- The Presiding Officer (Alex Fergusson):
The next item of business is a debate on motion S3M-4217, in the name of Nicola Sturgeon, on influenza A(H1N1).
- The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon):
I am grateful for the opportunity to open this debate on the H1N1 virus. In doing so, I acknowledge that there might be some who question the necessity of the debate, given the cross-party support for our preparations so far, for which I am grateful. Others might believe that the threat from the virus and, in particular, the threat of a flu pandemic, has gone away. However, it is important for Parliament to stay engaged with the issue for two reasons.
First, as events in the past 24 hours have reminded us, the threat has not gone away—I will update members shortly on developments in the past 24 hours and on what more has been learned about the H1N1 virus since my most recent statement. Secondly, our preparations for a possible pandemic later in the year involve some big decisions with substantial financial implications. It is therefore right that Parliament is not only kept informed but given the opportunity to comment.
I begin with an update on the current situation. As of this morning, the World Health Organization has reported some 13,000 cases in 46 countries across the world, including 92 deaths. The virus is spreading rapidly around the globe and the WHO expects that pattern to continue. It is worth pointing out that the number of laboratory-confirmed cases is likely to be an underestimate of the true situation across the world. In the United States, for example, the number of laboratory-confirmed cases stands at just under 7,000. However, the United States is no longer doing routine laboratory testing and it is believed that the actual number of cases there might be significantly higher than the official statistics suggest.
In the United Kingdom, as of today, there are 185 confirmed cases. As members are aware, that includes the 47 new cases that were confirmed yesterday, 44 of which were in one school in Birmingham. In Scotland, we have 13 confirmed cases, one probable case and 10 possible cases. Five of those possible cases are travel related, while the other five are related to the individual who is in hospital in Glasgow. There is a chance that some of the possible cases will become probable cases later today, but test results are not yet available.
As members are aware, the latest probable case is a 37-year-old Glasgow man who remains critically ill in the intensive care unit of the Victoria royal infirmary in Glasgow. The patient had pre-existing health problems when he was admitted to hospital. Routine testing for a number of viruses identified that the patient was positive for influenza A. He has not yet been confirmed as positive for the H1N1 strain, but that is highly probable. We hope to have test results from the Colindale laboratory later today or, possibly, this evening. Public health officials are tracing and contacting those who have been in close contact with the individual. I will of course keep members informed as the situation develops and I know that everybody will want to send our best wishes to the patient and his family.
Since the first cases were identified in Scotland towards the end of April, transmission has mainly been travel related or through known contacts. However, as the recent cases in Greenock—and perhaps the new case in Glasgow—have shown, we now know that the virus can also spread without any obvious known contact.
Notwithstanding the troubling case in Glasgow, the fact is that we have managed thus far to limit the spread of the virus in Scotland. That is largely due to two factors. The first is the detailed planning and preparations on how best to handle a flu pandemic, which have taken years to complete. The pandemic flu framework, which we published in November 2007 and work on which started under the previous Administration, has stood us in very good stead. So far, we have been successful in preventing any large-scale onward spread to the general population using the containment measures that are outlined in the framework.
The second factor is, of course, the tremendous effort of the health service, local authorities and partner agencies in rising to the challenge and ensuring that the measures that are outlined in the pandemic flu framework are implemented effectively in practice. A third, more fortuitous, factor that might be at play, of course, is that we are heading into the summer period, which—even in Scotland, hard though this can be to believe—is known to slow down considerably the progress of the flu virus.
In any event, the bottom line is that we have not yet seen large numbers of confirmed cases in Scotland. With the obvious exception of the man who is in hospital in Glasgow, it would also appear from the cases that we have had that the strain is relatively mild. However, a key message that I wish to stress is that we cannot afford to be complacent.
That brings me to the science. International understanding of the virus continues to grow. However, many questions about it remain unanswered. As the director-general of the WHO said last week:
"Influenza viruses are the ultimate moving target. Their behaviour is notoriously unpredictable. The behaviour of pandemics is as unpredictable as the viruses that cause them."
What do we know at this stage? First, the emerging evidence from across the world suggests that younger people are more susceptible to the virus. Accordingly, we need our young people in particular to be vigilant, to be aware of the threat that the virus poses and to follow the advice that has been given on good hygiene practices.
Information from the United States of America and Mexico suggests an attack rate of 22 to 30 per cent, which compares with a seasonal flu rate of 5 to 15 per cent, although, as I have said, recent seasonal flu attack rates in the United Kingdom have been much lower than that. The hospitalisation of confirmed cases ranges from 4 to 6 per cent, and the mortality of confirmed cases ranges from 0.1 to 1.9 per cent. I stress, however, that health care provision in the USA and Mexico is not directly comparable with that in this country, and it is likely that there is a significant number of undetected cases in those countries.
As we know, early experience points to this being an illness with relatively mild symptoms, leaving aside the obvious exception of the current case in Glasgow. However, we need to be quite clear that even mild flu can be unpleasant and debilitating and that, in exceptional cases, flu can cause complications or even deaths.
All in all, although we cannot be certain about anything, we must be prepared for an illness that might affect large numbers of people with symptoms that, although mild, might see them confined to bed for a few days. Members will appreciate that the impact of such a situation on our national health service and our economy could be significant. Even in a normal flu season, the demands on the NHS can put severe pressure on services.
Of course, there is a risk that the virus might mutate and become more virulent during the autumn and winter months. That is why, in collaboration with the other UK Administrations, we are preparing for all eventualities. The biggest decision that we have taken so far is to secure early supplies of vaccine. The day after my last statement to Parliament, letters of intent were signed with drug manufacturers GlaxoSmithKline and Baxter Vaccines to secure up to 90 million doses—on a UK basis—of a pre-pandemic vaccine. That is the first step to achieving 100 per cent vaccine coverage for all the Scottish population. It will take time to reach 100 per cent coverage, but those arrangements provide the opportunity for us to have, by December, enough pre-pandemic vaccine to protect priority groups and perhaps up to 50 per cent of the population. Precise delivery schedules would be influenced by any decision of the WHO to move to phase 6 of alert, at which point our advance supply agreements will be activated.
Of course, our ability to respond effectively requires much more than the securing of vaccine supplies, and we are doing more. For example, a web and telephone-based system—which will be available, if necessary, until flu line is ready in October—is in the advanced stages of development and will be able to facilitate large-scale distribution of antivirals, should that be necessary. We have also assessed the level of preparedness across individual sectors on a local and national basis. We are confident that organisations are as ready as they can be for a pandemic, with processes in place to take forward identified non-health issues. We will, of course, continue to work closely with our counterparts elsewhere in the UK, to ensure that we are sharing best practice and that we are learning continuously from work that is done elsewhere.
As I said, some of the decisions that we are making have substantial financial implications, so I want to address the question of funding. The measures that we are putting in place to deal with this issue have significant financial implications. Along with the other devolved Administrations and the UK Department of Health, we have prudently budgeted for what can be done in advance of knowing when a pandemic might strike—principally, the stockpiling of antivirals, antibiotics and face-masks. However, like the other UK Administrations, we have not and could not have budgeted for other costs, such as vaccine procurement, as it was impossible to know when or whether those costs might be incurred.
It is our view that those additional costs should be met from UK contingency funds. John Swinney has written to the Treasury to set out that case, as have the ministers with responsibility for finance in Wales and Northern Ireland, and we await a response. I will of course keep members informed of progress in that regard.
In conclusion, our success thus far in limiting the impact of the virus is testimony to the hard work of staff in the NHS, Health Protection Scotland, local authorities and partner organisations. However, we cannot be complacent and must be prepared for all eventualities. I pay tribute again to staff for their outstanding efforts to stop the spread of the virus and to the level-headedness of the public in their response to the evolving situation.
That the Parliament acknowledges the work of NHS Scotland, local authorities and other stakeholders in handling the recent outbreak of Influenza A (H1N1); commends NHS boards and Health Protection Scotland for the success so far of the containment strategy in limiting the spread of the virus by quickly and effectively treating confirmed cases, tracing contacts and dealing with possible and probable cases; accepts that we must maintain a high state of preparedness given the potential seriousness for the nation's health and economy of a full-scale pandemic, and supports the collaborative approach of the Scottish Government and all its partners, both within Scotland and beyond, in minimising the spread of A (H1N1).
- Dr Richard Simpson (Mid Scotland and Fife) (Lab):
I join the cabinet secretary in congratulating all the NHS staff who have been involved to date; in particular, I congratulate staff in NHS Forth Valley on their initial prompt actions, in Inverclyde, and in all the Government agencies that are involved.
The general thrust of my speech is that the Labour Party will support the Government motion. We do not want to be critical in any way of the Government at this stage. Alan Johnson has led the call for the World Health Organization to consider whether lethality should be a factor in determining alert level 6. Does the Government support an early review of alert levels?
The name that is now being given to the virus is swine-origin influenza virus, or S-OIV, which is unpronounceable. Thus far, one thing that is for certain is that it is a novel virus. In a recent article, Hugh Pennington referred to swine flu being acquired in 2005 by the Mayan population in Yucatan, which—like other populations in south-east Asia—keeps pigs and birds in its backyards. A mild form of swine flu may have gone unnoticed in significant numbers of people before it was formally identified. That reference is important in forming our exact knowledge of what the virus is about. For example, we have established that the current mutation does not produce PB1-F2 protein, which was the virulent factor in the 1918 flu outbreak.
Much of our planning worldwide was based on the supposition that the new virus would arise from an avian source in south-east Asia. It came as something of a surprise, therefore, that it was first found in Mexico and that the source was the pig. Much greater research is needed into pig viruses as the melting point for the triple reassortment of viruses from humans, birds and pigs. In that regard, what input will the Scottish Government make to that worldwide research effort?
The three areas of concern are the rate of spread, the degree of contagion and lethality. The cabinet secretary referred to them in detail, so I will not go into the same level of detail. On the rate of spread, the number of cases has risen from 1,000-odd cases at the beginning of May to 13,398 cases as of this morning. The spread from only a few countries to 46 indicates that we have problems in this regard. That said, the spread rate seems to be slowing. Is that accounted for entirely by an absence of testing in countries such as the United States of America, or is the rate naturally occurring? I do not expect an answer today; I simply pose the question for consideration.
Clearly, if the rate of spread is slowing, that says something about the second area of concern, which is the level of contagion. As the cabinet secretary indicated, the level of contagion looks like being somewhere between two and 10 times the normal flu rate for severe winter flu—not the mild flu outbreaks that we have had. What is the Government's estimate of the future level of contagion? Again, that question probably cannot be answered today; I simply pose it for future consideration. Labour Party colleagues will address the impact on education and on prisons and other closed units.
I turn to lethality. It is clear that, outside Mexico, the outbreak is very mild. I assume that we still do not know why that is. Certainly, there is nothing on the WHO website to indicate the reasons for the outbreak. As of this morning, there have been 95 deaths, 85 of which have been in Mexico. As the cabinet secretary said, the rate is considerably lower than that which applies at the top end of pandemic predictions. We do not know quite what is happening—there is a wide variation in the assumptions on lethality.
Unlike in previous pandemics, assessment of the three factors of spread, contagion and lethality is considerably complicated by new variables. First, there has been a massive increase in air travel since the last pandemic in 1968. Secondly, there has been the application of successful containment policies using antivirals that disrupt the normal development of the virus.
The one thing that we know about pandemics is that they tend to encircle the globe in at least two and sometimes three waves. From the three pandemics in the 20th century, we know that the first wave is always mild. The second wave of the Spanish flu outbreak of 1918 was particularly lethal. The 1957 pandemic, which also started in a mild form, returned in a form that was somewhat more severe but not nearly as severe as the 1918 outbreak. The 1968 pandemic was not severe in most countries in its second wave, but it was in some countries.
As the cabinet secretary indicated, we cannot predict what further genetic shift or drift might occur in the novel virus that confronts us today; nor can we predict what effect the intermix of H1N1 with H5N1 avian flu in south Asia will have, because there are only a few cases—some, in Taipei, for example, have only been reported in the past week. Very few cases have been reported in south-east Asia. The pressure on the virus to mutate, with the mix in pigs, birds and humans in south-east Asia, might present us with a severe challenge in the second phase.
The emergence of an inherently much more virulent virus in phase 2 can never be ruled out. The cabinet secretary and the UK Secretary of State for Health, Alan Johnson, are absolutely right to say that we must continue to plan on the supposition that the second wave could be more virulent, while continuing to hope that it will not be.
Do we have sufficient capacity in Scotland to maintain rapid diagnostic testing to ensure that, in the event of severe reaction, individuals can be tested for any new, potentially lethal, mutation of the virus? I understand that, at some point, we will probably have to drop general testing, although we need to maintain adequate testing facilities to look for that possible mutation.
As is clear from the cabinet secretary's speech, we have not yet moved from containment to disruption, or even to an open situation. However, I have some concerns. First, from the outset there has been an overreliance on Tamiflu—I make that criticism of all Administrations. The single purchase of Tamiflu, which has been augmented only recently by Relenza, might lead to our being overreliant on it. There has already been some resistance to Tamiflu in response to some cases of flu in Japan. I hope that stocks of Relenza, and indeed of amantadine, may be maintained. Amantadine was the original antiviral and although it was not particularly effective, perhaps for the very mild form of flu that we have at the moment, the use of amantadine—or of Relenza—could protect against resistance to Tamiflu. Is the Government considering that point, which has been raised in academic debate?
I will address some further issues related to pre-planning for a possible second wave, no matter how virulent it is. All the elements of the report that I did for the Health and Community Care Committee in 1999—published in 2000—and of the subsequent planning will be tested to a level beyond that of the winter willow simulation exercise that was carried out previously.
I ask the cabinet secretary to respond to a number of further questions, on the basis of continuing to hope for the best while preparing for the worst. First, I thank the cabinet secretary for her letter to me in response to my question regarding the register of retired doctors and nurses. Her letter indicated paragraph 27 of the guidance. Further to that, is the cabinet secretary satisfied that all health boards have such lists in place? As a semi-retired doctor, I have not yet been contacted. Will health boards offer training over the summer, as has been suggested, so that we are prepared for the second wave, should it occur?
Secondly, are there similar provisions for the temporary reregistration of nurses and allied health professionals, as there are for the General Medical Council, which has established a rapid reregistration system? Hopefully, such a system will be made available to nurses and allied health professionals. In addition, we have a number of unemployed allied health professionals, such as physiotherapists. Do we have a list of people who are currently not employed, but who are qualified and who might be able to help out in the second wave?
From previous correspondence with the cabinet secretary, I know that the Government has had discussions with, and has involved, the British Red Cross, the WRVS and other voluntary organisations at a national level. Have health boards and local authorities engaged with those two organisations in their plans? When I corresponded with the cabinet secretary on the matter last year, the Red Cross and the WRVS were indicating their satisfaction with national discussions, but they believed that local discussions were very patchy. Preparation must be made more adequate over the summer.
In my report, I suggested that we needed adequate supplies of pneumococcus vaccine for all relevant vulnerable groups. We should consider the potential for a summer programme of pneumococcal vaccination, rather than waiting until autumn, when the second wave might hit us and we might be otherwise occupied. I make the suggestion because a number of the deaths of young adults in Mexico have been associated with the pneumococcus virus and because, during the moderately severe pandemic in 1957, research in Holland showed that pneumococcal pneumonia was a significant factor in deaths. The preparation that I suggested might therefore help.
The new vaccine must be properly tested. The most recent significant swine flu outbreak, at Fort Dix, in America, in 1976, resulted in rapid production of a vaccine that had to be withdrawn because of its association with deaths and Guillain-Barré syndrome.
Will the cabinet secretary consider whether we have an adequate supply of ventilators? The health service in Mexico has had problems in that regard. We know from an Audit Scotland report that there is a significant maintenance backlog. If ventilators are to be replaced during the next two years, it might be worth bringing forward the purchase of replacements, to increase capacity.
As the cabinet secretary said, dealing with a pandemic is about managing uncertainty. Sam Goldwyn said:
"Making predictions is very difficult, especially about the future".
The remark has never been more applicable. We are only weeks into the outbreak—pandemic or not—and many of our assertions and plans have already been negated. We must be on guard and continue to plan and prepare, and we must be ready to be flexible. The Labour Party will support the Government motion.
- Mary Scanlon (Highlands and Islands) (Con):
I commend the work that has been done, particularly by the NHS staff who have assisted in the cases to date.
It is difficult to assess whether a debate is needed on the Government's preparations for the current H1N1 outbreak and the potential threat of pandemic influenza. The Royal Society of Edinburgh summed up the issue well in its briefing, which makes the point that
"the only thing certain about influenza is that nothing is certain".
Recent news from Birmingham confirms that.
The RSE said:
"With the benefit of hindsight it is clear that greater attention should be paid to influenza viruses in pigs and from a diverse series of sources, and their transmission to humans."
I hope that current efforts and energy are focused not only on addressing H1N1 but on developing a more preventive approach for the future, given that there is no doubt that we have learned a huge amount from the current situation. There is an emergence of zoonotic diseases of viral origin that can be passed to humans from wild and domesticated animals, so the issue is important and should not be lost in the Government's collaboration with other parts of the UK.
The RSE recommends that
"Scotland must have access to rapid diagnostic testing to inform an effective surveillance programme so that individuals with flu symptoms can be investigated at an early stage".
Richard Simpson made that point. Such an approach might not have been justified in the past, and I would welcome the Government's response to the suggestion in the context of future planning.
The RSE highlighted that H1N1 can be passed from humans to pigs. I think that that issue has been lost in the debate. What discussions have taken place with the Scottish farming industry, and particularly with pig farmers, about the current circumstances? Has agreement been reached in that regard?
The final point that I took from the RSE's paper was that the society is concerned that the UK has chosen to stockpile only Tamiflu, given that there is always the possibility that the virus will mutate and become resistant to the drug. Richard Simpson mentioned that issue, too. Further clarity on that issue would be welcome. I am grateful to the RSE for helping me with this speech and raising those excellent points.
As I have said before, I commend the Cabinet Secretary for Health and Wellbeing for her competent and professional handling of the issue. I attended one of the briefing sessions in the St Andrew's house bunker room and was impressed by how positively the range of representatives from the public and private sectors throughout Scotland worked together.
Although that level of the system is undoubtedly efficient, the British Medical Association has raised concerns that health boards need to do more planning with front-line clinical input. It also seeks greater clarity on distribution protocols—which it says must be communicated to the public effectively to avoid confusion about patients obtaining antivirals when they are ill—as well as how general practitioners and their staff can get immediate access to Tamiflu in case of infection by patients with flu. It is reassuring to know that national communications are good, and I commend that, but it is disappointing to hear the BMA state that there has been difficulty engaging some health boards in the planning process and that, in some areas, planning continues without GP input although the GP is probably the first port of call for the majority of patients.
- Nicola Sturgeon:
Perhaps Mary Scanlon will accept a point of information. I have read the BMA briefing, and she may be interested to know that we have asked health boards to give us an update on their plans, including their engagement with primary care contractors. In addition, if Mary Scanlon or any other member is aware of particular and specific local problems, I would be more than happy to address them if they raise them with me.
- Mary Scanlon:
That is helpful and I commend the approach that the health secretary has taken.
In her opening speech, the cabinet secretary mentioned the financial issues. If the flu outbreak is contained and does not become a pandemic, who would pay for all the vaccines and antivirals that have been ordered but which may never be used—the Government or the pharmaceutical companies?
I seek clarity on the storage of existing vaccines, which was covered in Scotland on Sunday. There are concerns about unstable temperatures affecting vaccines' effectiveness, so will the cabinet secretary confirm that the storage facilities for existing and future vaccines comply with the manufacturer's guidelines? It is of serious concern that the Scottish Government's health department found that, during a three-month period, 503 out of 1,030 GP practices were not fully compliant with the regulations on storing vaccines. Of those 503, 148 were reported as not storing their vaccines in accordance with manufacturers' instructions. I noted Richard Simpson's comments in the newspaper—I hope that he will forgive me for quoting him:
"The question is whether people who have been vaccinated are actually immune, or whether we have been given a false sense of security."
When people are given a vaccine, they need to be secure in the knowledge that it is effective.
As Richard Simpson said, in the previous major outbreaks in 1918 and 1957, the virus returned in a more virulent form in the autumn. Is there a point or date at which we will know whether the virus will mutate into something more serious? To put it another way, is there a safe date in the autumn when we will know that the current H1N1 strain will remain as it is? The cabinet secretary is shaking her head, so I think that the answer is no.
- Ross Finnie (West of Scotland) (LD):
My party and I wholly support the Government's motion. I do not doubt that many of the points that the RSE raised in its paper are excellent—Richard Simpson and Mary Scanlon referred to them extensively—but I think that there is a slight trend, because things appear to have gone reasonably well, to scour about looking for things to say that might not necessarily be critical but, rather, give the impression that there are many things that we just simply have not thought of before.
To my certain knowledge, because statisticians have been well aware for some time that the incidence of a pandemic is statistically very probable next year or the year after, Government planning has by and large been in place for some time. To be fair to all parties involved, the general proposition that we were somehow unaware that a pandemic had come upon us, and that everyone was unaware that the 1918 virus and its mutations were serious, is not the case. Those things were well known.
My other general point is that we should be careful about the two principal reasons for activating our civil contingency procedures. The first is the obvious one—referred to by the cabinet secretary, Richard Simpson and Mary Scanlon—that, if we face the threat of a disease and there is uncertainty connected to that, we must take those civil contingency steps. Even if it becomes clear in the early course of the outbreak, as occurred in this case, that the particular strain is not that serious, that does not in any way reduce the possibility that a highly virulent infection will give rise to considerable civil contingencies. We have only to close a few schools to discover suddenly that, statistically, we have also closed a ward in a hospital, because half of the people whose children are at the schools have to go off their work to look after their children.
We should not underestimate the need to deal with any potential threat that is raised to a WHO level. There is a need for calm reflection to address what the health risks are, but we should in no way lose sight of the fact that, as I said, a highly virulent infection can have a very serious effect on the civil population.
We are fortunate in the way in which the virus has developed, although in Inverclyde, where I live, we have managed to produce the highest proportion of cases in the country. Although she is not surrounded by us, the cabinet secretary may not necessarily be comforted to know that Stuart McMillan and I have travelled extensively in Greenock and Inverclyde and are perhaps the bearers of bad news—but there we are.
I want to pay a particular tribute because, while I welcome the tremendous efforts of NHS staff throughout the country in addressing the larger number of incidences, I am in no doubt that the way in which the health and education services and the general population have remained calm in the situation has been a great credit to all involved.
We then move forward to saying, "Well, okay, where do we go from here and what are the lessons that we must learn?" Clearly, this is one of the first times that such a virus has been subjected to careful investigation and analysis at such an early stage. We do not know the results of that, but our hopes and expectations must clearly be that, should the virus reappear in the autumn, we have a much better handle on precisely how it emerges. Indeed, it is apparent from one or two of the rogue cases, particularly in Greenock, that we are still not entirely clear about the epidemiology relating to how the virus emerges, which is slightly worrying, should—I stress "should"—a more virulent strain emerge at a later stage.
Once the decision has been made to go for one vaccine, the clever suggestion will be made that six others could have been stored, but I am not sure that anyone has second sight in that regard. However, an important principle emerges in relation to the funding of vaccines, and I will be very interested to see how the United Kingdom Government addresses that point. None of the current financial arrangements that relate to the devolved Administrations creates a reserve in any of those Administrations. Although the situation during the most virulent outbreak of foot-and-mouth disease in Scotland is not analogous, as someone who was the minister responsible for such matters at the time I know that it was extremely important that Scotland had access to a reserve so that it could meet the costs that had to be borne. Our party will therefore be highly sympathetic to any advances and overtures that the Government might make to the UK Government in that regard. One reason why animal health policy was never fully devolved was that it was necessary to have access to the reserve in the case of an emergency. The cabinet secretary alluded to that important principle.
I do not have the expertise to discuss diagnostic testing, but I am fully aware that the laboratory down south that we access represents the benchmark when it comes to testing for the virus. That does not come easily. One cannot just suddenly spend a sum of money and establish a laboratory, because without a reference point it will not be able to perform that role. Although I understand fully the concerns that the process of determining the rate of advance of the disease slows down without such a facility, we should not kid ourselves that it is simply a question of money. A number of other procedures would have to be put in place if such a proposal were to be given full vent.
By and large, the measures that have been adopted and rolled out have been successful. We know from what the cabinet secretary said that lessons have been learned. Lessons are always learned: every time one unveils procedures, there are things that can be done better once they have been looked at afresh. I hope that we take the time to do that over the summer. We should refresh our approach in the knowledge that, if the virus returns, it is unlikely to return in the same form in which it first manifested itself, with the result that we might be presented with a much more challenging position.
In general, the Liberal Democrats are content with the action that has been taken. We have given our full support to the Government's measures. We are particularly pleased that, through the arrangements that have been adopted, the cabinet secretary has been able to secure enough pre-pandemic vaccine to vaccinate at least half the Scottish population by December. As I understand it, the timing of that process means that it will not in any way interfere with the production of normal flu vaccine. I rather suspect that we are dealing with two different vulnerable groups: members of the group that is generally the most vulnerable, the elderly, are more likely to be protected by the traditional flu vaccine, whereas it appears from what the cabinet secretary has said about a possible outbreak of A(H1N1) early in the winter that younger people are the more vulnerable group and will need to be protected if that transpires.
We are satisfied with what has been done, but we are not suggesting for a moment that there is a scintilla of room for complacency. For the moment, we are happy with the general direction of travel and we support action to secure the nation's health should the virus re-emerge. That is why the motion before us is wholly supportable.
- Stuart McMillan (West of Scotland) (SNP):
I have a strong interest in the debate because there have been six confirmed cases of swine flu in Greenock, which not only forms part of the region that I represent but is where I live, as Ross Finnie alluded to.
I hope that all members will recognise that the way in which confirmed and suspected cases across Scotland have been handled by the Scottish Government and NHS staff has been a credit to the Scottish system for dealing with such outbreaks. That has certainly been recognised so far, but I am keen for there to be unanimity on that point throughout the debate.
Although media coverage of the outbreak has slowed down somewhat over the past week or so—other items appear to be leading the media agenda—we should not expect anyone to become complacent or assume that the issue has gone away. In her opening speech, the cabinet secretary highlighted the case of the individual who is in the Victoria hospital in Glasgow, and people are still being diagnosed in Scotland and elsewhere. I am pleased that the Scottish Government has not opted to overplay or underplay any of the dangers surrounding swine flu.
We have been able to cope admirably so far because we have had a pandemic flu framework in place since November 2007. The swine flu outbreak has been a test of that framework, which has proven to be successful so far. I am one of the co-conveners of the cross-party group on funerals and bereavement; the other co-convener, Nanette Milne, is also in the chamber. The membership of the group was grateful to the previous Scottish Executive and the current Scottish Government for their work on the framework, which is important, and was content that the funeral services industry had an input into it.
The swift action of working together with the UK Government and at European Union level appears to have allowed the Scottish response to be prompt and extremely efficient—so much so that the Scottish Government has been able to make just fewer than 1.5 million surgical face-masks available to England and Wales to cover the shortfall there. There are obvious public concerns, some of which have been touched on, about the possible resurgence of flu-like symptoms in autumn and over winter. However, the calm way in which all of us—especially the cabinet secretary and her officials—have conducted ourselves should be commended. I expect that to continue and that there will be no scaremongering tactics from anyone—politicians and the media alike. Such an atmosphere would not help in any circumstances.
The fact that the Scottish Government is prepared for the possibility of a future pandemic reaching WHO level 6 should be welcomed as a precautionary measure. The Scottish Government has advance agreements in place with manufacturers, should a vaccine be developed and pandemic level 6 be reached. I welcome the fact that we are going beyond that and buying supplies for the entire population early, as a precaution. As we have heard, the vaccine can be expected by December, but perhaps as early as September. We know that it will be offered on a voluntary basis in addition to the normal seasonal flu vaccination. All of us are now well aware that the symptoms of swine flu are no more dangerous than those of common flu.
As I said earlier, like Ross Finnie, I live in Greenock. The way in which the Inverclyde public, education staff, Inverclyde Council and all local health professionals have dealt with the situation has been nothing short of highly commendable. There has been no hysteria, but a tremendous amount of understanding and appreciation of the need to do whatever needs to be done. Coverage in the local newspaper, the Greenock Telegraph, has not overplayed the situation in any way, shape or form. People to whom I have spoken who have links, in one way or another, to local individuals involved in the situation have been tremendously appreciative of what has been done. Ultimately, the episode has shown the people of Greenock and the whole of Inverclyde at their best. I am sure that that will continue to be the case if other cases are uncovered in the future.
- Helen Eadie (Dunfermline East) (Lab):
I echo the thanks that the cabinet secretary and other members have offered to the national health service. I, too, pay tribute to the cabinet secretary and the Minister for Public Health and Sport for the calm, controlled approach that they have taken to the issue, which unites the Parliament and is of continuing concern.
There are two concerns for all of us today. First we have to protect our citizens, and secondly we have to play our part in dealing with a world pandemic, especially in poorer and developing countries that may not have access to the drugs that we have. I hope that, as Scots, we will do as we have always done and consider how we will lend a helping hand to those poorer and developing countries. [Interruption.] Excuse me. I do have a cold, cabinet secretary, but I hope that I will not be needing a doctor in the house. I have had a sore throat for four weeks.
I agree with the cabinet secretary that this debate gives us an opportunity to discuss the issues—as distinct from an opportunity to ask questions—following the statement that the cabinet secretary kindly made. Certain issues are important for parliamentarians to consider.
Our critical care capacity, when compared with that of other countries, is an important matter, and I hope that the cabinet secretary will be able to tell us what measures the Government has taken to support additional critical care capacity. Dr Richard Simpson said earlier that we have to ensure, for example, that additional ventilators are available, as well as additional beds.
The latest data on adult critical care services in a number of the most developed health economies are found in the Society of Critical Care Medicine's 2008 study. The study set out the number of adult intensive beds per 100,000 people, which is the relative measure. France has 9.3 such beds per 100,000 people; Canada has 13.5; the Netherlands has 8.4; Spain has 8.2; and the United Kingdom has 3.5. The Parliament will note the apparent substantial disparity between the availability of critical care capacity in this country and the availability in many other countries. What will the Scottish Government do to address that critical issue?
Anyone who has visited critical care units recently will know that they are generally full. The ethical and prioritisation impacts of a pandemic are therefore likely to be encountered rather faster in this country than in many others. Because we do not have spare capacity in our critical care units, we will fairly quickly have to turn beds that would otherwise be occupied by elective patients into beds that offer some degree of high-dependency support for patients who are suffering the complications of flu.
What discussions is the cabinet secretary having with Her Majesty's Government on advice for people travelling to the United States if there is a rapid increase in the number of cases there? People may be planning holidays now, and they will need advice on whether to go and on what precautions they should take when they get there. A report that appeared in The New York Times a couple of days ago refers to a leading American infectious disease expert who has been in Mexico to help the Mexicans tackle the swine flu outbreak and learn the lessons from that. The report says that many people who are suffering from the disease appear to show no symptoms of fever. That makes screening much more difficult and increases the difficulty of controlling the disease. I am not sure whether the cabinet secretary and the authorities in this country are fully aware of what is being discovered in Mexico, but it is critical that we rapidly learn the lessons. According to the report, half of those with the milder cases did not at any stage develop fever.
It is also reported that 12 per cent of patients in two Mexican hospitals are suffering from diarrhoea as one symptom of their condition, together with respiratory problems. The point is made in the report that there are implications for infection control, particularly in poorer countries, if diarrhoea is one symptom that emerges from this strain. The advice is that stools should be tested for the presence of swine flu virus. Will the cabinet secretary say whether any such advice is coming from health officials in Scotland? There has been no reference so far to such testing, so has that been properly monitored?
It is also reported in the article that the expert doctor from the United States, Dr Wenzel, suggests that there should be testing to determine whether people are carrying the virus but showing no symptoms. Newspapers tell us of one case in the UK of someone who has had a confirmed diagnosis but who has had no apparent contact with anyone who has suffered from the condition. Is a possible explanation that some people who are carrying the virus may not show any symptoms? That would make control much more difficult.
It is also reported that an unusual feature of the Mexican epidemic is the fact that there are, apparently, five different influenza viruses circulating at the same time, which makes it much more difficult to plan and to judge how the swine flu virus will develop.
All the things that I have mentioned from that article are happening in Mexico. Will the minister comment on the international learning process to ensure that what we are finding out from Mexico is fed into public health messages in this country and that the appropriate advice is disseminated? It is also reported that the number of pneumonia cases at one hospital was 120 a week, compared with an average of about 20 a week. That is clear evidence of the complications that can emerge from flu, as the cabinet secretary mentioned earlier.
That significant increase in the number of pneumonia cases reinforces the importance of preparedness for such complications. Will the minister comment on the development of the purchase of antibiotics? We discussed that after previous ministerial statements, and I know that the cabinet secretary has addressed the matter, but I should like to know where we have got to on that.
The final, really important, point in the report is the fact that Mexican doctors have apparently activated a programme to allay the anxieties of health staff. The expert from the United States commented that that matter had not been sufficiently addressed in the US. It is critical to remember that there will be health and social care staff in this country who are extremely anxious about their own health and family circumstances. The programme has been activated to provide an information hotline for staff, psychological support, which is critical, and medical examinations. I am sure that that is part of the planning process, but will the cabinet secretary reassure us that the matter is fully recognised as a priority?
- Jamie Stone (Caithness, Sutherland and Easter Ross) (LD):
I, too, pay tribute to the professionalism of NHS staff both in my constituency and throughout Scotland. One cannot but be impressed by the professional way in which they carry out their work.
The tone of the debate, as set by the cabinet secretary, has been appropriate. There has been no scaremongering; the debate has been balanced and thoughtful. She is right to say that there should be cross-party support on such issues. She also said that Parliament must stay engaged—that is absolutely correct. We are where we are, and although the appropriate measures have been taken, the situation is, as other members have said, constantly changing. Therefore, we must be constantly vigilant.
I also pay tribute to the cabinet secretary for the way in which she has been prepared to meet MSPs such as me to discuss the issue and to engage with us. That is very much appreciated by me and by my constituents. She spoke about containment, which is the policy at this stage, and she was good enough to pay tribute to the work of the previous Administration. That is appreciated.
My colleague, Ross Finnie, rightly drew our attention to the issue of financial reserves, which are not there at the moment. The BMA has paid tribute to the fact that all four Administrations in the United Kingdom have worked together. The virus does not respect borders, so there is a responsibility on the UK Government to consider—I hope fairly and properly—the issue of reserves, which will have an effect on the Scottish Government.
I turn to two briefings that I have received, one of which has been mentioned already. The first, which we have all read, is the BMA parliamentary briefing. Two issues sprang out at me as being worthy of note. The briefing talks about the large number of the "worried well" who are ringing in, which is having an impact on the workload of general practitioners and their staff. I know of someone in my constituency who felt ill in the middle of the night and rang the health service. They turned out to have the common cold followed by bronchitis, but they wondered what was wrong. Such calls take up the time of our health professionals. The BMA rightly points out that, if staff become ill, some smaller GP practices will bear quite a heavy burden.
The BMA also tells us that, with the Department of Health, it is developing a database of retired doctors who could be brought into action if necessary. I would be interested in the cabinet secretary's comments on that. Would other appropriate retired health professionals—perhaps people who worked in the nursing profession—be included? A skills update would be absolutely essential if such a policy were taken forward, although it is very attractive.
The second briefing paper is from NHS Highland, which describes the position fairly and accurately. I thank NHS Highland for its paper, the final paragraph of which states:
"There are particular challenges for the Highland CHPs because of sparsity and distance. Delivery of anti-virals to patients who cannot travel, and who cannot attend on their own behalf, is particularly challenging in rural areas. Each CHP is considering this, and it is likely that a range of options will be required across the NHS Highland area."
Exactly: we need to consider what happens if the people who do the deliveries, such as the drivers, get sick. We also need to consider what happens if, as has already been said, children or family members get sick and people have to stay behind to look after them.
Distance is a big issue. Some of my constituents—young and old—live in very remote areas that can be pretty inaccessible even with the most up-to-date forms of transport. The motto "Be prepared" applies to the pneumococcal vaccine and should apply in this situation, too. We must evaluate the likely impact of distance on a programme of rapid diagnostic testing, if such a programme is to take place.
As members have said, we are lucky that we are entering the summer period, which is beneficial in slowing down the spread of such a disease. However, as we have been warned, we must be careful about phase 2. If it occurs in the autumn as winter descends, when roads become difficult to drive on and transport becomes more difficult in the Highlands, it will be a big issue for us.
If someone becomes sick, an evaluation must be made of whether and for how long they should stay at home. We need to bear in mind the proximity of medical facilities, if those are necessary, as some people live very far from hospitals.
The cabinet secretary has generously said that she will respond to any problems and points that individual members raise. I do not view the disease as a problem—I do not want to see it in the wrong light—but we need to be aware of it and think about it as we go through the summer. I am grateful for the cabinet secretary's offer to work with me.
As a member who represents a remote and very large constituency—which, according to the Boundary Commission for Scotland, might be about to become larger still—I will be keeping a close eye on the issue, as will my Highland colleagues, no doubt. I reserve the right to come back to the cabinet secretary—if that becomes necessary, and only then.
I join Ross Finnie in associating our party with the motion. We should give credit where it is due—there has been a degree of professionalism by NHS staff, and the Scottish Government has handled the issue pretty well so far.
- Ian McKee (Lothians) (SNP):
The danger that flu viruses present, and always have presented, is their ability to mutate frequently into a different form. That poses two challenges: vaccines that have been developed to protect against yesterday's virus may be ineffectual today or tomorrow; and it is entirely possible that a relatively benign virus that causes symptoms that are little more than those of a severe cold may mutate into something much more serious, such as the pandemic of so-called Spanish flu that swept the world after the first world war.
We must always be on our toes, and I congratulate the cabinet secretary and national health service staff on the measures that they have taken so far in an attempt to contain H1N1 in Scotland. Pandemic level 5 means that the World Health Organization considers a pandemic to be imminent, and it is right that we take the matter very seriously indeed.
However, pandemics know no international boundaries, and people in developing countries are liable to suffer even more intensely from what is going around than those in the first world, as Helen Eadie has already mentioned. The spread of the disease from Mexico and the USA so far seems to have occurred mainly in developed countries, but it is suspected that that is simply because developed countries have more sophisticated surveillance and diagnostic facilities. Citizens in the third world are more likely to be malnourished and to suffer from chronic illnesses, which makes them more vulnerable, and health control measures in their countries are often rudimentary.
In Scotland, we may well have adequate supplies of antiviral drugs for our population, but there are only enough in production for less than 5 per cent of the world's population. Relying on those drugs to curb a global pandemic will lead to great disappointment. Not that we can afford to be complacent in Scotland. I do not intend to scaremonger, but we must consider the potential drawbacks to the measures that we are taking or which have been suggested.
We are waiting for a vaccine to be developed that gives protection against H1N1. Work on that continues apace, but it will take many months, and then we will face the not inconsiderable difficulties of producing the vaccine in big enough quantities for it to be useful, and administering it. By that time, the virus might have mutated into a version against which the vaccine is not as effective, although I accept that that is unlikely.
We can provide antiviral drugs such as Tamiflu and Relenza. Roche, the manufacturer of Tamiflu, tells us that it has the potential to decrease the likelihood of flu or to shorten an episode by an average of 1.3 days if it is taken within 48 hours of the development of symptoms. The preparation inhibits the protein neuraminidase, which is found on the surface membrane of the influenza virus and facilitates its multiplication and spread. The hope is that the inhibition of that protein will confine the infective virus to the host cell and prevent it from spreading elsewhere. However, the manufacturer says that the drug has not yet been shown to reduce the incidence of hospitalisation or morbidity, and its effects on new viruses on the block such as H1N1 cannot be predicted.
There is another concern about relying on antivirals during a pandemic. If large swathes of the population are ill or isolated as contacts, can we confidently predict that our supply and distribution chains for antivirals will work effectively? Not only will some personnel who service those chains be off work, but others might well shy away from exposing themselves and their families to increased danger when a virulent flu virus is rampant.
We can wear face masks and pay careful attention to hygiene. The latter is good basic practice to prevent the transmission of all sorts of diseases, but the jury is still out on face masks, as the pores are big enough to allow viruses to enter, and the disposal of sodden masks presents a problem. One rather cynical observer stated that the only purposes of wearing face masks are to prevent transmission by kissing and to mask any signs of panic on the clinician's face.
Do we have we the facilities and staff that we would need to cope with a major, virulent pandemic? As Helen Eadie said, does any nation have them? The patient in Glasgow needs intensive care treatment. Would we have the skilled staff that we would require if there was a bigger number of such patients? We hope that the H1N1 variety of influenza will not mutate into something more terrible and that the cynics will laugh, as they did when excitable experts warned of catastrophe on a huge scale because of severe acute respiratory syndrome—SARS—and new variant CJD. We must strike the right balance between making cautious preparations and forecasting inevitable doom, like Private Frazer.
Unlike in many previous health scares, the World Health Organization is taking a positive lead, although inconsistencies abound. Holidaymakers who return from Mexico are greeted by relatives in Britain but by masked and gowned airport staff in Tokyo. Egyptians are hard at work slaughtering pigs even though the disease, at present, is transmitted from human to human. There is uncertainty about whether immunisation against influenza last year will give any protection against H1N1. It might give some, but we just do not know.
Here at home, I am not a huge fan of NHS 24 in general, but it makes sense to make full use of that organisation rather than advising those with symptoms and the worried well to cram into their nearest GP surgery and risk spreading viruses to those who already have other illnesses. That is already happening in other countries.
As with so many other threats today, we have to learn to live with uncertainty. Our Government is making the best possible preparations, and for that we should be grateful. The truth is that, despite the huge advances in medical knowledge in recent years, we do not have all the answers to flu pandemics and we probably never will.
- Rhoda Grant (Highlands and Islands) (Lab):
It is fair to say that the public are at best bemused by the flu pandemic. At first, there was fear about what was happening, but people are now almost annoyed that their worst fears have not been realised. We should be delighted about that. I am sure that it is due to a number of factors, including the time of year, the steps that our Governments have taken to manage the spread of the virus, and the work of our health professionals.
However, there are issues of concern and confusion. Why were people not told when they might have come into contact with people at concerts or on aeroplanes? What is close contact? Why have some passengers been traced while others have not? I dare say that the episode is a learning curve, but we need to be clear about the lessons to be learned so far and ensure that that information is in the public domain. Although this debate might not appear to be the timeliest, it gives the opportunity for that information to be aired and put into the public domain.
People need to be able to understand what has happened, what difference the management of the outbreak has made and what precautions they should take for the future. For example, why, as we have been told, could the virus recur later in the year with very different consequences? We need clear information to ensure that people do not become blasé about the threat and relax their vigilance during a subsequent outbreak.
I will concentrate on how remote and rural areas will be served during an outbreak. The Government has suggested that people organise a network of flu friends, made up of neighbours who would get shopping and medicines for those affected. In an urban area, that might mean just a quick run down the road, but in rural areas, it requires a much greater time commitment. After all, shops, GP surgeries and pharmacies can be many miles away. In fact, for those who live on some of our islands, a ferry trip can be required. Although neighbours in rural areas tend to go the extra mile, I am not sure that the flu friends proposal will always be such a practical solution.
Indeed, Jamie Stone highlighted concerns about "sparsity and distance" with regard to NHS Highland; the health board says that it is looking at the issue but, as far as I can see, no one has found a solution. We must find ways of distributing medicines quickly to remote areas and of ensuring that there are sufficient medical professionals to administer them when required.
At today's meeting of the Health and Sport Committee, we considered a statutory instrument that will relax the regulations on medicine storage if we happen to find ourselves in a pandemic. However, as Mary Scanlon has pointed out, the press at the weekend reported concerns about the storage of vaccines. Has the issue been resolved, and will it have any impact on the availability of vaccines and medicines in a flu outbreak? Are there special conditions for the storage of vaccines and Tamiflu? If so, is the Government satisfied that they can be met in enough locations?
Given that medical professionals in rural locations have to cover very large geographical areas, have plans been drawn up to deal with the real challenge of finding replacements if they fall ill? Moreover, a lot of staff time in rural areas is being taken up with travelling to and attending planning meetings. We need to find ways of spreading information that do not require taking staff away from their day-to-day work.
Other public services face the same challenges. For example, the home care staff who deal with vulnerable people need to have their roles carefully considered as part of those plans; after all, if carers fall ill, vulnerable people might be left without a lifeline. We need emergency provision to ensure that that does not happen.
We also need to consider the role that home carers, who often have several clients, might play in spreading the virus to vulnerable people. What training have they received in preventing the spread of the virus, and what support is in place to ensure that they have the information that they need? Furthermore, although most home carers are employed by local government, that is not always the case, and we need to be able to reach those who work only for private clients.
We also need to consider the many other public services that involve contact with a large number of people. Will front-line staff and people who work in jobs where they are likely to come in to contact with people be treated differently from the majority of the population? For example, because they come into contact with a lot of people, those who work in our transport system must be more vulnerable to infection than others and more likely to spread the virus. When a vaccine becomes available, will those people be given priority? Indeed, will people with chronic illnesses also be given priority? The general public need to know the answers to those questions if they are to be prepared for any deterioration in the situation. Dealing with a real situation over a long period of time will show us where our systems are working and where they need to be updated and changed.
When the outbreak has passed, we will need to scrutinise fully what has taken place and learn from it. In the meantime, the most vulnerable in our society and the front-line staff who deliver public services must be protected if the outbreak escalates. I hope that in her summing-up the Minister for Public Health and Sport will clarify some of the issues that I have raised.
- Nigel Don (North East Scotland) (SNP):
I come to the debate knowing very little about anything medical. Basically, I know that people should keep themselves as fit as they possibly can, as doing so is probably the best defence against most of the things that might come their way.
As I tend to do quite often, I would like to follow Ross Finnie in developing some thoughts about civil contingencies and what we have to do as a society. I will come at those matters by reflecting on what NHS Grampian has been up to, as it has been good enough to tell me. I have a report that I think will be considered by its board—or its operational management team, at least—this afternoon.
I detect several things in the report that I would like to share with members. It states:
"At Phase 5, Health is lead agency."
It is known who is in charge. The strategic co-ordinating group is chaired by the board's chief executive. The individual concerned—Richard Carey—knows that he is in charge. The report says:
"The responsibility for the overall tactical coordination of the response is delegated to the Director of Public Health".
Again, it is entirely clear who is responsible.
The report continues:
"In the weeks since the implementation of the Pandemic Plan, a high level of activity has resulted from the need
to respond to reports of possible and probable cases;
to establish control room functions;
to communicate across the NHS …
to respond to and communicate guidance developed by Health Protection Scotland;
for all sectors and cross Grampian services to implement and review the readiness of their plans;
to review plans for antiviral distribution."
NHS Grampian has done those things. In other words, it has stopped and thought about what it will have to do in the future.
The board has also considered the risks and recognised that the risk aspects
Public Health management …
Travel and Port Health
Operational preparedness of NHS Grampian Sectors
Monitoring stock and access to antivirals
It has considered the control room and—crucially—NHS Grampian workforce issues. I would like to develop that point.
It seems to me that, over the past few weeks, the health professionals have got themselves organised. I do not say that in any disparaging sense. They have seen that they not only need to respond as health professionals, but need to know how to respond when life gets tough.
I have doubts about whether the wider community is getting on board. I am pretty sure that the NHS knows how to respond if 20 per cent of its staff are affected and off work, and I am quite sure that people in the public emergency services—the police and the fire brigade, for example—have thought about the same issues. They will have an emergency plan. I am also pretty sure—although I would not guarantee this—that every one of our 32 local councils has at least thought about the same things, although they may have thought that they will worry about them when they get there. It would be nice to be reassured that local councils really have thought their way through such matters, although it is hardly fair to ask the cabinet secretary for reassurance on that wider issue.
How is the business community responding? That is not the Government's problem, but it could quickly become a collective problem. The point has already been made that quite a lot of parents will be at home if a school has been closed or a couple of schools have been closed, and that that will have a knock-on effect in other areas of public service. I am grateful to Rhoda Grant for making the point that those in the transport business are more likely to have contact with the general public. What will happen if half the buses are not running? What will happen if the drivers or conductors are simply not available? Somebody somewhere needs to be thinking about those questions. What will happen if the trains simply cannot run because there are not enough signalmen to keep them running? I am not scaremongering; I am talking about contingency planning, which is quite straightforward.
People in businesses are probably thinking about such things. However, is the wider business community thinking about what will happen if the post does not arrive, the goods that have been ordered from suppliers simply do not get to people, or a third of the staff simply do not turn up for work because they are ill or cannot get in? I wonder how many businesses have seriously thought through such matters. I suspect that the really big businesses have probably done so—I used to work for a really big business—and that one-man bands probably have done so. One-man bands know that they will simply have to soldier on.
However, I suspect that most of those in the middle are too busy trying to survive the downturn in business to give thought to the matter. Therefore, my question for ministers—this is not quite the portfolio of the health ministers, but I ask them because they are in the chamber, on the front bench—is whether the Government is taking the opportunity to communicate to the wider community, and the wider business community in particular, the need to carry out some contingency planning. All businesses need to think this through.
We all hope that this one will go away—we have heard all sorts of comments about whether the second wave will be worse, although the truth is that we do not know—but we know that the current outbreak might be a trial run for an epidemic or pandemic of some proportions at some stage. Therefore, all the contingency planning that people can do would be well done now. Given that life might get quite difficult through the winter—although we all hope that it will not—now would actually be a very good time for small and medium-sized businesses to carry out the contingency planning that they might not have done so far.
- The Deputy Presiding Officer (Alasdair Morgan):
We move to wind-up speeches.
- Ross Finnie:
We have, very properly, had a thoughtful debate. Scotland has been part of a worldwide outbreak of H1N1. Thankfully, the outbreak has not developed to a great extent but, to the extent that it has developed, things have by and large been dealt with effectively and efficiently. It is right that Parliament should in no sense give any hint of complacency to the general public but, on the other hand, neither must we exaggerate the situation or contribute to any uncertainty. Nevertheless, despite all the many and varied speeches this afternoon, we are still left with the conundrum that is posed in the briefing that Mary Scanlon quoted from, which references the WHO high-level consultation of 18 May:
"the only thing certain about influenza is that nothing is certain".
Try hard as we might to remain calm, collected and focused on the task in hand, any influenza outbreak remains a very considerable challenge.
It is interesting indeed that the two doctors in our midst, Dr Richard Simpson and Dr Ian McKee, both raised issues that, without in any sense giving cause for alarm, drew on their extensive experience of having to deal with such outbreaks. They pointed out the extent of the conundrum that is posed by the fact that nothing is certain with influenza. I regret to say to them both that, despite their excellent attempts to explain the issues to me, I remained deeply uncertain when each of them closed his respective remarks. Perhaps that was their intention, but in any event their thoughtful and helpful speeches highlighted the extent and nature of the problem.
In the context of a debate that seeks to address how we in Scotland respond to the outbreak, it was right and proper that both Helen Eadie and Ian McKee gently reminded us that, as in all things, those who are most vulnerable and at risk suffer the most when there are problems and trouble. In this case, those in the underdeveloped countries are more likely to be attacked if the outbreak develops at a much greater pace. Therefore, we have a duty not only to share our knowledge and experience within the United Kingdom but to ensure that our Government contributes to greater worldwide efforts to ensure that all such information is shared. Given that we have some experience of the early development of the virus, there must be a way in which we can at least contribute to that process.
However, the general thrust of the debate has been simply to consider the extent to which our contingency planning has been tested to date and to examine both what lessons, if any, might be learned and what outstanding issues have emerged in the outbreak that require further consideration, given that the only thing certain about this uncertain influenza is that it will probably return in a worse form.
The debate has been helpful. We are not many weeks away from the summer recess. We are not looking for great advances, but we and, I suspect, many others would welcome the cabinet secretary reporting to us by some mechanism, possibly in the recess, her assessment of where the current episode has taken us and where she needs parliamentary support to develop other measures.
Our current policy of targeting antiviral prophylaxis has to be assessed; we have to be able to take account of it. Some members have mentioned access to diagnostics. My point was that benchmarking makes that difficult. It might be a question of trying, in conjunction with the other UK authorities, to increase existing capacity, rather than suggesting that we can replicate it, which would be difficult.
As Dr McKee said, we must participate in the development of an effective vaccine against H1N1, but we must be cautious, because that will not happen quickly. We should not try to suggest that it will solve the problem entirely.
The debate has been helpful. It has raised issues for further reflection. It has also allowed us an opportunity as a Parliament to express clearly where we believe we have got to. We are extremely concerned by the latest case in Glasgow, which is worrying, and we all share the cabinet secretary's concerns for the individual and their family. Nevertheless, by and large, the current phase appears to be broadly under control. Given the great uncertainty, we must be vigilant. We must reflect on this current phase. Should anything return in the autumn, we must be even better prepared then.
- Jackson Carlaw (West of Scotland) (Con):
Given that this is the first full health debate since the Easter recess—I make no complaint about that, given that I felt like I was in possession of a weekly season ticket in the term before that—during which I turned 50, I thank the cabinet secretary for the communication that I received from her. It was not all that I had hoped for, given that it was an invitation to present myself for bowel cancer screening but, nevertheless, it was gratefully received. I confirm that I will take up the invitation and, once again, I encourage all members to do all they can to encourage Scotland's male population to take their health seriously and to take advantage of the screening opportunities that are designed to save their lives whenever they are offered.
The debate follows various statements, all of which the Government has addressed competently and pretty comprehensively. Scotland's unenviable position in finding itself host to the first UK instances of the virus had the unforeseen consequence of catapulting the cabinet secretary's daily briefings to the screens of 24-hour news channels worldwide. I am told that there were even calls from around the globe for her to become health secretary for this or that nation. That is a prospect to contemplate, although I suspect that the cabinet secretary will resist the opportunity to have her head turned. I trust that, in days to come, she will not lament the passing of these dizzying heights of international fame. However, I congratulate her on setting a tone of calm and authority, which we can all be satisfied has been followed largely by the media and the public.
We can contrast that tone with the rather lurid hysteria that accompanied the previous avian flu outbreak, when rather alarmist and apocalyptic visions dominated media coverage. Although they certainly attracted the public's attention, they did rather less to enhance public understanding. In any event, today it is avian retreats—bird-houses—rather than avian flu, that occupy the favours of media attention. The contrast is important because, as we watch the outbreak progress, witness our reaction to it and measure the response of everything that we have put in place to deal with it, we can be quietly pleased at the collective efforts of all those who have been responsible for preparing the ground.
Mary Scanlon quoted the Royal Society of Edinburgh earlier. I was struck by this observation in its briefing:
"The current events in Scotland … are providing a real life test of plans for pandemics and it is crucial that we learn from it. Never before has the importation of a new influenza virus been studied so early in its progress and in such detail and with so much media attention. The targeted use of antivirals is new. It is also crucial that when the current outbreak subsides both the science of the outbreak and the response by international agencies and governments are reviewed in detail."
Although there are around 13,000 cases worldwide today, the overwhelming majority remain centred on one continent. It seems that, in preparing for a pandemic, we have done much that is required. However, the debate has illustrated the strong will of all participating to avoid any complacency, learn the appropriate lessons and improve further our response plans.
Richard Simpson brought his professional experience to the debate, with a comprehensive narrative and a series of well-informed questions, including points on diagnostic testing that were also raised by Mary Scanlon. She and Richard Simpson asked sensible questions regarding the possible reliance on one antiviral, Tamiflu.
Ross Finnie made a thoughtful speech on funding, on which we need to reflect.
Ian McKee posed a query on how the distribution of antivirals might be sustained if large numbers were affected, including those who are doing the distributing.
Mary Scanlon asked a number of important questions regarding the preparation of antivirals and vaccines, should there be a recurrence later in the year.
As the Royal Society of Edinburgh points out, there would need to be the much wider infection rate that we are doing so much to prevent for any recurrence to be classed as a second wave. However, we must prepare for eventualities and it would be useful to know how the cabinet secretary's observation that the flu appears to be affecting those who are not typically in the priority vaccination groups will be reflected in any vaccination programme, given that those people are not the people who might expect to be invited to present themselves for vaccination.
There has been no absence of candour or information throughout this episode. All parties and the public have been kept well informed. However, there is some concern that local health boards have been slightly less comprehensive in the information that they have disseminated. As Jamie Stone noted, it is important that general practitioners are closely involved. Candid, honest, calm and regularly delivered updates have enhanced the authority of those in charge in the public's minds—a lesson that might be learned by others, including some health boards that are less disposed to such an approach.
NHS teams have prepared and coped well, and we can be proud of them. A fortnight ago, I visited the Vale of Leven hospital with my Westminster colleague Andrew Lansley so that he could learn lessons at first hand following the Clostridium difficile tragedy there. I can confirm that the hospital has made spectacular progress in implementing the investment recommendations that were made. However, the teams on the ground were talking about their preparations for any H1N1 outbreak, and were keeping a close watch on events across the water in Greenock. We can all be impressed with their attention to detail and willingness to respond as required.
Stuart McMillan remarked on the response of a community at the centre of the outbreak, and congratulated those people on their forbearance, in which tribute I happily join him.
As an Opposition party, we have a responsibility to examine the conduct of the Government and question progress that is made. In so doing, we will assist in ensuring not just that this outbreak is dealt with effectively but that lessons are learned to improve further on plans that are already widely regarded as being well prepared and effective.
It is also our responsibility to offer support to the Government and ministers as they seek to map a route through the issue. We have been happy to do that, and we particularly welcome the easy relationship and willing partnership that have developed in this area between the Scottish Government and Administrations throughout the UK.
It might be a relative expression, especially to those who have been affected, those who are currently suffering and those who are at risk, but so far, so good.
- Cathy Jamieson (Carrick, Cumnock and Doon Valley) (Lab):
I would like to associate myself with the comments that have been made about the hard work and dedication of NHS staff and all the other staff who have been involved in tackling the outbreak.
The debate has been interesting and useful. When I first learned the subject of the debate, I wondered whether we might all just say pretty much the same thing. Common themes have been brought out during the afternoon, such as issues to do with the science of the possible pandemic, civil contingencies and the health service's preparedness and ability to respond, and I will pick up on a few of those points.
One theme has been the importance of not overreacting. I think that everyone recognises that, in dealing with the situation, the Scottish Government has not overreacted; we have been given information and the opportunity to participate. That perhaps contrasts with what happened during the avian flu outbreak. The Cellardyke swan incident remains imprinted on my memory, as I am sure it is on Ross Finnie's. Any "hysteria", as it was described, around the avian flu outbreak was certainly not for want of trying on Ross Finnie's part. He was a model of calm in trying to ensure the right response. If a slightly wrong approach were to be taken, however, we could again find ourselves in a very difficult situation.
The danger is that, in trying to strike a balance in any crisis situation, ministers get no credit. If there is no disaster, they are accused of having overplayed the dangers in the first place and, even if they do everything by the book, they get the blame if something goes wrong. Nicola Sturgeon has been in politics and—indeed—government for long enough to know all that, so I do not need to labour the point.
We should take comfort from the fact that we are still in the containment mode, particularly given that the planning assumptions were of a more aggressive and virulent strain of flu leading to a pandemic and of a much shorter timescale—perhaps only a few weeks—from containment to mitigation and dealing with the consequences. However, as many members said, we cannot be complacent. As we heard in the debate, there are concerns that the virus will return in a more aggressive form later in the year. We must be vigilant and prepared for that. Again, evidence suggests that, even though those who are most likely to be affected are younger than is traditionally the case with flu outbreaks, there is no saying what will happen in the event of a recurrence of the virus. Of course, if a further outbreak were to coincide with normal seasonal flu pressures, there would be an impact on health service and services for the elderly in particular. We would have to be prepared for that.
A number of members commented on the impact of an outbreak on rural areas and the need to ensure not only the availability of drugs and medical treatment but the provision of care, particularly, though not exclusively, for our elderly population. Rhoda Grant highlighted some useful points in that regard. When we think of a pandemic that affects the elderly, we tend to think about the impact of an outbreak in the care home sector. Nowadays, however, many elderly people live in their own homes and are absolutely reliant on carers. It will therefore not be enough simply to line up the medical professionals to deal with their part of the picture if social services, the voluntary sector and everyone in the community are not prepared to play their part in the process. As we heard, part of the preparation lies with Government and health agencies. They have to ensure that the necessary equipment, training and resources are in place and that partner agencies and, to an extent, the public are involved.
Nigel Don made a particularly thoughtful speech. He talked about the responsibility of the emergency planning authorities that are put hard at work to ensure that all the contingencies are covered. He also spoke of the business community, some members of which may have the outbreak on their radar but have not put in place any detailed planning.
The Government needs to strike a balance in planning for a pandemic. On the one hand, it must not go overboard and ask everyone to cross every t and dot every i but, on the other, it must not let people become blasé and think that, because the outbreak has not gone the way that everyone feared, it might not happen at all. If people become blasé in that way, they might do nothing by way of preparation. Another member mentioned that.
A number of points were raised in the debate. I hope that the Minister for Public Health and Sport will answer them in her summing up. For example, have changes been made to the planning process and the planning assumptions based on experience so far?
Particular issues were raised about improving access to rapid diagnostic testing. As we have heard, that is not simply a case of setting up another laboratory; nonetheless, if the pandemic were to arrive, as we fear it might well do, how will that matter be dealt with?
There are also issues to do with the supply of antivirals. We have heard discussion this afternoon about whether we should be focusing only on Tamiflu. Is there a case for considering Relenza or other options?
We need further debate and discussion on the issue of priority groups for vaccination, if and when the pandemic arises. I know that the cabinet secretary will wish to keep us all up to date about that.
In her opening speech, the cabinet secretary mentioned the setting up of the web-based and telephone-based system, and the need to ensure that the flu line would be there to provide information for people. That sort of information cannot be given out often enough in advance of a situation arising, when people have to use it. The information will not be on the public's general radar if it is not put out into the public domain time and again.
When planning for the future, it is important that we have some idea of what will happen with schools and other public services in the event of a pandemic. It is not simply a case of schools closing and the associated issues around what happens to pupils and children; if young people are going to be out of school or college for an extended period, what knock-on effect would that have on their overall education, exams and so on?
There are serious issues to be addressed regarding civil contingencies, and there are big decisions to be taken regarding prisons in the unfortunate event that something happened that meant that we had to consider the steps that were required for the prison population and for those who work in prisons.
I hope that, in the weeks ahead, the cabinet secretary will be able to pick up on the points that Ross Finnie and other members have raised about keeping Parliament up to date. It has been useful to have had the opportunity to participate in discussions. I also hope that the cabinet secretary will send a message to health boards that they need to be slightly more proactive in engaging with their local MSPs. A number of people have said that they have needed to go and look for information from health boards. It would be useful to get the message out that it would be helpful if, in managing the process, health boards kept local MSPs up to date on local plans.
We will be supporting the Government motion today—we have no reason to divide the chamber. There are some difficult questions and decisions ahead, however, and we look forward to further discussion on them.
- The Minister for Public Health and Sport (Shona Robison):
I thank everyone who has contributed to the debate, which has been good and constructive. It is clear that the Scottish Government cannot tackle an influenza outbreak, a pandemic or any major emergency, on its own; dealing with such an event requires effective joint working with a wide range of partners. We need to work closely with those partners, and we are doing so through the eight strategic co-ordinating groups, with the key principle of integrated emergency management.
Over the past four weeks, the arrangement has worked very well. Local agencies have risen extremely well to the challenges that have been presented by a fast-moving and unpredictable set of circumstances and we have seen the benefits of strategic co-ordinating groups, which have been working collaboratively. The existence of the groups has made communication so much easier. We have been able quickly to identify, discuss and resolve a range of questions on an on-going basis.
Following the events of the past month, Scotland has achieved a high state of readiness for dealing with the worst effects of a flu pandemic. We are acting now to ensure that we maintain that state of readiness over the coming months. For example, we are securing supplies of vaccines. We want to procure as much vaccine as possible to enable us to start a vaccination programme as soon as we can. Perhaps more important, however, is the fact that we have had the chance to test out the country's preparedness. We will learn from that experience so as to be even better prepared for future flu outbreaks.
We have put in place enhanced co-ordination arrangements, to lead and co-ordinate planning for a possible pandemic later in the year. The arrangements will be informed by and take account of the developing scientific analysis of the A(H1N1) virus and assumptions about prognosis, risk assessment and planning.
Our links with stakeholders will be key to collaborative working during the coming months. Although our work is not yet over, I thank stakeholders whole-heartedly for the efforts in all sectors of Scottish life that have enabled us to work together so effectively. I reassure Nigel Don that we have been in contact with the business community. Preparations by councils are well advanced and councils are involved in local emergency planning groups. The Convention of Scottish Local Authorities has joined us at national emergency planning group meetings. We have done as much as possible to ensure that all key stakeholders have been involved and are at a good state of preparedness in their plans.
I visited NHS Tayside's pandemic control room at King's Cross hospital on 8 May, to learn about local preparations for a possible flu pandemic. I was impressed by the effort and rapid response of everyone who is involved in the multi-agency team.
We have worked closely with the other Administrations in the UK. That has allowed us to keep in close touch with developments throughout the UK and enabled learning about processes and science to be shared quickly among the four countries. However, we have based our decisions on the best outcomes for the people of Scotland.
So far, the symptoms have not been too severe in most cases, but we need to remember that they can be severe for a person who has an underlying medical condition, as appears to be the case with the patient in Glasgow. I can inform the Parliament that in the past few minutes the probable case in Glasgow has been confirmed positive for H1N1. We cannot afford to be complacent.
At local level there has been the temporary and precautionary closure of a primary school and a nursery in Greenock. We acknowledge the potential for disruption when schools are closed but we are confident that local decision makers based their decisions on the expert advice that was available. Although it is still early days, the measures appear to have reduced the potential for contact spread.
I will talk about issues that have been raised and I will write to members about matters that I do not deal with. Richard Simpson asked too many questions for me to be able to respond to them all in my speech, but I will write to him. On the worldwide research effort, Scotland inputs data to the Health Protection Agency, which in turn submits data to the WHO. The collation of information worldwide is important in enabling us to understand as much as possible about the virus. This afternoon, a research meeting of the scientific pandemic influenza advisory group took place. Scotland is a partner in the group and our chief scientist office will share developments with Scotland's research fraternity.
Mary Scanlon asked about discussions with the farming industry. The chief veterinary officer for Scotland has been closely engaged in discussions. Communication has been important, to ensure that key stakeholders, including the farming community, are as informed as possible.
I welcome Ross Finnie's helpful comments about access to Treasury funding for vaccine procurement and about the precedent in relation to foot-and-mouth disease. We welcome his support in that regard.
Helen Eadie asked about travel advice. We encourage people to use the Foreign and Commonwealth Office website, which gives the most up-to-date travel advice. The FCO is best placed to provide such advice.
To assist with communication, a new pandemic preparedness planning team is being set up in Government, to co-ordinate our response, support responders and facilitate the identification and resolution of difficult issues. I hope that that provides Nigel Don with the reassurance that he sought.
The Edinburgh and Glasgow virus laboratories are completing validation work in conjunction with the Health Protection Agency's internationally recognised virus laboratory. We expect that to allow them to confirm H1N1 samples after 1 June—if the validation work completes satisfactorily. I hope that that responds to Cathy Jamieson's point about setting up another laboratory.
Many other issues have been raised—too many for me to respond to now, but we will try to respond to some of them in writing.
Scotland has shown itself to be ready to cope with an emergency. I commend the pace and willingness of all those involved, across a wide range of agencies, in dealing with the influenza H1N1 outbreak. It has also been helpful for the Government to have the support of other parties. We have tried our best to keep the other health spokespeople informed of developments. We will continue to do that and we welcome their support for the measures that we have taken.
I encourage local health boards to keep local MSPs as updated as possible, although I am sure that members realise that the priority for health boards must be getting their plans in place, ensuring that everything is done that must be done and ensuring that communication is accurate. I am sure that they will be able to respond to local MSPs' requests to be kept up to date as much as possible, but I ask members to bear in mind the fact that the situation is fast moving.
I thank all members for their speeches. We will respond to their specific points in writing in due course.