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Our policy on schools is that they should not close because of individual cases of swine flu but that they could close if the particular local circumstances warranted it. For example, there might be grounds for closure if a significant number of pupils or teachers are ill, or if it is
a special school with particularly vulnerable pupils. The HPA will advise on outbreak control issues as usual, and closures will be reported to the Department for Children, Schools and Families.
I must report to the House that the Civil Contingencies Committee has had lengthy discussions, drawing on expert scientific advice, about who should be treated with antivirals if they contract swine flu. Health Ministers across all four Administrations have noted clear scientific advice that the majority of cases in the UK so far have not been severe, with those catching the virus making a full and fast recovery. However, a minority of people here and overseas have had more serious illness and some have died.
As we move into the treatment phase, Ministers have considered whether we should continue to offer antivirals to all patients displaying symptoms or whether a more targeted approach should be adopted, focusing on those most at risk of becoming more seriously ill. When very little was known about the disease—especially given the reported fatalities in Mexico—using antivirals prophylactically was sensible to protect people, and may have helped to contain the initial spread of the disease.
During the containment phase, experts have had time to study the virus. Some experts now suggest that since the virus has proved largely mild, antivirals should be used only to treat those in designated higher-risk groups—that is, those who are more susceptible to developing serious illness or complications. Those are all the groups at risk from seasonal influenza, plus pregnant women and children under five. The experts argue that overusing the drugs can increase the chances of antiviral resistance and expose too many people to the risk of side effects from the medicine.
The scientific advisory group for emergencies—SAGE—says that, on balance, the science points towards a targeted approach, but it acknowledges that this is a “finely balanced” decision. Expert advice points to the fact that, as this is a new virus, its behaviour cannot be predicted with certainty. Swine flu is different from seasonal flu in that most serious illnesses have been in younger age groups, as happened in all three 20th-century influenza pandemics. A doctor faced with symptomatic patients cannot yet predict with certainty the course of their illness and whether or not they will be in the small proportion who may become more seriously ill.
Given that, we have decided to take a step-by-step approach. That means that, as in the outbreak-management phase, we will continue to offer antivirals to all those who have contracted the illness. However, it remains a matter of clinical discretion to decide whether antivirals should be prescribed in individual cases, particularly in circumstances where doctors are likely to be contacted by patients with coughs and colds and by the worried well, in addition to those with swine flu. Expert advice emphasises the high importance of treatment with antivirals of those in the higher risk groups. We will therefore issue clear guidance to doctors to ensure that those at higher risk get early priority access to antivirals.
I acknowledge that this is a cautious approach. Many people will be able to recover from swine flu without the need for antivirals and they may therefore choose not to seek treatment. However, we are much closer to the time when we will receive the first doses of the pandemic flu
vaccine that will potentially offer high protection. In the meantime, it is prudent to use our only current measure against the virus— antivirals—to the maximum effect. The science indicates that, as we discover more about the virus and develop a more precise categorisation of risk groups, we are likely to reassess our approach and move to a more targeted use of antivirals. We will keep the matter under review, with advice from SAGE, and will update the House as and when necessary.
Today, we will set out the new arrangements in a short guide which will be e-mailed to NHS staff and made available online for the public. I know that local GP surgeries and hospitals, particularly in hot-spot areas, are coming under increased pressure. It is important that we do everything we can to reduce the strain on local health services, so we will begin to establish and use alternative routes for people to receive treatment. Initially, that will be via www.nhs.uk or the swine flu information line. Subsequently, it will be via the national pandemic flu service.
So, if people think they have swine flu, they should first go online and check their symptoms on www.nhs.uk or call the swine flu information line on 0800 151 3513. If they are still concerned, they should then call their GP, who can provide a diagnosis over the phone. If swine flu is confirmed, they will be given an authorisation voucher that someone who can act as a flu friend can take to an antiviral collection point to pick up antivirals. The collection point may be a pharmacy or a community centre.
As cases increase still further, we will move to a system whereby cases are diagnosed and dealt with by the national pandemic flu service. That will take the pressure off GPs by allowing people to be diagnosed and given their antiviral vouchers either online or via a central call centre. I can tell the House today that preparations are now at an advanced stage, and that we expect the service to be ready when it is needed. At that point, if people have swine flu symptoms they should go on to the national pandemic flu service website, or ring the dedicated call centre.
Finally, I should like to update the House on vaccines. We have now signed contracts to secure enough vaccine for the whole population. We expect the first batches of vaccines to arrive in August, with around 60 million doses—enough to vaccinate 30 million people—available by the end of the year and more following that. Administering vaccines will need to be prioritised, and we will make a decision on that when we know more about the risk profile.
Most cases of swine flu have not been severe and we are in a strong position to deal with this pandemic. However, we must not become complacent and, while doubt remains about the way that the virus attacks different groups, today’s decision on the move to the treatment phase reflects our caution. I commend this statement to the House.
Mr. Andrew Lansley (South Cambridgeshire) (Con): I am sure that the House is grateful to the Secretary of State for the further update. I am grateful to him for the regular opportunities that he has allowed to discuss the matter, and I dare say that that view is shared by the Liberal Democrats.
I want to join the Secretary of State and the rest of the House in extending our condolences to the families of those who have died. I should also like to express
again our gratitude to NHS staff in the pathology laboratories and primary care, as they are under increasing pressure, especially where there are a lot of cases. I am also grateful to general practitioners: sometimes in the past they have felt that Health Ministers have engaged in too much GP-bashing, but we now appreciate how much we need them. Given that we are in the middle of a heat wave, primary care is coming under considerable pressure.
The Secretary of State will know that we supported the strategy of containment. It has had some success but it is no longer realistic to try to sustain that strategy across the country and we therefore support the move to a treatment strategy. However, given that the disease is less severe than we anticipated—it could have been a great deal worse—it is important that we do not engage in the wide-scale prophylactic use of antiviral drugs.
The Secretary of State knows that we agree with the proposal that treatment should be offered to all patients, and not just to those in the at-risk groups. About a quarter of fatalities associated with swine flu in the United States were among patients who were not at risk and did not have underlying conditions. Given the availability of antivirals in this country, and the potential to make them available to symptomatic patients, there is no reason why patients who need them and who might go on to have severe or even fatal complications should not be offered them.
We agree with the Secretary of State that there should be a presumption against automatic school closures: even so, risk assessments clearly should be made. They should cover classes and year groups but, as we go into the autumn, they should also take account of the pressure on the local health economy. If that pressure becomes very great, there might be a case for trying to prevent the rapid spread of the virus through schools, but that may require some future modelling.
Some of what should be in place according to the contingency plans for the pandemic phase is not ready. The Secretary of State has replied to a letter that I sent on 15 June, and I am grateful for that, but his response does not answer some central questions. He seemed to say that there was no national pandemic flu line because the antiviral distribution arrangements were not in place, but he went on to say that the antiviral distribution arrangements were not in place because the national pandemic flu line was not ready. I am afraid that that is not good enough: both were supposed to be ready by the time that the pandemic phase occurred, and they are not ready. I ask the right hon. Gentleman again: why is the national pandemic flu line not available now, when the Department said that it would be? He says that it will be ready when it is needed but, technically and according to the contingency plan, it is needed now.
Moreover, the primary care trusts are supposed to have antiviral collection points for the whole population available within seven days of a move to a treatment strategy. Can the Secretary of State therefore confirm that antiviral collection points will be available a week from today?
The Secretary of State’s predecessor wrote to me at the end of April to say that the Department was
“working urgently to accelerate the procurement process”
in relation to the acquisition of a national stockpile of antibiotics. Where there are difficulties and complications, especially with infection, treatment often requires antibiotics
rather than antivirals. Will the Secretary of State say when that antibiotic stockpile will be required? How large is it? The national modelling suggested that we needed enough for 14 per cent. of the population, but what is he aiming for?
Is the face-mask stockpile in place? Can the critical care capacity be increased rapidly? What are the criteria now for the cancellation of elective operations? The Secretary of State has made a projection that there will be 130,000 cases a day, and that would be consistent with up to 2,000 hospitalisations a day by the autumn—a figure that would create very considerable pressure on hospitals.
Vaccination may begin quite soon, in September. Will the Secretary of State therefore publish for debate the Government’s proposals for prioritisation for vaccinations?
Finally, we may not have an opportunity to debate this matter in the House over the recess. With that in mind, will the Secretary of State and the House authorities look for a mechanism to allow virtual statements to be made in that period? The right hon. Gentleman could put up a statement with a few hours’ notice and hon. Members, on behalf of our constituents, could ask questions and get answers in real time.
Andy Burnham: I thank the hon. Gentleman for the measured tone of his remarks, again, and for all his advice as we go along. I am grateful to him for the helpful discussions that we have had. I am particularly grateful for two points today. I welcome his support for moving to the treatment strategy and the timing of that move. He and I agree that the pressure on the system is such that it is the right time to take this step, and I think that it will be welcomed across the NHS. I also welcome his statement that he agrees with the cautious approach that we have outlined in the statement that antivirals should be offered to all those who display symptoms.
The House will have heard over the years, as we have prepared for this eventuality, how steps were taken by the Department of Health to put us in the strongest possible position to plan and face any outbreak of a flu pandemic, and because of that preparation we can use the stockpile of antivirals to offer that cautious approach. As I said in my statement, as the availability of the vaccine comes on line, pressure on the antiviral stockpile will obviously be relieved. So we think that that approach is prudent, although I say again that the science points us to a more targeted use of antivirals. In discussion with colleagues in the devolved Administrations, I felt that now was not the right time to go, given that SAGE said that the decision was “finely balanced.” We need to know more and we need to have more conclusive evidence before taking a move of that kind.
I further welcome what the hon. Gentleman said about the policy on school closures. It is worth pointing out that many schools in Scotland, Wales and Northern Ireland have already broken up for the summer, and that in itself may help us to control the spread of the illness in those countries. The policy has to be judged locally—a decision has to be taken on the ground—and I assure him that, if there are concerns and grounds to close, although it is the job of the Health Protection Agency and others to advise, it is the job of the head teacher and the school governing body to take the final decision about any school closure.
The hon. Gentleman asks about the flu line and the readiness of antiviral collection points around the country. I can confirm that, through strategic health authorities that have been working with PCTs, we have now in place sufficient collection points that can be stood up within seven days. So I can give him the assurance that he sought. Obviously, we can also activate the interim pandemic flu service within a short time frame. That point has not yet been reached, but I can assure him that we will update the House on that issue over the coming days.
The hon. Gentleman asks about access to antibiotics and the size of the antibiotic stockpile. We are on track to have sufficient antibiotic stocks to cover 31 per cent. of the UK population, which equates to 19.6 million courses, by the end of September, with the stockpile having reached over 10 per cent. of the population—6.2 million courses—by mid-June. He has challenged on that point a number of times; he is absolutely right to do so. I will continue to update him on it. Of course, antibiotics may be needed to treat some of the most common complications of flu, including bacterial infections of the respiratory tract and lungs. It is important that anyone who thinks that they are in danger of developing such complications should get in touch with their GP.
I want to make a couple of final points. The hon. Gentleman asks me whether we can debate prioritisation. I will have to reflect on whether a debate in the House is the right thing to do. At all times, we should be led by the guidance from SAGE and the experts. I can assure him that we will bring our conclusions to the House. Indeed, if there is a measure of debate about them, I do not think that that would be a bad thing, but I do not want to give a commitment to hold a debate on the Floor of the House, when we are obviously dealing with a fast-moving situation.
Lastly, as was raised during Prime Minister’s questions yesterday, there needs to be a mechanism so that we can continue to update both Front-Bench teams and hon. Members on both sides of the House over the summer. Perhaps we need to find a way—perhaps through the Speaker’s Office, or some other mechanism—whereby we can get virtual statements, as he referred to them, to any hon. Member who wants one.
Sandra Gidley (Romsey) (LD): I start by offering apologies from my hon. Friend the Member for North Norfolk (Norman Lamb), who is unable to be here today. He asked me to thank the Secretary of State and his predecessor for keeping him fully informed throughout the progress of the flu pandemic. I should like to add my thanks for the advance notice of today’s statement.
I, too, should like to thank the NHS staff who have been dealing with the illness and all those at the Department of Health who have been providing support to others behind the scenes and burning the midnight oil—they do not get praise very often. We, too, welcome the cautious approach that the Secretary of State is taking to these matters. It is a difficult decision—a finely balanced one—but we support him in the conclusion that Ministers have reached.
I have a short list of questions, which are designed both to be constructive and to elicit more information. First, at the moment, all who have contracted the illness will be offered medication, but that could change to its provision to at-risk groups only. The Secretary of State
did not mention the position of NHS staff. It seems to me that particularly front-line staff in hospitals are a special case, so has any different consideration been given to providing prophylactic measures for those staff and are they being offered any special treatment? What contingency plans are in place if flu affects the availability to work of large numbers of front-line staff?
What assessment has the Secretary of State made of PCTs’ preparedness? My hon. Friend the Member for North Norfolk has asked in the past for details of preparedness to be published, and it would be helpful if that was done. My understanding is that some PCTs have made excellent preparations and others less so. What measures are being taken to bring the less proactive PCTs up to speed?
Are sufficient stocks of Tamiflu left to meet predicted demand? Is there any clarity about whether the hot weather has affected the spread of the virus in any way, or has it had the opposite effect?
With regard to information, the Secretary of State mentioned the hotline, but he will probably recall that most households received leaflets earlier in the year at the beginning of the outbreak. I suspect that many householders will have thrown away those leaflets, which provided a useful range of information. So are there any plans to re-leaflet or to run a wider media campaign, so that people can be informed about the outbreak? Will the e-mail to NHS staff include pharmacies that are contracted to the NHS?
I have a couple of questions about collection points. Has any special consideration been given to the more rural areas, which very often rely on dispensing GPs? I suggest that it is probably not the best idea to have even flu friends or other possible contacts descending on dispending doctors’ surgeries. So has any thought been given to such access in rural areas?
There has been some publicity in the media about something called a flu party. It strikes me as particularly bizarre that parents want to try to improve their children’s chances of contracting flu. Has the Secretary of State had any advice on whether that is a good or a bad thing? It seems to me instinctively that it is a bad thing, but there has been much in the media about it.
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. The hon. Lady has exceeded her ration.
Andy Burnham: I thank the hon. Lady for making her remarks in a measured and helpful way, as the hon. Member for South Cambridgeshire (Mr. Lansley) did; I am very grateful for that. She was right to praise, as the hon. Gentleman did, those members of NHS staff who are sometimes unsung; they are not the ones on the front line whom we always think of and talk about. The hon. Gentleman mentioned staff in path labs, too. I think that staff in Richmond House will feel a little cheered today to have had their efforts recognised by the Lib Dem Front Bencher. Perhaps they will go about their work today with that extra lift in their heart. It is very nice of the hon. Lady to offer her thanks. Those staff have genuinely been working hard, and have put in a lot of work over a long period. It will be appreciated that that has been recognised by the hon. Lady.
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