Influenza A(H1N1)
Good morning. The first item of business is a statement by Nicola Sturgeon on influenza A(H1N1). The cabinet secretary will take questions at the end of her 10-minute statement, so there should be no interventions or interruptions.
I am grateful for the further opportunity to update Parliament on the current situation in relation to the A(H1N1) flu virus.
As of this morning, the World Health Organization reports that 27,737 cases of H1N1 have been officially reported across 74 countries. Some 2,500 of those cases have been reported in the past two days. There have been 141 reported deaths in five countries. A total of 797 cases have been confirmed in the United Kingdom; a third of those cases have been in Scotland. As of yesterday, there were 311 confirmed cases in seven health board areas in Scotland and 522 possible cases. We have no probable cases at this time.
The WHO's pandemic alert level remains at level 5, but in light of sustained community transmission in countries outside North America—most notably in Australia—it is likely that level 6 will be declared later today following the WHO's emergency committee meeting at 10 am in Geneva.
Members should be aware that a move to level 6 is not a verdict on the severity of the virus. It does not mean that the WHO thinks that the virus has become more serious; it simply means that the extent of its global spread now fulfils the definition of a pandemic. A move to level 6 means that countries need to be ready to implement pandemic plans immediately. However, it is important to stress that, as we are already operating at a heightened state of readiness, a move to level 6 will not trigger any material change in our response.
As I made clear in the statement that I made on 14 May, a move to level 6 may mean a change in the schedule for delivery of the H1N1 vaccine that we are now procuring. Level 6 would activate pre-existing contractual arrangements for securing pandemic vaccines and would cause adjustments to worldwide vaccine production timetables, which would mean that the UK receives supplies over a longer timeframe. We have, of course, factored that change into our contingency planning.
We have seen a rapid increase in the number of confirmed cases in Scotland over the past 10 days. Based on that experience, Health Protection Scotland has expressed the view that sustained community transmission appears to be taking place. The data are being shared with the Health Protection Agency for analysis on a UK basis.
The highest numbers of confirmed cases so far are within the 15 to 24-year-old age range. There has only been one reported case involving someone over the age of 65. Of the 311 confirmed cases in Scotland, 18 people have been admitted to hospital for clinical reasons. That gives us a hospitalisation rate that is broadly in line with that in the United States. Five people have required management in an intensive care or high-dependency unit. Two of them are critical but stable; the other three are stable. I emphasise that although a small number of people, most of whom have underlying health conditions, are developing complications, it is still the case that the vast majority of people contracting the virus are experiencing relatively mild symptoms.
We are still working hard to disrupt and slow the spread of the virus. That policy has been successful in limiting its transmission over the past six weeks. In areas in which there is only a small number of isolated cases, the current level of containment will continue to be appropriate, but where more sizeable clusters arise and there is evidence of community transmission—such as we have seen in Dunoon, Glasgow and Paisley—our current approach of tracing and offering prophylaxis to all close contacts becomes less effective. In addition, because it involves giving antivirals to very large numbers of people, many of whom will not be ill, the risk of the virus developing resistance to Tamiflu increases. Yesterday's meeting of COBRA—Cabinet Office briefing room A—therefore agreed a number of refinements to build more flexibility into our approach and better target the measures for containing the virus towards those who are at greatest risk. Those refinements will now be applied in areas of the country in which they are deemed to be appropriate by public health assessments. They include, first, the use of clinical diagnosis, rather than laboratory testing, where there is a high probability, due to close contact with confirmed cases, that symptomatic people are positive; secondly, continued antiviral treatment of all those who have the virus but more targeted use of antiviral prophylaxis, based on local risk assessment and limited to contacts considered most at risk of contracting the virus—in practice, mainly household or household-like contacts, or, in a school context, those at surrounding desks; and thirdly, the restriction of contact follow-up to those most at risk.
Decisions to close schools will continue to be taken on a case-by-case basis, following robust risk assessment and advice from public health officials. As of today, 15 schools and nurseries across the country are either closed or partially closed; of those, seven are fully closed. I take this opportunity to extend my and Fiona Hyslop's appreciation to education departments and staff for their hard work in managing the situation at affected schools and nurseries, and to parents for their understanding and co-operation.
The refinements to our containment strategy are based on expert advice and are appropriate to the reality of what we are dealing with now. However, there will come a point at which even that more flexible approach to containment will no longer be effective and the focus will shift from containing the spread of the virus to mitigating its impact. That mitigation phase has always been anticipated in our pandemic plans. Significant preparation and further planning for it have been carried out in recent weeks, involving health boards and NHS 24.
I will now touch on a number of issues relating to national health service preparedness. In my view, health boards across the country have dealt exceptionally well with the outbreak so far. NHS boards have built on their winter, pandemic flu and business continuity plans. Next week, as part of that routine planning, NHS board chief executives and chief operating officers will meet officials to discuss planning for the coming winter. In particular, they will consider what lessons have been learned from the outbreak of influenza A(H1N1) so far and how we can best plan for potential escalation, if that is required.
In addition to the work of territorial health boards, it is important to remember that, since the first cases of swine flu were confirmed in Scotland, NHS 24 has dealt with a significant increase in the number of calls to its core out-of-hours service, including the dedicated flu line. Last week, when further cases were announced, there was an increase of around 30 per cent, on average, in the number of calls to NHS 24. I am pleased to report that NHS 24 has coped extremely well with the rise in call demand, with more than 98 per cent of calls being answered within 30 seconds and an average time to answer of around four seconds.
The most recent development has been the setting up of the Scottish flu response centre, which is based at NHS 24's Cardonald contact centre and works in conjunction with Health Protection Scotland and health boards across the country. The centre has been established to help us deal with developments in the spread of flu. It will provide vital information, advice and reassurance to the public and to health professionals who are concerned about the virus and how it may affect them.
Finally, I will touch on wider preparations. The effects of a pandemic have the potential to have a wide-ranging impact, even if the symptoms continue to be no more serious than those of seasonal flu. Many agencies are already well prepared to deal with those effects, but we are continuing to work with our partner organisations to enhance further their levels of resilience. We are working closely with Scotland's eight strategic co-ordinating groups to ensure that the emergency services and other members of the groups are working together to refine their arrangements. Although we are in regular contact with the groups, we will host a specific meeting on 24 June to take stock of progress and to address any specific issues that have arisen. Colleagues will be aware that a pandemic has the potential to put some sectors under considerable strain. Under some scenarios, maintaining business exactly as normal will not be practical. To anticipate such challenges, we are continuing, in partnership with other Administrations across the UK, to ensure that our planning takes account of any possible eventuality.
The recent rapid increase in the number of cases in Scotland has undoubtedly put increased pressure on health and local authority services. I take this opportunity to thank all staff working in front-line services—including general practitioners, nurses, doctors, teachers, social workers and social care staff—for all of their efforts in tracing, treating and caring for those affected by the outbreak. I assure members that I will keep Parliament updated on any further developments.
The cabinet secretary will now take questions on the issues raised in her statement. We have exactly 20 minutes for such questions, after which we must move on to the next item of business.
I thank the cabinet secretary for her statement and for the regular briefings that she and the chief medical officer have provided. I also add my thanks to all the staff who have been involved in dealing with the situation so far.
With the move to a level 6 pandemic anticipated imminently, we are clearly in a new situation. Notwithstanding the fact that all the available information suggests that the actual flu might not be as severe as perhaps had been feared, there is no doubt that the general public will be concerned by the change in the designation. What additional measures does the Scottish Government intend to take to give further information to members of the public to explain what the new level of pandemic means and how the situation will be dealt with?
I also want to ask about the Dunoon and Paisley clusters, where there have been concerns about the lack of any obvious traceability of some of the contacts. In essence, the situation is almost like a test run for dealing with such clusters. Will the cabinet secretary indicate whether any lessons have been learned from the operation of the procedures that might need to be picked up by other health boards as we move on?
Finally, given that we will now move to a situation in which clinical diagnosis rather than lab testing will be used in those clusters, how will the numbers continue to be recorded and reported? Are GPs, in particular, geared up for that change in the procedures?
I thank Cathy Jamieson for her questions and for the support that she and her colleagues have given us so far in this outbreak.
Cathy Jamieson is absolutely right that, if the WHO goes to level 6 today—which is not definite but is widely anticipated—that will take us to a new level. However, we should all stress that the move to level 6 is a statement not about the severity of the virus but about the extent of the spread of the virus.
Cathy Jamieson is also right that the emerging evidence suggests that—apart from complications in a minority of cases—the flu seems to be no more severe than seasonal flu. We must be cautious about that, as there is still a possibility of mutation. In addition, even if the outbreak is no more serious than seasonal flu, the impact might still be considerable.
First, on the issue of further information to the public, we all have a duty and an obligation to get measured messages across to people. As members would expect, I will certainly play my part in doing that. We are also preparing to rerun the pandemic flu advertising material from early next week. That has a twofold significance: first, it will help to reassure people about the stage that we are now at; secondly, and more important, it will get the message across to individuals throughout Scotland about the part that they can play in helping to minimise spread by adopting good hygiene measures, such as hand washing, and by following the appropriate advice. Cathy Jamieson should be reassured that we will continue to work hard to get those messages across to the public.
Secondly, the Dunoon and Paisley clusters—and, indeed, the cluster in Glasgow—were the first clusters where we began to see significant numbers of sporadic cases for which we could not trace the source. That is to be expected in any outbreak and has happened in other parts of the UK and elsewhere in the world. Clearly, the clusters in Dunoon, Paisley and Glasgow have had significant impacts, not least on schools in those areas. Lessons will continue to be learned. As I said in my statement, a key focus of the meeting with stakeholders on 24 June will be to take stock of experience so far to ensure that we have used those experiences as learning lessons for the future.
Lastly, we will move to using clinical diagnosis in some circumstances, although in emerging clusters it will clearly still be important to use laboratory testing to confirm the presence of the H1N1 strain. We will continue to report the number of confirmed cases and to put in place arrangements to ensure that the genuine level of infection can be tracked and reported. GPs, like other members of primary health teams and the rest of the NHS and wider society, continue to ensure that they are geared up to cope with whatever might lie ahead.
I thank the Cabinet Secretary for Health and Wellbeing for keeping the Opposition health teams informed of all the issues relating to swine flu, and acknowledge the excellent work that has been done by all the staff who are addressing the outbreak.
First, given that Scotland has 9 per cent of the UK's population and 30 per cent of the confirmed cases of swine flu and that we are likely to move from containing the spread to mitigating its impact, what additional resources are being allocated to NHS 24 to help it to cope with the increased calls? Secondly, will the clinical diagnosis be done only by GPs, or is there any other source that will act as assistance to GPs in carrying that out? Finally, given that we are moving to level 6, can I have an assurance that the distribution system in the Highlands is in place?
Taking the last of those questions first, I can reassure Mary Scanlon that, as a result of a considerable amount of work in recent weeks, NHS Highland and health boards across the country are prepared for the mass distribution of antivirals, should they be needed. We have in place a telephone and web-based system that is ready to go, should we need it. It will allow the public to access and be assessed for antivirals, and the systems for distribution are in place beneath that.
Mary Scanlon is right to say that Scotland currently has 30 per cent of all UK cases. We can speculate about the reasons for that. I do not want to overstate this suggestion, but it might be that we measure and count cases more robustly here than elsewhere. However, it is more likely to be the case that the reason is to do with the fact that, in any virus outbreak, clusters tend to appear in particular areas. In England, the bulk of cases are in one geographical area: the West Midlands. That tends to be how viruses spread, and I would not read too much more into that.
NHS 24 has taken care to increase its staffing complement to deal with the increase in calls. We also have the dedicated flu line and flu response centre that I spoke about in my statement. We will continue to ensure that NHS 24 continues to have the resources that it needs to cope with the outbreak.
It would be reasonable to assume that clinical diagnosis would be done principally, although perhaps not exclusively, by GPs.
I think that I have answered all Mary Scanlon's questions. If I have missed any, I will come back to her in writing.
On behalf of the Liberal Democrats, I thank the cabinet secretary and the chief medical officer for their continued updating of parties and their health spokespeople on this crisis. I associate myself with the remarks about the excellent work of NHS staff—they deserve our thanks. Last Friday, on constituency business, I visited the Cardonald NHS 24 centre, where the 24-hour flu line was being established. It was a very impressive operation indeed.
The cabinet secretary has consistently taken a measured approach to keeping the public informed. If we move to level 6, the public are likely to infer that that means that there has been an escalation of the problem. However, on good clinical advice, you are advising us this morning that the Government will be adopting a more targeted use of antiviral prophylaxis. How does the Government intend to advise the public that, even though the general information gives an impression of an expansion, the availability of prophylaxis will not reflect that? I am not suggesting that there will be confusion, but I think that there is a need for the public to understand better that change in approach.
Finally, although we are delighted that the actual nature of the disease is not developing, there are a number of warnings of its possible or potential return in the autumn. In that regard, and with reference to the cabinet secretary's planning, is she any closer to being able to advise Parliament as to the epidemiology of the virus?
Ross Finnie is right to say that a move to level 6 will be considered an escalation. In some respects, it is an escalation. It is a statement that the virus has spread to the extent that it fulfils the definition of a global pandemic. However, it is important to continue to stress that it is not an escalation in terms of severity, nor will it necessarily trigger an escalation in our planning, because we are already operating at a heightened state of readiness. In particular, our public health response on the ground will continue to be dictated by the extent of the spread that we observe in Scotland.
As I said in response to Cathy Jamieson, I and others have a responsibility to continue to ensure that we communicate messages in a measured way. Ross Finnie is right to raise the issue of ensuring that the public understand the rationale for changes in our strategy. Again, there is no single, simple way of doing that. We have to communicate the rationale through the media and our public advertising campaigns. Our public health teams on the ground are already working hard, and will continue to work hard, to ensure that the public are advised and reassured about the steps that are being taken and why they are being taken. There is no doubt in my mind that the changes and refinements to our containment strategy that I announced to the Parliament today are right. They are based on expert evidence and they will allow us to ensure that resources are targeted to best effect so that we continue, as far as we can, to minimise the spread of the infection.
The chief medical officer is far more qualified to answer the question on the epidemiology of the virus than I am, but some evidence is emerging about the age range that the virus affects, which tends to be younger rather than older people, and the fact that it is no more severe than, say, seasonal flu, although we have to be careful about that when we have people in intensive care. However, experts continue to study the virus closely, and the knowledge will continue to grow.
We move to open questions. We are very tight for time, so I ask for strictly one question per person, please.
It has been estimated that the cost of the H1N1 vaccine and of delivering it will be more than £100 million. What financial help will the Treasury provide to help the NHS in Scotland to meet that substantial additional cost?
As I think I said when I last reported to Parliament on the matter, we have budgeted for certain things that we had to do to prepare for a pandemic. Our clinical countermeasures—such as the stockpiles of antivirals, antibiotics and face masks—were budgeted for and will be paid for out of those budgets. We could not have budgeted for a vaccine or the things that we have to do when a pandemic appears. No Administration in the UK has budgeted for that.
In common with the Welsh Assembly Government and the Northern Ireland Government, the Scottish Government has written to the Treasury to ask for assistance with those costs from UK contingency funding. To date, we have not received a reply on that. We continue to seek constructive discussions on the matter and I will keep the Parliament updated.
I thank the cabinet secretary for her statement and the way in which she has kept members up to date in recent days.
One consequence of the statement is that, in cluster areas such as Paisley, routine laboratory testing will stop and antivirals will not be given to whole classes. I believe that we need to communicate specific, targeted messages to the affected communities.
Given that we now know that children are the spreaders of the virus in many cases, will the cabinet secretary commit to a specific, school-based campaign to ensure that the catch it, bin it, kill it message is discussed in every Scottish classroom when pupils return to school? Given that the only way in which one can heed that message is to have a handkerchief, will the cabinet secretary consider backing up that campaign with the supply of paper hankies in every classroom, in the same way that water fountains are found in schools, to ensure that we prevent the spread of the virus?
I thank Wendy Alexander for her comments. As someone who is suffering from a cold—I stress that it is a cold—I understand the importance of the availability of handkerchiefs. I will certainly pass that suggestion on and discuss it with Fiona Hyslop, the Cabinet Secretary for Education and Lifelong Learning.
Wendy Alexander is right to stress the importance of communication, particularly when the strategies that we are pursuing are, for the best of reasons, changing. As she would expect, I will certainly consider carefully what further communication is required, and whether it should be targeted at particular communities, to ensure that we get the message across.
I will also take away her suggestion about specific campaigns in schools on the catch it, bin it, kill it theme, although the generic advertising material is appropriate in schools, too. I have anecdotal evidence from my constituency and from family members that there is a heightened awareness in schools of the importance of such messages, but Wendy Alexander is right to say that children shed virus more easily than adults, so they are more likely to spread it. That is why we must ensure that such messages get across to a part of the population that is perhaps not as susceptible to hygiene messages as other parts of it are.
Will the cabinet secretary advise us of what further conversations she is having to encourage continued media restraint? There has been responsible reporting to date, and that will be important in the light of the WHO's anticipated level 6 announcement later today and the tactical changes in the containment strategy that she is planning.
It is tempting to get drawn into a debate about media restraint—I quite like that idea.
So far, the Scottish media have behaved extremely responsibly. They have reported the outbreak, as we would expect them to do—after all, it is a news story, and they should be reporting it—but they have managed to strike a good balance. I hope that they will continue to do that. I have had discussions with newspapers over the past few days about what might happen in the future as regards the development of the virus.
For my part, I will continue to do what I have tried to do from the outset, which is to put as much information as possible into the public domain so that people can draw reasonable and reasoned conclusions from it. After the statement, in anticipation of the move to level 6, I will go to brief the media at St Andrew's house in an effort to get across some of the messages that we have discussed. Jackson Carlaw is right to raise an important point.
I note what the cabinet secretary said to Mary Scanlon about the distribution of medication in the Highlands, but I would like to press her further on the issues of sparsity, distance and rural transport. What is her officials' thinking on what would happen if the disease were to strike the people who provide us with rural transport?
I am sure that NHS Highland officials would be more than happy to brief Jamie Stone and, indeed, Mary Scanlon and others on the specific plans that they have in place. Suffice it to say that I am satisfied that all boards are planning, in the context of their geographic and other circumstances, to ensure that they are in a position to distribute antivirals to members of the population who need them.
Clearly, the campaign for mass distribution of antivirals will be based to a large extent on asking ill people to stay at home and to send a friend or family member to get their antivirals for them. However, we recognise that that will not always be possible, so all health boards are putting in place plans to ensure that they can take antivirals to people who need them.
The cabinet secretary will appreciate that there is growing concern about front-line public service workers; indeed, NHS workers have disproportionately borne infection. Can she provide more detail on how such workers will be supported and, just as important, what steps have been taken to communicate that message effectively to such vital and valued staff?
As briefly as possible, please.
NHS workers have clear guidance about what they should do to protect themselves if they are in prolonged contact with people who have the virus, which includes wearing face masks. When we received confirmation that health care workers had been infected with the virus, we altered that guidance to ensure that people who were admitted to hospital with certain symptoms that might be suggestive of the virus were treated as positive until we knew otherwise so that those protections would kick in as early as possible.
Hugh Henry will ask the final question.
I, too, commend the cabinet secretary for the way in which she has attempted to keep members informed.
In relation to schools, what additional information will be given out to those who are responsible at local level for assuring that teachers and other staff are also adequately protected during the outbreak?
We will continue to operate on the basis of risk assessment, and public health officials will continue to advise local authorities and schools on appropriate action. If teachers have been in close contact with pupils or other members of staff who have been confirmed as having the virus, they will be advised—as will pupils—to stay at home. We will continue to do what we can to ensure that those messages get across and that staff members in schools are adequately supported. I thank the member and his colleagues for their support in that regard over the past few days.
I apologise to Jamie Hepburn and Dr Richard Simpson, but I am unable to call them because we must move to the next item of business.