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7 May 2009 : Column 377

Scientists are now much closer to developing a vaccine strain from the virus. Although the first strain of the vaccine may be ready in a matter of weeks, developing it into an useable vaccine will take several months. The UK Government and the devolved Administrations already have agreements in place with manufacturers to supply stocks of a vaccine as soon after production begins as possible. In the meantime, we will continue to get expert advice on the most effective vaccine strategy, and what would best protect us if the virus returned in a more virulent form in the autumn. We also need to assess the effects on the availability of the seasonal flu vaccine this winter.

To make sure that we can distribute antivirals effectively, we are working to get the flu line up and running as quickly as possible, and it will be ready by the autumn. In the meantime, we are finalising plans for an alternative system, which we aim to use in the short term, should the virus become more widespread more quickly.

The interim arrangements that we are putting in place mean that people with symptoms can be assessed quickly, and antivirals made available so that they can start treatment within 48 hours of symptoms developing, without having to leave their home. We will co-ordinate local arrangements with primary care trusts for assessment and collection, web access and also the potential for phone services. It is critical that any system is robust and as thoroughly tested as possible before it is made operational.

Prescription-only medicines such as Tamiflu can currently be supplied to a patient only by a doctor or other qualified prescriber. In the community, they can be prescribed to patients only from registered pharmacies. That is enshrined in statute. Statutory instruments will be laid in the House this afternoon to enable us to make the necessary legal changes to support any interim arrangements so that people can access antiviral drugs quickly, should they need them.

Even with the best available scientific evidence at our disposal, it is impossible at this stage to give a cast-iron prediction of how the virus might develop over the coming months. However, with the preparations we have made, the hard work of our exceptional scientists, and, above all, the dedication and commitment of NHS staff, I can reassure the House that we are doing everything possible to protect our citizens against any eventuality that might emerge in the coming months.

Mr. Stephen O'Brien (Eddisbury) (Con): I thank the Secretary of State for advance sight of his statement. The House will be grateful to him for the further update.

As we discussed last week, there were grounds for optimism, which appear to have been justified. The severity and spread of the virus are much less than we might have feared. It is therefore a good moment to express our appreciation of the work of NHS staff, and staff in the Health Protection Agency, the pathology services and the Department on achieving such containment. We do, of course, still have a long way to go, and step one is to increase our knowledge of this virus and its clinical impact on those affected. Including Mexico, the case fatality rate is below 0.2 per cent., so this is broadly equivalent to a seasonal flu. However,
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the hospitalisation rate in the US is about 8 per cent., which is at least twice what we might have expected, although more precautionary measures are being taken at this stage.

As the House will know, the flu virus is capable of rapid mutation, and past experience has seen flu come in a number of waves with the later ones having significantly different clinical attack and fatality rates. We therefore support an aggressive containment strategy while we gather information and analysis on the virus. Subject to that, it may be desirable to maintain counter-measures to delay the spread while the vaccine is developed. Alternatively, it may be that our response should be more in proportion with that to a seasonal flu epidemic. A judgment to be made—not yet, but in the coming weeks—will be whether to continue with the production of a seasonal flu vaccine or to shift production capacity to a pandemic flu vaccine, at the risk of leaving us overexposed to seasonal flu as we enter the next winter. Will the Secretary of State undertake to include those issues for debate in the House next Thursday, once further analysis of the virus is available?

Can the Secretary of State confirm that the Government’s approach is to close schools where a case is confirmed in order to stop the spread of the virus? The Centers for Disease Control in America has changed its guidance from advising closure to a policy of keeping symptomatic students and staff out of school while they are ill and recovering. That is based on the evidence that the virus is circulating widely in the US, whereas that is not the case in the UK. It is debatable whether isolating symptomatic students and staff is as effective as closure, as a combination of household prophylaxis and school closures appears to reduce significantly the spread of the virus. However, if the virus is mild and the impact of school closures is significant, not least during this exam period, it may be better to follow the US line.

Given that some schools in the UK—the five named schools that the Secretary of State mentioned—are closing and others are simply restricting year groups coming into school, can he clarify whose advice schools should follow? If schools do close, should that be for one week, which is the period adopted in the UK generally by the five schools affected so far, or for two weeks, which is the time scale advised in the US? Alternatively, should schools close for three weeks, which is the period denoted in the strategy, or 10 days, which is what is indicated for a virus such as this, whose characteristics—the ones known so far—are a 48-hour incubation period followed by an infectious stage of two to three days? Can the Secretary of State outline in what circumstances the school exam timetables and arrangements would need to be changed? Would it be fair, either to pupils forced to stay at home or to those still attending school, to use coursework in place of an exam in order to test and grade students—reports have suggested such an approach—rather than use, for instance, the retake system?

As regards other preparations, beyond bringing forward the distribution of the phase 6 information leaflets to UK households, TV and radio advertisements, and regional and local authority civil contingency preparations—I had a very constructive meeting with the leader and the chief executive of Cheshire East council on Friday, which confirmed their preparedness—I am glad to note that the Government have ordered
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extra antivirals, face masks and antibiotics, as we have asked them to do repeatedly over the past four years. Will the Secretary of State confirm that the use of Tamiflu for NHS workers and, equally crucially, for those working in the social care services—I noted that he mentioned only NHS staff in his statement, whereas in response to a question following his previous statement he said that this did extend to social care workers too, so I hope that he will be able to reconfirm that today—will occur only if people in these front-line jobs are symptomatic?

As the Secretary of State knows, I first asked a written parliamentary question about the important subject of the national flu line as far back as November 2008, in order to ascertain the Government’s preparedness for a pandemic. In the light of the answers from the Minister of State, Department of Health, the right hon. Member for Bristol, South (Dawn Primarolo) last year, which revealed and admitted to the delay from last autumn to early this year and now until autumn this year, can he explain why the contract was held up for some months last year by the Office of Government Commerce and the Treasury? Can he also explain why the Department told the Select Committee in the Lords just in March that the national flu line would be available in May, when in fact it will now not be effective until the autumn?

Will the Secretary of State explain how NHS Direct will be able to scale up, to be the means through which symptomatic patients can access antivirals within hours? The plans would call for the national pandemic flu line to be brought into operation at World Health Organisation phase 6. Is that still the Government’s intention? If so, how many of the planned 7,500 call centre seats will actually be available?

We have been receiving reports that there is a degree of confusion both among general practitioners and among pharmacists: when a GP gives a prescription for Tamiflu, pharmacists are not in a position to fulfil the prescription, as the Tamiflu is held effectively by the health protection unit. The confusion lies in the protocols, so who is to advise and authorise the administration of Tamiflu locally? I noted something additional in the Secretary of State’s statement that was not in the bit faxed to me earlier: he added that with doctors only prescribing and pharmacists only dispensing, he will be laying statutory instruments before Parliament to ensure that the necessary legal changes can be made. That may be a partial answer to my question about authorisation, which is now on the minds of many GPs and pharmacists.

Finally, can the Secretary of State reassure us on our concern about the potential deep disparity between the resources available to respond in the US and Europe, and the impact on populations in the least developed countries. Flu is a dangerous enemy and we must be vigilant, as even this virus, in the absence of antiviral drugs in many countries, may prove very damaging. What further steps will our Government therefore consider to offer assistance through the WHO to combat the spread to the most vulnerable populations across the globe?

Alan Johnson: I am grateful to the hon. Gentleman for raising those points for clarification, and I confirm my understanding that a debate will take place in this House on 14 May, when we will consider all these issues.
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By then, I hope we will be in a much better position on the science to answer some of the questions that at the moment are just imponderables.

The hon. Gentleman asked about school closures. Our policy remains that the Health Protection Agency and the health protection unit in the area should be the authoritative voice on whether or not a school needs to close. In one case, they decided that because the child, who was symptomatic, did not develop those symptoms at the school but did so when they were away from school, the school should remain open. They have taken different approaches in respect of other schools, but the length of time has always been the same—seven days. Paignton community and sports college is on two sites, so they kept one part of the school open. The decision depends on whether the pupils who have the symptoms have mixed in the same eating area as other pupils and whether they have the same restaurant facilities as other pupils—a number of measures need to be taken into account. At Alleyn’s school, the pupils are all in one building and there is no separation between the different annexes of the school. The decision needs to be taken by the HPA, in conjunction with the local education authority and the school, based on the circumstances.

The HPA’s advice is that this virus has an incubation period of seven days and that has therefore driven our approach on seven days. There is some evidence from the WHO that the period may be less than that, but that is where the seven days approach comes from. It is kept under review, and if at the end of that seven days the HPA decides that it can keep a school open for longer, it does so.

On the question of exams, which is tremendously worrying for pupils and parents, I refer the hon. Gentleman to the statement that Ofqual made on 1 May and the subsequent information that came from the Department for Children, Schools and Families. There has been a practised approach to this—most recently, it was used successfully in my constituency after the floods in Hull to deal with the problems—so it is not as if we are in uncharted territory. However, it is important that the information reaches parents and pupils as quickly as possible.

The hon. Gentleman raised the issue of the flu line and said that for the past four years he had asked for face masks and so on to be ordered. This is not the place or the time for political point scoring, although doubtless there will be a look back at what has taken place. I ask him and other hon. Members to recognise that we are well prepared, but that when we take the decision, as we have done in the framework, to order face masks, to increase the stock of antivirals and of antibiotics, we then need to go through the process of an outline business case, a full business case and proper procurement. In the case of flu line, the problem has been that this is a completely untested revolutionary system, and we have had our problems in the past with revolutionary IT systems that have not been tested and probed sufficiently.

I can think of no worse occasion than a pandemic for us to put all our eggs in one basket and then to fail, so a perhaps more cautious approach has been taken than in other areas of new technology. We signed the contract with BT in December 2008 and it will be ready in October, having been fully tested. We are not willing to take the risk of running the system any earlier in those
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circumstances. My noble Friend Lord Carter, the Minister responsible for telecommunications, has done a tremendous job in bringing together the current interim measure, which I shall say more about at the right time.

NHS Direct can double its capacity within 10 minutes. It is an amazing organisation, as the Prime Minister and I saw last Friday, and it is working extremely efficiently in the current circumstances. However, the interim arrangements—the pre-flu line arrangements, which I hope to say more about in next week’s debate—will not rely just on NHS Direct, because it deals with all the other things that happen, such as people ringing about heart attacks and so on. We are not using up all of NHS Direct’s capacity, but it will play a part, as I hope to explain next week.

As for the statutory instrument, I apologise to the hon. Gentleman. I realised after we had sent a statement across to him that we were due to lay statutory instruments this afternoon, to ensure other channels of distribution. It would have been quite wrong of me not to mention that to the House in this statement, so I added it at the last moment.

Finally, the international position is of course important. The World Health Organisation is co-ordinating help for less advantaged and poorer countries, so that they can have access to protection. I know that France has sent a supply of antivirals, and we have given money to the same extent—we have not put medicines in, but we have given £4 million to the World Health Organisation pandemic emergency fund through the Department for International Development. We have also given an amount to the UN contingency fund, which may or may not be necessary. We remain fully alert to the dangers, as the House would want us to be, and we are ready to help other countries. Thankfully, the problem has so far not spread to sub-Saharan Africa, but if it does, we need to be ready to counter it there, too.

Nia Griffith (Llanelli) (Lab): In talking to people about how we can prevent the spread of infection, I have been surprised to find out how few people know that a sneeze can be prevented by licking the roof of the mouth. Putting the tongue firmly against the top of the mouth can stop a sneeze coming out or at least stave it off long enough to get a handkerchief out. Will my right hon. Friend consider including that idea in advice to people about how to prevent the spread of infection?

Alan Johnson: My hon. Friend helpfully passed me a note about that after the statement last week, which I passed on to the clinicians. I had never heard of it before. All I can say is that I have road-tested it, as has the Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), and it does not work, so perhaps we need some instruction from my hon. Friend.

Norman Lamb (North Norfolk) (LD): I join others in thanking the Secretary of State for early sight of the statement. I also thank him and the chief medical officer for the briefings that they have conducted away from the Chamber and join others in thanking staff across the NHS for their hard work in preparing for the potential pandemic.

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There were reports last weekend of concerns contained in a Department of Health document about capacity that hospitals, including intensive care units, could be overwhelmed. What assessment has the Secretary of State made of current capacity, particularly in parts of the country where hospitals are operating at close to capacity, if not full capacity, and what are the potential risks?

There is reference in the same document to the potential for 10 times as many people requiring ventilators than the NHS can supply, owing to complications such as pneumonia. What plans, if any, does the Secretary of State have to increase the supply of ventilators? There have also been reports of GPs struggling to get access to swabs. Can he provide an update on that?

As for the use of antivirals prophylactically, the Secretary of State mentioned the potential for a change of strategy. It will obviously be difficult to persuade people who are potentially affected of the case for a change. Is that dealt with in the planning document? How will the judgment be made and how will it be communicated to people who will obviously be suffering considerable anxiety?

What assessment has the Secretary of State made of local preparedness around the country? There have been reports of PCT board minutes showing quite a variable picture around the country. Would he be prepared to publish every PCT’s assessment of its current preparedness?

I note what the Secretary of State said about the flu line business case, but it took the Treasury 32 weeks to approve it. Does he share the frustration that was felt by NHS Direct at board level at how long that took? What pressure was his Department putting on the Treasury to speed things up? The statement refers to the fact that we now need to make alternative plans because the flu line is not ready. How much will those alternative plans cost? Surely that cost and inconvenience has been caused by inertia in the Treasury.

Finally, concerns have been expressed about action at EU level. There are reports that EU Health Ministers failed to reach agreement on the right strategy for travel bans and on plans for a European drug bank for flu remedies and vaccines. Can the Secretary of State update the House on the current position? Is he satisfied that the Council of Ministers is getting its act together and that there is a coherent action plan across the whole EU?

Alan Johnson: On capacity in hospitals, we are sure that the plans are in place to deal with that. We are a long way from that stage yet, which will mean dealing with complications when we have a full-blown pandemic, which is the same reason why we need the antibiotics. In those circumstances, hospitals would delay non-essential operations and change their whole mode of operation to concentrate on that priority.

Compared with 1969 and 1957, fewer beds are available in hospitals. In 1950, the average stay in hospital was 45 weeks; now it is 4.5 weeks, so we do not need the number of hospital beds that we had then. However, I am assured that we have the capacity in beds and, in particular, intensive care beds out there to deal with the problem, and the same goes for ventilators.

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