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My noble friend made some point about efficiency savings which I support. However, following what was said by the Chancellor in the Budget last week, is the Ministry of Justice now looking more seriously at specific expenditure cuts, as I hope are all government departments?

Lord Bach: My Lords, on my noble friend’s final question, like all government departments we are, of course, doing our duty. As to his first question, it is necessary that I go away and write a letter to the noble Lord, Lord Thomas of Gresford, with a response to his point. Britain is not exactly the same as other countries. It has a higher number of crimes of certain

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types and a lesser number of other types, but the question that has been repeated around the House deserves a more detailed answer than I have been able to give this afternoon. That is what I shall do.

Swine Flu


4.55 pm

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, with the leave of the House I should like to repeat a Statement made by my right honourable friend the Secretary of State in another place. The Statement is as follows:

“With permission, Mr Speaker, I should like to make a Statement on the reports of human cases of swine influenza, known as the AH1N1 infection, in some parts of the world, notably Mexico and the United States of America.

The outbreak began in Mexico on 18 March and as at 9 pm last night there have been over 800 cases and 89 deaths in that country. However, to date, only 18 cases have been confirmed as being caused by the AH1N1 virus and it is highly possible that other, more routine causes of infection are currently circulating in Mexico.

On Tuesday last week, under the terms of the international health regulations, the United States reported seven cases of the AH1N1 infection. On Friday 24 April, the United States Centers for Disease Control confirmed that samples from Mexico contained the same virus as those in the United States.

Twenty cases have now been confirmed in five different states of the USA; four have been confirmed in Canada and one in Spain. Suspected cases have also been reported from New Zealand, France and Israel, although it is important to note that these are suspected cases and have not yet been confirmed as the AH1N1 infection.

In the UK, 25 cases under investigation have been reported. Eight of these have proved to be negative, and three are currently undergoing further specialist tests. These patients are in isolation wards in hospital, after recently travelling in Mexico. People who have been in close contact with them are currently being contacted. The remaining 14 suspected cases are undergoing initial investigation and are sufficiently well to be managed in the community.

It is too early to say whether the cases in Mexico and the US will lead to a pandemic. Scientists do not yet understand the extent to which cases in Mexico and the US are linked and are not yet able to make a complete assessment of the health implications of this new virus.

A pandemic is declared when the World Health Organisation raises the pandemic alert to Phase 6. This means that there is widespread person-to-person transmission of a virus in the general population. At the moment we are at Phase 3.

The director-general of the WHO, Dr Margaret Chan, has declared that this is a public health emergency of international concern. The WHO is convening a

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committee of experts from around the world which is meeting this afternoon to review the situation and determine what further action is required at a global level.

In deciding the pandemic alert state, the WHO bases its decision on expert scientific advice based on the available epidemiological and scientific evidence. The range of symptoms in those affected is similar to those of regular human seasonal influenza. It is important to note that, apart from in Mexico, all those infected with the virus have experienced mild symptoms and have made a full recovery.

The swine flu that has been isolated in Mexico and the United States is sensitive to the antiviral drugs Tamiflu and Relenza. These drugs are effective in treating the illness, provided they are taken quickly enough. These medicines can reduce the length of symptoms and usually their severity.

I would like to outline to the House the measures that we are taking in response to this situation in the UK. The UK has been preparing for a flu pandemic for the past five years. We have established a stockpile of enough antivirals to treat more than 33 million people—that is, half the population of the UK. All NHS organisations have pandemic flu plans in place and the Department of Health is now working closely with the NHS to ensure that these plans can be put into action so that antivirals can be made available to the public very rapidly, should we reach that stage.

Over the weekend, the Government have been putting in place precautionary measures to implement the plans we have been developing in the case of more widespread infections in the UK. I have spoken to ministerial colleagues and my opposition shadows this morning, and I will be convening a meeting of the Civil Contingencies Committee immediately following this Statement.

We have enhanced our port health checks so that passengers arriving in the UK with symptoms of illness are identified and assessed. Information is being made available to passengers arriving at ports and we have provided urgent advice to doctors.

Should the virus start spreading widely in the UK, we propose to use our antiviral stockpile for the treatment of symptomatic patients. We already have an advanced agreement in place with manufacturers should a vaccine be developed, although it is important to note that it will be some time before scientists can develop a vaccine, as this virus is not yet sufficiently understood. Experts are currently examining whether vaccination with regular, seasonal flu vaccine can in any way boost immunity to the H1N1 strain, and we are considering how best we can use the limited stocks that are currently available within the UK.

Many people will wish to know whether they should wear face masks. Although we are aware that face masks are being given out to the public in Mexico, the available scientific evidence does not support the general wearing of face masks by those who are not ill while they are going about their normal activities. We are, however, urgently looking into how we can increase our stockpiles of face masks for healthcare workers who are treating sick patients. We have also published infection-control guidance for support staff treating or caring for people who have symptoms.

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We already have well advanced plans for providing information to the public in the event of a pandemic—in particular, about what people can do to help themselves in the event of swine influenza being confirmed in the UK. Updated information is available on the NHS Choices and HPA websites, and further information is also available for health and social care staff on the Department of Health website. We are putting in place an information line containing recorded, up-to-date information for those who want to know more about this type of flu. In addition, NHS Direct is providing information to people who have recently travelled overseas and are worried that they may have symptoms.

There are three key messages I would like to stress at this stage. First, it is important to emphasise that in all cases outside Mexico the symptoms of this illness are mild and all patients have made a full recovery. Secondly, we can all take simple measures to prevent infection—in particular, covering the nose and mouth when coughing or sneezing and washing hands regularly. Anyone who develops flu-like symptoms should go home and contact NHS Direct or their GP by phone. Thirdly, anyone who has recently travelled to the affected areas and is experiencing influenza-like illness should stay at home to limit contact with others and seek medical advice by phone from a local health professional or NHS Direct.

In line with advice from the WHO, there are currently no travel restrictions on those who are planning to visit affected areas. Anyone planning to do so is advised to ensure that they take the measures I have outlined to prevent infection and to consult a doctor immediately if they show signs of flu-like symptoms. To enable local health services to respond to the pressure that the possibility of a pandemic may bring on services, we are working with primary care trusts to ensure that arrangements are in place to support the distribution arrangement for antivirals, should that become necessary,

There is trepidation and concern across the world. Here in the UK, we are monitoring the situation very closely, alongside the WHO and our international partners. The UK has been preparing for such an occurrence for a number of years and the World Health Organisation has recognised that the UK and France are the two best prepared countries in the world. I will of course keep Parliament fully updated on what is obviously a rapidly developing situation”.

My Lords, that concludes the Statement.

5.05 pm

Lord McColl of Dulwich: My Lords, I thank the Minister for giving me a copy of the Statement an hour or so beforehand. I also want to express our deepest sympathy for all those affected by this outbreak. I congratulate the World Health Organisation on its rapid response when the outbreak came to light in Mexico. It has greatly improved its all-round performance under the very able leadership of the director-general, Dr Margaret Chan, who was appointed two years ago.

Perhaps I can reassure the Government that they can count on our full support in their efforts to prevent the spread of this disease. We shall do all we can to

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boost the nation’s morale and confidence that the epidemic will be contained. The fact that the UK is among the best prepared countries is in no small measure due to the constant pressure applied to the Government, since 2004, by Mr Andrew Lansley in another place. It is a pity that the Government refused his request for a debate on the pandemic influenza in January. I am sure that if our Minister, the noble Lord, Lord Darzi, had been in another place, he would have insisted on such a debate and would have excised the objections from the congenital snag hunters.

Can the Minister tell the House how the Government propose to inform the public if the national flu contingency plan is triggered? I assume from the Minister’s Statement that the national flu line service is not yet ready. Perhaps he could tell us when it will be ready. The EU has advised against non-essential travel, but the UK Government have not followed suit. Perhaps the Minister could say why that is so.

On face masks, the Minister and I are very well aware that if a mask is lowered, as it often is, and left for a while round the neck, it is much less effective when returned to the face. Perhaps that could be emphasised.

Most of all I want to emphasise that I am very worried indeed that the Government have decided to treat only those with symptoms and not to give the antiviral treatment prophylactically to the family contacts of those who contract the disease. I cannot emphasise strongly enough what a serious mistake that is and I urge the Minister to persuade the Government to change their mind. In the flu epidemic of 1918-19, many returning members of the Armed Forces knocked on the doors of their homes but received no answer as the whole family was dead inside. The Minister has said that we have a very plentiful supply of antivirals, which is great, but they should be used prophylactically to protect family members from this disastrous possibility. Will the Minister give us an assurance that he will use his charm and pressure to get the Government to change their mind?

5.09 pm

Baroness Tonge: My Lords, I also thank the Minister for allowing us to see the Statement before he repeated it in this House, and I associate myself with the remarks made by the noble Lord, Lord McColl.

The Prime Minister must be feeling a little like the Pharaoh in ancient Egypt who had the seven plagues visited upon him. I have lost count of the number of plagues that the Prime Minister has had in his 18 months, but he must be wondering what he has to do to make them stop. This is one such and, as ever, the tabloid press are making a feast of it. This morning alone we have had front-page headlines such as “Pig sick”, “Killer pig flu”, “Swine flu sweeps globe”—which it has not yet quite done—and the Daily Mirror modestly asking: “Is swine flu already here?”. The general public are being subjected to those headlines and to all sorts of opinions and advice in the newspapers by medical journalists, ordinary journalists, retired doctors, active doctors, people who are not doctors at all, soothsayers and an awful lot of other people.

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What stood out for me was the advice from the 1918 flu epidemic, which recommended that everyone in the population should wash out their nostrils with soap and water—carbolic soap, presumably—night and morning and eat lots of oats. I am not sure whether oats are a good preventative, but it cannot do us any harm to eat more oats, so that is what I shall be doing.

We have had two reports that may be relevant, and I look forward to reading them. There was one in 2007 on controlling international borders and the spread of diseases, which I must confess that I have not read, but I think that the gist of it was that we should not always wait for top-down direction from international organisations but should get active ourselves—which the Government have done, and I give credit to them for that. I understand that the Select Committee on Science and Technology is investigating UK readiness for a pandemic and that that report will be out quite soon.

I shall ask a few questions briefly. First, on the subject of wearing masks, I wonder whether the general public would not feel more comfortable if they were told that on crowded underground trains and aeroplanes it might be prudent to wear masks. After all, it is the hay fever season, so an awful lot of sneezing, coughing and blowing of noses is going on anyway. I, for one, would feel more comfortable, and I ask whether we have a sufficient supply of masks. I presume that they are available from pharmacies, but I do not know. We need to know that and people should make up their own minds whether they wear them.

Will the Minister tell us how long he estimates that it will be before the new vaccine is ready? Do we have firm plans in place for its delivery? Do we have enough staff, enough people on the ground, to immunise people? As it has already been said that the old vaccine confers some immunity against this new swine influenza, I would have thought that it would be prudent to vaccinate the young, fit and vulnerable people with it straight away. Let us use up the old stock, because we will have a new vaccine by next winter anyway. Why not use up last winter's stock to protect our young people, who, it is thought, are the most vulnerable?

I would like to know whether Tamiflu and Relenza will be available off-prescription. I agree with the noble Lord, Lord McColl, that it is better to use them prophylactically for people who have swine influenza among their family circle. Will they be available off-prescription? If so, are the supplies adequate? Do we have a mechanism to ensure that individuals are not stockpiling it already by some means or other to protect their families? When patients are advised not to go to GP surgeries but to call their GPs for advice, what will happen if their condition worsens rapidly? Will GPs do home visits or will those patients who fear that they may have swine influenza be dialling 999 and infecting ambulance crews up and down the country? Do we have a system in place for rapid disinfection of our ambulance services if that occurs? We are told that official advice from the Department of Health is coming. Could we please have it as soon as possible? People are being subjected to so many opinions on this that we need official advice on websites, and in doctors’ surgeries and pharmacies, as soon as possible.

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5.15 pm

Lord Darzi of Denham: My Lords, I am grateful for that response to the Statement made by the Secretary of State. First, I will try to address some of the very important issues raised by the noble Lord, Lord McColl. On the national flu line, we have a contract with British Telecom, and we anticipate that the flu line will not be ready until the autumn. Lest we forget, most pandemics occur in waves, as we saw in Spanish flu, which was in three waves. Obviously, we are focusing all our efforts on ensuring that the line is available in the autumn. Through the NHS operating framework, we have also ensured that the NHS is ready to deal with such a situation. NHS Direct and all PCTs are looking at the options in which they could release the stockpile of antivirals if such a need arises. I hope I have covered that point.

There has been a fair bit of debate about travel and the evidence of the benefits and disadvantages of the approaches for border closure, an issue raised by the noble Baroness, Lady Tonge. This is still under review. UK nationals may be advised against all essential travel to certain countries or areas during the pandemic through the usual FCO travel advice process. If I remember correctly, we did this in the days of SARS when a statement was released by the FCO. We are keeping a close eye on that. Unlike the United States, we do not have a major border with a country like Mexico where cases have been identified.

The noble Lord raised the issue of wearing masks, and I could not agree more. Most surgical trainees are taught how to wear a mask. If masks are used in certain situations, we have a duty to ensure that they are appropriately worn. I will come back to the issue of masks, which was raised by the noble Baroness. Masks tend to prevent cross-infection from someone who is infected for up to three feet. There is evidence that healthcare providers, such as staff working in health services, should wear masks because they are in fairly close contact with patients. But there is no evidence to suggest that an individual who is not infected needs to wear a mask in open spaces. However, if an individual has the flu, he or she should wear a mask. Perhaps I may remind noble Lords of public health advice that is well known to all of us: if you have the flu you should remain at home. You should not be wearing a mask on the streets. That is the relevant evidence as far as masks are concerned.

On the use of antivirals, there is a debate in the scientific community on whether they should be used as a prophylactic measure. I do not think any other country has adopted a clear policy on household prophylaxis using antivirals, but we should consider it. Much will depend on demand for antivirals, and I have made a point of saying that we have enough to supply 50 per cent of the population. We may look at this again in considering a move from symptomatic patients to looking at close members of the household who might be at risk. However, that is all being kept under review and at the moment the policy is to treat only symptomatic patients because we cannot predict actual demand.

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I turn now to some of the points raised by the noble Baroness, Lady Tonge. She asked about new vaccines. It will take a while to map out the mutation of this virus. We know that it is an H1N1 virus and a relative of the Spanish flu virus. I predict that at best it will take three months to come up with a new vaccine, but let us not forget that we also have to build up a stockpile of the drug. That is why the Statement makes it clear that it could take up to a year to acquire an adequate supply.

On whether we have enough staff to administer the vaccine, I think that we are in a good place in that regard. We have done a lot over the past three or four years in getting the public to understand that the ordinary influenza vaccinations that we have been giving to high-risk groups, such as the elderly and the young, are of value. Moreover, one of the advantages of a universal healthcare system where patients are registered across the board is that it puts the UK in a good place to ensure that vaccinations can be made available.

On the point about advice and algorithms in management, we are in the right place to come up with these on either the HPA or Department of Health website, and I have no doubt that the Chief Medical Officer is actively engaged in the process as we speak. I hope that I have addressed the major questions that have been raised.

5.22 pm

Lord Sutherland of Houndwood: My Lords, I thank the Minister warmly for his prompt and appropriate repetition of the Statement prepared for the other place. Reference has been made to the fact that the Science and Technology Committee of this House has been engaged in detailed discussions on these matters, and I bring forward two questions which arise from the issue of treating symptomatic patients. This first is this: do the Government have a policy on giving key workers early access to the drugs that are already available? Secondly, are there clear criteria for the identification of these key workers, not all of whom will necessarily be in the health and care services?

Lord Darzi of Denham: My Lords, I am grateful for the noble Lord’s intervention in relation to the work of the Science and Technology Committee, and I await its report. We have a policy in place for ensuring that all key workers in the healthcare system are protected as much as possible, which includes giving them supplies of the antiviral drugs. As I said earlier, we do not yet have a vaccine that we know works in this situation. We have a small supply of the H5N1 vaccine, but it is not effective here. Antivirals will be distributed and certainly all other precautions will be taken. The priority is to ensure that we have not just a competent but a healthy workforce that is able to deal with some of the challenges we will face if this becomes a pandemic.

Lord Jenkin of Roding: My Lords, I have to say that I found the noble Lord’s response to the question put by my noble friend about the suggestion that antivirals should be used prophylactically less than satisfactory. As a co-opted member of the Select Committee that is

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currently looking at this area, we have recently been given some interesting information by the noble Lord’s department. It refers to two published papers on the use of antivirals for post-exposure household prophylaxis. However, let me make it clear that I am not talking about pre-exposure prophylaxis, because I accept that it is probably ineffective.

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