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As I said, the Health Protection Agency reported 909 confirmed cases of swine flu in the UK. Twenty-eight people are known to have been hospitalised and the majority have already made a full recovery. Nearly all those people had previous underlying conditions. We now have enough antivirals to treat half the UK population, with orders to increase that to 80 per cent. We also have orders for 226 million facemasks, 34 million respirators and 15.2 million courses of antibiotics, which will be delivered within the coming months.
The free swine flu information line, along with the nationwide leaflet, TV and advertising campaign, has kept the general public well informed about the steps they can take to protect themselves and limit spread. However, we recognised from the outset that we would be unlikely to prevent a widespread outbreak indefinitely. In recent days, there have been significant increases in the daily number of cases in certain parts of the UK, most notably Scotland, where Health Protection Scotland has concluded that sustained community transmission appears to be taking place. This is characterised by an increased number of sporadic cases—that is, cases with no identifiable link with other confirmed cases.
Those increases come as no surprise and are in line with what we know from similar outbreaks, but it remains the case that, at some point, we will need to move our focus away from limiting the spread of a localised virus towards mitigating the effects of a widespread virus. I want to be clear: that point has not yet been reached. We continue to monitor the situation carefully, and any decision to move to mitigation will be based on the best public health, clinical and scientific advice.
There is always a careful balance to be struck between benefit and risk when offering any drugs to healthy people. The extra knowledge that we have gained during the last six weeks of containment means that we can now refine our approach. The Health Protection Agency will be using all its expertise and clinical judgment to look even more carefully at the circumstances behind local outbreaks before deciding who should be given antivirals.
The single most effective way to limit the impact of any future epidemic is the successful development and distribution of a vaccine. Significant progress has already been made, including the identification of virus prototypes, which are so important in the production of the vaccine.
The declaration of phase 6 is highly significant because it means that manufacturers will now be expected to meet the contractual obligations of advance purchase agreements for vaccine that countries, including ourselves, had already agreed in the event of phase 6 being declared. We are already speaking to manufacturers to agree what this means for our own plans for full country coverage of pandemic-specific vaccine, should it be required. We have advance purchase agreements that enable the UK to purchase up to 132 million doses of pandemic-specific vaccine—enough for two doses for 100 per cent. of the population, should that be necessary. On current projections, we expect the first deliveries of the pandemic vaccine to arrive in the autumn.
Current indications are that seasonal flu vaccine production is well advanced and is expected to be completed in the next few weeks with the requested UK quantities being delivered at the usual time. The WHO
does not expect switching to pandemic flu vaccine production to have an impact on seasonal flu vaccine production.
The final important thing to stress is that people should continue to follow our advice on good hand hygiene, and the “catch it, bin it, kill it” messages. They should cover their noses and mouths with tissues when they cough and sneeze, throw the tissue away, and wash their hands. People who have flu-like symptoms should not panic, but should stay at home and check their symptoms using the online symptom checker or the swine flu information line. If people are still concerned, they should call their GP or NHS Direct.
The WHO’s announcement is an important signal that all countries should now ready themselves to deal with increased flu cases. The UK has been preparing for this for years. We are recognised by the WHO as one of the best prepared countries in the world, so we are in a very strong position to respond to the global pandemic we now face.
I commend this statement to the House.
Mr. Andrew Lansley (South Cambridgeshire) (Con): I am sure that the House will be grateful to the Secretary of State for giving us an update in the light of the World Health Organisation’s announcement yesterday about the move to pandemic phase 6 status.
In addition to thanking the Secretary of State, may I extend through him our thanks to all the staff in the Department of Health, the Health Protection Agency and the NHS across the country for the way they have responded to the spread of this virus? I reflect, as the Secretary of State perhaps has, on the fact that preparation turned out to be very important and useful. The spread of the virus in this country, relative to the spread in some other countries, has been limited. The containment strategy has clearly had a substantial beneficial effect, not least because in Scotland the schools are breaking up for the holidays and because we will shortly be seeing the school holidays in England. There was a risk that if the virus had spread rapidly it could have had a big impact on the public examination system, but it did not have as big an impact as it might have done. The containment strategy worked well, from that point of view. We should convey our thanks to all the staff involved.
I entirely endorse what the Secretary of State had to say about the desirability of maintaining a containment strategy while we can do so, and agree that it is perfectly reasonable to do so with more limited use of antiviral drugs, if we can do that. We do not want to medicate people if it is not necessary. Clearly in Scotland, and perhaps soon in England, we may need to move to a mitigation strategy rather than a containment strategy, and in that context, and bearing in mind the risks of a substantial recurrence of the virus in the autumn—in our flu season—the need for preparation is even greater now that we are in a pandemic phase. We will increasingly see additional cases coming into this country from overseas, as well as community transmission in this country. To that end, may I ask the Secretary of State a number of further questions about the preparations that we undertake in this country?
The Secretary of State will have observed that Professor Neil Ferguson’s report the other day suggested the desirability of surveillance in hospitals of young adults
who present with respiratory illness, as the virus seems not to attack the elderly particularly, and to attack young adults especially. Does he propose that the Department and the NHS encourage that surveillance?
The Secretary of State has talked about the current strategy of restricting the use of antivirals to close contacts. He will know that our view is that we should, in the mitigation phase, continue to pursue what is called a household prophylaxis strategy—that is, we think that close contacts of people who are confirmed or suspected of having the virus should be offered antivirals. In that context, he will know that the phase 6 alert from the WHO, under the contingency plan, should trigger the national pandemic flu line, which is not the same thing as the free swine flu information line. People should be able to ring the pandemic flu line to have their diagnosis confirmed, to have a prescription for antiviral drugs confirmed, to be given a unique number, and to be told where their collection point is.
On that flu line, in papers supplied only a few months ago to the House of Lords Science and Technology Committee, the Department of Health said:
“Signing the contract in December”—
“should mean that the National Flu Line Service system is available for use in the event of a pandemic by April/May 2009.”
The Secretary of State knows that that is not the case, and that the national flu line is not available, even though it is due. Will he explain why? In addition, the national flu line should link to the distribution of antivirals through collection points. The same document said:
“In line with the NHS Operating Framework, the target date for identification of Antiviral Collection Points is the end of December 2008.”
So by now, primary care trusts across the country should know where those collection points are, but clearly they do not. There appears to be continuing uncertainty and confusion among community pharmacies about whether they should, or should not, be the antiviral collection points. Will the Secretary of State confirm that in many cases they should be? Community pharmacies that currently seem uncertain about whether they should be a collection point, and resistant to the thought, should be. We are not talking about people with flu symptoms visiting their local pharmacies; clearly they should not do that. We are talking about flu friends visiting local pharmacies.
Will the Secretary of State ensure that we have a further debate about the issue of school closures in the autumn? If the virus continues to be relatively modest in its severity, there will be an argument that school closures may be an excessive response, but there is also an argument that if there is a very large number of cases, and if schools look like they are places where the virus will spread rapidly, there would be a risk that if we did not close schools for a short period where cases were confirmed, we would overwhelm local health service facilities.
On health care facilities, can the Secretary of State say what measures have been taken to extend critical care capacity for the coming flu season? What has been done to make available teams trained in the use of
non-invasive ventilatory support? The document from the Department on surge capacity suggests that in the case of this virus, such a strategy might be desirable. Can he say further, or let us know later—
Madam Deputy Speaker (Sylvia Heal): Order. May I ask the shadow Secretary of State to begin to draw his comments to a close, because we are interrupting discussion on private Members’ Bills, and there are quite a few Members hoping to catch my eye?
Mr. Lansley: I have just a couple of questions to ask, if I may, about critical capacity. Under what circumstances might elective work in hospitals be stopped, and what has happened to the concept of enhanced rest centres, which were to have helped to offset the pressure in the acute sector? Finally, what more can we do to help developing countries, in addition to providing £6 million for that purpose? What would happen, for example, if the virus were to reach South Africa in its current flu season? It is a developing country that has a serious problem with the risk of HIV immune-compromised patients, but its medical system would have the capacity to deliver antivirals rapidly to patients if the country had access to sufficient antivirals; many developing countries do not have that capacity. Can we contrive to assist southern Africa, for example, in responding to the outbreak?
Andy Burnham: I thank the shadow Health Secretary for the measured tone of his comments, and the help that he has given us today to ensure that together we can give a reassuring message to the public, as we should. I strongly agree with him that we in the House should today send our thanks to staff in my Department—the Department of Health—and the Health Protection Agency, and to front-line NHS, public health and local government staff, who are working on the ground to ensure that we are in a strong position to deal with the outbreak.
As the shadow Health Secretary knows, we have been preparing for years. I was pleased with his acknowledgment that the containment measures that we have worked to put in place have had an effect. That in itself has given us more time to improve our preparedness for the spread of the disease. He said that we should maintain the containment strategy, and I should like to confirm that that is our intention. Nothing is changed by the WHO’s declaration; we continue to follow the plans that we have laid out. However, obviously it is important to keep that under review. There will come a point when we have to move from the containment to the mitigation phase, as he acknowledged, but we are not there yet. We keep the matter under review, and we would update the House at such a point.
The Civil Contingencies Committee will consider the matter next week, including what the trigger points might be for moving from the containment phase to a mitigation phase, and what arrangements are needed to ensure successful distribution and treatment in that phase. Those are matters that we will consider next week with colleagues from Scotland, Wales and Northern Ireland. Of course we will update the shadow Health Secretary and the House when we have more information to give. On the decision taken this week about flexibility, I should just say that it is important to allow flexibility
to the experts on the ground where clusters have developed. That was very much the message from Scotland. We agreed to that flexibility this week, and we think it is the sensible thing to have done in the circumstances.
The shadow Health Secretary asked me about the work of Professor Neil Ferguson and, in particular, the surveillance of young people in hospitals. I want to reassure him that we recognise the importance of that. As he will know, Professor Ferguson is on the Strategic Advisory Group of Experts, or SAGE. Obviously, his advice is being fed in directly to us on matters such as the one we are discussing. The hon. Gentleman also asked about restricting the use of antivirals to close contacts. I think he asked that question in the context of the mitigation phase of the spread of the disease. I want to assure him that that is precisely the kind of thing the committee will consider next week. The balance has to be struck between a flexible response that is practical for health professionals, including public health professionals on the ground, and taking sensible and precautionary steps to prevent the spread of the disease. But we think the important thing is to give public health professionals the flexibility that they need on the ground to make those judgments. We will consider the matter in more detail next week and I will update the hon. Gentleman at that point.
The shadow Health Secretary asked about the national pandemic flu service. As I indicated in my statement, that will be up and running by the autumn. We have put in place interim services to give the public the information that they need. We have well developed plans for such a service which, as I said, will be in place by the autumn, and it will be able to deal with the demand, as necessary.
The hon. Gentleman suggested that there was some uncertainty and that PCTs did not know where collection points were. May I assure him that work is continuing to refine plans to set up the collection points, should they be necessary? Ian Dalton, director of NHS Flu Resilience, has worked in close partnership with PCTs on this. The hon. Gentleman also asked about the role of pharmacists. Again, that is an issue we will consider next week, and I will update him on that.
It is important for the public who are listening to this debate not to get a sense that there is about to be a widespread plan for school closures. I am sure the shadow Health Secretary would agree that it is business as usual and that life must go on. Obviously there may be circumstances in which the HPA considers it necessary to require or advise school closures because that may help with local containment of the disease. It is properly a decision taken at a local level on the advice of the HPA, but at all times it is the head teacher and the board of governors of any school who should listen to that advice and take the necessary action. However, it is important to keep the issue in proportion and avoid overreaction.
The hon. Gentleman’s two final points were about critical care capacity and other measures in the national health service to deal with any expected pressure on NHS services as we work our way through. I want to assure him that I had a conversation with David Nicholson, the chief executive of the NHS, very soon after coming into office, in order to be assured that and understand how the NHS is ready to cope. It is important to say that the NHS has been preparing for this moment for a long time, and it was an important part of the operating
framework which was sent out to the NHS last year. The plans are in place and we will ensure that the capacity is in place where it is needed. I am grateful to the hon. Gentleman for raising that point.
Lastly, of course we need to work through the WHO to ensure that we assist developing countries to manage the spread of the disease. I mentioned the £6 million that we have allocated for this purpose. The hon. Gentleman was right to mention southern Africa and the obligations that we have to help across the developing world. We take those incredibly seriously, and we will update the House as we have more information on precisely what practical steps we will take to make that happen.
Mr. David Heath (Somerton and Frome) (LD): I, too, thank the Secretary of State for making the statement today. In the context of the World Health Organisation decision to raise the alert status, it was important that the House be made aware of the Government’s position. I raised the issue of a pandemic and our preparations for it in a debate five or six years ago, at which time we were inadequately prepared. Enormous progress has since been made, and I give credit to the Government for their response to the current situation.
Given that the Government have, I think, been acting appropriately, does the Secretary of State share my concern that there might still be a lack of public understanding of some of the consequences? The media have generally been helpful, but there were elements of alarmist reporting in the early stages and, more recently, perhaps of complacency. The most important thing that the Secretary of State has to do is to increase public understanding of what is an appropriate response. He mentioned the closure of schools. That is often an important component of the response, particularly in terms of containment, because it removes a potent incubator population from the local community rather than any particular threat to the children at the school.
Does the Secretary of State foresee any difficulties if and when he feels it appropriate to move from the strategy of containment to the strategy of mitigation? Questions will inevitably be asked—“Why are we no longer being given Tamiflu when, last week, that was the response?” He needs to think through how he gets that information across. He must be clear about the level of prophylaxis and the distribution of antivirals if we move to a mitigation stage.
For instance, are we still going to concentrate on health care professionals in the wider sense—all those who work in close proximity to patients? I speak as a former optician. I realise that I would be likely to be in some danger of spreading the disease, were I working in close proximity to the face of someone who was affected.
What is the Secretary of State’s epidemiological assessment for the UK? Is he expecting a rapid increase over the coming weeks, or that when we reach the period for seasonal flu outbreaks in the autumn, we are likely to see a rapid escalation in the incidence of community infection in this country? In that context, are there any dangers inherent in the combination of swine flu and seasonal flu? How will the professionals know how to respond appropriately? Will they be aware which immunisation they should give, for instance, and will they be aware of the circumstances in which they should give a double immunisation, if appropriate?
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