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Secondly, I am concerned that we have not heard much about so-called closed communities. I have a young offenders institution in my constituency, and I
am worried that robust plans may not exist for those closed communities. I would welcome the Minister’s comments on whether there are any national plans, and on what advice on best practice has been given to local PCTs. Obviously, we are talking not just about prisons, but about places such as residential homes.
Finally, my PCT’s local plan does not allow for prophylaxis for family members, and I believe that that is a mistake. If we are to limit and subdue the spread of the illness, such prophylaxis is particularly necessary. I understand that national guidance is moving us towards prophylaxis for family members and those in close contact with people who have the illness. Would the Minister like to comment on the advice being given to local PCTs, so that their plans might be updated in the light of that? I expressed my view to my local PCT in no uncertain terms: I told it that I think the omission is a weakness in its local plan. Having made those few comments, I look forward to the Minister’s response.
3.52 pm
Mike Penning (Hemel Hempstead) (Con): Looking at the clock, it seems that the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo), and I have about an hour each in which to speak, but with the permission of the House, I will not go over much of what has already been discussed this afternoon. It has been an excellent debate, and I hope in good faith that the Minister will understand that there are questions that need to be asked on various issues, with regard to the situation both in the UK and abroad. Bearing that in mind, I hope that she accepts that the questions are asked in good faith. Front Benchers on both sides of the House have worked closely together. I know that the shadow Secretary of State, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who is sitting beside me, is grateful for the briefings that the Secretary of State has given the Front Benchers throughout the past four weeks.
It is only four weeks since we first knew of the state of swine flu—I will call it that for the moment, but I will come on to the point made by my hon. Friend the Member for Leominster (Bill Wiggin) shortly. The debate’s title is “Swine Flu”, but I agree that it should not be, and there are reasons why it should not. Sadly, in the past four weeks, there have been difficult articles in the press across the country that have, at times, genuinely frightened people. I pay tribute to the Evening Standard, which realised that it had got things wrong; the Secretary of State mentioned the matter earlier. It advertised extensively to address the mistakes that it had made. I know that the Evening Standard is a large newspaper, but I wish that some of the national newspapers would address the fact that they got some of the coverage wrong. There was a degree of scaremongering.
Some of the so-called experts on the periphery of the debate have also not helped in keeping the public not only correctly aware of what is going on, but factually aware, as has been shown by some of the polling over the last few days. About 50 per cent. of the public think that the reaction of Her Majesty’s Government and the NHS has been correct and proportionate, and about 50 per cent. think that there has been an overreaction. As the leaflets drop through the letterboxes and the advertising campaigns on the websites and in the national
media continue, the public will be more aware of the difficult situation that we are in, particularly in Britain where our responsibilities lie, but also elsewhere. It may be necessary to move to stage 6, the pandemic situation, and if we do, the pandemic flu plan structure will be the bedrock from which we go forward.
Much of what has been proposed cannot be rigidly adhered to within the planning structure. For example, according to the pandemic flu planning documents, in the event of an outbreak in a school, that school would expect to be closed for three weeks. Most schools have decided to close for a week and assess the situation as it develops, and that is a sensible way to proceed. What we do not want is headmasters deciding to shut a school for three weeks when the situation is fine within 10 days.
We have had an excellent debate, and many new points have been made, which shows that we are all on a steep learning curve as to the effect that this will have on our communities, whether we are on the Opposition Front Bench, in the Minister’s Department, or on the Back Benches. The hon. Member for Hayes and Harlington (John McDonnell) has apologised to the House for leaving to chair a Committee, but he raised some important points on behalf of his constituents. Heathrow is smack-bang in the middle of his constituency, and he was very concerned about training not just for cabin crew—a point also raised by the Liberal Democrats—but for staff within the airport infrastructure, so that they know how they can help. [ Interruption. ] I welcome the hon. Gentleman back to the Chamber.
The hon. Member for North Norfolk (Norman Lamb) made some important points. Will the Minister tell us either when she replies or later in writing how the negotiations were taken up early on and why the national flu line is completely separate from NHS Direct and NHS Choices, the online information service. That may be because the NHS deals with about 6 million calls a year and we expect the national flu line at full on-stream capacity to be dealing with about 2 million a day. Such IT and telecommunications infrastructure will require a robustness and resilience that this country has never experienced before. I listened intently when the Secretary of State told us that we were piloting and testing, but there is no way that that infrastructure could be tested to that capacity, unless it went through a similar telecommunications system. Why has NHS Direct been asked to pick up the situation now—it is doing a good job, but it is struggling—yet it was excluded from the contract for the NHS emergency flu line?
The hon. Gentleman also dealt with the assessment of people who think that they may have swine flu. Why are we not using our skilled pharmacists to asses whether patients have swine flu before giving them the drugs required. I know that my hon. Friend the shadow Secretary of State has taken that up with the Secretary of State. Those pharmacists are the biggest point of contact in our constituencies for medication and the plan is to distribute the drugs through them. For years, we have quite rightly been increasingly using the expertise of pharmacists to diagnose, take blood pressure, undertake blood tests and lots of other things, so it would seem to be logical to use them for diagnosis. Will the Minister respond to that point?
I have been slightly confused in the past couple of days as to who is in charge of handling the pandemic situation. The people in charge of producing the
November 2007 document were Professor Lindsey Davies and Mr. Bruce Mann. The former is the national director of pandemic influenza preparedness in the Department of Health, but last week, the chief executive of the NHS—completely out of the blue, because there is nothing within the document to indicate his involvement—indicated that he had appointed a national flu resilience director, Mr. Ian Dalton. Will the Minister indicate what the roles of those two people are? Has Professor Davies’s role changed, and what role has Mr. Ian Dalton taken up? Who is in charge and to whom do they report? There seems to have been an important change in the protocols.
My hon. Friend the Member for Poole (Mr. Syms) raised many important issues, but hand washing is very important. We are conscious of the capacity of the influenza to spread. If we get to the pandemic stage, facilities for hand washing are absolutely imperative, especially where there are large congregations of the public, such as railway stations and airports. Hand-washing facilities therefore must be open to the public free at the point of use, which can happen at the flick of a switch. I am sure that the odd 20p that is lost to the people who operate those facilities is tiny in proportion to what we could lose.
Another important question raised by my hon. Friends the Members for Poole and for Reading, East (Mr. Wilson) is what we do about closed institutions such as prisons, secure hospitals and, especially, barracks. We know from experience that such influenza viruses move very fast through closed institutions and we have heard absolutely nothing, as far as I am aware, about what we are planning to do—that is not a criticism, but a genuine question. What are we planning to do about closed institutions? The Mount prison, which is on the edge of my constituency, has 640 inmates and most of the people who work there live in my constituency. If we go to a pandemic situation, we must have a strategic plan for those people. We have learned from experience, particularly of 1919, that flu flies through military barracks once inside.
The Secretary of State said quite a lot about the purchase of face masks—specialist face masks that can restrict the virus getting through rather than the sorts of things we saw on the streets of Mexico City. I have tried to find out from different organisations, especially in the NHS supply chain, about gloves. Within the pandemic flu protocols, disposable gloves are crucial in containing influenza, yet we do not seem to know how many have been purchased or how many are out there. It would be useful to know exactly what is happening.
The other question asked by my hon. Friend the Member for Poole is this: what happens if and when we move to the next level? Page 55 of the flu pandemic document shows that we should go to a gold command structure. The structure is quite complicated, but it is understandable. The civil contingencies committee is at the head of the structure, but who chairs that committee? I have experienced gold command in my constituency. The police tend to chair gold commands, but who will chair that committee?
Mr. Syms:
I have not ploughed through the booklet, although I presume that my hon. Friend, as a health spokesman, has done so. I just think it would be useful if we had some information in our offices, particularly
relating to our own area, so that we or our local authorities have the right phone numbers and know what the chain of command is.
Mike Penning: My hon. Friend is absolutely right to raise that important point. Smack-bang in the model set out in the document is the local resilience forum and strategic co-ordination group. I do not expect everyone to read the document, but it does explain the arrangements. The next step in preparing for the next stage—stage 6—is ensuring that we in our constituency offices and, more important, our communities as a whole have the information needed on what to do next; it should not be left to gossip. We will be able to work with our constituents, local councillors and others to make that sort of information is available. In addition, local authority call centres need to know whom they should pass calls on to.
I fully understand the point my hon. Friend the Member for Leominster made about pigs. We should stand up in this place and the Minister should say from the Dispatch Box that there is no danger from eating pork: as long as it is cooked correctly, pork makes wonderful eating. I agree with my hon. Friend when he says surely this strain of flu could have been given another name. In fact, it has—we do not need to call it swine flu. The World Health Organisation calls it influenza H1N1—that is the official title. It should not be called Mexican flu, either. As I was told a few minutes ago, the so-called Spanish flu of 1919 appeared in America. I think that people can understand its official title—it is in the papers often enough—and we should wean ourselves off calling it swine flu, because that has had a detrimental effect on pork sales here and in other countries. I know that we have no influence on decisions by other countries, such as Egypt, to slaughter their pigs, but, to be frank, what a waste that is of good stock.
My hon. Friend the Member for Reading, East talked about the quality of out-of-hours GP services. That topic was raised at Health questions this week and it is regularly discussed by Back Benchers and Front Benchers. The truth is that our GPs are the best people to commission the out-of-hours care that our constituents deserve, because they have the empathy, understanding and knowledge needed. In fact, the situation is a complete mess, with a postcode lottery for out-of-hours services. At a time of crisis, the last thing we need is confusion in such services.
My final point is on third world or less economically developed countries. It is possible that some such countries will suffer a pandemic outbreak and we will not. It is imperative that, with our European friends and the WHO, we have in place a structure or plan whereby we do not stockpile a vaccine here when we have not and are not likely to move to stage 6, and leave other countries to suffer because they cannot obtain supplies. Although I fully understand that we have a sleeping contract and will, we hope, get the vaccine within the next few months, if other countries, particularly third-world countries, suffer a pandemic and we do not, we will have to examine our conscience and decide how to help those countries in their hour of need.
4.9 pm
The Minister of State, Department of Health (Dawn Primarolo): I thank all hon. Members for their contributions to today’s debate. It will be clear to anyone listening to
or watching the debate that all hon. Members, regardless of party, are focused on making sure that we have in place the best measures to protect our citizens, should that become necessary.
The challenges that swine flu poses in this country are real and considerable. Before I go any further, however, I should pick up on the point that the hon. Member for Leominster (Bill Wiggin) made about its name. If he turns to the leaflet that was sent out, he will see that it clearly states:
“There is no evidence of this...disease circulating in pigs in the UK”
and that scientists are investigating the origin. Linked to that, the hon. Gentleman referred to the statements that my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs and the chief veterinary officer made about the safety of consuming pig products in this country, and I agree with everything that the hon. Member for Hemel Hempstead (Mike Penning) said in his closing remarks about the safe consumption of pig products.
However, I must say to both hon. Gentlemen that, from tracking public recognition and measuring public awareness, we have found that the virus is clearly fixed in people’s minds as being called swine flu. Indeed, recent information shows that 75 per cent. of people agree that the Government are very well or fairly well prepared, and that 80 per cent. are satisfied with the information available. I am sure that all of us agree that awareness, clear information and transparency are of great importance to the general public, so I caution the hon. Member for Hemel Hempstead and others that changing tack and calling the virus H1N1—that snappy title—or anything else may not necessarily help in the communication of information. Nevertheless, I absolutely take his point that language is important to ensure that people are properly informed, while not causing concern elsewhere or, as he rightly and understandably pointed out, detriment to others’ occupations, whether they are in the pig industry or anywhere else.
Although scientists are making progress on charting the genetic fingerprint of the virus, understanding its characteristics and tentatively assessing its impacts, there is still a great deal that we do not know about the infection and how it will develop in the weeks and months ahead. That point crucially underpins the information that we make available, and, as the hon. Member for South Cambridgeshire (Mr. Lansley) said in his opening remarks, transparency and proportionate information are crucial.
In the face of that uncertainty, it is imperative that we have the appropriate measures to protect the public and ensure continuity throughout the public services—all points, indeed, that hon. Members have addressed themselves to today. We must ensure also that when the virus becomes more established in this country, if it does, we are properly prepared and, as the hon. Member for North Norfolk (Norman Lamb) said, hope for the best but prepare for the worst.
My right hon. Friend the Secretary of State for Health made it clear that experts warn us to expect further increases in the number of cases in the short term, and we must brace ourselves for the strong likelihood of a serious pandemic in the next six to nine months. Fast, effective prophylaxis has so far helped to contain
the spread of the disease in this country. I join other Members in expressing thanks to the national health service staff, health protection officers and Department of Health officials who have worked tirelessly in this containment phase. We have yet to see sustained, community-based transmission, but I reiterate that we need everyone, including the general public, to continue to do their bit. Preparing for a wholesale pandemic is important; appropriate plans and measures must be in place so that we will be ready if the virus becomes more established. That means monitoring and assessing whether and when the current policy of using Tamiflu is becoming ineffective or counter-productive as the virus becomes endemic.
In his opening remarks, the hon. Member for South Cambridgeshire posed a number of questions, as did all the other Members who spoke. When I can, I shall do my best to answer them. There is the issue of antiviral stocks and of the triggers that will move us from our current containment phase to a mitigation phase. How do we judge when that will be, given that all the current evidence is that in this country the infection is very mild and that people respond well to Tamiflu and recover? I am still taking advice and having discussions with scientists, but at this stage there are two principles. The first should be in respect of sustained community transmission. Secondly, we should consider the severity of the disease and take scientific advice at the relevant point on whether we can still contain it and whether we need to move to the next stage. We are doing a lot of work on that so that we understand precisely when that shift may be made. As the hon. Gentleman rightly said, that issue is important in respect of the impact on the antiviral stockpile and of moving to household prophylaxis as a sensible strategy in that period.
The hon. Gentleman also asked why our approach to school closures was different from that in the United States. He said that he thought that the US was now basing its considerations more on economic and educational outcomes than on the disease, and that might well have played a part in the decisions. The advice to us, however, is that the US is no longer in the containment phase; it has moved to the mitigation phase for reasons of geographical distribution and its ability to contain the viral infections. Given that, its attitude to school closures is different from ours.
Mr. Lansley: I am grateful to the right hon. Lady for giving way, but I was not asking about the difference between the position in America and that here. I entirely understand that the Americans decided that they could no longer contain the virus, which was circulating in the community; sustained community transmission was taking place. My question was different. Looking at the second principle, if we believed that there was sustained community transmission of the virus in this country, and if the virus was not severe, would we have begun the process of examining whether our advice would remain the same as that in the national contingency plan? The current advice is that a school closure should be triggered automatically when a case is confirmed. Alternatively, would we re-examine the issue? Clearly, the Americans have re-examined it and reached a different conclusion.
Dawn Primarolo:
I misunderstood the hon. Gentleman’s question—I hope he will forgive me. I can confirm that we are undertaking consideration of what advice would
be given and what action we should be taking if the outbreak remains mild. I am sure that the Secretary of State will want to continue to keep the hon. Gentleman and the hon. Member for North Norfolk apprised of those considerations as we move through them. This goes back to my earlier point about a better understanding of the nature of the virus and the extent of the illness that it causes here in the UK. It is about not only the current investigations into the production of a pandemic vaccine, should that be necessary, but informing the other strategies in the plan.
The hon. Gentleman asked about critical care and ventilators. Trusts have been advised that they could double their critical care capacity for ventilated patients during a pandemic. The possibility of additional ventilators is being considered, including the question of whether all ventilators are being used. That will form part of the ongoing discussions.
The hon. Gentleman asked about support for other countries, as did the hon. Member for Hemel Hempstead, and referred to the money that has already been contributed by the Department for International Development. In addition, the World Health Organisation has a stockpile of drugs. The WHO meets this coming weekend and early next week, and those considerations will be very much on its agenda. We look forward to seeing exactly what type of measures will be necessary, and we have made it clear that we stand ready to make our contributions in exactly the areas that the hon. Gentleman mentioned.
Mr. Lansley: I welcome what the right hon. Lady says about our willingness to participate positively and constructively in the next few days in the discussions with the WHO. So that we do not convey any misleading impression, I should point out that its stockpile of antiviral drugs is probably no more than about 5 million doses, so its ability to satisfy potential demand in developing countries may be very limited.
Dawn Primarolo: The hon. Gentleman is right. However, he also knows that the WHO, the US authorities, the UK authorities and all the health authorities that are working on this are looking carefully at exactly what we are dealing with. The virus is being analysed to see what may happen—particularly, as we track it through the southern hemisphere’s flu season, what that may mean in terms of where a returning virus, whether mutated or not, goes next and what arrangements therefore need to be in place. These are absolutely the right questions for the hon. Gentleman and others to be asking. The Government are very alive to this. We completely appreciate the dual wishes of this House: first, that we protect our own citizens; and secondly, that in a world pandemic, we play our part, particularly with the poorer and developing countries that may not have access to the drugs that we have.
My hon. Friend the Member for Hayes and Harlington (John McDonnell) referred to actions at airports, in particular, and ports of entry. He went on to ask several questions about the responsibilities of airlines to their staff, and about whether there is greater vulnerability among the communities around Heathrow. He has been able to return from his other duties, and I hope to address the points that he raised.
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