UK Ebola Preparedness

Oral Answers to Questions — Home Department – in the House of Commons am 4:26 pm ar 5 Ionawr 2015.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health 4:26, 5 Ionawr 2015

With permission, Mr Speaker, I would like to make a statement about the UK’s Ebola preparedness and the care being given to Pauline Cafferkey, the NHS nurse being treated for Ebola at the Royal Free hospital in London.

I know the whole House will join me in wishing Pauline well and commending her and her NHS colleagues for the exceptional bravery and compassion they showed in joining the battle against Ebola in Sierra Leone. The work done by Pauline and her colleagues is not just helping to save thousands of lives in Africa; it is protecting the UK from potentially disastrous consequences if the disease spreads beyond the countries where it has currently taken hold. Alongside 69 other NHS volunteers from UK-Med, Pauline spent Christmas on the front line of this vital battle. This House and this country owe them and other colleagues from Public Health England, the Department for International Development, the Foreign Office and the Ministry of Defence an enormous debt of gratitude.

You will appreciate, Mr Speaker, that for reasons of patient confidentiality I cannot go into great detail about Pauline’s current medical condition. However, I have this morning spoken to Dr Mike Jacobs, an expert in infectious diseases who is leading the team of doctors and nurses caring for Pauline at the Royal Free. As has been reported, Pauline’s condition has deteriorated to a critical state, although she stabilised yesterday and continues to receive the best possible care. She said in Sierra Leone that she hoped her loved ones would be proud of her. Well, she should know today that the whole country is proud of her for her bravery and dedication to the service of others. She stands, quite simply, for the very best of NHS values.

I wish to turn to the issue of screening and why Pauline continued her journey from Heathrow to Glasgow. Having worked in Sierra Leone for six weeks caring for Ebola patients, she was screened and cleared to depart on her exit from Sierra Leone on Sunday 28 December. She arrived at Heathrow after a connection in Casablanca at 3.50 pm that day, where she was again screened in line with the protocols introduced into major airports and Eurostar terminals last October. As her temperature was within the acceptable range, she was cleared to fly home to Scotland. Clinical experts have always been clear that the process will pick up a few active infections, but it also provides the best opportunity to ensure that returning staff know whom to contact, and this system worked. While still at Heathrow, her reassessment was triggered because of concerns that she may have had an elevated temperature. She was reassessed and her temperature taken a further six times over 30 minutes. As her temperature was within the acceptable range, she was again cleared to travel.

Pauline arrived in Glasgow at around 11.30 pm on Sunday 28 December and was driven home. She became feverish overnight and, in line with the public health advice that she had been given at Heathrow, she contacted local services. She was admitted to an isolation facility at the Brownlee unit in Gartnavel hospital in Glasgow at 8 am on Monday 29 December. A blood sample tested positive for Ebola at the NHS Lothian testing facility that afternoon, so she was transferred overnight to the Royal Free in a military plane, arriving at 8 am on Tuesday 30 December.

Some have asked whether it was appropriate for Pauline to be allowed to travel on to Glasgow after she raised concerns about her health at Heathrow. The clinical advice on this is clear. Someone can contract Ebola only by coming into contact with the bodily fluids of an infected person—that means blood, vomit or diarrhoea—which becomes a risk when a patient is exhibiting feverish symptoms. Because she did not have a high temperature, the clinical judgment was made to allow her to continue her journey home.

However, we recognise that medical understanding of the disease is not complete, which is why we had already taken a number of precautionary steps that go further than strictly required by the clinical evidence. These include asking potential Ebola carriers to avoid crowded places and long journeys on public transport within the 21-day potential incubation period once they arrive back home. Existing guidance also bans any direct patient work for returning health care workers.

On that precautionary basis, we have, as of last Monday, strengthened our guidance to ensure that anyone from a higher risk group who feels unwell will be reassessed. Advice will immediately be sought from an infectious diseases specialist and the passenger will be referred for testing, if appropriate. The screening centres at Heathrow were viewed first hand on 1 January by the chief medical officer and the Minister with responsibility for public health and all arrangements, including the revised protocols, were found to be working well.

We will continue to keep screening and logistical arrangements under review and look to improve or strengthen the process, as guided by expert clinical advice. It is important, however, to remember that the risk to the public of contracting Ebola from contact with someone carrying the virus remains very low indeed while they are not exhibiting any symptoms. The critical point—this is the main purpose of the screening—is to ensure that potential Ebola carriers are identified and know how to ask for medical assistance the moment they display any feverish symptoms, so that they can then be isolated, tested and given full medical support as quickly as possible.

For that reason, on a precautionary basis, Public Health England has been making contact with passengers on the flight that Pauline was on from Casablanca to Heathrow, and has been working with Moroccan colleagues to trace additional UK passengers on the flight from Freetown to Casablanca to make sure that they know what to do if they start exhibiting symptoms consistent with Ebola. I can inform the House that Health Protection Scotland has made contact with all the passengers on the London to Glasgow flight, and Public Health England has made contact with all UK-based passengers who travelled on the flight from Casablanca to London. I would like to thank British Airways and Royal Air Maroc for their assistance in this process.

The safety of our volunteers is our first priority. Before any NHS workers are deployed to treatment centres, staff from UK-Med, which runs the NHS humanitarian register, review the clinical protocols and procedures and confirm that they are content that the centre meets appropriate standards. All UK-Med volunteers receive thorough training in the UK and in Sierra Leone before they treat any Ebola patients so that they know how to use their personal protective equipment and understand the nature of the work. In the current case, as the House would expect, Save the Children is conducting a review into its procedures to ensure that any lessons are learned.

The House will want to be reassured about the overall state of UK preparedness for Ebola. This country was the first in Europe to screen arrivals from high-risk places in west Africa, and numerous countries have since asked for information on how we did this. We have committed more than £230 million to fight the disease in Sierra Leone. We have sent more than 800 military personnel, 150 Department for International Development staff, 70 NHS staff through UK-Med and 64 Public Health England staff to fight the outbreak on the ground—a bigger contribution than any country in the world except for the United States.

The chief medical officer, Professor Dame Sally Davies, has always been clear that we are likely to see up to a handful of cases in this country, of which, very sadly, this is the first to be diagnosed. NHS England has procured personal protective equipment for each of the hazardous area response teams in England and has additionally arranged for 75,000 PPE suits to be procured for the NHS.

We have been practising Ebola resilience since 30 July and have had 16 ministerial Cobra meetings in total, including five chaired by the Prime Minister. Both the chief medical officer and the NHS England medical director, Professor Sir Bruce Keogh, are satisfied that at this stage we have made sufficient preparations. However, they stress that, although the risk to the public remains low, we must remain vigilant and be constantly prepared to adjust and improve our processes and protocols as this rapidly changing situation evolves.

I would like to place on record my thanks to colleagues in the Scottish Government and the UK Government, to the authorities in Sierra Leone and Morocco, to NHS England and to the NHS doctors and nurses at both Gartnavel hospital and the Royal Free for their dedication and hard work over the past few days. I would also like to pay tribute to the dedicated PHE staff who set up the new screening process so rapidly, and thank Border Force staff for their assistance.

Our thoughts are with Pauline Cafferkey today, but I know all of us are also thinking about her friends and colleagues and the many UK NHS and other personnel working in Sierra Leone right now. They can be reassured that we have no greater priority than their safety, and I commend this statement to the House.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health 4:36, 5 Ionawr 2015

Over the break, there have been a number of reports suggesting that the Ebola outbreak is far from under control and we saw, as the Secretary of State has said, the first case diagnosed here in the UK. Concerns are rising and that is why the Secretary of State was right to give his informative update to the House at the very first opportunity.

May I echo the tribute he paid to all the NHS staff, members of the armed forces and aid workers who are showing immense courage in the most difficult of circumstances? In particular, we echo his moving words and good wishes for Pauline Cafferkey. Our thoughts are with her and her family right now, and we know she could not be in better hands than those of the team at the Royal Free.

On the substance of the Secretary of State’s statement, we welcome what he had to say and the action he is taking. As I said the last time he updated the House, we will play a constructive part in helping the Government to minimise the risk to the public. That remains the case and the questions I will put to him—some of which will cover areas he has not mentioned, particularly treatment and vaccine—will be asked in that constructive spirit.

Let me begin with the circumstances surrounding the case. The Secretary of State mentioned the Save the Children review of how Pauline caught the disease. Are the Government part of that review and/or are they carrying out their own, and when will the results be known? He did not mention when it would be published, but that is important as the next group of NHS volunteers will leave for west Africa in the coming weeks. They will want to know whether procedures and guidance for medical staff working out in west Africa will be reviewed in the light of this case.

I would also be grateful if the Secretary of State could tell us whether he is satisfied with current guidance to NHS staff here on handling Ebola patients. He will be aware that the US Centres for Disease Control and Prevention have recently strengthened their infection control guidance, and on the last occasion he updated the House he said he would follow their lead. What revisions, if any, have been made to those protocols following the CDC’s changes?

Let me turn to screening. We know that Pauline travelled to Glasgow via London Heathrow and despite informing screening staff at Heathrow that she felt unwell she was still allowed to fly home. I welcome what the Secretary of State has just said about reviewing procedures for future passengers in a similar position, but there are broader concerns. Martin Deahl, who was part of the same volunteer group as Pauline and sat next to her on the plane home, said:

“The precautions and checks at the airport were shambolic. There seemed to be too few staff and too few rooms or places to put us in. We were crowded into a small reception area where we waited for an hour or more. I had a higher temperature so they wanted to put me in a room by myself—but they could not find one because they were using every inch of space.”

I welcome the Secretary of State’s commitment to keep the arrangements under review, but may I ask him to look into the specific concerns raised by Mr Deahl and to rectify any problems as a matter of urgency, and certainly before the return of the next group of volunteers?

More broadly, is the Secretary of State satisfied that the screening procedure is adequate in terms of the medical checks that are carried out—are more checks needed than just temperature checks—and, indeed, is he satisfied that staff have had sufficient training? Were the Scottish NHS, the Scottish Government and, crucially, Glasgow airport informed that Miss Cafferkey had warned officials that she felt unwell? In the light of this case, should screening checks be expanded to cover more ports? I would be interested in the Secretary of State’s views on those points. I am sure he would agree that maintaining public confidence in the screening procedure is crucial, and I hope he will continue to keep all those questions under review, as he has said he would.

Let me turn to post-arrival monitoring. A number of states in America have introduced it for all travellers returning from an affected country, whereas only those showing symptoms on return are actively monitored here. Given that symptoms of Ebola can emerge up to 21 days after exposure, is there a case for strengthening post-arrival monitoring in line with other countries?

On treatment, we understand that Pauline is receiving an experimental drug, not ZMapp, due to a worldwide shortage. When the Secretary of State last updated the House, I asked him whether plans were in hand to increase supplies of ZMapp, so the latest news is a matter of concern. Are any efforts under way to increase manufacturing capacity for ZMapp and/or any other potential treatments? Of course, what would give most confidence to people in the countries affected and further afield is the development of an effective vaccine. Will he say something about the timetable for that, and about the Government’s role in trying to expedite it?

More broadly, will the Secretary of State give the House his latest view on the adequacy of the international response to Ebola. We hear that the health system in Sierra Leone is in danger of collapse, immunisation programmes have come to a halt and people are not going to the hospitals or clinics because they are frightened of catching Ebola, and that might lead to the spread of other diseases. Over Christmas, William Pooley said:

“This is a global problem and it will take the world to fix it.”

Does the Secretary of State share that sentiment, and what are the Government doing to bring about a better global response than we have seen to date?

In conclusion, it is clear that Ebola will remain a threat for the foreseeable future, and it will not be easy to meet that challenge. We join the Secretary of State in sending our best wishes to Pauline and her family, and we will continue to work with him and the Government to minimise the risk to others.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

May I first thank the right hon. Gentleman for the constructive tone of his comments and the official Opposition’s willingness to work closely with us on this very important issue? Let me cover some of the important points that he made.

The right hon. Gentleman is right that the disease is continuing to progress in those countries. We now have a total of 7,905 reported deaths, and there are 20,206 reported cases, which is likely to be an underestimate. There are some early—I stress, early—signs that the rate at which the disease is reproducing itself is beginning to fall to about the level where it is stabilising. However, those are early signs, and the truth is that we still need to do a huge amount of work to bring the disease under control.

We think that it is absolutely vital to proceed as quickly as possible with the vaccine that the right hon. Gentleman mentioned, and I can tell him that we currently have three vaccines in the first phase of clinical trials. We have made some changes to speed up the process by which they can be used in the field, and DFID has put in £1.34 million to establish a joint research fund with the Wellcome Trust, so we are making progress on that front.

It has been impossible to get supplies of ZMapp—the drug given to the other Ebola patient treated in the UK, Will Pooley—because it is grown using genetically modified tobacco plants, so there is a time constraint. Clinically, we do not yet know whether it was significant in Will Pooley’s recovery. We have tried other experimental treatments on Pauline Cafferkey, including using some of the plasma from Will Pooley, and we hope that will have an effect.

The review by Save the Children is being conducted in conjunction with Public Health England staff in Sierra Leone, and I hope that it will report in the next few days. We are obviously keen for them to report as quickly as possible, but we do not want to put them under pressure not to do a thorough report. I am satisfied with current protective arrangements on the basis of our clinical evidence, but as we saw with the screening arrangements, with a disease such as Ebola we must constantly keep an open mind about the best ways of dealing with things, and we will look carefully at what Save the Children recommends. I am satisfied with the protections in place for NHS workers in the UK on the basis of advice from the chief medical officer, and we will obviously also look at what happened in the US. At the moment we do not believe that the personal protective equipment suits have been breached, but we must keep an open mind and see what other evidence comes forward.

On the screening procedure, our clinical protocols were followed when Pauline Cafferkey arrived, but organisationally I do not think that it was as smooth as it needed to be. There were a lot of people to deal with, and because it was over the Christmas period we probably did not have as many people to do that as we needed, which meant that those coming for screening needed to wait longer than we would have liked. However, on the basis of revised protocols, and to ensure that we do not repeat this situation—nine more volunteers are coming back this Sunday and 60 more the following Sunday—the Under-Secretary of State for Health, my hon. Friend Jane Ellison, and the chief medical officer have been to inspect what is happening, to ensure that we learn the necessary lessons. Other volunteers have said that they think the screening procedure is working smoothly. This was a relatively isolated incident, but we must learn the lessons.

On expanding screening to other airports, I will look into whether Glasgow airport was informed and let the right hon. Gentleman know, but we have obviously learned from this event the importance of close working with the Scottish Government, and that has worked very well.

Finally, the right hon. Gentleman mentioned the active monitoring of people who come back, and I think that we have the best system. We are not only actively monitoring those who have been tested for having contracted the disease, but actively monitoring anyone in the high-risk groups. Of the 2,495 people who have been screened since we set up the process, 54 have been identified as having had direct contact with Ebola patients and as being in the high-risk group, and we have an enhanced monitoring process for them. Everyone else is informed exactly what to do if they develop feverish symptoms, which is what happened with Pauline Cafferkey.

I again thank the right hon. Gentleman for his constructive approach to this issue.

Photo of Sarah Wollaston Sarah Wollaston Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

I join the Secretary of State in paying tribute to Pauline Cafferkey and all NHS volunteers, aid workers, staff at DFID and Public Health England for the work they are doing to keep us safe in the UK by fighting Ebola on the front line in west Africa at great personal risk. I also thank him for updating the House so succinctly on the improvements to the screening protocols, so that everyone will be screened if they have symptoms, not just a temperature. Will he update the House on the vaccines and say whether there has been any progress on the provision of rapid screening for Ebola? Will he reassure us that he will not follow the knee-jerk response that we have heard calls for from some quarters, which is to quarantine all NHS staff, because of the unintended consequences of such an approach?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I thank my hon. Friend for her constructive comments and I agree with what she has said on this issue. Some 678 health care workers have contracted Ebola since the outbreak of the disease, and of those nearly 400 have died, the vast majority African. That shows how incredibly brave front-line workers are, and perhaps the fact that—tragically—we have someone in this country who has contracted Ebola is a good way of reminding ourselves that many hundreds of other people have already been in this situation. They are all incredibly brave. We are proceeding as quickly as we can with the possibility of having a much speedier Ebola test, which would obviously be helpful for the screening process.

I agree with my hon. Friend that we do not want a knee-jerk response on quarantining people who come back. The contribution of NHS volunteers and health care workers from western countries in fighting the disease in Sierra Leone, Guinea and Liberia is critical. Some 1,500 people from the NHS have volunteered, but they volunteer on the basis that we will follow proper clinical protocols, meaning quarantining people when it is clinically necessary to do so, but not doing so when it is not necessary. If we are to keep their confidence, we must be proportionate in our response.

Photo of Tom Greatrex Tom Greatrex Shadow Minister (Energy)

Pauline Cafferkey is a constituent of mine and works at Blantyre health centre in my constituency. I have spoken to a number of those whom she has treated and her colleagues over the past few days. I am sure the House will appreciate that there is a huge amount of support and concern for her locally, but also a huge admiration for her work in Sierra Leone as an NHS volunteer. I am sure that that is shared by communities throughout the UK, with the exception of a small handful of people who should keep their opinions to themselves.

On the Secretary of State’s concerns about the screening process, when an experienced clinician describes a process as shambolic, it is not only about the protocol, but about the practicalities. As well as keeping the matter under review, will he ensure constant monitoring each weekend as people come back to ensure that the practicalities are properly kept in check, to ensure that the situation that seemed to happen last Sunday is not repeated?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I echo the hon. Gentleman’s comments about what a remarkable lady Pauline Cafferkey is. When she was asked why she was going, she said, “Why wouldn’t you go when so much suffering is happening in west Africa?” That is the measure of the woman.

On the screening process, I am satisfied that the right clinical processes were followed, but I am not satisfied that it was as well organised as it should have been. That is why we have revised not just the clinical protocols, but the organisation, to ensure that we have the right capacity in place, and that we do not make people wait for as long as they did when Pauline returned on her flight. It is also important to recognise that the Public Health England staff at Heathrow are working very hard doing a difficult job, and are doing their very best.

Photo of David Heath David Heath Democratiaid Rhyddfrydol, Somerton and Frome

I commend the federal and state authorities in Nigeria for the work they did in containing the Ebola outbreak there last year. In the space of a four-day visit, I had my temperature taken 34 times—whenever one goes into a public building, one has one’s temperature taken. Everyone who visits a Nigerian airport has to fill out a form giving details of where they have been and where they are going, contact details, and details of where they sat on the plane. Is the Secretary of State confident that he has the same level of traceability in this country as the Nigerian authorities have achieved in their country?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Yes, I am. I join the hon. Gentleman in commending the actions of the Nigerian authorities. What has happened in Nigeria in respect of Ebola shows a great deal of hope for what is changing in Africa more generally. There was a perception that all African countries would find it as challenging to deal with Ebola as Sierra Leone, Liberia and Guinea have found it, but it is clear that a generation of African countries have developed substantially and are able to respond in a much more effective way. That is a very encouraging change from what might have been the case 10 or 20 years ago.

Photo of Frank Dobson Frank Dobson Llafur, Holborn and St Pancras

I thank the Secretary of State for his statement. I am in no position whatever to comment on the effectiveness of the screening and suspect that no one else in the Chamber is. On long-term preparedness, it is several decades since Peter Piot, now director of the London School of Hygiene and Tropical Medicine, first identified Ebola. Worldwide, not enough has been done to address the problems. We should not be looking for a vaccine now; it should have been looked for years ago. I hope the Secretary of State gives full support to the rare disease consortium that has been established by the London School of Hygiene and Tropical Medicine, Imperial college and the Royal Veterinary college to look at infectious diseases that are capable of crossing from one species to another, and in particular this species.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The right hon. Gentleman is absolutely right. Peter Piot is a remarkable man who came to Downing street to advise the Prime Minister and me early in the development of the Ebola crisis. He is well worth listening to on this subject.

The right hon. Gentleman also makes a good point in that the global response to Ebola was far from adequate. The World Health Organisation has some important lessons to learn, and tomorrow my right hon. Friend the Secretary of State for International Development and I will meet Margaret Chan, when we will no doubt talk about those lessons. In an era of globalised travel, it is important that we have a much faster and more effective response when we have outbreaks of deadly viruses.

Photo of Sarah Newton Sarah Newton Ceidwadwyr, Truro and Falmouth

Will my right hon. Friend join me in thanking the staff of the Royal Cornwall hospital who treated someone returning from Sierra Leone with great professionalism, caring and compassion? Will he reassure me and those staff that, as well as those arriving back from west Africa by plane or train, those arriving back into our ports by ship are effectively screened?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I am happy to pass on my thanks to the staff of the Royal Cornwall—in fact, I spoke to someone from that hospital this morning and I know that they are very focused on this issue, as are all NHS hospitals. We have introduced information at all ports and, where necessary, screening. My hon. Friend makes an important point—it is never actually possible to put every single person through a screening process. We are one of the most open economies in the world and people constantly come in and out of the UK. We depend on public knowledge, so that people who have been to the affected areas know to present themselves to get immediate assistance if they develop any feverish symptoms.

Photo of Peter Hain Peter Hain Llafur, Castell-nedd

Has the Secretary of State had the chance to consult the British Medical Journal editorial of 13 October, which insisted—more than two months ago—that the Government’s airport screening policy for Ebola was illogical? I spoke to the author yesterday and he argues that we have missed the one case to have been imported while thousands, many at low risk, have been delayed, detained and made to fill in a form just because they have been to west Africa. Experts such as the author insist that what the Government should have been doing is ensuring that all those at risk, especially health workers such as Pauline, know exactly what to do if they start to feel unwell. Might it be sensible to keep health workers away from direct patient contact for 21 days after they return?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Perhaps I can reassure the right hon. Gentleman on that point. Health care workers are kept away from direct patient work for that incubation period, so that protocol has been put in place. The BMJ article to which he refers is based, I think, on the misunderstanding that screening is the same as testing. The reality is that the tests for Ebola show up only when the virus has reached a certain level, at which point the patient will have become feverish and started displaying symptoms. So testing before that point is a waste of time. The purpose of the screening process is to identify those at highest risk so that we can make sure that they are actively monitored when they go home and that they know exactly what to do if they do develop symptoms. That is exactly what happened with Pauline Cafferkey.

Photo of Andrew Bridgen Andrew Bridgen Ceidwadwyr, North West Leicestershire

There is a saying that when it rains everyone’s roof gets wet. That is apt in the case of Ebola which, as we have heard, poses a global threat. Does my right hon. Friend agree that the best way to protect the British people from the Ebola outbreak is to continue to actively support international efforts to eradicate it in west Africa itself?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend is right. The most important thing we can do is to eliminate this disease at source, and that is why we can be extremely proud of the efforts of DFID and my right hon. Friend the Secretary of State. As I have said, we are the country that is doing the second most in the entire world to combat the disease in west Africa. There is no better example of the link between proper development policy abroad and security at home.

Photo of Glenda Jackson Glenda Jackson Llafur, Hampstead and Kilburn

May I thank the Secretary of State for his statement, affording as it does an opportunity for the House to pay tribute not only to Nurse Cafferkey and all the other NHS volunteers, but the staff of the Royal Free hospital in my constituency who day in, day out demonstrate all that is best in our NHS? When the Secretary of State meets the World Health Organisation tomorrow, will he highlight a most recent report that states that, although it is possible there has been a diminution in urban areas in west Africa, rural areas in west Africa are still giving great cause for concern? There seems to be no overarching co-ordinated work in those particularly difficult areas. Will he also, as the United Kingdom was the first off the blocks to offer services to sufferers of Ebola, act as some kind of needle to the other countries in the international community that are still failing to help in the fight against this potential catastrophe?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The hon. Lady is absolutely right that we need all countries to play their part. We have been very involved in international efforts to try to ensure that other countries, particularly in Europe, play their part as we in the UK have been doing. I commend her constituents who work at the Royal Free for their remarkable work, which really is world beating and incredibly impressive. It is also very challenging. The situation that Pauline is in is very difficult for them to cope with, but they are doing so with the highest levels of professionalism. On rural areas, DFID has been focused from the start on how to ramp up community care in rural areas. She is right to say that that is a very important priority.

Photo of Philip Hollobone Philip Hollobone Ceidwadwyr, Kettering

I thank the Secretary of State for the tone and content of his statement. Nevertheless, I think my constituents in Kettering would have two concerns about the Pauline Cafferkey incident. First, what my constituents do not understand is why, when this health worker reported feeling unwell, caution was not prioritised and she was not tested before travelling, as we now know on a crowded underground train into the centre of London. Secondly, I understand that she travelled back to this country with quite a large number of other health workers. When an airport knows that a large number of health workers are about to descend on it, why are resources not in place to deal with quite a large number of people all in one go?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

We have learned the lessons to speed up the process so that people, I trust, will not have to wait as long. One of the lessons we learned in the Christmas period is that we do not want people to have to wait as long. I want to stress to my hon. Friend—perhaps he could stress this to his constituents—that the clinical risk of contracting Ebola from sitting next to someone who is not exhibiting feverish symptoms is very low. That is why the clinical advice was, and remains, that it is perfectly safe for someone to travel on a train if they are not displaying the symptoms. We want to go further, however. We recognise that we do not know everything about this disease and therefore want to be precautionary. That is why we have said that if people in the high-risk categories—those who have had contact with Ebola patients—say they are unwell, we will have a different protocol going forward even if their temperature is within the normal range. I hope that will reassure his constituents.

Photo of Keith Vaz Keith Vaz Chair, Home Affairs Committee, Chair, Home Affairs Committee

The Government were absolutely right to start screening on 14 October. May I urge the Secretary of State to resist calls from those who say that screening is not effective and should stop? This was not a direct flight: it went through Casablanca. Although we have put a lot of resources into Sierra Leone and we have resources at Heathrow, there appears to be no international effort in the major hubs in Africa. What steps are going to be taken to help Governments such as that in Morocco, specifically in Casablanca, which receives so many flights from other countries in Africa that end up at Heathrow airport?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I thank the right hon. Gentleman for raising that point; he has done so on a number of occasions. It is very important that there is not a weak link in the chain. We have been relatively satisfied with the screening procedures at Casablanca, which we have obviously inquired into in great detail because of the fact that Pauline came through Casablanca, but I will ask Public Health England to reassure me that it is satisfied with those screening procedures, and, if not, if there is any assistance we can provide to the Moroccan authorities.

Photo of Jeremy Lefroy Jeremy Lefroy Ceidwadwyr, Stafford

I thank my right hon. Friend for paying tribute not only to the British defence, NHS, Public Health England and DFID workers, but to the immense courage of Sierra Leonean, Liberian, Guinean and Nigerian health workers, as well as many others. As he said, several hundred have paid the ultimate price for their devotion to their patients. Andy Burnham mentioned the health system in Sierra Leone. Will the Secretary of State, along with my right hon. Friend the Secretary of State for International Development, ensure that as much help as possible is given to the Sierra Leonean Government to strengthen their health system and avoid a collapse that could pose a great risk to the UK?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I can reassure my hon. Friend that my right hon. Friend the International Development Secretary has spoken to the President of Sierra Leone about that very issue. One of the big learning points from the relative success of Nigeria, which we discussed earlier, in combating Ebola compared with Sierra Leone has been about the strength of the local health system. One particular challenge is that the entire health system in Sierra Leone is now focused on Ebola, raising the risk of other diseases, such as malaria, tuberculosis and

HIV, killing more people even than Ebola. Strong local health care systems are an important long-term insurance policy to ensure that countries can deal with infectious diseases.

Photo of Gisela Stuart Gisela Stuart Llafur, Birmingham, Edgbaston

We are still learning about Ebola and the efficacy of the screening processes. What discussions has the Secretary of State had with other European countries, particularly European Health Ministers, to share best practice, exchange what we have learned and ensure a comprehensive approach?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I have spoken to several European Health Ministers, and the Under-Secretary of State for Health, my hon. Friend Jane Ellison, who has responsibility for public health, is in regular touch with them about the international effort. The hon. Lady is right that no one country can solve this on its own, and we collaborate well with others—perhaps most closely with the French, who have taken responsibility for the fight against Ebola in Guinea.

Photo of Martin Horwood Martin Horwood Democratiaid Rhyddfrydol, Cheltenham

I declare an interest, as my wife worked for Public Health England. I am sure that all PHE staff will appreciate the Secretary of State’s calm and supportive words today.

Local directors of public health have traditionally formed part of the response to such incidents, not least in reassuring the general public—perhaps Mr Hollobone as well—so is the Secretary of State confident that they still have the resources and organisational support to do this effectively now that they are part of local government, not the NHS?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

To date, no issues have been raised about resourcing for those very important responsibilities, but we will keep an eye on that. Every local area has had a resilience exercise to ensure it is prepared for what happens if someone contracts Ebola in its area, and so far we have been satisfied with the response, but obviously we will keep it under review.

Photo of Frank Roy Frank Roy Llafur, Motherwell and Wishaw

I understand the constraints on the availability of the ZMapp drug to fight Ebola, but is the Secretary of State really telling the House that there is nothing the Government can do to minimise those constraints?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

If we could buy it, we would, but there is no availability internationally, and we are waiting for more supplies. We are using other experimental treatments on Pauline, and it is important to stress that we do not know whether ZMapp actually worked, but we want to do absolutely everything we can.

Photo of Margot James Margot James Ceidwadwyr, Stourbridge

I wholeheartedly support my right hon. Friend’s comments about the bravery of Pauline Cafferkey and the other health and military workers fighting Ebola in Sierra Leone. Their sacrifice and bravery humble us all. Will he confirm that the Government will continue to follow medical advice and keep a sense of perspective regarding the real threat of contagion when monitoring and setting screening policies here in the UK?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Yes, I can absolutely confirm that, and I thank my hon. Friend for raising the point. It is important to say that this is not an exact science, because we do not know everything about the disease, so a balance sometimes has to be struck, but I think my discussions with Professor Paul Cosford and the chief medical officer have brought us to the right place: we follow the clear clinical guidelines, but where there is a precautionary extra step we think would be sensible in the circumstances, we take that as well.

Photo of Stewart Hosie Stewart Hosie SNP Chief Whip, SNP Deputy Leader, Shadow SNP Spokesperson (Treasury), Deputy Leader, Scottish National Party

I place on record my thanks for the work done by Pauline Cafferkey and her colleagues and express my sympathy for the predicament in which she finds herself. I would like to thank the Secretary of State, too, for what he said about continuing to keep screening arrangements under review and looking to improve them on the basis of expert clinical advice. If recommendations emerge quickly for improvements to, or an expansion of, screening, will he move equally quickly to put those recommendations into place?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I can absolutely give the hon. Gentleman that assurance. When we have decided to change protocols, they have been changed within hours, not within days.

Photo of Diane Abbott Diane Abbott Llafur, Hackney North and Stoke Newington

Pauline Cafferkey is a heroine and the thoughts of the whole House are with her and her family at this difficult time. Many people will be glad that the Secretary of State mentioned the hundreds of African health workers who have died fighting Ebola, showing extraordinary heroism and devotion to duty. Our constituents, including those linked to families in that region, will want to know that we will continue to give the region all the support we can in fighting Ebola long after it has dropped from the headlines.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I could not agree more with the hon. Lady. Some 382 health care workers have died from Ebola, and it is worth saying that they include not just local people from Sierra Leone, Liberia and Guinea, but people from all over Africa as well as small numbers from other parts of the world. The very least we can do is to continue to support an aid budget, which will allow them to continue to improve their local health care systems.

Photo of Barry Gardiner Barry Gardiner Shadow Minister (Environment, Food and Rural Affairs)

The Prime Minister said over the weekend that those displaying symptoms at Heathrow would be referred straight to Northwick Park hospital in my constituency for the reason that the isolation units are based there. Those isolation units are, however, strictly limited—I think there were only six at the last count—so can the Secretary of State advise us whether back-up facilities will be put in place? Given the nature of this disease, six isolation may prove inadequate.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I would like to reassure the hon. Gentleman that isolation facilities are available at other London hospitals. The ones he mentioned happen to be the closest, so they are the ones we would use first. Let me briefly clarify that it has always been the case that if someone showed any symptoms, we would isolate them and put them into quarantine. The change in protocol I am announcing today—we enacted it last week, but I wanted to report it to the House at the earliest opportunity—will mean that even if someone is not displaying the symptoms but says that they are feeling a bit under the weather, they will be isolated if they are in the high-risk category.

Photo of Russell Brown Russell Brown Shadow Minister (Scotland)

It is somewhat ironic that only a couple of days before Christmas, I wrote to the Prime Minister saying that we should fully recognise all the volunteers who leave this country to do this excellent, selfless work, putting themselves in danger—and here we are today discussing the case of Pauline Cafferkey. Everyone’s thoughts are with Pauline and her friends and family.

I am led to believe that any problem should be dealt with at source, and there is still great concern about the amount of contaminated material, medical waste and contaminated protective equipment that is perhaps not being dealt with properly at source—being buried rather than incinerated, for example. I contacted the office of Professor Dame Sally Davies, and was told to write to her. I did so last week, asking her to look at finding a means of disposing of waste in a far better manner. So far, I have not had word back from her, but I am sure the Secretary of State will want to take this matter on board and ensure that it is dealt with better at the source of the infection.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

To clarify the question, I think the hon. Gentleman is talking about how waste is disposed of in Sierra Leone, as we are satisfied with the way in which it is disposed of in the UK.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That being the case, I will ask the Secretary of State for International Development to write to the hon. Gentleman with her assessment of how satisfactorily that process is handled in Sierra Leone.

Photo of Louise Ellman Louise Ellman Chair, Transport Committee, Chair, Transport Committee

Will the Secretary of State tell us more about the support given across all Departments in finding treatments for Ebola, including support for the current trials being conducted by the Institute of Infection and Global Health at Liverpool university under Professor Tom Solomon?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

We are giving strong support to that important work. Our support is being led in the Cabinet Office by my right hon. Friend the Minister for Government Policy and Chancellor of the Duchy of Lancaster, who is bringing together all the Departments that can provide it. The sooner we can obtain a vaccine or a treatment that works, the better, and this could prove to be a very important part of the process of turning the tide.