions; GPs will now provide clinical diagnosis of swine flu cases rather than awaiting laboratory test results; and primary care trusts will now begin to establish antiviral collection points where necessary. This new approach will mean an end to the daily reported figures from the Health Protection Agency.

Our policy on schools is that they should not close because of individual cases of swine flu but they could close if the particular local circumstances warranted it. For example, there may be grounds for closure if a significant number of pupils or teachers are ill. The HPA will advise on outbreak control issues as usual and closures would be reported to the Department for Children, Schools and Families.

I must emphasise to the House that the Civil Contingencies Committee has had lengthy discussions, drawing on expert scientific advice, about who should be treated with antivirals if they contract swine flu. Health Ministers across all four Administrations have noted clear scientific advice that the majority of cases in the UK have so far not been severe, with those catching the virus making a full and fast recovery, though a minority of people here and overseas have had more serious illness and some have died.

As we move into the treatment phase, Ministers have considered whether we continue to offer antivirals to all patients displaying symptoms or whether a more targeted approach should be adopted, focusing on those most at risk of becoming more seriously ill. When very little was known about the disease—and especially given the reported fatalities in Mexico—using antivirals prophylactically was sensible to protect people, and may have helped contain the initial spread of the disease.

During the containment phase, experts have had time to study the virus. Some experts now suggest that since the virus has proved largely mild, antivirals should be used only to treat those in designated “higher risk groups”; that is, those more susceptible to developing serious illness or complications. These are all the groups at risk from seasonal influenza, plus pregnant women and children under five. They argue that overusing the drugs can increase the chances of antiviral resistance, and exposes too many people to the risk of side effects from the medicine.

The Scientific Advisory Group for Emergencies says that, on balance, the science points towards a targeted approach, but acknowledges that this is a “finely balanced” decision. Expert advice points to the fact that, as this is a new virus, its behaviour cannot be predicted with certainty. Swine flu is different from seasonal flu in that most serious illnesses have been in younger age groups, as happened in all three 20th-century influenza pandemics. A doctor faced with a symptomatic patient cannot yet predict with certainty the course of their illness and whether or not they will be in the small proportion who may become more seriously ill.

Given this, we have decided to take a step-by-step approach. This means that, as in the outbreak management phase, we will continue to offer antivirals to all those who have contracted the illness. However, it remains a matter of clinical discretion to decide whether antivirals should be prescribed in individual cases, particularly in circumstances where doctors are likely to be contacted by patients with coughs, colds and the worried well, in addition to those with swine flu. Expert advice emphasises the high importance of treatment with antivirals of those in the higher risk groups, so we will issue clear guidance to doctors to ensure that those at higher risk get priority access to antivirals within 48 hours of the onset of symptoms.

I acknowledge that this is a cautious approach. Many people will be able to recover from swine flu without the need for antivirals, and may therefore choose not to seek treatment. However, we are much closer to the time when we will receive the first doses of pandemic flu vaccine. This will potentially offer high protection. In the mean time, it is prudent to use our only current measure against the virus—antivirals—to the maximum effect. The science indicates that as we discover more about the virus and develop a more precise categorisation of risk groups, we are likely to reassess our approach and move to a more targeted use of antivirals. We will keep this matter under review, with advice from SAGE, and will update the House as and when this is necessary.

Today we will set out these new arrangements through a short guide that will be e-mailed to NHS staff, and will be available online to the public. I know that local GP surgeries and hospitals, particularly in hotspot areas, are coming under increased pressure. So it is important that we do everything we can to reduce the strain on local health services and begin to establish and use alternative routes for people to receive treatment. Initially, this will be via www.nhs.uk or the swine flu information line; subsequently, it will be via the National Pandemic Flu Service.

So, if people think they have swine flu, they should first go online and check their symptoms on www.nhs.uk or call the swine flu information line on 0800 1 513 513. If they are still concerned, they should then call their GP, who can provide a diagnosis over the phone. If swine flu is confirmed, this will give them an authorisation voucher, which a flu friend can take to an antiviral collection point to pick up their antivirals. This may be a pharmacy or a community centre.

As cases rise further, we will move to a system whereby cases are diagnosed and dealt with by the National Pandemic Flu Service. This will take pressure off GPs by allowing people to be diagnosed and given their antiviral vouchers either online or via a central call centre.

Today, I can tell the House that preparations are now at an advanced stage, and that we expect the service to be ready when it is needed. At that point, if people have swine flu symptoms, they should go onto the National Pandemic Flu Service website, or ring the dedicated call centre. However, people in the higher-risk groups should still contact their GP.

Finally, I would like to update the House on vaccines. We have now signed contracts to secure enough vaccine for the whole population. We expect the first batches of vaccines to arrive in August, and around 60 million doses will be available by the end of the year—enough for 30 million people—with more following after that. Administering vaccines will need to be prioritised. We will make a decision on this when we know more about the risk profile.

Most cases of swine flu have been mild and we are in a strong position to deal with this pandemic. But we must not become complacent and, while doubt remains about the way the virus attacks different groups, today’s decision on the move to the treatment phase reflects our caution.

I commend this Statement to the House”.

My Lords, that concludes the Statement.

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My Lords, from these Benches, I should like to thank the Minister for repeating the Statement, which makes it very clear that we have moved into a new phase of the epidemic involving a much greater number of current cases than we were looking at a month or so ago, and the probability of an even higher number, by several orders of magnitude, during the coming weeks. The national and local response to this situation is quite rightly under continual review, and I accept that it is now appropriate to modify our approach to the way that we tackle the disease. Our emphasis now, as the Minister said, has to be on mitigating its impact on those who have contracted it, taking into account the severity of the virus. That must mean that we make sure that those who are most at risk of severe morbidity or complications as a result of the virus are treated rapidly.

Against that background, I have a number of questions. Am I correct in understanding from the Statement that the stockpile of antivirals will be reserved exclusively for symptomatic patients and those who are seen as being most at risk, and that post-exposure prophylaxis is no longer a strategy that will be pursued, other than with the approval of a GP? I ask this because I wonder about particular situations; for example, what is the policy to be applied in prisons? Are healthcare staff and employees of the emergency services not seen as possible deserving cases for post-exposure prophylaxis?

Can the Minister confirm that a decision on whether to close a particular school will be taken on the basis of a risk assessment by the HPA, particularly in the context of the year groups involved, but that closure of a school should no longer be seen as the preferred option, as I think it has been up to now? Most schools are about to break up for the holidays, which is fortunate, but this means that when term is about to start again in September there may be insufficient information available on which to base a decision on closure. Will schools be advised about the transmission rates in their own areas and other relevant information, including what they should do before the start of term?

What advice is being given to the public as regards avoiding exposure to potential infection? It has been reported in the press that there is a school of thought which states that it is in the interests of fit and able-bodied people to try to contract the virus in order to build up immunity to what may be a more severe version of it in the future. Can the Minister take this opportunity to indicate that this is not sensible advice and that the current virus, although milder than initially feared, is nevertheless capable of making people ill or, indeed, very ill, and that the prudent course is to try to avoid it?

The Minister said that swab tests for swine flu are no longer being taken as a matter of routine and that, as a result, the running total of cases will no longer be a matter of public record. I am sure she will agree that that is unfortunate, and I cannot help observing that if the flu line were up and running, that situation would not have arisen, because we would have had a better handle on the numbers. However, can the Minister confirm that the collection points for antivirals are now determined in all areas? Can she also confirm that the interim helpline for those who suspect that they may have contracted H1N1 is working satisfactorily and that it has the capacity to deal with the very high volume of calls which are likely to arise during the next few weeks? If there are likely to be many tens of thousands, if not hundreds of thousands, of new cases by the end of August, what guidance has been issued to NHS trusts to enable them to cope with the high numbers of hospitalised patients that can be expected? What is the Government’s view of the capacity of our system to cope with critical care cases on the scale that is implied? Has modelling been done which shows the probable impact of severe cases on critical care beds? What is the clinical attack rate of this virus?

Finally, the Statement referred to the vaccine currently in preparation. The question of who is given the vaccine will be decided, in the words of the Statement,

“when we know more about the risk profile”.

Can the Minister elaborate on what is meant by this? Do we not already have sufficient information to tell us who is most at risk? If not, when do the Government expect that we will have enough to go on? The Government have, after all, already defined the at-risk groups as regards the use of antivirals. At all events, will the Government undertake to make public the basis of prioritisation once this has been determined?

I end by joining the Government in expressing my condolences and sympathy to the families of those who have died of the virus. I also pay tribute to the staff of the NHS, including officials, GPs, those in primary care, in pathology labs, in hospitals, and the Health Protection Agency, who are working so hard on our behalf. We wish them well during what look certain to be some very difficult and pressurised few weeks ahead.

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My Lords, I register our condolences from these Benches to the families of those who have died. I thank the Minister for repeating the Statement in this House. Given the dramatic increase in the number of people who have contracted flu, it is right that we should reassess whether the strategy that the Government have been following continues to be relevant and the right course of action.

While the Government’s actions to date have rightly been focused on trying to contain the virus and then to mitigate the effects of its transmission, there is a parallel activity to monitor the information about the incidence of the disease and to evaluate the effectiveness of the NHS response. That is in many ways as valuable an activity. It will set out some valuable learning points, were there to be a future pandemic of another disease. I put my questions to the Government in that light.

The noble Baroness said that the Government were now moving to the treatment phase. I understand the reasons for that, but what lessons have been learnt from the containment phase of the strategy? She indicated that there had clearly been a failure to contain the virus. That failure was not entirely unexpected, but what have the Government learnt so far about the ability of the NHS to contain outbreaks? How would that be of value in any future pandemic? To what extent has the progression of the epidemic matched predicted modelling, which I believe the NHS has undertaken for some considerable years?

I have one nagging question about the Statement. Was the decision to offer antivirals only to high-risk groups made purely on scientific advice or was it an economic decision as well? What is the department’s response to that?

The noble Baroness made the important point that there will be a changed role for the Health Protection Agency. It will now step back and the immediate registering and treatment of the virus will go to primary care, in particular to GPs. Has the department estimated the extent to which drawing back the HPA from its front-line role will jeopardise the tracking of data that it has been gathering about the progression of the pandemic? Does the changed role of the HPA offer any risk to the spotting or detection of a mutated virus? The noble Lord, Lord Darzi, recognised as a key problem the chance that the virus might mutate, which could mean that the antivirals that we have are not so effective.

Following the noble Earl, Lord Howe, I ask what the Government plan to do, particularly over the critical period of September, October and November. During that period, the start of the academic year, not only will schools be going back but a number of students will be coming to this country to universities. As always, we welcome them, but that will coincide with the peak activity period for the seasonal flu programme. Is the department now preparing to give additional plans and guidance to primary care staff to cope with a potential spike in demand over those three months?

Can the noble Baroness update the House—this was not in the Statement—on the liaison that the Government have had with foreign Governments and with the Centre for Disease Control in Atlanta and the European health observatories? We can then track any parallels or distinctions between the progression of the virus in this country and its progression abroad.

In the Statement, the noble Baroness mentioned the Scientific Advisory Group for Emergencies—the aptly named SAGE. She said that the change in policy to target only high-risk groups was based on SAGE’s evidence but that that decision was, in its words, “finely balanced”. How quickly have the Government acted on the advice that SAGE has given to date? How quickly could they act were SAGE to give different advice if that balance changes in future?

I, too, congratulate the scientists and front-line practitioners in the NHS on the way in which they have approached this pandemic. It is clear that the NHS has had to deal with a most difficult public health problem. Individuals recognise that it is a public health risk, but it is one that they cannot measure and quantify; they do not yet know how serious this condition will be for them and their families. So far, the NHS has managed to keep the tenor of its information campaign correct. In the face of some rather hyperbolic headlines, the NHS is to be congratulated on having got on with doing a difficult job in a temperate manner.

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My Lords, I thank the noble Earl and the noble Baroness for their support and for their recognition that the NHS has had pandemic plans in place and that the Health Protection Agency, with the NHS, has to date done an excellent job working to limit the spread of this virus. I will attempt to answer the questions that they raised.

The noble Earl asked about the policy of antiviral prophylaxis and treatment. There will be an end to antiviral prophylaxis in the norm. Treatment will be for those at higher risk of becoming severely ill. There will continue to be a clinical discretion to offer antivirals to any patient should the need arise, particularly those who we recognise would need that support, such as health service workers. I had not thought of prisons; that is a good case. I will refer that back to the department for consideration. I am sure that somebody there will have thought about it.

On school closures, as I said in the Statement, the HPA will help with the risk assessment, but this is not now seen as a preferred option. The noble Earl made the point about schools being about to break up and restarting in September and about our need to ensure that the information is available to them so that they are in a state of preparedness. It is a point well made. Indeed, it is in hand. Running alongside the activity of moving to treatment is a huge communications campaign to inform people and health service workers. That will make sure that schools and all those who need to will know what is going to happen and how it will happen—in what order—in a timely fashion.

Who will be offered antivirals? The use of antivirals for prophylaxis will stop. As I said, they will be used only in exceptional circumstances. With transmission in the community, the policy of widespread prophylaxis is no longer appropriate. There will continue to be clinical discretion to offer antivirals to any patient should the need arise. They will be offered to people who are diagnosed with swine flu. Anyone who thinks that they have swine flu has the right to ask their GP for the health service to provide them with antivirals.

The noble Earl raised the issue that I had anticipated about what the media have called “swine flu parties”. The Chief Medical Officer has made a firm statement about that, which I can do no more than repeat:

“We would never recommend intentionally exposing anyone to swine flu. It is seriously flawed thinking to allow the virus to spread unabated through swine flu parties. We don’t yet know enough about the risk profile of the virus and, whilst it has been mild in the UK, in some parts of the world young, previously healthy, adults have died. Parents would never forgive themselves if they exposed a vulnerable child (perhaps a contact of a child at a party) to serious illness. We need to be mindful of any future development of the virus and we remain vigilant in monitoring the disease”.

I do not need to add to those words.

What support is being made available to primary care trusts, GPs and the health service? We are aware that GP practices must expect to be under considerable pressure during the flu pandemic. I have already mentioned the local flexibilities that we have introduced in the hot spots to enable primary care to sustain its response. The national flu service has been designed to minimise the pressure on GPs and primary care teams in a widespread outbreak by allowing patients to receive their antiviral medication via the web, a telephone call or a local network. That means that GPs can concentrate their expertise on treating patients whom they would normally see, plus those who have complications of the flu, as opposed to the potentially very large number of patients who think that they might have flu. Our aim is to divert those patients into the swine flu support mechanism through the web and a telephone line.

How will intensive care manage this? We know that fluctuating demand for and capacity in the NHS are part of normal working activity, but in May we published guidance for the NHS entitled Pandemic Flu: Managing Demand and Capacity in Health Care Organisations. We are giving support as far as we can.

Communication is very important. A communications strategy goes with this, which I have already outlined. The flu surveillance information on infections is co-ordinated and collated by the Health Protection Agency Centre for Infections. It receives regular reports from separate schemes run in England, Wales, Scotland and Northern Ireland, which use the data provided by networks of GPs. The GP network includes 3,300 surgeries covering more than a quarter of the UK population and provides reports on symptoms of flu in patients as part of the QSurveillance system. A further 100 surgeries across the country collect information on flu symptoms as part of the Royal College of General Practitioners’ surveillance. That is during the normal flu season but the fact that we are moving into this new phase does not mean that we will not be surveying and counting.

The noble Earl asked how we predict the disease will progress. Obviously, we cannot predict the spread of the disease precisely, but we know that it has proved to be mild, except in a very few cases. Apart from the figures that I gave in the Statement, I cannot give any further information. The noble Baroness and the noble Earl asked how we will manage the transition. At the moment, we have an interim service, which we felt we needed to introduce immediately because of the increase in swine flu. We recognise that it is important to ensure that the systems are sufficiently tested before they are used. The interim solution has now been tested. It has the capacity to cope. A full programme of testing has been built into its delivery line, before a full system kicks in in the autumn.

The noble Baroness also asked about the lessons that we have learnt from the hot spots and the period that we are just passing out of. The Health Protection Agency, with the NHS, has done an excellent job in limiting the spread. We have learnt that what we need to do when we realise that we have hot spots is immediately to give flexibility locally to reduce the number of patient swabbings, to reduce the pressure on GPs to allow them to treat symptomatic patients on the basis of their clinical judgment, to ensure that other staff such as primary care nurses can swab and to ensure rapid access to antivirals. That is the phase that we are moving into now. The lesson that we have learnt is that that is how we need to proceed.

On the international situation, we fully recognise the importance of ensuring proper protection for countries in Europe and globally. I probably need to write to the noble Baroness about the spike of students coming back to this country in September and October; that is a point very well made. We support the European Commission in helping those countries without contracts to obtain vaccine for a minimum of 5 per cent of their population. We continue to work with the ECDC and the World Health Organisation and we will ensure that we do not duplicate what the World Health Organisation does but that our work in Europe complements it.

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My Lords, I thank the Minister for repeating the Statement by the Secretary of State, which I welcome, because it helps to clarify government thinking and intentions on this important topic.

The Minister will be aware that the House’s Select Committee on Science and Technology this morning met the Minister of State for Public Health to take evidence on this and related matters. The first piece of evidence was that a Statement would be made later in the day. However, I can fairly say that that did not inhibit what was a vigorous but good-natured discussion. One piece of evidence available to us and to the relevant Minister was from the Royal College of General Practitioners. I agree with all that has been said positively about the important role that general practitioners play, but there were some questions in the evidence that we received. For example, headings coming through the website from GPs included lack of information and conflicting advice and variation in support from primary care trusts. There was a positive side to those topics as well, but there was a serious expression of concern from the royal college, which represents the first-line troops in this area.

Can the Minister assure us that the effectiveness of the provisions in the Statement will be measured? It would be wrong to say that the jury is still out, because the jury is still taking evidence about the effectiveness of the policies outlined. It would be good if we could be assured, for example, that organisations such as the royal college will be consulted and that the information coming back from its network of GPs will help to inform the modification of government policy in the weeks and months to come.

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My Lords, I was aware that my honourable friend Gillian Merron was giving evidence to the committee, and therefore worked out that several Members of your Lordships' House might be better informed than I am, having just had a refresher course, as it were.

The point about information is well made. In preparing myself for the Statement, I went online and tested it by Googling and other ways. I decided that I had swine flu and filled in the questionnaire to see what happened at the end. I did not use the phone, because I thought that that would be improper, but I thought that it would be useful to see how those things work. I must say that I found them both easy and accessible. I know that not everybody has access to the internet and would know how to do that, which is why the telephone line and the telephone number that went out to every household are so important.

I take the noble Lord’s point and am absolutely sure that the royal colleges will be fully involved in both consultation and evaluation as we move forward. Plans are being finalised at the moment at both national and local level to communicate to GPs and service users about what will be expected of them when the service is introduced. The exact nature of those messages will be dependent on operational decisions about how the service will be delivered, but they are likely to include national media briefing, advertising and direct marketing. Communications to GPs will be through existing Department of Health channels. That will mean, for example, that in hotspots, where we know there is a great deal of pressure, the distribution of antivirals might not be through local pharmacies; it might be through a community centre. It might be done in a way that removes pressure from the existing health services. On the other hand, in a place where that is not the case, it will be done through the usual GP and pharmacy services.

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My Lords, I thank my noble friend the Minister for giving this report as it affects England, but as I live in Wales, will she say what consultations there will be with the Health Ministers in the devolved nations to ensure that there is a continuous, concerted campaign throughout the whole of the UK? Will she also say how the publicity will be handled about the website, the telephone line, and other means of communication, to ensure that everybody is informed and knows exactly where to go?

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My Lords, as I said in the Statement, we are working very closely with the devolved Administrations. The arrangements for the National Pandemic Flu Service in each devolved Administration are still being finalised, and are, of course, the object of consultation and agreement as we move forward. This is not something that can possibly be imposed on anybody: it has to be done through co-operation. While it is the case in England that we are taking the precautionary approach as outlined in the Statement, at present in Scotland and Wales they are more likely to confine their antiviral treatments to high-risk groups. But as we discussed already, scientific opinion is very balanced on that issue.

I think my noble friend is asking me, “What do I do if I wake up and think I might have swine flu?” The answer is, that you check your symptoms if you are online, with www.direct.gov.uk or www.nhs.uk, or you phone the flu line. If you are still concerned, you should phone your local GP, who will be able to provide a clinical diagnosis over the phone. If swine flu is confirmed, they would give you a voucher number which you should give to your flu friend. A flu friend is, obviously, a neighbour or relation or somebody near you who could collect those antivirals from a collection point.

As the number of cases rise, we will need to move to a different system, where cases are diagnosed and dealt with by the National Pandemic Flu Service, to take the pressure off GPs. For those people who are isolated or vulnerable, the job of GPs and the National Pandemic Flu Service, when it kicks in, will be to deliver antivirals to people’s homes.

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My Lords, like the noble Lord, Lord Sutherland of Houndwood, I have also had the privilege of sitting on the Select Committee upstairs, and we got a lot of useful evidence this morning from the colleague of the noble Baroness, the Minister of State for Public Health. I think there is still some confusion as to how we are going to move from what the noble Baroness described as the interim arrangements for the distribution of antivirals, to the full-blooded national flu line service, which will bypass the GPs and the existing channels and give the patient, diagnosed over the telephone, a number with which they can collect their antivirals from a collection point. I would be grateful to know whether there will be a specific decision on when we move from the interim arrangements to the final arrangements. Will that be generally across the country or will that happen region by region, as appears appropriate?

I remain very confused about the Government’s policy on this. Like my noble friend, I regret that the full-blooded flu line was not up and running by the end of May, as had originally been promised. We now are not going to have it until the autumn. Therefore, it seems to me that the transition from the interim to the final scheme is a very important stage, and I wonder if the Minister could tell us a bit more about that.

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My Lords, the noble Lord is exactly right. That is why we are we are clearly calling this an interim phase. That means that the Health Protection Agency is stepping back from front-line response, and primary care is taking a lead in diagnosing and distributing antivirals. We are ending contact-tracing and prophylaxis in all areas, and will now be identifying by clinical diagnosis or from the pandemic flu service. People who are diagnosed with swine flu will be offered antivirals. We are preparing the National Pandemic Flu Service for launch within the next couple of weeks, and my understanding is that it will happen across the UK—although if that is wrong, I will write to the noble Lord and the House about that. That will provide people with alternative routes to access antiviral treatment, and will relieve pressure on primary care. The noble Lord raises exactly the key point: this has to backed by a full communications strategy, aimed both at the health service and the general public, to explain why things have changed and what this means for people. That is a major part of this work.

We are finalising the plans for the public communications on the move to the treatment-only approach. There is some potential for regional variation in the initial approach, and it will partly depend on the amount of pressure that is brought to bear on the local health service in that area. So in areas like parts of London, where there are very large numbers and large demand, the collection of antivirals will be provided by other means. The strategic health authorities are already testing the PCTs’ ability to do that and the operational arrangements to do that. We also recognise that there has to be a clear rationale behind who will or will not get antivirals, and that has to be communicated clearly in our national messaging. The noble Lord is quite right.

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My Lords, I, too, thank the Minister both for the Statement and for her response to the questions. I also thank those in the NHS and outside who have done so much already to respond to the threat of a pandemic.

I want to concentrate on asking her about community preparation and the responsibility of the general public in this whole situation. I was pleased about the very brief mention in the Statement of flu friend networks, and then about her more positive comments made since then in her answers to questions. It seems that these networks are going to be crucial in getting to people whom other people will not get to.

I was also very pleased that the Minister affirmed that she recognised that there are many people without access to the internet. Indeed, there are those who have no access to phones. One of the most important things in this situation is to do all that we can to ensure contact with those who are the most deprived in our communities and who may well fall through welfare gaps. Churches and faith organisations have a particular responsibility, in that they are among those who may have contact with those who do not fit in with the way in which our society normally operates. What are the Minister’s reflections on the need to get to those who will not be found by many of the methods about which she has spoken so well in the Statement and in her previous answers?

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My Lords, the right reverend Prelate is quite correct to point to the importance of community organisations and their resilience to support people during this outbreak.

In addition to publishing extensive guidance for social care providers, people will be encouraged to build up networks of flu friends from among their family, friends and neighbours who may be willing to support them should they become ill and need not only someone to collect their antiviral medication from the nearest collection point and deliver it back to them but other support: namely, food shopping and getting in basic supplies. Everyone may be vulnerable during a widespread outbreak, although people with pre-existing conditions or a lifestyle that leads to their being vulnerable may be in much worse circumstances. That is why churches and third-sector organisations have a key role to play in identifying needs and supporting people, particularly those who are socially isolated.

Third-sector groups, charities and churches could be flu friends to vulnerable and hard-to-reach people and contact them through their local strategic co-ordination group. Many of them are already involved in their local resilience planning, so I expect that many of them are already gearing up to help with this. It is very important that they do so. We recognise that they have an important role to play.

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My Lords, I, too, join my noble friend in thanking all those in the NHS and the Health Protection Agency who have helped. The way in which the WHO has maintained vigilance and has been able to call each stage before the pandemic has also been remarkable. I found that very reassuring compared with the reaction to the financial crisis, in which economists have said different things and not all people agree; some people have protectionist views about what to do. At least here we are operating together as a global community and helping each other. That ought to be mentioned and noted.

I have always felt that the term “swine flu” is unfortunate, but no one has taken H1N1 and made it into a nice little name. I call it “Hen-one flu”. If that is helpful, I give it free to the Government. I know it sounds a bit like “Henman”, which is unfortunate, but I think “Hen-one” would be better.

I have one question. I may have got it wrong, but did my noble friend say that the number of people who are reported as having swine flu will cease to be made public at some stage? That would be very unfortunate, because we really must have total transparency, even if the situation becomes very serious.

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My Lords, I reassure my noble friend that I said that the daily reporting of HPA figures will not continue because we are no longer testing for this. That does not mean that the surveillance systems that we have in place will not periodically produce figures on the progress of the disease and what we are doing about it.

I absolutely agree with my noble friend about the role of the WHO and the importance of us continuing to work very closely with it and support it. The UK has been in the lead in supporting the WHO in its work to ensure that we support those countries that need it, that we do not duplicate each other’s efforts and that we ensure that information flows across the world that will help us to take the right decisions for our own country, for the rest of the world, and indeed for people who, as the noble Baroness, Lady Barker, reminded us—I include my own family in this—travel the world all the time.