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Alan Johnson: That has been working well. The Health Protection Agency has been doing the contact tracing—tracing those who have been in close contact with people who are symptomatic. When we publish the information about new cases, the agency makes sure that the families and close relatives have been advised first, so that the information is known to them first, and then we do the contact tracing.
Generally, it is no secret when there has been an outbreak. One of our worries has been the problems that children have been having. Text messages have been sent and there has been bullying around the idea that people from the school concerned have some kind of plague. That has caused the Health Protection Agency not to name publicly the schools involved. I guess that, locally, the schools will become known pretty quickly, not least because they generally close for seven days. But people are trying to be sensitive about the information and to ensure that the policy of containment works and that people support it. Incidentally, all our evidence from the public—most recently this morning—is that between 75 and 80 per cent. of them think that what I have described is the right way to deal with the outbreak.
Bob Spink (Castle Point) (Ind): Castle View school on Canvey Island in my constituency is now closed following five outbreaks of swine influenza. I congratulate the Government on their strategy and in particular on their building up of Tamiflu stocks. Will the Secretary of State estimate how long it will take for a specific H1N1 vaccine to become available? What research is being done on that right now? Will he confirm how long schools that are closed must remain closed, so that our constituents can start to plan again?
Alan Johnson: I hope to be able to say more about the vaccine in the debate on Thursday. British scientists at the Health Protection Agency in Colindale have identified the strain—the so-called isolate. They have passed that to Potters Bar, where the National Institute for Biological Standards and Control will now do the work of producing a vaccine. That work has been completed, and the next stage is what I hope to be able to tell Parliament about on Thursday. Efforts are going on in this country and abroad to ensure that we get a vaccine developed as quickly as possible. Of course, it would take at least five to six months to manufacture and produce it. However, we hope that having taken the first step, whereby we have identified the isolate, the next stage—to get the vaccine from that—is very close.
Ms Dari Taylor (Stockton, South) (Lab): Accepting that if swine flu does take place, the elderly will be particularly vulnerable, will my right hon. Friend not only acknowledge that fact but explain to the House what systems are in place locally within the community to ensure that an early warning system is available and that medical help is immediate?
Alan Johnson:
The elderly are obviously a prime concern, particularly if they are living on their own and need someone else to get their antivirals for them. At the moment, the evidence from Mexico—the HPA has just finished a week there and has brought back lots of detailed information—is that the people who are dying are aged between 25 and 50. My hon. Friend raises an important point. We must try to produce the vaccine
that the hon. Member for Castle Point (Bob Spink) spoke about without interfering with the production of seasonal flu vaccines, which are to a great extent used by the elderly, but also by people with chronic conditions. We are aware of the issues with the elderly. We are considering who would be the priorities for a vaccine once it starts coming through; the elderly may or may not be in that category once we know more about this disease.
Choose and Book System
5. Andrew George (St. Ives) (LD): What proportion of expenditure on the NHS IT programme has been incurred on the choose and book system to date; and if he will make a statement. [274102]
The Minister of State, Department of Health (Mr. Ben Bradshaw): Spending on the development, delivery and maintenance of the choose and book IT system to March 2009 was £134 million. As at 31 March 2008, which is the latest date for which an estimate of the overall local and central expenditure on the NHS IT programme was made, the National Audit Office estimated that a total of some £3.55 billion had been spent on the programme.
Andrew George: I am grateful to the Minister for that reply. I speak to a lot of GPs, as I am sure all Members do, and the impression that I get from them is that patients prefer their GPs’ advice. GPs know their patients rather better than do software systems, which often override patient preferences anyway. In view of that, and given that the system has had a long time to bed in, is the Minister content that it is giving real value for money?
Mr. Bradshaw: I am slightly puzzled by the hon. Gentleman’s question. There is no contradiction between using choose and book and giving patients choice; in fact, choose and book is a vital component in helping GPs to ensure that their patients are given choice. If, as he says, there are GPs in Cornwall who are not offering their patients that choice, I find that as unacceptable as he does. If there is a problem with the choose and book system whereby slots are not becoming available, which may be what he wants me to address, that is an issue that the local primary care trust needs to address. The latest figures for Cornwall that I have show that it is one of the highest performers in the country on choose and book, with up to 80 per cent. of GP referrals being made through that system. It therefore sounds to me as though both choose and book and the choice system are working pretty well in Cornwall.
Mr. Andy Reed (Loughborough) (Lab/Co-op): My hon. Friend is right to introduce technology into the national health service, particularly in these formats. However, given that according to the National Audit Office the figures are running at £3.5 billion, has he analysed the benefit that is derived from such schemes compared with the cost of investing in other parts of the NHS? There is a great feeling that IT is overtaking many other aspects of clinical care, and that many local needs could otherwise be met through those funds. Is he convinced of the value for money of this funding?
Mr. Bradshaw: There is no doubt that an initiative such as choose and book is cheaper and easier to use and helps to enable the choice system or other elements of the national IT programme such as picture archiving, which is incredibly important and successful around the country. No one can have any doubt that these initiatives have not only improved the quality of patient care but are saving the NHS a lot of money. At this stage of the national programme’s development, it is difficult to quantify the total benefit in terms of economics and patient gain, but every day patients and clinicians are benefiting from the advantages that the computer system provides to them. There are still many challenges ahead—I do not duck those at all—but countries all over the world are considering this, including Barack Obama’s America, where people are looking to introduce a similar sort of national computer system into the American health care system as the one we have here.
Mr. Stephen O'Brien (Eddisbury) (Con): More than three years ago, Tony Blair promised that patient choice would be a key driver of reform, but in February this year the Minister had to admit that the choose and book system was being used by as few as 12 per cent. of GPs in some primary care trusts and that a mere three PCTs had, only recently, hit the Government’s downgraded target of 90 per cent. usage, which was meant to be reached two years ago. Given that doctors are finding that the system is slow to use and crashes frequently, will the Minister tell the House the average percentage of GP referrals that are now being made through choose and book, and whether he thinks that this is yet another example of his failure to deliver?
Mr. Bradshaw: Fifty-three per cent., and no.
Whistleblowers
6. Mr. Jim Cunningham (Coventry, South) (Lab): What steps he is taking to ensure adequate protection for whistleblowers in the NHS. [274103]
The Secretary of State for Health (Alan Johnson): The Public Interest Disclosure Act 1998 gives clear legal safeguards to NHS staff who disclose protected information in the public interest. The penalties for those who punish staff for using that law are severe. The Department has made it clear that every NHS trust should have local policies and procedures in place to comply with the Act. The NHS constitution handbook, published on 21 January 2009, sets out how staff should have
“protection from detriment in employment and the right not to be unfairly dismissed for ‘whistleblowing’ or reporting wrongdoing in the workplace.”
Mr. Cunningham: I thank my right hon. Friend for that answer, but some weeks ago, he was asked why we do not have enough whistleblowers. In my experience in Coventry, we have had one or two whistleblowers who were on the receiving end of disciplinary action. How can we encourage whistleblowers if that sort of thing happens?
Alan Johnson: That is unacceptable, and it certainly is not the view of Public Concern at Work, the independent charity that, to a large degree, drove the introduction of the Public Interest Disclosure Act back in the late ’90s. It states that
“the culture is changing and people up and down the NHS are much more aware today that they may have to account for their actions...Recent initiatives mean that many, if not most, NHS
Trusts are committed to promoting responsible whistleblowing as an essential aspect of good clinical governance. Whistleblowing in today’s NHS need not end in tears.”
That is supplemented by a survey of nurses, to which 87 per cent. responded that they would blow the whistle, so to speak, even if they suffered reprisals. The good news is that nurses say that the culture is improving year on year, and 77 per cent. say that the culture for raising concerns in their work is better than it was three years ago.
Mr. William Cash (Stone) (Con): I am afraid that the Secretary of State completely misunderstands the position. The fact is that there are whistleblowers, but they are terrified to come forward. I have my own evidence of that, which I was hoping to raise when he gave an oral statement on Stafford hospital, which he has declined to do. The reality is that devices are being employed by certain hospitals and hospital authorities to bypass the 1998 Act, which is good in intention.
I strongly dispute the idea that Public Concern at Work or the Royal College of Nursing takes the view that the Secretary of State describes. He grossly misunderstands the nature of the exercise. It is very serious, and people are being terrified into not making statements. At Stafford hospital and others in the region, from which people have contacted me, the situation is very serious and needs to be dealt with. He is thoroughly complacent.
Alan Johnson: We have talked before about the mystery at Stafford being the absence of any whistleblower. There was an absence of whistleblowers when the general secretary of the RCN visited Stafford, when the Leader of the Opposition visited Stafford and said to the press afterwards what a great hospital it was, and through all the different procedures.
The hon. Gentleman accuses me of complacency, but give us the evidence and we will deal with things. The law on whistleblowing, which the Opposition voted against at the time, is very clear. There is a very clear protection. I have quoted the charity that has been responsible for pushing the matter—those were not my words but the charity’s. We also have the evidence of a very wide survey of nursing staff. Against all that, the hon. Gentleman says that we are complacent. We have introduced the legislation and the constitution that bolsters it, and we have made it absolutely clear that the law protects people in that situation. I do not accept that nurses, and least of all consultants or doctors—I have yet to meet a shy consultant—would not come forward on such a serious issue because they were somehow terrified, despite the protection of the law. I am sorry, but I do not accept it.
Mr. David Kidney (Stafford) (Lab): I must say to my right hon. Friend that the culture is changing more quickly in some parts of the NHS than in others.
To be constructive, will my right hon. Friend confirm that the Department has a contract with Public Concern at Work to provide free, confidential legal advice to NHS staff about whistleblowing? Will he consider perhaps making more effort to promote and publicise access to that service?
Alan Johnson: I will confirm that. I was the junior Minister who introduced the Act and we do have such an agreement with Public Concern at Work.
However, my hon. Friend was with me at Stafford hospital when we sat with all the representatives of the unions and the royal colleges—no manager in sight. We said that we were a bit puzzled about why no one blew the whistle, but there was no answer to that. No one told us that it was because people were terrified of raising points. I have no doubt that there were serious problems at Stafford hospital or that the staff were not listened to the many times they made representations, but my hon. Friend will agree that there is a total absence of evidence to show that someone was prepared to blow the whistle, but was disinclined to do so because they did not feel that they had the protection of the law.
Anne Milton (Guildford) (Con): The Secretary of State acknowledged in the House on 18 March with reference to the Healthcare Commission’s report on Mid Staffordshire NHS Foundation Trust:
“The Healthcare Commission has said that clinicians and staff gave up registering complaints at the hospital because they felt that they were wasting their time”.
He also acknowledged that the absence of whistleblowers was
“one of the great mysteries of Stafford”.—[ Official Report, 18 March 2009; Vol. 489, c. 922.]
He should not be surprised. I cannot help feeling that we are living in parallel universes. A recent RCN poll of 5,000 nurses said that two thirds of nurses had raised concerns about care—
Mr. Speaker: Order. Front Benchers have the privilege of getting in on the questions they choose, but that is not an opportunity to make a statement. Back Benchers must be considered, so perhaps the Secretary of State will try to answer what the hon. Lady has already said.
Alan Johnson: I do not think that there are any party political differences on the matter—we all want the issues at Stafford to be resolved. The hon. Member for Stone (Mr. Cash) has pushed the matter vociferously, as has my hon. Friend the Member for Stafford (Mr. Kidney). We want a solution.
I am also struck by the reluctance of the public in Stafford to be involved in Stafford hospital. We have talked about the staff—it is a foundation trust, so the staff have an important involvement in it—but there is also a problem with the public coming forward and getting involved—
Mr. Speaker: Order. Maybe the hon. Lady has a point when she feels peeved that I told her she was making a statement, so I shall tell the Secretary of State that his answer is a bit too long. How’s that? I can be more even handed.
Swine Influenza
9. Dr. Nick Palmer (Broxtowe) (Lab): What his most recent assessment is of the level of risk posed to public health by the current outbreak of swine influenza. [274106]
The Minister of State, Department of Health (Dawn Primarolo): It is hard to assess the risk posed by swine flu as the clinical picture remains unclear. There are some indications that the virus may cause only mild symptoms, and that, in some cases, people have recovered without antivirals. However, an overall prognosis for the impact of the virus is still difficult to determine at present and it is still too early for confident predictions about the possible severity of the flu in the United Kingdom.
Dr. Palmer: I am grateful to my right hon. Friend for that reply. I read with great interest the brochure that the Department circulated, and it is helpful. However, I am sure that my right hon. Friend agrees that there is some difficulty with the substantial overlap between the symptoms of normal flu and those of swine flu. What would she recommend that my constituents do if they seem to have a severe case of what may well be normal flu? Should they go to their GP, ring a helpline or wait and see?
Dawn Primarolo: What I would say to my hon. Friend and, in particular, to anybody who has been following the media coverage is that either there has to be contact with somebody who has travelled to Mexico or the person affected has to have travelled to Mexico. They should then phone for advice, from either their GP, NHS Direct or the flu service line.
David Tredinnick (Bosworth) (Con): Earlier the Secretary of State said that the isolate had been identified and he spoke about the work of Potters Bar on the vaccine. What international co-operation has there been between the Department and other countries, or are we at risk of seeing vaccines being almost completed in countries around the world, yet without any proper understanding between them?
Dawn Primarolo: I can assure the hon. Gentleman that we are co-operating with our European neighbours, the World Health Organisation and the United States. That information is shared, because the isolation of the virus in the UK, for instance, is the isolation of the virus that happens to be in the UK, and it is compared with the isolates of the virus in, for instance, the United States. There is international co-operation to ensure that the development of a vaccine, if that is possible, is shared equally on a world basis.
Mr. Andrew Lansley (South Cambridgeshire) (Con): The right hon. Lady will know that, through its modelling, which has been published in the journal Science, the Imperial College team has said, albeit with great uncertainty at this stage, that the information points to a pandemic, potentially at the lowest end of the scenarios that we have discussed for a number of years in the contingency plan. That would imply something in the order of one quarter more of the population being affected, with perhaps four in 100 people affected being hospitalised and perhaps four in 1,000 people affected dying. Given that, will the right hon. Lady confirm that we need to continue the counter-measures against the virus, in order to seek to contain it, and, in particular, that we will maintain post-exposure prophylaxis until such time as the virus is spread in the community and that we will pursue household prophylaxis thereafter?
Dawn Primarolo: I am grateful to the hon. Gentleman, because I know that he and my right hon. Friend the Secretary of State have been able to speak about the issue a number of times. I would like to confirm to him what the Secretary of State has already said about containment before—and if—the flu moves to sustained person-to-person transmission across communities. I absolutely confirm to the hon. Gentleman, particularly given that the World Health Organisation is at phase 5, that we will continue that planning until we have a much better understanding of the virus. We would then be able to share the details of that planning with him, including what steps should be taken after that. It is crucial that we continue to share that information.
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