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Mr. Graham Stuart : Will the Minister give way?
Ms Winterton: If the hon. Gentleman will forgive me, I must move on because other hon. Members want to speak.
The hon. Member for South Cambridgeshire is right that good communication with the public and health professionals will be crucial both before and during a pandemic. As I have said, stories have appeared in the media about avian flu, pandemic flu and seasonal flu, and such stories sometimes cause confusion. We want to ensure that the public have clear and accurate information about a pandemic and its consequences. We have extensively tested the communications materials that will be used in the event of a pandemic with the public, and during the summer the chief medical officer alerted all doctors to guidance and advice on the Department of Health and the Health Protection Agency websites.
Next week, we will be sending packs of information, including that already available on the website, to all primary care professionals, including GPs, and the CMO will send a letter enclosing frequently asked questions and key facts to every GP to help them support patients who may have concerns about pandemic flu, and those materials are available on the Department of Health website, too. As I have said, our planning for a pandemic has been highly commended by the World Health Organisation as being at the forefront of international preparation. I assure hon. Members that we are not complacent and that we keep our plans for not only pandemic flu, but general emergency preparedness under constant review, and we will make any necessary updates on the best available evidence.
I hope that I have reassured the House about our strategy, and I urge hon. Members to reject the Opposition motion and to support the Government amendment.
5.32 pm
Steve Webb (Northavon) (LD): Although our debate has focused on avian flu and preparation for a possible pandemic, I join the hon. Member for South Cambridgeshire (Mr. Lansley) and the Minister in highlighting the superb performance of our emergency services and Transport for London in responding to the events of 7 and 21 July, and I endorse the Conservative Opposition's decision to put that point on the record in their motion.
I, too, want predominantly to focus on preparation for a flu pandemic, but I want briefly to comment on whether the best way to respond to emergencies is to have a dedicated Minister for homeland security.
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This afternoon's debate has helped to clarify the Conservative proposal. I entered the debate with an open mind, which I try not to do very often, but the Conservative proposal is paradoxical, because the Minister is supposed to be a senior Minister, but not necessarily a Cabinet Minister. The Secretary of State for Health is currently taking the lead and working with other Departments on avian flu. The proposal is to appoint a Minister junior to the Chancellor of the Duchy of Lancaster, who is not a household name: I had to ask my hon. Friend the Member for Somerton and Frome (Mr. Heath) who holds that post. It seems implausible that the Chancellor of the Duchy of Lancaster's junior will have enough clout in government to make things happen. Because of the rest of the text, I encourage my hon. Friends to support the Conservative motion, but I want to register the point that we are not convinced by that proposal.
Adam Afriyie: Does the hon. Gentleman agree that having a single Minister of whatever rank who is responsible for homeland security, which is one of the key issues that we all face, is sensible and reasonable in principle?
Steve Webb: I certainly think that having a Minister with overarching responsibility for these matters is a good thing. The Home Secretary is already that person in relation to preparation for a terrorist emergency. I would be surprised if the Conservatives wanted to create more Ministers and extra bureaucracy and duplication. The debate is a funny mixture—it is almost as if there were two very different things that they wanted to talk about and which they lumped together. The Minister with the expertise to respond to a pandemic would be a very different person from the person who has to prepare the country for a terrorist attack. Using the same debate to cover two different areas does not help.
We have discussed how far in advance the Government were alerted to these issues. I place on record my tribute to my hon. Friend the Member for Somerton and Frome, who had the foresight to raise them in the House in March 2003 in a debate called, "Viral Pandemics". As long as two and a half years ago, he challenged the Government on their state of preparedness for them. The then Health Minister, the hon. Member for Tottenham (Mr. Lammy), said:
"The UK was one of the first countries to publish a national pandemic influenza contingency plan in 1997"—
under the previous Government. He went on:
"it is important that plans are kept up to date and the plan is now being updated". —[Official Report, 26 March 2003; Vol. 402, c. 137WH.]
If it was being updated in March 2003 when my hon. Friend drew attention to the issue, why did it take until March 2005 to produce it? The Government have taken too long to get moving on these important issues.
Several concerns have been expressed about the Government's strategy, one of which relates to the stockpiling of Tamiflu. It is obviously, as far as we know, the best game in town, but there are worries about its effectiveness. A July 2003 academic study into the clinical effectiveness of oral oseltamivir, which is the same thing as Tamiflu, says:
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"One systematic review found that oseltamivir reduces the duration of symptoms by up to 1 day but one subsequent RCT"—
"found a smaller difference between oseltamivir and placebo. Two RCTs found that oseltamivir increased nausea and vomiting compared with the placebo."
Although that was a couple of years ago, how reassured are the Government that Tamiflu is effective?
A report in the journal Nature refers to a Vietnamese patient who has a form of bird flu virus that has become partially resistant to Tamiflu. The report suggests that it
I understand that, if there were an alternative, the Government would be buying it instead of Tamiflu, but how robust is their advice on its effectiveness? Are they confident that it is effective as is hoped?
The Minister talked about the pros and cons of Relenza as an alternative antiviral. It may be unsuitable for some groups, but if there are question marks over Tamiflu should not the Government be looking at other antivirals as part of the strategy? For example, should not we be stockpiling them for groups for whom using an inhaler is not a problem?
The Government say that it will be another year before they reach their target of covering a quarter of the population. What are they doing to work with Roche and other providers to increase supplies more rapidly? Roche has said:
"we are prepared to discuss all available options, including granting sub-licences, with any government or private company who approach us to manufacture Tamiflu or collaborate with us in its manufacturing."
I appreciate that the Minister said that another manufacturing plant was being opened in the United States, and that is welcome, but what are the British Government doing to talk to Roche about the possibility of sub-licensing alternative manufacturers? Clearly, we all hope that we will get away with it and that nothing happens before we have our stockpiles, but should not the Government do more by working closely with the drug companies to ensure that things move more rapidly?
Let us consider the adequacy of the contingency plans. I was startled by the response of the Secretary of State for Health on Monday to my urgent question when she said:
"My understanding is that all health authorities and PCTs have plans in place".—[Official Report, 17 October 2005; Vol. 437, c. 632.]
Will the Minister who responds to the debate clarify what plans the Secretary of State was talking about? Do all health authorities and primary care trusts have pandemic flu contingency plans in place? That is not my impression and I would therefore appreciate some clarification.
I am also worried because primary care trusts have to implement the plans. At the moment, they have other things on their minds, such as being abolished, merged or restructured—[Interruption.] And, indeed, in deficit. Will the Government reconsider the plan to restructure PCTs and health authorities while anxiety about a possible pandemic is gearing up and we are asking them to be thoroughly prepared to put emergency measures in place? Are organisations that are undergoing huge
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turbulence and upheaval best placed to do that? Is not it more important that the emergency plans are in place than that the Government's restructuring is effected? Should not the restructuring be put on ice?
My hon. Friend the Member for Somerton and Frome asked the Minister about measures to prevent veterinary spread. In other words, if there are outbreaks of bird flu in, unsurprisingly, the bird population, what will be done not so much with large-scale poultry farmers—the Minister's response was all about the National Farmers Union and the industry—but about people with a few chickens in the back garden? The disease could be spread just as easily through them. I am not talking about poultry workers, who may be well organised and briefed, but individuals whose actions or inaction could lead to the spread of the disease. I do not imagine that someone with half a dozen chickens in the back yard regularly checks the DEFRA website for guidance. What are the Government doing about proactively ensuring that people who keep poultry use the best possible animal husbandry methods and are aware of what they should do if they detect symptoms and, indeed, that they know what the symptoms are? That could apply to large numbers of people. What is being done to ensure that they have the best available advice?
In The Times today, the United Nations expert made a powerful observation. He said:
I would be delighted if the Government could tell us that we have not only one of the best plans but the best in the world. If it is true, that is great but we are vulnerable if we are not doing everything we can to ensure that the places where a human outbreak might start are also as well prepared as possible.
Although the Minister said that scientific experts are travelling around—I think she said that they are examining research into vaccines—what are the Government doing to ensure that poor countries that perhaps cannot afford stockpiles of antivirals or all the necessary vaccines, get support from our Government and others to put them in the best possible position to contain an outbreak, thus protecting both ourselves and the citizens of those poor countries? Clearly, we have a self-interest as well as a humanitarian interest in ensuring that that is done. Although some of the manufacturers of antivirals and vaccines have pledged to make limited supplies available cheaply, if not for nothing, to some of those countries, what part are the Government playing in ensuring that that happens?
I raised the matter on Monday in an urgent question and we received an initial response from the Government. Today, the Minister tried to respond thoroughly to several issues that the Opposition raised in their motion. However, when the chief medical officer refers to 50,000 deaths, it is not well understood that that estimate is based on 14 million people getting the symptoms of a flu pandemic. We can remember what happened when people believed that they would run out of petrol. The country almost ground to a halt because everyone panicked, people rushed out and that caused problems for the distribution network.
I want the House to imagine the build-up to 14 million people—over a long period, admittedly, but the Minister said that the peak could occur sooner than we
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think—having the symptoms of a disease that is killing people. There will be stories on television night after night of thousands of people dying and being buried. If someone in my family got those symptoms and we then discovered that there were not enough antivirals and that my child or my brother would not have access to them, I cannot begin to imagine how different the scenario would be from the calm, measured ones that we might sit and plan in Whitehall or Westminster.
I do not want to be alarmist—this has not been an alarmist debate—but I would like to seek reassurance from the Minister that contingency planning is based not on the response of calm, rational, reasoned individuals but on irrationality, and on people panicking and being desperate. How would everything work if that scenario were meshed with a situation in which large numbers of people were off sick and the transport infrastructure was not working? Can the Government reassure us that they have built into their planning scenario that kind of world, rather than one in which people have a measured and rational response to the crisis, because I fear that that is not what we would get?
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