Swine Flu Update

Business of the House – in the House of Commons am 12:23 pm ar 2 Gorffennaf 2009.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Andy Burnham Andy Burnham The Secretary of State for Health 12:23, 2 Gorffennaf 2009

With permission, Mr. Speaker, I should like to make a statement on the AH1N1 swine flu pandemic.

As of today, there are 7,447 laboratory confirmed cases of swine flu in the UK. A significant number of people have been hospitalised. Three people, all of whom had underlying health problems, have, sadly, died. Since the first UK case was confirmed on 27 April, health protection officers, NHS staff from across the UK and Department of Health officials have been leading the fight to contain the virus.

Last week we started to see a considerable rise in swine flu cases, and the emergence of hot spots in London, the west midlands and Scotland. Since then cases have continued to rise significantly. There are now, on average, several hundred new cases every day. This creates challenges on the ground and pressure on services, but the response from the health community has been tremendous. I hope that the House will join me in putting on record again our sincere thanks to staff in the Health Protection Agency and the NHS, and to general practitioners and all those who work in primary care.

Our efforts during the containment phase have given us precious time to learn more about the virus, to build up antiviral and antibiotic stockpiles and to start to develop a vaccine. We have always known it would be impossible to contain the virus indefinitely, and that at some point we would need to move away from containment to treating the increasing numbers falling ill. That is why last week I announced the move to outbreak management. That gave hot spots, where there is sustained community-based transmission, more flexibility to deal with the virus.

Scientists now expect to see rapid rises in the number of cases. Cases are doubling every week, and on this trend we could see more than 100,000 cases per day by the end of August—although I stress that that is only a projection. As cases continue to rise, we have reached the next step in our management of the disease. Our national focus should be on treating the increasing numbers affected by swine flu. Based on experts' recommendations and with the agreement of Health Ministers across all four Administrations, I can today tell the House that we will move to this treatment phase across the UK with immediate effect.

That will mean that in England the Health Protection Agency will take a step back and primary care will take the lead in diagnosing and distributing antivirals. There will be an immediate end to contact tracing and prophylaxis in all regions, GPs will now provide clinical diagnosis of swine flu cases rather than awaiting laboratory test results, and primary care trusts will now begin to establish antiviral collection points where necessary. The new approach will also mean a move from the daily reported figures of laboratory confirmed cases from the Health Protection Agency to more general estimates of spread.

Our policy on schools is that they should not close because of individual cases of swine flu but that they could close if the particular local circumstances warranted it. For example, there might be grounds for closure if a significant number of pupils or teachers are ill, or if it is a special school with particularly vulnerable pupils. The HPA will advise on outbreak control issues as usual, and closures will be reported to the Department for Children, Schools and Families.

I must report to the House that the Civil Contingencies Committee has had lengthy discussions, drawing on expert scientific advice, about who should be treated with antivirals if they contract swine flu. Health Ministers across all four Administrations have noted clear scientific advice that the majority of cases in the UK so far have not been severe, with those catching the virus making a full and fast recovery. However, a minority of people here and overseas have had more serious illness and some have died.

As we move into the treatment phase, Ministers have considered whether we should continue to offer antivirals to all patients displaying symptoms or whether a more targeted approach should be adopted, focusing on those most at risk of becoming more seriously ill. When very little was known about the disease—especially given the reported fatalities in Mexico—using antivirals prophylactically was sensible to protect people, and may have helped to contain the initial spread of the disease.

During the containment phase, experts have had time to study the virus. Some experts now suggest that since the virus has proved largely mild, antivirals should be used only to treat those in designated higher-risk groups—that is, those who are more susceptible to developing serious illness or complications. Those are all the groups at risk from seasonal influenza, plus pregnant women and children under five. The experts argue that overusing the drugs can increase the chances of antiviral resistance and expose too many people to the risk of side effects from the medicine.

The scientific advisory group for emergencies—SAGE—says that, on balance, the science points towards a targeted approach, but it acknowledges that this is a "finely balanced" decision. Expert advice points to the fact that, as this is a new virus, its behaviour cannot be predicted with certainty. Swine flu is different from seasonal flu in that most serious illnesses have been in younger age groups, as happened in all three 20th-century influenza pandemics. A doctor faced with symptomatic patients cannot yet predict with certainty the course of their illness and whether or not they will be in the small proportion who may become more seriously ill.

Given that, we have decided to take a step-by-step approach. That means that, as in the outbreak-management phase, we will continue to offer antivirals to all those who have contracted the illness. However, it remains a matter of clinical discretion to decide whether antivirals should be prescribed in individual cases, particularly in circumstances where doctors are likely to be contacted by patients with coughs and colds and by the worried well, in addition to those with swine flu. Expert advice emphasises the high importance of treatment with antivirals of those in the higher risk groups. We will therefore issue clear guidance to doctors to ensure that those at higher risk get early priority access to antivirals.

I acknowledge that this is a cautious approach. Many people will be able to recover from swine flu without the need for antivirals and they may therefore choose not to seek treatment. However, we are much closer to the time when we will receive the first doses of the pandemic flu vaccine that will potentially offer high protection. In the meantime, it is prudent to use our only current measure against the virus— antivirals—to the maximum effect. The science indicates that, as we discover more about the virus and develop a more precise categorisation of risk groups, we are likely to reassess our approach and move to a more targeted use of antivirals. We will keep the matter under review, with advice from SAGE, and will update the House as and when necessary.

Today, we will set out the new arrangements in a short guide which will be e-mailed to NHS staff and made available online for the public. I know that local GP surgeries and hospitals, particularly in hot-spot areas, are coming under increased pressure. It is important that we do everything we can to reduce the strain on local health services, so we will begin to establish and use alternative routes for people to receive treatment. Initially, that will be via www.nhs.uk or the swine flu information line. Subsequently, it will be via the national pandemic flu service.

So, if people think they have swine flu, they should first go online and check their symptoms on www.nhs.uk or call the swine flu information line on 0800 151 3513. If they are still concerned, they should then call their GP, who can provide a diagnosis over the phone. If swine flu is confirmed, they will be given an authorisation voucher that someone who can act as a flu friend can take to an antiviral collection point to pick up antivirals. The collection point may be a pharmacy or a community centre.

As cases increase still further, we will move to a system whereby cases are diagnosed and dealt with by the national pandemic flu service. That will take the pressure off GPs by allowing people to be diagnosed and given their antiviral vouchers either online or via a central call centre. I can tell the House today that preparations are now at an advanced stage, and that we expect the service to be ready when it is needed. At that point, if people have swine flu symptoms they should go on to the national pandemic flu service website, or ring the dedicated call centre.

Finally, I should like to update the House on vaccines. We have now signed contracts to secure enough vaccine for the whole population. We expect the first batches of vaccines to arrive in August, with around 60 million doses—enough to vaccinate 30 million people—available by the end of the year and more following that. Administering vaccines will need to be prioritised, and we will make a decision on that when we know more about the risk profile.

Most cases of swine flu have not been severe and we are in a strong position to deal with this pandemic. However, we must not become complacent and, while doubt remains about the way that the virus attacks different groups, today's decision on the move to the treatment phase reflects our caution. I commend this statement to the House.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am sure that the House is grateful to the Secretary of State for the further update. I am grateful to him for the regular opportunities that he has allowed to discuss the matter, and I dare say that that view is shared by the Liberal Democrats.

I want to join the Secretary of State and the rest of the House in extending our condolences to the families of those who have died. I should also like to express again our gratitude to NHS staff in the pathology laboratories and primary care, as they are under increasing pressure, especially where there are a lot of cases. I am also grateful to general practitioners: sometimes in the past they have felt that Health Ministers have engaged in too much GP-bashing, but we now appreciate how much we need them. Given that we are in the middle of a heat wave, primary care is coming under considerable pressure.

The Secretary of State will know that we supported the strategy of containment. It has had some success but it is no longer realistic to try to sustain that strategy across the country and we therefore support the move to a treatment strategy. However, given that the disease is less severe than we anticipated—it could have been a great deal worse—it is important that we do not engage in the wide-scale prophylactic use of antiviral drugs.

The Secretary of State knows that we agree with the proposal that treatment should be offered to all patients, and not just to those in the at-risk groups. About a quarter of fatalities associated with swine flu in the United States were among patients who were not at risk and did not have underlying conditions. Given the availability of antivirals in this country, and the potential to make them available to symptomatic patients, there is no reason why patients who need them and who might go on to have severe or even fatal complications should not be offered them.

We agree with the Secretary of State that there should be a presumption against automatic school closures: even so, risk assessments clearly should be made. They should cover classes and year groups but, as we go into the autumn, they should also take account of the pressure on the local health economy. If that pressure becomes very great, there might be a case for trying to prevent the rapid spread of the virus through schools, but that may require some future modelling.

Some of what should be in place according to the contingency plans for the pandemic phase is not ready. The Secretary of State has replied to a letter that I sent on 15 June, and I am grateful for that, but his response does not answer some central questions. He seemed to say that there was no national pandemic flu line because the antiviral distribution arrangements were not in place, but he went on to say that the antiviral distribution arrangements were not in place because the national pandemic flu line was not ready. I am afraid that that is not good enough: both were supposed to be ready by the time that the pandemic phase occurred, and they are not ready. I ask the right hon. Gentleman again: why is the national pandemic flu line not available now, when the Department said that it would be? He says that it will be ready when it is needed but, technically and according to the contingency plan, it is needed now.

Moreover, the primary care trusts are supposed to have antiviral collection points for the whole population available within seven days of a move to a treatment strategy. Can the Secretary of State therefore confirm that antiviral collection points will be available a week from today?

The Secretary of State's predecessor wrote to me at the end of April to say that the Department was

"working urgently to accelerate the procurement process" in relation to the acquisition of a national stockpile of antibiotics. Where there are difficulties and complications, especially with infection, treatment often requires antibiotics rather than antivirals. Will the Secretary of State say when that antibiotic stockpile will be required? How large is it? The national modelling suggested that we needed enough for 14 per cent. of the population, but what is he aiming for?

Is the face-mask stockpile in place? Can the critical care capacity be increased rapidly? What are the criteria now for the cancellation of elective operations? The Secretary of State has made a projection that there will be 130,000 cases a day, and that would be consistent with up to 2,000 hospitalisations a day by the autumn—a figure that would create very considerable pressure on hospitals.

Vaccination may begin quite soon, in September. Will the Secretary of State therefore publish for debate the Government's proposals for prioritisation for vaccinations?

Finally, we may not have an opportunity to debate this matter in the House over the recess. With that in mind, will the Secretary of State and the House authorities look for a mechanism to allow virtual statements to be made in that period? The right hon. Gentleman could put up a statement with a few hours' notice and hon. Members, on behalf of our constituents, could ask questions and get answers in real time.

Photo of Andy Burnham Andy Burnham The Secretary of State for Health

I thank the hon. Gentleman for the measured tone of his remarks, again, and for all his advice as we go along. I am grateful to him for the helpful discussions that we have had. I am particularly grateful for two points today. I welcome his support for moving to the treatment strategy and the timing of that move. He and I agree that the pressure on the system is such that it is the right time to take this step, and I think that it will be welcomed across the NHS. I also welcome his statement that he agrees with the cautious approach that we have outlined in the statement that antivirals should be offered to all those who display symptoms.

The House will have heard over the years, as we have prepared for this eventuality, how steps were taken by the Department of Health to put us in the strongest possible position to plan and face any outbreak of a flu pandemic, and because of that preparation we can use the stockpile of antivirals to offer that cautious approach. As I said in my statement, as the availability of the vaccine comes on line, pressure on the antiviral stockpile will obviously be relieved. So we think that that approach is prudent, although I say again that the science points us to a more targeted use of antivirals. In discussion with colleagues in the devolved Administrations, I felt that now was not the right time to go, given that SAGE said that the decision was "finely balanced." We need to know more and we need to have more conclusive evidence before taking a move of that kind.

I further welcome what the hon. Gentleman said about the policy on school closures. It is worth pointing out that many schools in Scotland, Wales and Northern Ireland have already broken up for the summer, and that in itself may help us to control the spread of the illness in those countries. The policy has to be judged locally—a decision has to be taken on the ground—and I assure him that, if there are concerns and grounds to close, although it is the job of the Health Protection Agency and others to advise, it is the job of the head teacher and the school governing body to take the final decision about any school closure.

The hon. Gentleman asks about the flu line and the readiness of antiviral collection points around the country. I can confirm that, through strategic health authorities that have been working with PCTs, we have now in place sufficient collection points that can be stood up within seven days. So I can give him the assurance that he sought. Obviously, we can also activate the interim pandemic flu service within a short time frame. That point has not yet been reached, but I can assure him that we will update the House on that issue over the coming days.

The hon. Gentleman asks about access to antibiotics and the size of the antibiotic stockpile. We are on track to have sufficient antibiotic stocks to cover 31 per cent. of the UK population, which equates to 19.6 million courses, by the end of September, with the stockpile having reached over 10 per cent. of the population—6.2 million courses—by mid-June. He has challenged on that point a number of times; he is absolutely right to do so. I will continue to update him on it. Of course, antibiotics may be needed to treat some of the most common complications of flu, including bacterial infections of the respiratory tract and lungs. It is important that anyone who thinks that they are in danger of developing such complications should get in touch with their GP.

I want to make a couple of final points. The hon. Gentleman asks me whether we can debate prioritisation. I will have to reflect on whether a debate in the House is the right thing to do. At all times, we should be led by the guidance from SAGE and the experts. I can assure him that we will bring our conclusions to the House. Indeed, if there is a measure of debate about them, I do not think that that would be a bad thing, but I do not want to give a commitment to hold a debate on the Floor of the House, when we are obviously dealing with a fast-moving situation.

Lastly, as was raised during Prime Minister's questions yesterday, there needs to be a mechanism so that we can continue to update both Front-Bench teams and hon. Members on both sides of the House over the summer. Perhaps we need to find a way—perhaps through the Speaker's Office, or some other mechanism—whereby we can get virtual statements, as he referred to them, to any hon. Member who wants one.

Photo of Sandra Gidley Sandra Gidley Shadow Health Minister

I start by offering apologies from my hon. Friend Norman Lamb, who is unable to be here today. He asked me to thank the Secretary of State and his predecessor for keeping him fully informed throughout the progress of the flu pandemic. I should like to add my thanks for the advance notice of today's statement.

I, too, should like to thank the NHS staff who have been dealing with the illness and all those at the Department of Health who have been providing support to others behind the scenes and burning the midnight oil—they do not get praise very often. We, too, welcome the cautious approach that the Secretary of State is taking to these matters. It is a difficult decision—a finely balanced one—but we support him in the conclusion that Ministers have reached.

I have a short list of questions, which are designed both to be constructive and to elicit more information. First, at the moment, all who have contracted the illness will be offered medication, but that could change to its provision to at-risk groups only. The Secretary of State did not mention the position of NHS staff. It seems to me that particularly front-line staff in hospitals are a special case, so has any different consideration been given to providing prophylactic measures for those staff and are they being offered any special treatment? What contingency plans are in place if flu affects the availability to work of large numbers of front-line staff?

What assessment has the Secretary of State made of PCTs' preparedness? My hon. Friend the Member for North Norfolk has asked in the past for details of preparedness to be published, and it would be helpful if that was done. My understanding is that some PCTs have made excellent preparations and others less so. What measures are being taken to bring the less proactive PCTs up to speed?

Are sufficient stocks of Tamiflu left to meet predicted demand? Is there any clarity about whether the hot weather has affected the spread of the virus in any way, or has it had the opposite effect?

With regard to information, the Secretary of State mentioned the hotline, but he will probably recall that most households received leaflets earlier in the year at the beginning of the outbreak. I suspect that many householders will have thrown away those leaflets, which provided a useful range of information. So are there any plans to re-leaflet or to run a wider media campaign, so that people can be informed about the outbreak? Will the e-mail to NHS staff include pharmacies that are contracted to the NHS?

I have a couple of questions about collection points. Has any special consideration been given to the more rural areas, which very often rely on dispensing GPs? I suggest that it is probably not the best idea to have even flu friends or other possible contacts descending on dispending doctors' surgeries. So has any thought been given to such access in rural areas?

There has been some publicity in the media about something called a flu party. It strikes me as particularly bizarre that parents want to try to improve their children's chances of contracting flu. Has the Secretary of State had any advice on whether that is a good or a bad thing? It seems to me instinctively that it is a bad thing, but there has been much in the media about it.

Finally, I welcome—

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

Order. The hon. Lady has exceeded her ration.

Photo of Andy Burnham Andy Burnham The Secretary of State for Health

I thank the hon. Lady for making her remarks in a measured and helpful way, as Mr. Lansley did; I am very grateful for that. She was right to praise, as the hon. Gentleman did, those members of NHS staff who are sometimes unsung; they are not the ones on the front line whom we always think of and talk about. The hon. Gentleman mentioned staff in path labs, too. I think that staff in Richmond House will feel a little cheered today to have had their efforts recognised by the Lib Dem Front Bencher. Perhaps they will go about their work today with that extra lift in their heart. It is very nice of the hon. Lady to offer her thanks. Those staff have genuinely been working hard, and have put in a lot of work over a long period. It will be appreciated that that has been recognised by the hon. Lady.

Lots of the questions that the hon. Lady asked deal with the issues to which our minds are now turning—the preparedness of the NHS to deal with the pressure that it will face in the coming weeks, and the logistics of the systems that we are putting in place to make sure that we can provide credible alternative routes, so that people do not have to go straight to their general practitioner. If they did, GPs' other business would, as life went on, become more and more difficult. She is absolutely right to ask about and probe us on those issues. All our efforts are now fully engaged on that task.

I shall try to deal with some of the questions that the hon. Lady raised. On NHS staff, currently the advice is that they are to be offered prophylactic treatment after contact with flu patients. We have proposed that there be special arrangements for staff in the treatment phase. That is being looked at again by Ministers, and I will update the House as and when necessary. The issue will be considered at next week's Cobra meeting. We will, of course, update the House at that point.

The hon. Lady asked about the preparedness of PCTs and asked whether there were variants. That is a question that I have raised; again, it will be raised at the Cobra meeting next week. I said in response to the hon. Member for South Cambridgeshire that all PCTs have been assessed, and their readiness to stand up collection points within seven days has been confirmed, but the hon. Lady is right to say that the quality of preparedness may vary from one place to another. I will respond to her on that point as and when we have more information that we can place in the public domain. However, she should feel reassured that a considerable amount of attention has gone into the matter, and that PCTs in all parts of the country are ready to step up to the challenge that they will face.

I neglected to deal with a point that the hon. Member for South Cambridgeshire raised. The Department of Health has provided surge capacity guidance more generally to the NHS, with advice on a range of measures, including on cancellation of elective surgery being brought into play when local circumstances require it. He asked whether we had issued such guidance; I can confirm that we have. I can provide more details to him, if that would be helpful.

Sandra Gidley mentioned the weather. I am not sure that it is playing a role. However, we are seeing spread during a part of the year when we would not normally expect to see considerable spread. If there is more that we can tell her, we will do so. We believe that now is a good moment to reiterate our communications messages through public-facing, simple and clear documents that can be issued more widely. One of them is perhaps more for people working in local government and other parts of the public sector, but I will take on board what she said about repeating our leaflet and other messaging campaigns. She is right to say that we need to be on top of providing clear and consistent communications at all times.

Pharmacies may have a role as collection points in some parts of the country, where primary care trusts have deemed that to be appropriate. Of course, we will ensure that they are in the communications loop, because the issues may impact on their day-to-day job anyway. On the question about rural areas—

Photo of Andy Burnham Andy Burnham The Secretary of State for Health

I am answering the questions. In response to the point on rural areas, we ensure that representatives from the Local Government Association are invited to all meetings of the Ministerial Committee on Civil Contingencies. Of course, PCTs, particularly in rural areas, will give particular attention to the issues that the hon. Lady raises.

Finally, on swine flu parties, the best thing that I can say is that if anybody receives an invitation to one, they should politely turn it down. The chief medical officer said yesterday:

"It is seriously flawed thinking to allow the virus to spread unabated through 'swine flu parties'."

We hope that that message will be heard loud and clear by anybody who is planning such a party, or plans to attend one.

Photo of Joan Walley Joan Walley Llafur, Stoke-on-Trent North

I welcome my right hon. Friend's careful, considered and co-ordinated approach, but on behalf of laryngectomy patients in my constituency and in north Staffordshire, may I ask him whether he will pay particular regard to their concerns about the need for a special filter, the micron filter, for neck breathers? Will he make inquiries of the National Institute for Health and Clinical Excellence and find out whether, despite the delays so far in getting approval from NICE, that approval can be hurried through the system, so that people who are particularly highly prone to infection can receive some safeguards and support in this difficult time of swine flu?

Photo of Andy Burnham Andy Burnham The Secretary of State for Health

My hon. Friend raises an important question. I have to say to her that I do not have the answer to hand, but I will get an answer for her. Of course, we want to ensure that no vulnerable group is exposed to risk in this period, so I will get back to her on the subject.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Defence)

It is good to hear that a vaccine for H1N1 will be available in the autumn, but of course that is about the time when elderly and vulnerable people would ordinarily expect to be vaccinated for seasonal flu. I assume that the Department of Health's position is that that vaccination should go ahead. It would be useful to have the Minister's confirmation that he will attempt to deconflict advice on H1N1 and seasonal flu, because obviously there is considerable scope for confusion on the subject.

Photo of Andy Burnham Andy Burnham The Secretary of State for Health

I am grateful for the hon. Gentleman's comments. Of course, the measures do not conflict with the seasonal flu vaccination programme. If we need to improve guidance on the subject, then of course we will do so. As I indicated, there is a decision to be taken about the time scale and the prioritisation of how vaccine is made available once it is received. Stocks will begin to arrive in August. They will build up in September and October, but obviously we will not be able to treat everybody until later in the year. However, that has to be carefully planned alongside the seasonal flu vaccination programme. We will ensure that once decisions are taken, clear guidance is given to general practitioners in that regard.

Photo of Richard Burden Richard Burden Chair, West Midlands Regional Select Committee, Chair, West Midlands Regional Select Committee

My right hon. Friend will know that Birmingham is one of the areas most extensively affected by swine flu. May I endorse what he and others have said about expressing thanks to all the NHS staff who have worked so hard over the period? On Monday this week, another south Birmingham MP and I met South Birmingham primary care trust to talk about the situation in south Birmingham. I understand what my right hon. Friend is saying about the evidence perhaps moving us towards greater consideration of more targeted approaches, but I am sure that he is right to adopt the cautious approach. So far, the PCT has a very good record of keeping in touch with MPs daily, with updates and guidance about what is being provided in the area. May I put it to him that it is important that that continues, and is perhaps generalised elsewhere, particularly as we move towards the treatment phase?

Photo of Andy Burnham Andy Burnham The Secretary of State for Health

I thank my hon. Friend for that. It was a visit that I made to Birmingham a fortnight ago that really gave me a clear picture of the pressure on staff on the ground in the west midlands. It was impressive to see how the HPA works with colleagues from across the health service in the west midlands, and with local government. The visit also showed how staff had been tested. I was tremendously impressed by how they had come through that test and provided a very good service to his constituents. Those staff do indeed deserve our praise.

I am pleased that my hon. Friend says that he feels that we have taken the right approach. The science is pointing towards a more targeted approach; we need to be clear about that. It is likely that we will move in that direction at some point, although I do not think that anybody in this House would feel that a finely balanced judgment on the science would, at this stage, allow us to move a couple of steps further than we want to go. We proceed with a step-by-step approach, and I am pleased to hear that he feels that that is the right approach to take.

Information for MPs is very important; Mr. Lansley asked me about availability of information during the summer break. This is incredibly important. I shall take the point back, and see whether, as we move into the treatment phase, PCTs, without being placed under any undue burden, can offer to colleagues throughout the House a simple, regular breakdown of local information that would help inform Members and councillors about the situation on the ground. I shall take back that suggestion, which would help keep the House updated over the summer. At the same time, however, I would not want to place any undue burden on primary care trusts. We will look at that very sensible suggestion and let my hon. Friend know the decision.

Photo of Richard Younger-Ross Richard Younger-Ross Shadow Culture, Media and Sport Minister

I thank the Minister for his comments to my hon. Friend Sandra Gidley on public information. He will be aware that I wrote to him in early June about Kenton in my constituency, which did not receive the initial leaflet. When will those areas that missed out receive such leaflets? I also emphasise the point about public information and encouraging people not to go to work or other public places, but to keep their virus at home, so that they do not spread it to people at risk, in particular, such as the elderly. Will the Minister therefore talk to people such as church representatives? Churches still encourage people to attend every Sunday, but if we take our flu virus and give it to the elderly person sat next to us, we might send some people to meet their maker earlier than we want them to.

Photo of Andy Burnham Andy Burnham The Secretary of State for Health

I shall certainly look into the question of leaflet distribution. There were some complaints from my own constituency, I have to say—before I took this job, obviously. It is also important to point out that the website offers the same advice, and that leaflets are available in public places. That said, it is important that we get as much as information as possible into the home.

The hon. Gentleman spoke about advising people to stay at home, which is incredibly important. That relates to the point about swine flu parties. We do not yet know enough about the condition. We can say that it is mild, although some cases have been more severe, so the advice is to go home and rest, take plenty of fluids, and take paracetamol—the usual things that we all do. That is the advice for people, and if they are symptomatic, they really should not continue with their normal life, because it could add to the spread of the disease. The fact that the hon. Gentleman has raised the point may have allowed a few people watching the Parliament channel to hear it again.

Photo of Barry Gardiner Barry Gardiner Llafur, Brent North

In this phase or in respect of any future recurrence of the pandemic, is there a need to expand the capacity of isolation units, such as that at Northwick Park hospital in my constituency, and will central funding be made available to trusts to upgrade these nationally important resources?

Photo of Andy Burnham Andy Burnham The Secretary of State for Health

My hon. Friend has raised that point with me before, and it is incredibly important. Hospitals are able to provide isolation facilities, but as cases increased, that would become progressively more difficult. These issues are kept under very careful review, and Ian Dalton is the NHS lead on preparedness for pandemic flu. I shall ask that he write to my hon. Friend on this particular issue and give him a full answer on the situation not just around the country but in his constituency.

Photo of Roger Williams Roger Williams Opposition Whip (Commons), Shadow Secretary of State for Wales, Shadow Minister (Environment, Food and Rural Affairs)

I support the Secretary of State's decision to cease the routine prophylactic use of antivirals for the contacts of people who have the disease. I heard what he said to my hon. Friend Sandra Gidley about keeping prophylactic use in hospitals and other health services under consideration, but I hope that he will not rule out prophylactic use for vulnerable individuals or groups of individuals whose health is compromised in some way and may be more severely affected by the disease than the average person.

Photo of Andy Burnham Andy Burnham The Secretary of State for Health

That is an important point, and of course we would not rule out such a possibility. However, the judgment should be made locally. Where particularly vulnerable people are close to somebody who has come down with the illness, we want it to be clinicians and GPs who take those issues into account, when dealing with the patient.

Photo of Howard Stoate Howard Stoate Llafur, Dartford

May I join my right hon. Friend in recognising the almost unique ability of British primary care to deal with such an outbreak, and thank him for his kind words on all the hard work that staff do? Of course, that includes GPs, practice nurses, pharmacists and any other support staff.

There is a problem, however, as primary care could become overwhelmed if the pandemic takes off as predicted. Will my right hon. Friend ensure that the public are informed through a regular information campaign, operating daily, to let them know precisely what they should do in certain circumstances? Many people do not have access to the internet and many do not read newspapers, but they need to be kept well informed almost daily about the changing situation and how they ought to respond should they be struck down with an illness.

Photo of Andy Burnham Andy Burnham The Secretary of State for Health

The House has been debating second jobs this week, and my hon. Friend's second job is particularly useful in this regard. He is not only representing his constituents here on swine flu, but treating them, and my praise of GPs of course extends to him.

We are very conscious of the ability of primary care to cope, and although the national pandemic flu service is new, we think it is important to send out the message today and consistently about why it is important for people, where they can, to use that alternative route to secure treatment. There will continue to be patients who will wish to go to their GP, and that is right and proper; I am sure that my hon. Friend agrees and does not want any heavy-handed interference. We want to encourage the vast majority of people, however—particularly those to whom the hon. Member for South Cambridgeshire referred, such as young people who want to get on with life—to use the new access routes that we are creating. I agree that because the routes are new, it is important that they are communicated clearly and regularly, so that people are not in any doubt. Regular public information will be important as we enter a phase in which the numbers of cases rise. As I said to my hon. Friend Richard Burden, I would not want us to place undue burdens on the service in asking it to churn or crank out statistics when it should be doing other things, but public information is very important in such a situation. I take very seriously what my hon. Friend Dr. Stoate said, and I shall see what is the appropriate level of information to put out regularly.