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We face something of a difficulty at the moment in that this item has slipped off the news agenda, not only because other items relating to this place are rather
dominating things, but because the prevalence and virulence of the flu has so far been slight. There is therefore a danger that we are lulled into a false sense of security and people start to say, “What’s all the fuss about? Hasn’t there been an overreaction? People who have suffered from it have recovered very quickly.” It is very important—the Secretary of State made this clear, and I share his view—that we maintain absolute focus on this, and get the message across to the public, in recognising that we do not know the implications or the extent to which the virulence will increase as the strain develops and potentially changes in character.
I was struck by a recent BBC report about what is happening in the United States, which noted that there has been a significant increase in reported cases. The numbers have gone up by 600 since last Friday, and there have been 2,532 cases. As the Conservative spokesman said, the Americans are no longer closing schools because the disease is now recognised to be in the general community. The truth is, of course, that the American health system has no mechanism for controlling or monitoring the development of this epidemic. There are genuine concerns about its potentially spreading very rapidly from the US into Europe. Of course, the amount of travel between Europe and the US is vastly greater than that between Europe and Mexico, so we have to be prepared for a rapid advance.
Mr. Lansley: Before we leave what the hon. Gentleman says about America on the record, I think, having been in the control room at the Department of Health and Human Services in Washington and discussed with people how they would respond to a pandemic, that the Americans have all the resources and legal powers that are necessary for surveillance and counter-measures to respond to a public health impact. We should not confuse the limitations of access to American medicine with limitations in the American response to public health demands.
Norman Lamb: I hear the hon. Gentleman’s reassurance, but the views that I have heard expressed do not match his confidence about the American capacity to spread messages and to ensure similar concerted action to our production of a national plan that can then be implemented at all local levels. He may be right, but concern is being expressed that the system in the US makes things more difficult.
If there is to be a rapid increase in the number of cases in the US, what is the Secretary of State’s advice for people travelling there—they may be planning holidays now—about whether to go and what precautions they should take when they get there? A report that appeared in The New York Times a couple of days ago refers to a leading American infectious disease expert who has been in Mexico helping the Mexicans to tackle the swine flu outbreak and learning the lessons from that. It reports that many people who are suffering from the disease appear to be showing no symptoms of fever, which makes screening much more difficult and increases the difficulty of controlling it. I am not sure whether the Secretary of State and the authorities in this country are fully aware of what is being discovered in Mexico, but it is critical that we rapidly learn the lessons from that. According to the report, half those with the milder cases did not at any stage develop fever.
It is also reported that 12 per cent. of patients in two Mexican hospitals are suffering from diarrhoea as one of the symptoms of their condition together with respiratory problems. The point is made in the article that there are implications for infection control, particularly in poorer countries, if diarrhoea is one of the symptoms that emerges from this strain. The advice that is reported is that stools should be tested for the presence of swine virus. When she winds up the debate, will the Minister of State say whether any such advice is coming across to the Health Protection Agency? There has been no reference so far to such testing, so has that been properly monitored?
It is also reported in the article that the expert doctor from the United States, Dr. Wenzel, suggests that there should be testing to determine whether there are people without symptoms who are still carrying the virus. The Secretary of State mentioned one case in the UK of someone who has had a confirmed diagnosis but who has had no apparent contact with anyone who has suffered from the condition. Is a possible explanation that people carrying the virus may not be showing any symptoms? That would make control much more difficult. It is also reported that an unusual feature of the Mexican epidemic is that there are apparently five different influenza viruses circulating at the same time, making it much more difficult to plan and to judge how the swine flu virus will develop.
All the things that I have mentioned from the article are happening in Mexico. Will the Minister comment on the international learning process to ensure that what we are finding out from Mexico is being fed into public health messages in this country, and that the appropriate advice is being disseminated?
It is also reported that pneumonia rates at one hospital were at 120 a week, compared with an average of about 20 a week. That is clear evidence of the complications that can emerge from flu, which the Secretary of State has previously mentioned. That significant increase in pneumonia cases reinforces the importance of preparedness for such complications. Will the Minister comment on the development of the purchase of antibiotics? I know that the Secretary of State has addressed that, but I should like to know where we have got to on that.
The final, really important, point in the report is that Mexican doctors have apparently activated a programme to allay the anxieties of health staff. The expert from the United States commented that that matter had not been sufficiently addressed in the US. It is critical to remember that there will be health and social care staff who are extremely anxious about their own health and family circumstances. The programme has been activated to provide information to staff, a hotline, psychological support—that is critical—and medical examinations. I am sure that that is part of the planning process, but can the Minister reassure us that the matter is fully recognised as an important priority?
My hon. Friend the Member for Twickenham (Dr. Cable) mentioned BA cabin crew, and the hon. Member for Hayes and Harlington (John McDonnell) raised concerns about both cabin crew and airport staff. The reports that my hon. Friend has had suggest that cabin crew working on the route between Heathrow and Mexico City have not been receiving the duty of care from BA that one might expect. It is worth making the point that the circumstances have provided a potential profit for
BA. I saw a report that single tickets from Mexico City to Heathrow are being sold at $4,000 each. There is a premium in getting out of Mexico—
John McDonnell: One-way ticket.
Norman Lamb: I note the hon. Gentleman’s comment. BA has been making good money out of the situation, but BA staff have been anxious about whether they are being sufficiently protected. Professor John Oxford has expressed surprise that BA has not ensured that all cabin crew are given Tamiflu. He makes the point that toilets on board on aircraft are the focus for infection during a flight, because people sneeze, then visit the toilet, and the infection gets on to handles, taps and so on. In the Minister’s closing remarks, will she confirm the specific advice being given by the Health Protection Agency to airlines to ensure that every step is taken to protect the health and safety of cabin crew and passengers on flights, particularly those flying between heavily infected areas and the UK?
Mr. Syms: The rate at which cabin air conditioning works is also an issue. When smoking was allowed on flights, the rate had to be very high, but it is turned down now that smoking is not allowed. Given the relationship between the air conditioning units and fuel, that means more germs can circulate. What advice are the Government giving to airlines?
Norman Lamb: The hon. Gentleman makes a good point. We all know that flights are a perfect breeding ground for infections, and it is important to take every step to ensure that all airlines meet the highest possible standards, and that they meet their duty of care to their staff and passengers. I have had reports that different airlines are responding differently, but the same high standards should apply to all airlines, so that all staff are protected.
Critically, the Treasury appears to have delayed the implementation of the flu line for some seven months. Under freedom of information legislation, I am seeking further documentation about why the implementation has taken so long. From newspaper reports and board minutes, we know that the NHS Direct board was getting increasingly frustrated by the apparent delays at the Treasury. Will the Minister comment on the costs incurred from the temporary arrangements that will apply until the flu line proper is in place?
The BMA makes the point that some primary care trusts are setting up their own arrangements for local flu lines. It comments that long waiting times have been experienced by people calling NHS Direct. One case was reported of a wait of eight hours, which seems fairly incredible, but that is what the BMA reports. Is there sufficient co-ordination? If local flu lines are set up at the same time as the Government introduce temporary arrangements nationally, we need to ensure that everyone knows which line to use. The BMA also states:
“The publication of the ‘Manual Flu Line Algorithm’ is regarded as crucial to ensure consistent messages and avoid postcode variation.”
Will the Minister also deal with that point?
“Formal notification that antivirals will all be distributed centrally rather than through GPs or pharmacists is still awaited.”
Will the Minister clarify the position on that? It also says that there is a need for clarity on distribution protocols. It would be helpful if we could hear from her on that point too.
Last weekend, newspaper reports said that primary care trusts across the country had been making variable progress on implementing plans. The BMA complains that GPs in some areas have not been involved in the planning process locally. The reports suggested that the Department of Health was refusing to publish details of the state of preparedness of primary care trusts around the country. It seems to me that publication of where every PCT has got to would help to concentrate minds and ensure that the laggards get up to the state of preparedness of the best. I ask the Minister to consider publishing where every PCT around the country has got to in its plans on preparing for the pandemic.
The hon. Member for South Cambridgeshire raised concern about critical care capacity. That has also been raised with me. I was told by the Royal College of General Practitioners that in the last two pandemics in this country, in 1957-58 and 1968-69, more people died of conditions other than flu. There was a higher excess mortality of people suffering from other conditions who were displaced from hospital by those who went there because of the flu pandemic. I suspect many people do not recognise that. It reinforces the absolute importance of having clear guidelines on prioritisation of cases for hospital treatment during a pandemic. The communication of those guidelines to the general public is critical. There will be many cases in which people are due to go into hospital—they may well have a planned operation—but are told that they cannot because the hospital is full as a result of the flu pandemic. That will cause a great deal of anxiety for many people. The communication of that prioritisation is vital.
The briefing by the British Red Cross highlights the importance of the voluntary sector and the role that it can play in supporting statutory services in dealing with the challenge of a flu pandemic. It makes the point that it is essential that all volunteers who are participating in any way in support of statutory services get treated in the same way as staff to ensure that they are protected, given that they are giving their time voluntarily to help. The British Red Cross also makes the point that many volunteers will prepare to go overseas during a pandemic to help to make a difference in the real hot spots. It says that it is important that those people get access to medication speedily so that they are protected.
I have appreciated the opportunity to raise these issues. I recognise that the Minister may not be able to deal with all the concerns that I have highlighted, but perhaps she can respond in writing to those that she is unable to answer.
3.19 pm
Mr. Robert Syms (Poole) (Con): I thank the Secretary of State for again updating the House on progress on this very serious matter. I am glad to note that when it comes to such matters the House can be constructive, we can make suggestions to the Government, and we can learn of preparations that I consider sensible. I think it is a case of “so far so good”, but as we know, it is still early days. I pay tribute, as others have done, to the staff of the national health service, who are working terribly hard, and to those who are working long hours in the pathology labs to deal with the crisis.
I think that the national public information campaign is being run very well, and is having an impact. I presume that it will roll on in the coming weeks and months, and may be uprated if the profile of what is happening changes. It sends a very good message with regard to flu in general, and not least with regard to this very serious form of flu. However, I have a few concerns.
It is easy for those who have bins in which to chuck paper handkerchiefs and somewhere to wash their hands, but if a pandemic does develop, we shall have to make an effort to provide better hand-washing facilities in public places. Perhaps the Minister could tell us whether it has been established that there are enough of the various soap products that people use to disinfect their hands as an alternative to ordinary hand washing. When I was at Euston station the other day I noticed that it costs 20p to go into the toilets, and I know that nowadays a number of other major rail centres charge people for using public facilities. I believe that that applies at Paddington station, for instance. I hope that the Government will consider allowing such charges to be waived in the short term if the situation deteriorates, so that people can have access to hand-washing facilities.
We have already had an exchange about masks, and I understand the medical advice about them, but I think that ordering a lot more and distributing them widely would be a sensible precaution. Many people work in the public services. If someone does not turn up for work because they are ill at home, a police officer or local authority representative, for example, may have to ring the front doorbell and go in to see them. It is true that in the short term, the sight of people wearing masks on the tube will not do a great deal for the tourist trade. However, notwithstanding what was said by the Secretary of State, I think that if the pandemic becomes much more widespread, seeing people walking around wearing masks would be a good way of reminding others that there is a crisis, and that they need to take the sensible advice being issued and use a paper handkerchief, “bin it”, wash their hands, and generally conduct themselves very carefully.
I have a few more questions for the Minister. So far, the scientific information is that the genetic make-up of the flu virus does not seem to be quite as virulent in north America—or, indeed, here—as it is in Mexico. Is that related to diet, or to the general health levels in the population? We know that a number of drugs are available on the internet, such as Tamiflu and Relenza. If people do not take prescribed drugs but obtain them from the internet so that they are used more widely, there is a risk that a resistant strain of the virus will develop. Have the Government any plans to try to restrict online provision?
Last week a useful leaflet about flu from the primary care trust was delivered in Bournemouth and Poole. We have heard a little about the swine flu information line; is there a plan for its capacity to be increased if the number of cases multiplies? As we have heard, in the event of a relatively rare occurrence it may be possible to get through on the line, but if thousands of people suddenly become infected, more phone lines and volunteers will be needed so that the service can be expanded rapidly rather than crashing. I welcome what the Secretary of State said about going online and setting up a website.
I would like the Minister who responds to the debate to say a little more about the role of the national director of pandemic influenza preparedness. What meetings have taken place, and how is it envisaged that the role will unfold if a crisis develops?
On the flu line, there is a difference between people phoning up about symptoms and decision makers trying to get sensible advice. In earlier exchanges, we talked about who was responsible for making decisions about whether to close a school, a place of work or a particular institution. I presume that the primary care trust would be the body to which people would refer at the local level. This is an interesting issue, however, because public health decisions will have to be made at various levels, and I wonder what the hierarchy of decision makers is. I presume that at the top will be the national director of pandemic influenza preparedness, or Richmond house, but what will be the local decision-making hierarchy in, for instance, Dorset—or around Heathrow, as we have heard about the special risks that that area of London faces? Who will be in charge? We must ensure that people make proper and informed decisions at all levels, so we do not get panic, but rather a response that is measured, proportionate and sensible.
Mr. John Gummer (Suffolk, Coastal) (Con): I too would like the Minister to elaborate on that. We in Suffolk have an extremely good operation for dealing with crises, and I would like to know how that local hierarchy will fit into this situation. In the past—for example, when we have had to deal with animal diseases—it has been hugely successful. I think the Minister will know that the Department congratulated Suffolk on what we did in the last epidemic, and we had to congratulate the Minister concerned for keeping us in touch. I wonder whether the same system will operate.
Mr. Syms: That is a good point. I wonder whether there ought to be a chart setting out who is on top of the hierarchy and who takes decisions at various different stages. That would be particularly useful for Members, who could put it up on their wall, and there might also be relevant phone numbers for their area, so if a situation developed we would know who to talk to and who to refer people to. I suspect that if the swine flu emergency line has difficulties and PCTs are overwhelmed, people will phone up Members asking for their advice. It would be useful, therefore, if the Minister were to say a little more at the end of the debate about what we can have in our offices for our staff, so that we know who to go to, and to whom to refer people in our area if a situation develops.
We must wait and see how the situation develops. History teaches us that these events can get very bad—I am thinking about the events of 1918—and it is best to take the precautionary approach and to plan for the worst. I am pleased with the preparations that the Secretary of State for Health has taken so far, and I hope that we will get a little more information from the Minister at the conclusion of the debate. Let us keep our fingers crossed and hope that this is not as bad as some people think it will be.
3.28 pm
John Mason (Glasgow, East) (SNP): I appreciate having the opportunity to speak in this debate, and I also appreciate the fact that the Secretary of State has made previous statements on this subject.
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