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House of Lords

Monday, 4 February 2008.

The House met at half-past two: the LORD SPEAKER on the Woolsack.

Prayers—Read by the Lord Bishop of Southwell and Nottingham.

Influenza Pandemic

The Lord Bishop of Southwell and Nottingham asked Her Majesty’s Government:

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, our approach to responding to a pandemic requires employers to take responsibility for deciding how best to protect their staff during a pandemic. Our plan is for symptomatic patients to be treated irrespective of the profession to which they belong. If the pandemic virus necessitates any form of prioritisation, the decision will be taken in the light of evidence available at the time. This would also inform our plans for any subsequent vaccination programme.

The Lord Bishop of Southwell and Nottingham: My Lords, I am grateful to the Minister for that reply. If the Government are to defer the decision on how best to use the pandemic-specific vaccine, which I believe can be prepared only five or six months after the first wave of outbreak, will the noble Lord say which criteria they will use, whom they will consult before arriving at a decision, and whether other partners such as faith leaders will be part of that consultation?

Lord Darzi of Denham: My Lords, this will be a clinical decision, based on the prevailing circumstances and certainly on the stocks that become available. Decisions of this nature are difficult. However, we believe that initially limited supply will depend on the clinical impact of the pandemic. For example, if certain population groups are more severely affected, other members of the same group might be inoculated once a vaccine becomes available. A pandemic-specific vaccine could also play an important role in preventing a second pandemic. As for consultation, we will consult our advisory groups, which include both the scientific and ethical communities.

Earl Howe: My Lords, a short time ago a government Written Answer said that supplies of the H5N1 vaccine were being held by the Department of Health on behalf of the Ministry of Defence. Will the Minister say what proportion of the antiviral stockpile has been allocated for the exclusive use of the Armed Forces, and how many courses of antivirals have been taken out of the country?

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Lord Darzi of Denham: My Lords, the stockpile of antivirals is currently for about 25 per cent of the population whom we envisaged will be infected. That stockpile—that resilience—is being increased to 50 per cent. I am not sure of the exact number that has been assigned to the Armed Forces, but I will be more than happy to respond in writing.

Lord Walton of Detchant: My Lords, would the Minister care to comment on recent press reports suggesting that recent strains of the H5N1 virus isolated from birds on the Continent have proved to be resistant to the Tamiflu remedy which has been stockpiled by the Government to be used in the event of an epidemic?

Lord Darzi of Denham: My Lords, I am not aware of that scientific study. However, so far as we are aware, while one of the antivirals we have is Tamiflu, we are looking at other antivirals in the field. One of the issues in relation to pandemic flu is knowing exactly which strain it is and its sensitivity to antivirals.

The Countess of Mar: My Lords, does the noble Lord accept that H5N1 is turning out to be a fairly stable virus and that it is now considered unlikely that humans will get it? Does he agree, however, that a number of bird flu virus strains might be potentially much more dangerous because they are not so stable?

Lord Darzi of Denham: My Lords, I agree with the noble Countess. The issue is not knowing which of the mutated viruses will be responsible for the next pandemic, or whether it would be through the mutation of a human or an animal virus. What is important from the Government’s perspective is to be ready for a pandemic irrespective of the virus or the strain, and that is what the Government are providing leadership for with stakeholders involved in the management of such a pandemic.

Baroness Barker: My Lords, in November 2007 the Minister in another place said that the Government were undertaking research into prioritising at-risk groups for vaccination. Can the Minister tell us what progress has been made in identifying those at-risk groups and on the prioritisation of resources?

Lord Darzi of Denham: My Lords, as things stand at the moment the Government have a stockpile of H5N1 vaccine. If that is the strain responsible for a pandemic, the NHS will provide that vaccine for health workers within the NHS.

Lord Swinfen: My Lords, I think I am right that the Minister has said that it would take five or six months to produce a vaccine. How long does he anticipate that a pandemic would last? Would there be time to produce a vaccine?

Lord Darzi of Denham: My Lords, it is very difficult to predict the exact timing of a pandemic. Indeed, we are not even sure whether we would get a second or even a third wave of it. The first pandemic in 1918 had a second and a third wave, while the

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pandemics of 1957 and 1968 both had a second wave. In our modelling we usually predict that it would take about six months, giving us enough time to create a vaccine against the strain that was infective in the first pandemic.

Baroness Tonge: My Lords, in the event of an influenza epidemic in this country, would GPs deliver all the vaccinations required in their surgeries or are there other plans to make sure that the population is properly dealt with?

Lord Darzi of Denham: My Lords, the primary care community will have a significant role to play in the provision of vaccinations, but the national flu line will be available during a pandemic which will ensure that supplies are sent through the mail for GPs’ patients or to local communities in order to provide vaccinations. We have highlighted through a number of educational websites and through the BMA and colleagues at doctors.net.uk the way in which we could educate healthcare workers in the provision of vaccinations.

Lord Winston: My Lords, can my noble friend tell us what the situation is with our friends on the Continent with regard to vaccines? If there was a shortage of vaccine on the Continent, would we supply stockpiled vaccines from this country even if for no other reason than to protect ourselves from a possible spreading pandemic?

Lord Darzi of Denham: My Lords, we have taken precautions to avoid that eventuality. The possibility of export bans was discussed during the negotiations process for the advanced supply contract. As a result, the risks of nationalisation or the closure of borders have also been minimised as far as possible with the following provisions. First, the production facilities must be located in the EU and remain within the EU unless the UK Government give written consent otherwise. Secondly, manufacturers have warranted that the host country of production has either already sourced all the vaccines it needs for its own population or it is aware of its commitments to the UK Government.

Medical Education

2.45 pm

Baroness Cumberlege asked Her Majesty’s Government:

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, following the difficulties in 2007 with the implementation of MMC, we have made changes this year in line with the recommendations from the programme board. Recruitments to most specialty training posts are held by the deaneries at a local

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level. There is no limit to the number of applications an individual can make. Sir John Tooke has produced an excellent report and we intend to respond to many of his recommendations by the end of this month.

Baroness Cumberlege: My Lords, I thank the Minister for that comprehensive reply. Bearing in mind the great complexity of and, indeed, the tragic history of the department in attempting to manage medical careers, will the Government accept Sir John Tooke’s 47th recommendation—that a new body, NHS Medical Education England, be formed to co-ordinate and maintain standards across the country, as has proved so successful in Scotland? As uncertainty is so damaging, will the Government announce their decision on this recommendation at the end of this month?

Lord Darzi of Denham: My Lords, recommendation 47 in Sir John’s report is a very creative idea and is receiving careful consideration. It is important to remind the House, however, that it was not in Sir John’s interim report, which was published in October, so we have had very little time to consult on it. There are good things about the idea but we have learnt, not least through MMC, as I am sure the noble Baroness will agree, that structures without clarity and explicit lines of accountability can create major problems. We will respond to this recommendation as soon as possible as part of our reply to Sir John’s report. We also need to consider it within the context of the next-stage review and some of the national working groups, which also involve the professional bodies, in coming up with the final decision.

Baroness Murphy: My Lords, given the oversupply of medical students choosing oversubscribed specialties such as the Minister’s own in surgery, what plans do the Government have to encourage medical schools to divert some medical students into undersubscribed specialties such as mental health and other branches of medicine which may appear less attractive at first sight?

Lord Darzi of Denham: My Lords, I am grateful for the noble Baroness’s intervention. She makes an extremely important point. I strongly believe, as she does, that trainees must have more information in guiding them to a final conclusion on what type of specialty they should end up in—particularly at undergraduate level—so that their expectations can be in line with service needs. For example, when I was a trainee, for my first job I wanted to apply to become a brain surgeon, but I realised very quickly that the opportunities in that area were fairly limited. We need guidance and support for trainees, not in their postgraduate years but in their undergraduate years, to ensure that they go into the right specialties.

Baroness Tonge: My Lords, in a letter to me on 24 January the Minister explained that money for medical education and training would not be ring-fenced at trust level but would be based in 2007-08 on,

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Can he explain how this framework will work and how we can ensure that education and training will be protected at trust level?

Lord Darzi of Denham: My Lords, the role of the Department of Health should be to focus on outputs and accountability rather than on ensuring that fixed amounts of money are spent on a particular purpose. For that specific reason, the service level agreement and the accountability framework issued in 2007-08 on the MPET allocations ensure that SHAs and other providers are held to account for the training they support for healthcare students and the NHS workforce, so that they develop the workforce needed to deliver the services required by patients rather than spend that money elsewhere.

Lord Crisp: My Lords, what arrangements are the Government making to ensure that doctors can still gain experience abroad as part of their education and training? Conversely, what arrangements are being made to ensure that the UK maintains its leading position as an educator of doctors in developing countries, whether that is done at home or abroad?

Lord Darzi of Denham: My Lords, if a trainee seeks a fellowship abroad—which usually means transatlantic—there are the right structures within the deanery to ensure that that individual could take a year or two to gain further experience abroad. I am aware that many of my trainees are seeking some form of post-training fellowship in the US and, in some cases, South Africa. With regard to the UK being a centre of excellence in providing training for those who come from abroad, that is well known historically. The challenge for us now with postgraduate training is how to ensure that preference is given to our UK graduates and that the gaps are then filled with others from abroad.

Lord Turnberg: My Lords, one of the major casualties of the new training arrangements has been the loss of the team approach to care in hospitals. At one time we used to have the consultant, the trainees, the nurses and others working in a cohesive and co-ordinated way on patient care, but most of that has been lost as we have seen a rise in rotas, shifts and the shortening of hours. Is there any way the Minister can see to redress that balance? If he does so, he will earn even more respect than he already has.

Lord Darzi of Denham: My Lords, I could not agree more that the spirit of any team is based on the integrity of that team and, from a patient perspective, the continuity of care. However, we are all aware of certain working time directives, although as it stands the current WTD is coming up to 48 hours a week. We need to ensure that we also have doctors who have slept through the night and are at their full competence when seeing patients. It is a matter of

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balancing the sleeping hours with the teamwork. I have no doubt that at a local level, with some creative solutions, we can help maintain the integrity of such teams.

House of Lords: Accommodation

2.51 pm

Lord Roberts of Llandudno asked the Chairman of Committees:

The Chairman of Committees (Lord Brabazon of Tara): My Lords, the House has secured accommodation in 14 Tothill Street for use as decant space during the refurbishment of the Millbank island site. Staff currently located in 2 Millbank will relocate to 14 Tothill Street for the duration of the refurbishment works. Office space suitable for use by Members will be provided in 14 Tothill Street and elsewhere in the parliamentary estate. Noble Lords will be informed of the arrangements at the earliest opportunity.

Lord Roberts of Llandudno: My Lords, I thank the noble Lord for his reply. I have to declare an interest as one of the 71 Peers who will be evicted from 2 Millbank in July this year. It should be a day of celebration for every Welsh man and women, but it is also a day of distress for us. Does the Chairman of Committees agree that every Peer who is appointed as a working Peer needs at least a desk, a filing cabinet, a telephone and a computer to fulfil his obligation? Secondly, does he agree that some offices are luxurious, with many sofas, and that each sofa could be replaced by a desk? The communal rooms, especially the Salisbury Room, which is often totally empty, could, for the duration, be adapted for the use of the working Peers.

The Chairman of Committees: My Lords, I cannot discriminate to say who are working Peers and who are not. All Peers are working Peers these days. I assure the noble Lord that all Peers who are currently in 2 Millbank—I am well aware that he himself is one of them—will be offered accommodation in Tothill Street, the palace or one of the outbuildings. No one will go without. It is also intended that additional computer terminals will be provided within the Library and the Writing Room to facilitate those Members who may not require a desk but who wish to be able to access a computer.

Lord Anderson of Swansea: My Lords, would one not have to be faster than the Welsh wing to reach the House from Tothill Street in time for a Division?

The Chairman of Committees: My Lords, as an Englishman who watched the game on Saturday afternoon, I think I would rather not say awfully much about it. It was a good first half.

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The time that it takes to get from Tothill Street to the House is seven minutes. Were it necessary to look into the time for Divisions, that could be done.

Lord Winston: My Lords, when is the House going to allow wi-fi access for computers? That would make much better use of the entire establishment of the Palace of Westminster, it would abolish the need for many offices and it is vital for those of us with laptops.

The Chairman of Committees: My Lords, I cannot answer precisely the point made by the noble Lord. I believe that wi-fi access is available in certain places—I have seen it in the Corridor by the Library—but I take on board his point and come back to him.

Lord Dykes: Will the Chairman of Committees confirm that the addition of the island site will enable most Peers eventually to have an office— sometimes sharing but mostly for themselves? Will he confirm that yet again, particularly since, with reform coming along, the total number of Peers will presumably decline?

The Chairman of Committees: My Lords, I cannot possibly comment on the second part of the noble Lord’s question. The purchase of the whole of the island site was made possible by the reviews that underpinned the need for better accommodation for Peers. If it was as easy as many people would like it to be to accommodate occupants of 2 Millbank within the palace or elsewhere, there would have been no justification for buying the whole site.

Lord Fowler: My Lords, am I not right in thinking that there is empty accommodation only a short distance down Millbank that is owned by the House of Commons? Have there been discussions on the use of that accommodation? It would be more convenient and save public funds.

The Chairman of Committees: Yes, my Lords, there have been discussions and they have been fruitless, as far as this House is concerned.

The Countess of Mar: My Lords, may I congratulate the Chairman of Committees on the hard work that he and other staff in the House have put in to organising this move? When I first came to the House of Lords, it took me 11 years to get a locker and 25 years to get a desk. I very much appreciate the facilities that I have now. As these arrangements are temporary, perhaps we ought to be a little more patient with the noble Lord.

The Chairman of Committees: My Lords, I am very grateful to the noble Countess. Not that long ago there was not the demand for desks that there is now in the House. As I said earlier, the review pointed out the need for proper working arrangements for everybody. That was why we went ahead with the decision to buy the whole of the Millbank site.

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