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We have to plan for many more hospitalisations over coming weeks. The planning assumptions are for a clinical attack rate of up to 30 per cent. Will the Secretary of State now publish the modelling that forms the evidence base for that assumption? What is the basis for his belief that up to 50 per cent. of children may contract this influenza?
We know that the UK has the smallest number of critical care beds in relation to population of any major health system. May I ask the Secretary of State again what criteria he thinks should be applied to the cancellation of elective operations, and what plans the Government have to train additional NHS staff in the use of non-invasive ventilatory support?
Finally, last Thursday Margaret Chan of the World Health Organisation warned of the threat that developing countries face and their disadvantage in placing orders for a finite supply of vaccines. What more do the Government intend to do to ensure that access to vaccination reaches the most at-risk groups in developing countries?
Andy Burnham: I thank the hon. Gentleman for his remarks, and I agree with him: I am sure that we would all wish to pass on our condolences to those who have, sadly, seen a loved one die in the current outbreak. I also want to put on record again my thanks to the staff of the national health service, particularly those working at primary care level. I visited the antiviral collection point in Tower Hamlets this morning. Obviously, there has been some very real pressure on staff on the front line, who are dealing with lots of cases. In that part of the country, where staff have dealt with some of the highest levels of pressure, they have coped admirably well. We all owe them a great deal of thanks, as we plan to deal with the further challenges ahead.
Let me go through the issues that the hon. Gentleman raised; I shall take each one in turn. He asked me first about the policy of containment, and asked whether I would commission a review. I am confident-this is backed up by the advice from experts in the Department-that the containment policy worked well. It allowed us more time and breathing space, and it provided high-quality information, with which we were able to assess the early development of the virus. It is right to say, of course, that there came a point when it was hard to sustain the procedures of the containment policy in areas that were experiencing great pressure. He will recall that we relieved that pressure by allowing the outbreak management phase to commence. Let me just say to him that we will come back to the issue and look again at it-now is not the time to do that-but the early feeling is that the containment period worked well, and bought us time, which helped us to plan.
The hon. Gentleman asked me about the planning assumptions. I hope that he will agree with my judgment that in this day and age, it is right to share with the public, business and public services the information that is given to the Department and Ministers about the likely effects of the virus, in terms of the spread of disease, hospitalisations and the deaths that sadly occur. I have taken the judgment that we should continue with that policy of openness, but we will at all times explain it and put it in the right context. As he will have heard, in all my statements I have stressed the "business as
usual" message at all times, as have the Minister of State, Department of Health, my hon. Friend the Member for Lincoln (Gillian Merron), and Professor Sir Liam Donaldson. I can do so again for the hon. Member for South Cambridgeshire (Mr. Lansley) today; indeed, I did so in my statement. That is always the context.
The hon. Gentleman asked me about antiviral collection points and the steps being taken to ensure that they are accessible to people all over the country. He asked whether there should be maximum distances. Obviously, those are matters for every primary care trust. I said in my statement that I have asked that all Members be given information on the local collection points in their constituencies. We will make sure that that information is given before the national pandemic flu service launches. It is possible that pharmacies could play a greater role in developing that network, and I am open to the possibility that any Member, from any part of the House, may bump into me in the next few days and say, "We haven't got enough collection points; some people will find it a long distance to travel." Let us have that discussion, and respond to concerns, as we go along. We are confident that from the latter part of this week, we can stand up a service that will significantly relieve pressure on primary care and enable us to get medication to people who need it quickly.
The hon. Gentleman asked me about the advice for pregnant mothers, which he said was confusing. Let me say again that our advice has not changed. I cannot make that clear enough. The front page of a newspaper stated that one voluntary body had said that people should not plan for a pregnancy-should postpone pregnancy, in effect-and there was a response to that from the Royal College of General Practitioners. I would be grateful if he would listen to this point: comment has been made on the advice prepared a long time ago for H5N1, bird flu, which, as I think he knows, would have been a more serious virus. It is important that care is taken to ensure that the statements that are made relate to the current advice. As I say, that advice has not changed.
The Royal College of General Practitioners and the Royal College of Obstetricians and Gynaecologists have played a superb role over the past few weeks, and I am sure that they will continue to do so. Both organisations have given clear advice today and in the past week, and of course we will continue to liaise with them to ensure that they can continue to play that role.
The hon. Gentleman said that the national pandemic flu service was "a month late", and asked who had caused the delays. This brings us to the heart of some of the information that the Liberal Democrats were putting out this weekend. I am afraid that they were trying to score a political point when none was justified. As I have explained, when I came into the Department, the clear advice to me was that it would be justified to stand up a new national network-with all the resource, energy and time that that would take-when we had simultaneous outbreaks in many parts of the country and there was not only pressure in two or three places but more sustained pressure across the country.
I want to refer the hon. Gentleman back to the numbers that I quoted in my statement. I will read them to him again, because they illuminate this point. I said: "On 8 July, just six primary care trusts reported exceptional levels of flu-like illness." One week later, that figure had
increased to 110. On that day, 15 July, I took the decision-which was endorsed by Cobra-to activate the national pandemic flu service. We could have done it earlier, had the circumstances justified that. I have been clear since I came into the Department that the service could have been activated, should that have proved necessary. The change in the facts on the ground last week justified the activation of the service, and I do not believe that it is right to build a story about long delays and infighting. That has not been the case, and the decision was not technology-driven; it was driven by pressure on the ground.
The hon. Gentleman asked about a vaccine. There is a difficult discussion to be had about putting in place a prioritisation programme for vaccination that deals with higher-risk groups and health and social care staff at the same time. I believe that that can be done. Given that such a decision will be taken in the next week, or longer ahead, after the House has risen, I undertake to share that information in advance with the Members on both Front Benches, so that they can have an input into the decision.
The hon. Gentleman asked about a licensed vaccine. I repeat what I said in my statement: we obviously want to ensure that any vaccine is properly and thoroughly tested. A process was put in place for H5N1 but, as we are dealing with a mild virus, the circumstances are now different. The balance of risk attached to pursuing an unlicensed product is obviously much changed, given that this is a mild virus. I know that the hon. Gentleman understands these complexities. For me, the important thing is to get in place the necessary assurances on the vaccine as quickly as possible, so that we can move ahead with a prioritised vaccination programme, come the autumn.
The hon. Gentleman asked about critical care. We have taken great steps, not just recently but over a long period of time, strategic health authority by strategic heath authority and primary care trust by primary care trust, to ensure that there is sufficient critical care capacity in all parts of England to enable the NHS to cope. The publication of the planning assumptions last week gave further information to help local health services to plan for the expected levels of demand. Of course we will continue to do that at all stages, and to endeavour at all stages to give full answers and all information so that the hon. Gentleman and all other hon. Members can make informed judgments on these important matters.
Sandra Gidley (Romsey) (LD): I thank the Secretary of State for providing a copy of an early draft of his statement. I also add my thanks to health workers who are working on the front line and behind the scenes. I want to start by asking about the advice to pregnant mothers. Why, if the advice has not changed, did the National Childbirth Trust say that it was acting on departmental advice? Why was the website changed so late in the day?
The right hon. Gentleman talked about patients being advised to contact the national pandemic flu service. They have previously been putting quite a strain on our GPs' services. Will he explain the six-month delay in getting Treasury approval for the hotline? The freedom of information request made it quite clear that there had been a significant delay in signing it off, which could have resulted in an undue work load on our GPs.
"how many primary care trusts had designated influenza treatment distribution centres on 1 July 2009."-[ Official Report, 13 July 2009; Vol. 496, c. 174W.]
The answer, which I am sure the Secretary of State will be interested to hear, was that the information is "not collected centrally". That does not inspire confidence at all. Who is in charge? Does the Department have a handle on what PCTs are doing, or is it all delegated to a different level?
There have been worrying reports in the newspapers about whether children can receive the vaccine before the final trial results are available. The right hon. Gentleman has tried to reassure us today, but will he explain why manufacturers have been exempted from liability for certain side-effects arising from the vaccines? No decision appears to have been made about the prioritisation of vaccines, yet SAGE-the Strategic Advisory Group of Experts-discussed the matter and made recommendations on 7 July. If that advice was available on 7 July, why has the Department not acted on it, and why are we still waiting for decisions to be made?
Finally, hospital staff are likely to be catered for, but what about care workers? My hon. Friend the Member for North Norfolk (Norman Lamb) has been advised by a care home that the PCT said it did not have the resources to give Tamiflu to care workers in the private sector, who would have to pay. Given that those workers are at the front line, and given the crossover between NHS and social care, will the Secretary of State address that? Will he also clarify what quantities of antivirals are left and explain why so few discussions with pharmaceutical wholesalers about the wider distribution of these products have been held?
The hon. Lady began by asking about the advice to pregnant women. I repeat that the advice has not changed. The Department has given very clear advice since the beginning- [Interruption.] Let me be absolutely clear to the hon. Lady in answering her question, which is very important to many people. Advice was given over the weekend that was based on planning for H5N1, so that clearly was not and is not relevant in this case. The advice was subsequently withdrawn by the organisation concerned.
In those circumstances, it is important to ensure good liaison and sharing of advice, ensuring that different organisations can give their own advice-there is more than one voice in this debate and there is international experience to draw on. At all times, however, we want to give the clearest possible advice, and where further advice or clarification is necessary, we will always provide it. As I said in my statement, the chief medical officer will reissue existing advice, bringing together all the latest information, which I hope will provide some reassurance to the hon. Lady. I do not think that what she said particularly helps in this situation. It is important to recognise that people need clear advice, so we must not and should not invent confusion where there is none.
On the hon. Lady's claims about a six-month delay, it is important to recognise that the national pandemic flu service is the first of its kind in the world. I am sure that if there were any problems or glitches, Members of all parties would not hesitate to say that it was outrageous and would criticise us for launching a service that had not been properly tested. The service, which is innovative and provides a different approach, will significantly relieve pressure on the primary care front line. Our decision was not technology-driven or, indeed, driven by delays in government. The service has been available for commissioning for some time. With pressure increasing simultaneously in different parts of the country last week, I judged it the right moment to bring this service into being. If we had done that any sooner, however, it could have been a distraction to staff dealing with the early effects of the outbreak in their areas.
The hon. Lady made a fair point about PCTs and about data on antiviral collection points not being collected centrally. I undertook this week to supply all Members with information on local antiviral collection points before the launch of the new service. She is perfectly entitled to hold me to that commitment.
SAGE has discussed vaccines and has made recommendations to Ministers. The Cobra civil contingencies committee first discussed the matter at last week's meeting. We recognised that further time might be necessary to consider the higher-risk groups and the order of priority for receiving the vaccine. We must ensure that we strike the right balance in respect of health and social care workers. Of course, that must be linked to schedules for the delivery of vaccine. The issues are complicated and interlinked, but I commit myself to sharing important information with the hon. Members for South Cambridgeshire and for North Norfolk (Norman Lamb) over the summer.
The hon. Lady made an important point about private care home workers: such front-line staff must be able to do their job, thereby relieving pressure on the national health service. That point has been relayed to me by various people in recent weeks, and it is not lost on me. We will come to a final decision on the matter soon. The aim of giving vaccine to health and social care workers is to ensure that essential services can operate, and that extra pressure is not put on already overstretched services. That principle will guide our approach to issuing vaccine.
Mr. Speaker: Order. May I say to the House that, at 32 minutes, the statement and Front-Bench exchanges took considerably longer than I would have wanted or expected? I say politely to representatives of the Front Bench that it is almost invariably an unalloyed joy for me to hear them, but it is better for them to leave me hearing less and wanting more, rather than hearing more and wanting less. At least 15 Back Benchers are seeking to put a question, and I want to accommodate them all, so the usual rule applies: short questions and short answers.
Frank Dobson (Holborn and St. Pancras) (Lab):
Will my right hon. Friend the Secretary of State give us his assessment of how local parts of the NHS are dealing with the distribution of antiviral drugs? I would not
want that question to be interpreted as being in any way critical of what has happened so far, as I commend him, his ministerial colleagues and everyone in the Department and the national health service for their contingency planning and for the implementation of contingency plans, as endorsed by that responsible BBC correspondent Mr. Fergus Walsh, whatever some other people might say.
Andy Burnham: I thank my right hon. Friend. Mr. Walsh has indeed done a superb job in providing balanced coverage to the public, and we pay tribute to him: if coverage is not so well and carefully done, pressure can be put on NHS services as a result of people worrying unnecessarily.
Let me outline what is happening in Camden: three chemists have extended opening hours; three antiviral collection points will be in place later this week, and I shall ensure my right hon. Friend has the details. I am told that there is a flu car for those without flu friends, so there is a local distribution system for people who might find it hard to get antivirals, and 350 courses of antivirals have been issued to date. The local response varies: some PCTs are putting in plans to respond to the requests of their local community, but in Camden, as he can clearly see, a detailed local operation is already in place.
Mr. Nigel Evans (Ribble Valley) (Con): We are now in the holiday season and a lot of people will be going abroad, so what advice does the Secretary of State have for airlines and travellers, especially as nine youngsters have been diagnosed with swine flu in China? Should not those considering going abroad ensure that they have proper insurance: the European health insurance card if they are going to Europe, and proper paid-for insurance if they are going to other countries?
Andy Burnham: The hon. Gentleman raises an important point, as people will be about to travel. It is important that people take the same precautions when travelling as they would when at home. As I have said several times today, it is very important that people travelling within Europe-not just one member of the family, but all family members-have the European health insurance card, as that entitles people to necessary medical treatment, including for swine flu, across the European Union. I hope that the hon. Gentleman will encourage his constituents to ensure that they take that card on holiday. We recommend that if people have swine flu, they do not travel until their symptoms have stopped. We also recommend that people check the Foreign Office website for advice on travel to particular countries. If he wants more detail, I can write to him, but he is correct that people will want clear information on this important matter.
Mr. Kevin Barron (Rother Valley) (Lab): The Department, the Secretary of State and his predecessor have handled the swine flu outbreak very sensibly. While I accept that the outbreak has had tragic consequences for a few people, it is still mild and self-limiting. Is it not incumbent on all of us, both Members of Parliament and the media, to ensure that any reporting takes place on that basis, and that people are not panicked into believing there is something in the country that is worse than what we have-and are controlling-at the moment?
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