Lamb, Harris and Williams quiz Johnson on Swine Flu

• [May 7] Norman Lamb (North Norfolk, Liberal Democrat): ' . . THE statement refers to the fact that we now need to make alternative plans because the flu line is not ready. How much will those alternative plans cost? Surely that cost and inconvenience has been caused by inertia in the Treasury.?'

I join others in thanking the Secretary of State for early sight of the statement. I also thank him and the chief medical officer for the briefings that they have conducted away from the Chamber and join others in thanking staff across the NHS for their hard work in preparing for the potential pandemic.

There were reports last weekend of concerns contained in a Department of Health document about capacity that hospitals, including intensive care units, could be overwhelmed. What assessment has the Secretary of State made of current capacity, particularly in parts of the country where hospitals are operating at close to capacity, if not full capacity, and what are the potential risks?

There is reference in the same document to the potential for 10 times as many people requiring ventilators than the NHS can supply, owing to complications such as pneumonia. What plans, if any, does the Secretary of State have to increase the supply of ventilators? There have also been reports of GPs struggling to get access to swabs. Can he provide an update on that?

As for the use of antivirals prophylactically, the Secretary of State mentioned the potential for a change of strategy. It will obviously be difficult to persuade people who are potentially affected of the case for a change. Is that dealt with in the planning document? How will the judgment be made and how will it be communicated to people who will obviously be suffering considerable anxiety?

What assessment has the Secretary of State made of local preparedness around the country? There have been reports of PCT board minutes showing quite a variable picture around the country. Would he be prepared to publish every PCT's assessment of its current preparedness?

I note what the Secretary of State said about the flu line business case, but it took the Treasury 32 weeks to approve it. Does he share the frustration that was felt by NHS Direct at board level at how long that took? What pressure was his Department putting on the Treasury to speed things up? The statement refers to the fact that we now need to make alternative plans because the flu line is not ready. How much will those alternative plans cost? Surely that cost and inconvenience has been caused by inertia in the Treasury.

Finally, concerns have been expressed about action at EU level. There are reports that EU Health Ministers failed to reach agreement on the right strategy for travel bans and on plans for a European drug bank for flu remedies and vaccines. Can the Secretary of State update the House on the current position? Is he satisfied that the Council of Ministers is getting its act together and that there is a coherent action plan across the whole EU?

Alan Johnson (Secretary of State, Department of Health; Kingston upon Hull West & Hessle, Labour): On capacity in hospitals, we are sure that the plans are in place to deal with that. We are a long way from that stage yet, which will mean dealing with complications when we have a full-blown pandemic, which is the same reason why we need the antibiotics. In those circumstances, hospitals would delay non-essential operations and change their whole mode of operation to concentrate on that priority.

Compared with 1969 and 1957, fewer beds are available in hospitals. In 1950, the average stay in hospital was 45 weeks; now it is 4.5 weeks, so we do not need the number of hospital beds that we had then. However, I am assured that we have the capacity in beds and, in particular, intensive care beds out there to deal with the problem, and the same goes for ventilators.

With swabs, however, there was a problem. We are talking about one of those issues where we can have the best framework in place and everything can be set at the national level, but then we find glitches in the system. The British Medical Association was very helpful to us on that, as were others, and we have resolved the problem, which was one of the reasons why Ian Dalton has been appointed. I do not like the title that some of the newspapers have given him, but we need to bring him down from the north-east to look at the role of co-ordinating all the different systems. That was something that we planned to do later in the national framework, but which we are doing immediately.

An important point that the hon. Gentleman raised is how we explain moving from containment to mitigation. That is partly why I mentioned the issue today-to get us thinking about it, as it will certainly be an important element of the public health messages that we give people. I think that the public will understand that, whereas we can currently give this precious resource, Tamiflu, when people do not have symptoms and may not even develop them, when the problem becomes much more widespread, the help will still be available. We would still use household prophylaxis and post-exposure prophylaxis for NHS workers, but we would need to ensure that we got that to people within 48 hours, which is the essential time scale, only if they were symptomatic. That is the best way to use that resource. I agree with the hon. Gentleman that we need to explain the trigger points that move us from containment to mitigation, although I am sure that we will explore that much more in next week's debate.

I am not going to go through every cut and thrust of our discussions with the Treasury, but it has an important job to do. The Treasury needs to be absolutely sure that we are spending taxpayers' money on the right thing-that is, on something that will do what it is supposed to do and work properly-and it put us through a rigorous process. I think that Her Majesty's Treasury would do that under any Government; it is right that it should do so. This was a huge expenditure, and I have no complaints about that-no complaints that I am willing to mention publicly, anyway.

On the issue of action at the European Union, it is not the case that the EU failed to agree. The Minister of State, Department of Health, my right hon. Friend Dawn Primarolo, was there taking a prominent role, and there was agreement after what I am told was a pretty amicable meeting. There was no move away from the importance of the EU acting within the World Health Organisation's international co-ordination role, which it does very well-without removing the oversight that each member state must have for its own arrangements, of course. Reports of rows were greatly exaggerated.

• . . Evan Harris (Oxford West & Abingdon, Liberal Democrat): I should like to ask the Secretary of State about the importance of those making public statements sticking to a clear consensus expert view. One hon. Member has said on her blog, in relation to schools and nurseries closing, that

"it is madness. The Minister for public health should stop schools from closing. Far better everyone catches the virus now, and builds up their own anti-bodies whilst it's still relatively weak, and presents as nothing worse than a cold."

She goes on to suggest that children will be better off in the long run if they catch the virus now. She does say:

"Viruses are much cleverer than we are."

Apart from the obvious problem of the threat to the immuno-compromised and the frail of the virus becoming widespread, there is also a danger of viral reassortment within the human population if it goes wide. Will the Secretary of State give his view on whether it is wise to put out public statements such as that one?

Alan Johnson (Secretary of State, Department of Health; Kingston upon Hull West & Hessle, Labour): I am glad that the hon. Gentleman raised that matter; I did see it. I will give not my view, but that of the experts, including the chief medical officer-it is that such advice is totally irresponsible. We do not yet know enough about this virus; it is novel and we do not know its characteristics or how it mutates. It would be utter madness to tell people that their best bet is to get this virus and build up some immunity. Immunity from what? If it mutates, that will be an immunity from a previous phase. I have discussed this idea-it seems to be a piece of cracker-barrel philosophy that is going around-with all the clinicians and they say, without any hesitation, that it is totally irresponsible. I am glad that the hon. Gentleman has given me an opportunity to put that on the record.

• . . Roger Williams (Brecon & Radnorshire, Liberal Democrat): It appears that this particular virus at this particular time is producing relatively mild symptoms, but the Secretary of State is right to say that it could easily mutate. What we do not know is where and when it might mutate. I am sure that the WHO has a worldwide observatory for the influenza virus and that it takes samples continuously to try to identify any new variety that might emerge. In less developed countries, however, it probably does not have facilities for taking the samples, getting them to the laboratory and carrying out the tests. Will the UK put more resources into that vital work, because identifying any new mutation and getting a vaccine ready for it will be absolutely essential to containing what could become a much more serious disease?

Alan Johnson (Secretary of State, Department of Health; Kingston upon Hull West & Hessle, Labour): Yes, the WHO has the necessary focus on this. One of the first statements made by Margaret Chan was that the WHO's major role was ensuring that once the vaccine was produced, we could get it to countries that do not have the resources that we have. That will be an important element of what happens. On the general point about the vaccine, both in this country and in America, GlaxoSmithKline and Baxter are working very hard. They have already identified a strain here, and we are well on the way to getting the vaccine, but as the hon. Gentleman and all Members know, getting it through the manufacturing stage and getting it delivered involves months rather than weeks. The vaccine will not come quickly, but when it becomes available, the WHO has plans in place to ensure that it is distributed around the world. There is nothing worse for developed countries than to resolve this pandemic among themselves, only to find that it is still prevalent elsewhere-and therefore still an international threat.

Related Links

• • Full Debate in Parliament