13 May 2009
Mike Penning winds up a wide-ranging debate on 'swine flu' and calls for clear leadership and easy access to information should the situation develop. He also highlights the importance of better out-of-hours GP services which can currently be confusing.
Mike Penning (Hemel Hempstead) (Con): Looking at the clock, it seems that the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo), and I have about an hour each in which to speak, but with the permission of the House, I will not go over much of what has already been discussed this afternoon. It has been an excellent debate, and I hope in good faith that the Minister will understand that there are questions that need to be asked on various issues, with regard to the situation both in the UK and abroad. Bearing that in mind, I hope that she accepts that the questions are asked in good faith. Front Benchers on both sides of the House have worked closely together. I know that the shadow Secretary of State, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who is sitting beside me, is grateful for the briefings that the Secretary of State has given the Front Benchers throughout the past four weeks.
It is only four weeks since we first knew of the state of swine flu—I will call it that for the moment, but I will come on to the point made by my hon. Friend the Member for Leominster (Bill Wiggin) shortly. The debate’s title is “Swine Flu”, but I agree that it should not be, and there are reasons why it should not. Sadly, in the past four weeks, there have been difficult articles in the press across the country that have, at times, genuinely frightened people. I pay tribute to the Evening Standard, which realised that it had got things wrong; the Secretary of State mentioned the matter earlier. It advertised extensively to address the mistakes that it had made. I know that the Evening Standard is a large newspaper, but I wish that some of the national newspapers would address the fact that they got some of the coverage wrong. There was a degree of scaremongering.
Some of the so-called experts on the periphery of the debate have also not helped in keeping the public not only correctly aware of what is going on, but factually aware, as has been shown by some of the polling over the last few days. About 50 per cent. of the public think that the reaction of Her Majesty’s Government and the NHS has been correct and proportionate, and about 50 per cent. think that there has been an overreaction. As the leaflets drop through the letterboxes and the advertising campaigns on the websites and in the national media continue, the public will be more aware of the difficult situation that we are in, particularly in Britain where our responsibilities lie, but also elsewhere. It may be necessary to move to stage 6, the pandemic situation, and if we do, the pandemic flu plan structure will be the bedrock from which we go forward.
Much of what has been proposed cannot be rigidly adhered to within the planning structure. For example, according to the pandemic flu planning documents, in the event of an outbreak in a school, that school would expect to be closed for three weeks. Most schools have decided to close for a week and assess the situation as it develops, and that is a sensible way to proceed. What we do not want is headmasters deciding to shut a school for three weeks when the situation is fine within 10 days.
We have had an excellent debate, and many new points have been made, which shows that we are all on a steep learning curve as to the effect that this will have on our communities, whether we are on the Opposition Front Bench, in the Minister’s Department, or on the Back Benches. The hon. Member for Hayes and Harlington (John McDonnell) has apologised to the House for leaving to chair a Committee, but he raised some important points on behalf of his constituents. Heathrow is smack-bang in the middle of his constituency, and he was very concerned about training not just for cabin crew—a point also raised by the Liberal Democrats—but for staff within the airport infrastructure, so that they know how they can help. [ Interruption. ] I welcome the hon. Gentleman back to the Chamber.
The hon. Member for North Norfolk (Norman Lamb) made some important points. Will the Minister tell us either when she replies or later in writing how the negotiations were taken up early on and why the national flu line is completely separate from NHS Direct and NHS Choices, the online information service. That may be because the NHS deals with about 6 million calls a year and we expect the national flu line at full on-stream capacity to be dealing with about 2 million a day. Such IT and telecommunications infrastructure will require a robustness and resilience that this country has never experienced before. I listened intently when the Secretary of State told us that we were piloting and testing, but there is no way that that infrastructure could be tested to that capacity, unless it went through a similar telecommunications system. Why has NHS Direct been asked to pick up the situation now—it is doing a good job, but it is struggling—yet it was excluded from the contract for the NHS emergency flu line?
The hon. Gentleman also dealt with the assessment of people who think that they may have swine flu. Why are we not using our skilled pharmacists to asses whether patients have swine flu before giving them the drugs required. I know that my hon. Friend the shadow Secretary of State has taken that up with the Secretary of State. Those pharmacists are the biggest point of contact in our constituencies for medication and the plan is to distribute the drugs through them. For years, we have quite rightly been increasingly using the expertise of pharmacists to diagnose, take blood pressure, undertake blood tests and lots of other things, so it would seem to be logical to use them for diagnosis. Will the Minister respond to that point?
I have been slightly confused in the past couple of days as to who is in charge of handling the pandemic situation. The people in charge of producing the November 2007 document were Professor Lindsey Davies and Mr. Bruce Mann. The former is the national director of pandemic influenza preparedness in the Department of Health, but last week, the chief executive of the NHS—completely out of the blue, because there is nothing within the document to indicate his involvement—indicated that he had appointed a national flu resilience director, Mr. Ian Dalton. Will the Minister indicate what the roles of those two people are? Has Professor Davies’s role changed, and what role has Mr. Ian Dalton taken up? Who is in charge and to whom do they report? There seems to have been an important change in the protocols.
My hon. Friend the Member for Poole (Mr. Syms) raised many important issues, but hand washing is very important. We are conscious of the capacity of the influenza to spread. If we get to the pandemic stage, facilities for hand washing are absolutely imperative, especially where there are large congregations of the public, such as railway stations and airports. Hand-washing facilities therefore must be open to the public free at the point of use, which can happen at the flick of a switch. I am sure that the odd 20p that is lost to the people who operate those facilities is tiny in proportion to what we could lose.
Another important question raised by my hon. Friends the Members for Poole and for Reading, East (Mr. Wilson) is what we do about closed institutions such as prisons, secure hospitals and, especially, barracks. We know from experience that such influenza viruses move very fast through closed institutions and we have heard absolutely nothing, as far as I am aware, about what we are planning to do—that is not a criticism, but a genuine question. What are we planning to do about closed institutions? The Mount prison, which is on the edge of my constituency, has 640 inmates and most of the people who work there live in my constituency. If we go to a pandemic situation, we must have a strategic plan for those people. We have learned from experience, particularly of 1919, that flu flies through military barracks once inside.
The Secretary of State said quite a lot about the purchase of face masks—specialist face masks that can restrict the virus getting through rather than the sorts of things we saw on the streets of Mexico City. I have tried to find out from different organisations, especially in the NHS supply chain, about gloves. Within the pandemic flu protocols, disposable gloves are crucial in containing influenza, yet we do not seem to know how many have been purchased or how many are out there. It would be useful to know exactly what is happening.
The other question asked by my hon. Friend the Member for Poole is this: what happens if and when we move to the next level? Page 55 of the flu pandemic document shows that we should go to a gold command structure. The structure is quite complicated, but it is understandable. The civil contingencies committee is at the head of the structure, but who chairs that committee? I have experienced gold command in my constituency. The police tend to chair gold commands, but who will chair that committee?
Mr. Syms: I have not ploughed through the booklet, although I presume that my hon. Friend, as a health spokesman, has done so. I just think it would be useful if we had some information in our offices, particularly relating to our own area, so that we or our local authorities have the right phone numbers and know what the chain of command is.
Mike Penning: My hon. Friend is absolutely right to raise that important point. Smack-bang in the model set out in the document is the local resilience forum and strategic co-ordination group. I do not expect everyone to read the document, but it does explain the arrangements. The next step in preparing for the next stage—stage 6—is ensuring that we in our constituency offices and, more important, our communities as a whole have the information needed on what to do next; it should not be left to gossip. We will be able to work with our constituents, local councillors and others to make that sort of information is available. In addition, local authority call centres need to know whom they should pass calls on to.
I fully understand the point my hon. Friend the Member for Leominster made about pigs. We should stand up in this place and the Minister should say from the Dispatch Box that there is no danger from eating pork: as long as it is cooked correctly, pork makes wonderful eating. I agree with my hon. Friend when he says surely this strain of flu could have been given another name. In fact, it has—we do not need to call it swine flu. The World Health Organisation calls it influenza H1N1—that is the official title. It should not be called Mexican flu, either. As I was told a few minutes ago, the so-called Spanish flu of 1919 appeared in America. I think that people can understand its official title—it is in the papers often enough—and we should wean ourselves off calling it swine flu, because that has had a detrimental effect on pork sales here and in other countries. I know that we have no influence on decisions by other countries, such as Egypt, to slaughter their pigs, but, to be frank, what a waste that is of good stock.
My hon. Friend the Member for Reading, East talked about the quality of out-of-hours GP services. That topic was raised at Health questions this week and it is regularly discussed by Back Benchers and Front Benchers. The truth is that our GPs are the best people to commission the out-of-hours care that our constituents deserve, because they have the empathy, understanding and knowledge needed. In fact, the situation is a complete mess, with a postcode lottery for out-of-hours services. At a time of crisis, the last thing we need is confusion in such services.
My final point is on third world or less economically developed countries. It is possible that some such countries will suffer a pandemic outbreak and we will not. It is imperative that, with our European friends and the WHO, we have in place a structure or plan whereby we do not stockpile a vaccine here when we have not and are not likely to move to stage 6, and leave other countries to suffer because they cannot obtain supplies. Although I fully understand that we have a sleeping contract and will, we hope, get the vaccine within the next few months, if other countries, particularly third-world countries, suffer a pandemic and we do not, we will have to examine our conscience and decide how to help those countries in their hour of need.
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Mike Penning (Hemel Hempstead) (Con): Looking at the clock, it seems that the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo), and I have about an hour each in which to speak, but with the permission of the House, I will not go over much of what has already been discussed this afternoon. It has been an excellent debate, and I hope in good faith that the Minister will understand that there are questions that need to be asked on various issues, with regard to the situation both in the UK and abroad. Bearing that in mind, I hope that she accepts that the questions are asked in good faith. Front Benchers on both sides of the House have worked closely together. I know that the shadow Secretary of State, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who is sitting beside me, is grateful for the briefings that the Secretary of State has given the Front Benchers throughout the past four weeks.
It is only four weeks since we first knew of the state of swine flu—I will call it that for the moment, but I will come on to the point made by my hon. Friend the Member for Leominster (Bill Wiggin) shortly. The debate’s title is “Swine Flu”, but I agree that it should not be, and there are reasons why it should not. Sadly, in the past four weeks, there have been difficult articles in the press across the country that have, at times, genuinely frightened people. I pay tribute to the Evening Standard, which realised that it had got things wrong; the Secretary of State mentioned the matter earlier. It advertised extensively to address the mistakes that it had made. I know that the Evening Standard is a large newspaper, but I wish that some of the national newspapers would address the fact that they got some of the coverage wrong. There was a degree of scaremongering.
Some of the so-called experts on the periphery of the debate have also not helped in keeping the public not only correctly aware of what is going on, but factually aware, as has been shown by some of the polling over the last few days. About 50 per cent. of the public think that the reaction of Her Majesty’s Government and the NHS has been correct and proportionate, and about 50 per cent. think that there has been an overreaction. As the leaflets drop through the letterboxes and the advertising campaigns on the websites and in the national media continue, the public will be more aware of the difficult situation that we are in, particularly in Britain where our responsibilities lie, but also elsewhere. It may be necessary to move to stage 6, the pandemic situation, and if we do, the pandemic flu plan structure will be the bedrock from which we go forward.
Much of what has been proposed cannot be rigidly adhered to within the planning structure. For example, according to the pandemic flu planning documents, in the event of an outbreak in a school, that school would expect to be closed for three weeks. Most schools have decided to close for a week and assess the situation as it develops, and that is a sensible way to proceed. What we do not want is headmasters deciding to shut a school for three weeks when the situation is fine within 10 days.
We have had an excellent debate, and many new points have been made, which shows that we are all on a steep learning curve as to the effect that this will have on our communities, whether we are on the Opposition Front Bench, in the Minister’s Department, or on the Back Benches. The hon. Member for Hayes and Harlington (John McDonnell) has apologised to the House for leaving to chair a Committee, but he raised some important points on behalf of his constituents. Heathrow is smack-bang in the middle of his constituency, and he was very concerned about training not just for cabin crew—a point also raised by the Liberal Democrats—but for staff within the airport infrastructure, so that they know how they can help. [ Interruption. ] I welcome the hon. Gentleman back to the Chamber.
The hon. Member for North Norfolk (Norman Lamb) made some important points. Will the Minister tell us either when she replies or later in writing how the negotiations were taken up early on and why the national flu line is completely separate from NHS Direct and NHS Choices, the online information service. That may be because the NHS deals with about 6 million calls a year and we expect the national flu line at full on-stream capacity to be dealing with about 2 million a day. Such IT and telecommunications infrastructure will require a robustness and resilience that this country has never experienced before. I listened intently when the Secretary of State told us that we were piloting and testing, but there is no way that that infrastructure could be tested to that capacity, unless it went through a similar telecommunications system. Why has NHS Direct been asked to pick up the situation now—it is doing a good job, but it is struggling—yet it was excluded from the contract for the NHS emergency flu line?
The hon. Gentleman also dealt with the assessment of people who think that they may have swine flu. Why are we not using our skilled pharmacists to asses whether patients have swine flu before giving them the drugs required. I know that my hon. Friend the shadow Secretary of State has taken that up with the Secretary of State. Those pharmacists are the biggest point of contact in our constituencies for medication and the plan is to distribute the drugs through them. For years, we have quite rightly been increasingly using the expertise of pharmacists to diagnose, take blood pressure, undertake blood tests and lots of other things, so it would seem to be logical to use them for diagnosis. Will the Minister respond to that point?
I have been slightly confused in the past couple of days as to who is in charge of handling the pandemic situation. The people in charge of producing the November 2007 document were Professor Lindsey Davies and Mr. Bruce Mann. The former is the national director of pandemic influenza preparedness in the Department of Health, but last week, the chief executive of the NHS—completely out of the blue, because there is nothing within the document to indicate his involvement—indicated that he had appointed a national flu resilience director, Mr. Ian Dalton. Will the Minister indicate what the roles of those two people are? Has Professor Davies’s role changed, and what role has Mr. Ian Dalton taken up? Who is in charge and to whom do they report? There seems to have been an important change in the protocols.
My hon. Friend the Member for Poole (Mr. Syms) raised many important issues, but hand washing is very important. We are conscious of the capacity of the influenza to spread. If we get to the pandemic stage, facilities for hand washing are absolutely imperative, especially where there are large congregations of the public, such as railway stations and airports. Hand-washing facilities therefore must be open to the public free at the point of use, which can happen at the flick of a switch. I am sure that the odd 20p that is lost to the people who operate those facilities is tiny in proportion to what we could lose.
Another important question raised by my hon. Friends the Members for Poole and for Reading, East (Mr. Wilson) is what we do about closed institutions such as prisons, secure hospitals and, especially, barracks. We know from experience that such influenza viruses move very fast through closed institutions and we have heard absolutely nothing, as far as I am aware, about what we are planning to do—that is not a criticism, but a genuine question. What are we planning to do about closed institutions? The Mount prison, which is on the edge of my constituency, has 640 inmates and most of the people who work there live in my constituency. If we go to a pandemic situation, we must have a strategic plan for those people. We have learned from experience, particularly of 1919, that flu flies through military barracks once inside.
The Secretary of State said quite a lot about the purchase of face masks—specialist face masks that can restrict the virus getting through rather than the sorts of things we saw on the streets of Mexico City. I have tried to find out from different organisations, especially in the NHS supply chain, about gloves. Within the pandemic flu protocols, disposable gloves are crucial in containing influenza, yet we do not seem to know how many have been purchased or how many are out there. It would be useful to know exactly what is happening.
The other question asked by my hon. Friend the Member for Poole is this: what happens if and when we move to the next level? Page 55 of the flu pandemic document shows that we should go to a gold command structure. The structure is quite complicated, but it is understandable. The civil contingencies committee is at the head of the structure, but who chairs that committee? I have experienced gold command in my constituency. The police tend to chair gold commands, but who will chair that committee?
Mr. Syms: I have not ploughed through the booklet, although I presume that my hon. Friend, as a health spokesman, has done so. I just think it would be useful if we had some information in our offices, particularly relating to our own area, so that we or our local authorities have the right phone numbers and know what the chain of command is.
Mike Penning: My hon. Friend is absolutely right to raise that important point. Smack-bang in the model set out in the document is the local resilience forum and strategic co-ordination group. I do not expect everyone to read the document, but it does explain the arrangements. The next step in preparing for the next stage—stage 6—is ensuring that we in our constituency offices and, more important, our communities as a whole have the information needed on what to do next; it should not be left to gossip. We will be able to work with our constituents, local councillors and others to make that sort of information is available. In addition, local authority call centres need to know whom they should pass calls on to.
I fully understand the point my hon. Friend the Member for Leominster made about pigs. We should stand up in this place and the Minister should say from the Dispatch Box that there is no danger from eating pork: as long as it is cooked correctly, pork makes wonderful eating. I agree with my hon. Friend when he says surely this strain of flu could have been given another name. In fact, it has—we do not need to call it swine flu. The World Health Organisation calls it influenza H1N1—that is the official title. It should not be called Mexican flu, either. As I was told a few minutes ago, the so-called Spanish flu of 1919 appeared in America. I think that people can understand its official title—it is in the papers often enough—and we should wean ourselves off calling it swine flu, because that has had a detrimental effect on pork sales here and in other countries. I know that we have no influence on decisions by other countries, such as Egypt, to slaughter their pigs, but, to be frank, what a waste that is of good stock.
My hon. Friend the Member for Reading, East talked about the quality of out-of-hours GP services. That topic was raised at Health questions this week and it is regularly discussed by Back Benchers and Front Benchers. The truth is that our GPs are the best people to commission the out-of-hours care that our constituents deserve, because they have the empathy, understanding and knowledge needed. In fact, the situation is a complete mess, with a postcode lottery for out-of-hours services. At a time of crisis, the last thing we need is confusion in such services.
My final point is on third world or less economically developed countries. It is possible that some such countries will suffer a pandemic outbreak and we will not. It is imperative that, with our European friends and the WHO, we have in place a structure or plan whereby we do not stockpile a vaccine here when we have not and are not likely to move to stage 6, and leave other countries to suffer because they cannot obtain supplies. Although I fully understand that we have a sleeping contract and will, we hope, get the vaccine within the next few months, if other countries, particularly third-world countries, suffer a pandemic and we do not, we will have to examine our conscience and decide how to help those countries in their hour of need.
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