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Finally, the Statement referred to the vaccine currently in preparation. The question of who is given the vaccine will be decided, in the words of the Statement,
Can the Minister elaborate on what is meant by this? Do we not already have sufficient information to tell us who is most at risk? If not, when do the Government expect that we will have enough to go on? The Government have, after all, already defined the at-risk groups as regards the use of antivirals. At all events, will the Government undertake to make public the basis of prioritisation once this has been determined?
I end by joining the Government in expressing my condolences and sympathy to the families of those who have died of the virus. I also pay tribute to the staff of the NHS, including officials, GPs, those in primary care, in pathology labs, in hospitals, and the Health Protection Agency, who are working so hard on our behalf. We wish them well during what look certain to be some very difficult and pressurised few weeks ahead.
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Baroness Barker: My Lords, I register our condolences from these Benches to the families of those who have died. I thank the Minister for repeating the Statement in this House. Given the dramatic increase in the number of people who have contracted flu, it is right that we should reassess whether the strategy that the Government have been following continues to be relevant and the right course of action.
While the Government's actions to date have rightly been focused on trying to contain the virus and then to mitigate the effects of its transmission, there is a parallel activity to monitor the information about the incidence of the disease and to evaluate the effectiveness of the NHS response. That is in many ways as valuable an activity. It will set out some valuable learning points, were there to be a future pandemic of another disease. I put my questions to the Government in that light.
The noble Baroness said that the Government were now moving to the treatment phase. I understand the reasons for that, but what lessons have been learnt from the containment phase of the strategy? She indicated that there had clearly been a failure to contain the virus. That failure was not entirely unexpected, but what have the Government learnt so far about the ability of the NHS to contain outbreaks? How would that be of value in any future pandemic? To what extent has the progression of the epidemic matched predicted modelling, which I believe the NHS has undertaken for some considerable years?
I have one nagging question about the Statement. Was the decision to offer antivirals only to high-risk groups made purely on scientific advice or was it an economic decision as well? What is the department's response to that?
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The noble Baroness made the important point that there will be a changed role for the Health Protection Agency. It will now step back and the immediate registering and treatment of the virus will go to primary care, in particular to GPs. Has the department estimated the extent to which drawing back the HPA from its front-line role will jeopardise the tracking of data that it has been gathering about the progression of the pandemic? Does the changed role of the HPA offer any risk to the spotting or detection of a mutated virus? The noble Lord, Lord Darzi, recognised as a key problem the chance that the virus might mutate, which could mean that the antivirals that we have are not so effective.
Following the noble Earl, Lord Howe, I ask what the Government plan to do, particularly over the critical period of September, October and November. During that period, the start of the academic year, not only will schools be going back but a number of students will be coming to this country to universities. As always, we welcome them, but that will coincide with the peak activity period for the seasonal flu programme. Is the department now preparing to give additional plans and guidance to primary care staff to cope with a potential spike in demand over those three months?
Can the noble Baroness update the House-this was not in the Statement-on the liaison that the Government have had with foreign Governments and with the Centre for Disease Control in Atlanta and the European health observatories? We can then track any parallels or distinctions between the progression of the virus in this country and its progression abroad.
In the Statement, the noble Baroness mentioned the Scientific Advisory Group for Emergencies-the aptly named SAGE. She said that the change in policy to target only high-risk groups was based on SAGE's evidence but that that decision was, in its words, "finely balanced". How quickly have the Government acted on the advice that SAGE has given to date? How quickly could they act were SAGE to give different advice if that balance changes in future?
I, too, congratulate the scientists and front-line practitioners in the NHS on the way in which they have approached this pandemic. It is clear that the NHS has had to deal with a most difficult public health problem. Individuals recognise that it is a public health risk, but it is one that they cannot measure and quantify; they do not yet know how serious this condition will be for them and their families. So far, the NHS has managed to keep the tenor of its information campaign correct. In the face of some rather hyperbolic headlines, the NHS is to be congratulated on having got on with doing a difficult job in a temperate manner.
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Baroness Thornton: My Lords, I thank the noble Earl and the noble Baroness for their support and for their recognition that the NHS has had pandemic plans in place and that the Health Protection Agency, with the NHS, has to date done an excellent job working to limit the spread of this virus. I will attempt to answer the questions that they raised.
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The noble Earl asked about the policy of antiviral prophylaxis and treatment. There will be an end to antiviral prophylaxis in the norm. Treatment will be for those at higher risk of becoming severely ill. There will continue to be a clinical discretion to offer antivirals to any patient should the need arise, particularly those who we recognise would need that support, such as health service workers. I had not thought of prisons; that is a good case. I will refer that back to the department for consideration. I am sure that somebody there will have thought about it.
On school closures, as I said in the Statement, the HPA will help with the risk assessment, but this is not now seen as a preferred option. The noble Earl made the point about schools being about to break up and restarting in September and about our need to ensure that the information is available to them so that they are in a state of preparedness. It is a point well made. Indeed, it is in hand. Running alongside the activity of moving to treatment is a huge communications campaign to inform people and health service workers. That will make sure that schools and all those who need to will know what is going to happen and how it will happen-in what order-in a timely fashion.
Who will be offered antivirals? The use of antivirals for prophylaxis will stop. As I said, they will be used only in exceptional circumstances. With transmission in the community, the policy of widespread prophylaxis is no longer appropriate. There will continue to be clinical discretion to offer antivirals to any patient should the need arise. They will be offered to people who are diagnosed with swine flu. Anyone who thinks that they have swine flu has the right to ask their GP for the health service to provide them with antivirals.
The noble Earl raised the issue that I had anticipated about what the media have called "swine flu parties". The Chief Medical Officer has made a firm statement about that, which I can do no more than repeat:
"We would never recommend intentionally exposing anyone to swine flu. It is seriously flawed thinking to allow the virus to spread unabated through swine flu parties. We don't yet know enough about the risk profile of the virus and, whilst it has been mild in the UK, in some parts of the world young, previously healthy, adults have died. Parents would never forgive themselves if they exposed a vulnerable child (perhaps a contact of a child at a party) to serious illness. We need to be mindful of any future development of the virus and we remain vigilant in monitoring the disease".
I do not need to add to those words.
What support is being made available to primary care trusts, GPs and the health service? We are aware that GP practices must expect to be under considerable pressure during the flu pandemic. I have already mentioned the local flexibilities that we have introduced in the hot spots to enable primary care to sustain its response. The national flu service has been designed to minimise the pressure on GPs and primary care teams in a widespread outbreak by allowing patients to receive their antiviral medication via the web, a telephone call or a local network. That means that GPs can concentrate their expertise on treating patients whom they would normally see, plus those who have complications of the flu, as opposed to the potentially very large number of patients who think that they might have flu. Our
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How will intensive care manage this? We know that fluctuating demand for and capacity in the NHS are part of normal working activity, but in May we published guidance for the NHS entitled Pandemic Flu: Managing Demand and Capacity in Health Care Organisations. We are giving support as far as we can.
Communication is very important. A communications strategy goes with this, which I have already outlined. The flu surveillance information on infections is co-ordinated and collated by the Health Protection Agency Centre for Infections. It receives regular reports from separate schemes run in England, Wales, Scotland and Northern Ireland, which use the data provided by networks of GPs. The GP network includes 3,300 surgeries covering more than a quarter of the UK population and provides reports on symptoms of flu in patients as part of the QSurveillance system. A further 100 surgeries across the country collect information on flu symptoms as part of the Royal College of General Practitioners' surveillance. That is during the normal flu season but the fact that we are moving into this new phase does not mean that we will not be surveying and counting.
The noble Earl asked how we predict the disease will progress. Obviously, we cannot predict the spread of the disease precisely, but we know that it has proved to be mild, except in a very few cases. Apart from the figures that I gave in the Statement, I cannot give any further information. The noble Baroness and the noble Earl asked how we will manage the transition. At the moment, we have an interim service, which we felt we needed to introduce immediately because of the increase in swine flu. We recognise that it is important to ensure that the systems are sufficiently tested before they are used. The interim solution has now been tested. It has the capacity to cope. A full programme of testing has been built into its delivery line, before a full system kicks in in the autumn.
The noble Baroness also asked about the lessons that we have learnt from the hot spots and the period that we are just passing out of. The Health Protection Agency, with the NHS, has done an excellent job in limiting the spread. We have learnt that what we need to do when we realise that we have hot spots is immediately to give flexibility locally to reduce the number of patient swabbings, to reduce the pressure on GPs to allow them to treat symptomatic patients on the basis of their clinical judgment, to ensure that other staff such as primary care nurses can swab and to ensure rapid access to antivirals. That is the phase that we are moving into now. The lesson that we have learnt is that that is how we need to proceed.
On the international situation, we fully recognise the importance of ensuring proper protection for countries in Europe and globally. I probably need to write to the noble Baroness about the spike of students coming back to this country in September and October; that is a point very well made. We support the European Commission in helping those countries without contracts to obtain vaccine for a minimum of 5 per cent of their population. We continue to work with the ECDC and
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1.36 pm
Lord Sutherland of Houndwood: My Lords, I thank the Minister for repeating the Statement by the Secretary of State, which I welcome, because it helps to clarify government thinking and intentions on this important topic.
The Minister will be aware that the House's Select Committee on Science and Technology this morning met the Minister of State for Public Health to take evidence on this and related matters. The first piece of evidence was that a Statement would be made later in the day. However, I can fairly say that that did not inhibit what was a vigorous but good-natured discussion. One piece of evidence available to us and to the relevant Minister was from the Royal College of General Practitioners. I agree with all that has been said positively about the important role that general practitioners play, but there were some questions in the evidence that we received. For example, headings coming through the website from GPs included lack of information and conflicting advice and variation in support from primary care trusts. There was a positive side to those topics as well, but there was a serious expression of concern from the royal college, which represents the first-line troops in this area.
Can the Minister assure us that the effectiveness of the provisions in the Statement will be measured? It would be wrong to say that the jury is still out, because the jury is still taking evidence about the effectiveness of the policies outlined. It would be good if we could be assured, for example, that organisations such as the royal college will be consulted and that the information coming back from its network of GPs will help to inform the modification of government policy in the weeks and months to come.
Baroness Thornton: My Lords, I was aware that my honourable friend Gillian Merron was giving evidence to the committee, and therefore worked out that several Members of your Lordships' House might be better informed than I am, having just had a refresher course, as it were.
The point about information is well made. In preparing myself for the Statement, I went online and tested it by Googling and other ways. I decided that I had swine flu and filled in the questionnaire to see what happened at the end. I did not use the phone, because I thought that that would be improper, but I thought that it would be useful to see how those things work. I must say that I found them both easy and accessible. I know that not everybody has access to the internet and would know how to do that, which is why the telephone line and the telephone number that went out to every household are so important.
I take the noble Lord's point and am absolutely sure that the royal colleges will be fully involved in both consultation and evaluation as we move forward. Plans are being finalised at the moment at both national and local level to communicate to GPs and service users about what will be expected of them when the service is introduced. The exact nature of those messages
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Baroness Gale: My Lords, I thank my noble friend the Minister for giving this report as it affects England, but as I live in Wales, will she say what consultations there will be with the Health Ministers in the devolved nations to ensure that there is a continuous, concerted campaign throughout the whole of the UK? Will she also say how the publicity will be handled about the website, the telephone line, and other means of communication, to ensure that everybody is informed and knows exactly where to go?
Baroness Thornton: My Lords, as I said in the Statement, we are working very closely with the devolved Administrations. The arrangements for the National Pandemic Flu Service in each devolved Administration are still being finalised, and are, of course, the object of consultation and agreement as we move forward. This is not something that can possibly be imposed on anybody: it has to be done through co-operation. While it is the case in England that we are taking the precautionary approach as outlined in the Statement, at present in Scotland and Wales they are more likely to confine their antiviral treatments to high-risk groups. But as we discussed already, scientific opinion is very balanced on that issue.
I think my noble friend is asking me, "What do I do if I wake up and think I might have swine flu?" The answer is, that you check your symptoms if you are online, with www.direct.gov.uk or www.nhs.uk, or you phone the flu line. If you are still concerned, you should phone your local GP, who will be able to provide a clinical diagnosis over the phone. If swine flu is confirmed, they would give you a voucher number which you should give to your flu friend. A flu friend is, obviously, a neighbour or relation or somebody near you who could collect those antivirals from a collection point.
As the number of cases rise, we will need to move to a different system, where cases are diagnosed and dealt with by the National Pandemic Flu Service, to take the pressure off GPs. For those people who are isolated or vulnerable, the job of GPs and the National Pandemic Flu Service, when it kicks in, will be to deliver antivirals to people's homes.
Lord Jenkin of Roding: My Lords, like the noble Lord, Lord Sutherland of Houndwood, I have also had the privilege of sitting on the Select Committee upstairs, and we got a lot of useful evidence this morning from the colleague of the noble Baroness, the
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I remain very confused about the Government's policy on this. Like my noble friend, I regret that the full-blooded flu line was not up and running by the end of May, as had originally been promised. We now are not going to have it until the autumn. Therefore, it seems to me that the transition from the interim to the final scheme is a very important stage, and I wonder if the Minister could tell us a bit more about that.
Baroness Thornton: My Lords, the noble Lord is exactly right. That is why we are we are clearly calling this an interim phase. That means that the Health Protection Agency is stepping back from front-line response, and primary care is taking a lead in diagnosing and distributing antivirals. We are ending contact-tracing and prophylaxis in all areas, and will now be identifying by clinical diagnosis or from the pandemic flu service. People who are diagnosed with swine flu will be offered antivirals. We are preparing the National Pandemic Flu Service for launch within the next couple of weeks, and my understanding is that it will happen across the UK-although if that is wrong, I will write to the noble Lord and the House about that. That will provide people with alternative routes to access antiviral treatment, and will relieve pressure on primary care. The noble Lord raises exactly the key point: this has to backed by a full communications strategy, aimed both at the health service and the general public, to explain why things have changed and what this means for people. That is a major part of this work.
We are finalising the plans for the public communications on the move to the treatment-only approach. There is some potential for regional variation in the initial approach, and it will partly depend on the amount of pressure that is brought to bear on the local health service in that area. So in areas like parts of London, where there are very large numbers and large demand, the collection of antivirals will be provided by other means. The strategic health authorities are already testing the PCTs' ability to do that and the operational arrangements to do that. We also recognise that there has to be a clear rationale behind who will or will not get antivirals, and that has to be communicated clearly in our national messaging. The noble Lord is quite right.
The Lord Bishop of Ripon and Leeds: My Lords, I, too, thank the Minister both for the Statement and for her response to the questions. I also thank those in the NHS and outside who have done so much already to respond to the threat of a pandemic.
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I want to concentrate on asking her about community preparation and the responsibility of the general public in this whole situation. I was pleased about the very brief mention in the Statement of flu friend networks, and then about her more positive comments made since then in her answers to questions. It seems that these networks are going to be crucial in getting to people whom other people will not get to.
I was also very pleased that the Minister affirmed that she recognised that there are many people without access to the internet. Indeed, there are those who have no access to phones. One of the most important things in this situation is to do all that we can to ensure contact with those who are the most deprived in our communities and who may well fall through welfare gaps. Churches and faith organisations have a particular responsibility, in that they are among those who may have contact with those who do not fit in with the way in which our society normally operates. What are the Minister's reflections on the need to get to those who will not be found by many of the methods about which she has spoken so well in the Statement and in her previous answers?
Baroness Thornton: My Lords, the right reverend Prelate is quite correct to point to the importance of community organisations and their resilience to support people during this outbreak.
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