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Jon Trickett (Hemsworth): I feel reassured by the Secretary of State's statement, and I have absolute confidence that a properly funded national health service with an effective public health infrastructure is the best way to deal with this problem. I want to refer to an issue that was raised by one of my constituents on Thursday last. She is a parent escort for nine special needs children. She accompanies them back and forth to school, and one of them has just returned from a SARS-affected area. My right hon. Friend can understand the concern of other parents in the school or on the bus each morning. The local education authority was unable to give effective advice, except to monitor the progress of the child who had come back from the far east. What information does my right hon. Friend have about the level of infectivity prior to the display of symptoms? Can he reassure the House that there is proper liaison at local level between the health service and LEAs and other public bodies?
Mr. Milburn: Separately but in tandem with the advice that the chief medical officer has distributed to the national health service at local level, the Department for Education and Skills has also distributed information to LEAs through its channels. If it is helpful to my hon. Friend, I shall get a copy of that advice sent to him.
Fortunately, to the best of our knowledge, at this moment in time at least, people with SARS are not infectious until the symptoms appear. People with flu are highly infectious during the period leading up to the appearance of symptoms, but this disease appears on the face of it to be different. That should give us ground for optimism.
My final point is a response to my hon. Friend's first. A situation such as this clearly reveals the considerable strengths of a single national health service for our country, which are integrated provision and the integration of public health services at local, regional and national levels. That is why we on this side of the House, at least, intend to maintain a national health service.
Mr. Patrick McLoughlin (West Derbyshire): Can the Secretary of State assure us that the advice given by the chief medical officer about areas that people should not visit is reflected in that given by the Foreign and Commonwealth Office?
Mr. Milburn: Yes it is, as far as I know.
Mr. Tam Dalyell (Linlithgow): If I may be forgiven a constituency question, the Secretary of State may or may not know that after Glasgow and Edinburgh,
Toronto is the third most populous Scottish city in the world. Many of my constituents go to and fro between Scotland and Toronto, particularly when taking their holidays. The big issue is whether they should cancel, or indeed in some cases book, trips to see their kin and loved ones in Toronto in July, August, September or October. What advice should we give to them?
Mr. Milburn: I am extremely reluctant to get involved in Scottish matters in general and Scottish holiday matters in particular. The best advice to which I can refer my hon. Friend is that given by the chief medical officer, and if it will help him, I will make sure that he gets a copy of it.
Dr. Andrew Murrison (Westbury): Officials within the Secretary of State's Department have said that it is bureaucracy that is preventing this disease from being notifiable; in fact, the problem is under-reporting and under-notification through current legislation. Does he agree that his officials' comments have further undermined professionals' confidence in the reporting and notification system, and that those comments have not helped during the current outbreak? If he genuinely believes that the level of bureaucracy is at fault and that it is the reason why notification reporting has not been used for SARS, how does he intend to remove or to improve it?
Mr. Milburn: As far as under-reporting is concerned, the fault lines in the official notification system have been a cause for some concern not only for people in my Department but for public health professionals. As the hon. Gentleman must be aware, under-reporting has got progressively worse, rather than better, over many years. However, he will also know from the variant Creutzfeldt-Jakob disease episode that other systems of reporting can be at least as effective—they are often more effective—as the official disease notification system. Indeed, to the best of our knowledge, at least, vCJD is almost 100 per cent. successfully reported. All of the cases that are identified are properly reported.
The hon. Gentleman will share my desire—particularly in the early phase of what is a serious outbreak of this disease—that all cases be reported as quickly as possible with the minimum of bureaucracy, and that is what is happening. Cases are being reported directly to the chief medical officer and also to the new Health Protection Agency, rather than going through the form-filling exercise of which the hon. Gentleman is doubtless painfully aware.
Geraint Davies (Croydon, Central): Given that the disease is much more well established in China, what is known about its profile in the later stages of its evolution in China in terms of spread, growth, transmission and mutation? Indeed, what is known about the actions that the Chinese are taking to combat the later stages of its evolution? Would it not be a good idea to take such actions in a pre-emptive way as a precautionary measure?
Mr. Milburn: As far as action in China is concerned, I understand that the Chinese Government are taking the matter and the accurate reporting of cases extremely
seriously. Without accurate epidemiology, this or any other country will simply not be able to deal with the problems.We know that the worst cases of the spread of SARS—including, tragically, not only those in China but in Toronto—have occurred where there have been inadequate cross-infection control procedures, particularly in hospitals.
We know from information from the Canadian authorities and through the World Health Organisation that, because several cases in Toronto hospitals were not spotted quickly, the isolated nursing procedures now recommended by the WHO were not put in place, leading to the fairly rapid spread of SARS. Many people adversely affected have been in close contact with SARS sufferers, so they tend to be close members of the family or, sadly, health care workers who have had to treat SARS patients. We know that much, and, because we know it, we can act appropriately and proportionately. That is why we are providing the advice and adopting the approach that we are.
Mr. Peter Luff (Mid-Worcestershire): In his statement today, the Secretary of State was dismissive of the notifiable disease regime, effectively ruling it out as an effective tool in the battle to secure public health. If it is really as bad as that, what does he intend to do to reform it?
Mr. Milburn: The hon. Gentleman was present during my statement and he knows full well that I did not say that. I said that if I received advice from the chief medical officer that further powers were necessary, on top of those already available in legislation through the 1979 regulations, we would not hesitate to take them. However, I hope that the hon. Gentleman agrees that it is important to take decisions on the basis of the best clinical and scientific advice, which is what we will continue to do. The fact that we have done so to date is one of the reasons why we have so few SARS cases in this country so far, and we shall continue to adopt the same approach in the weeks and months to come.
Mr. George Foulkes (Carrick, Cumnock and Doon Valley): Should we not put SARS more into perspective, as I am probably in greater danger of catching malaria? Should we not be more worried about the three children in hospital in Scotland with E. coli? Does not the panic caused by outrageous statements made in the media by Tory and Liberal spokesmen—I am glad that they were a little more responsible today—create tremendous problems? We should tell people that of course it is safe to go to Toronto. If we continue with this panic, not only transportation, but our economies will be adversely affected. If that happens, many more young children in the developing world will die of malnutrition as a result, which is something that we should really be worried about.
Mr. Milburn: I think that it is right to take the SARS outbreak seriously, but I also think that it is important to keep it in perspective and in proportion. I read with interest in one of the weekend papers an article by Dr. Robert Baker, who is a specialist in infectious diseases at King's College hospital in London. He reminded us that in the course of a day, 3,000 children die of malaria
worldwide; that nearly 3 million more people will have died of tuberculosis by the end of 2003; that 40 million people have died from AIDS; and that in the USA, ordinary influenza kills between 20,000 and 30,000 people each and every year. There are also several thousand such deaths in this country alone. However, that is not to downplay in any way the significance of a new and serious illness.My right hon. Friend is right that we have to keep a sense of proportion about SARS. I simply refer him to what Dr. Vivienne Nathanson, head of science at the British Medical Association, said about the problem:
- "It is extremely important that the public does not panic over Sars. The Department of Health, the Health Protection Agency and the World Health Organisation are taking all appropriate steps."
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