Influenza and NHS Winter Planning
The next item of business is a ministerial statement on influenza and national health service winter planning. Questions will be taken at the end of the statement. Therefore, there should be no interventions during it.
Thank you, Presiding Officer. I am grateful for this opportunity to make a statement to Parliament on the flu outbreak that is currently affecting people the length and breadth of the country and on the impact that the outbreak is having on the national health service in Scotland.
Over the past few weeks, a combination of flu, flu-like illnesses and cold weather has resulted in many thousands of Scots becoming ill and, sadly, some of them becoming critically ill.
Earlier this week, the Scottish centre for infection and environmental health reported to us that, as of Monday, it is estimated that 793 in every 100,000 Scots have sought help from their general practitioner, suffering from flu-like illness. The figure has shown a marked and consistent upward trend over recent weeks.
Officially, the situation does not constitute an epidemic. However, that is of little consequence to people suffering from the illness. In practical terms, whether this outbreak is classified as an epidemic or not, the consequences of it are the worst experienced in Scotland for a decade. The impact on individuals, families, employers and, of course, the NHS has been severe.
There is, however, light at the end of the tunnel. Our scientific and medical advisers tell us that the outbreak should peak during the next week or so and thereafter should begin to tail off. However, illness will still be common and the Scottish weather remains as unpredictable as ever at this time of year.
Of course, we in Scotland are not alone in suffering the effects of the illness; the pattern is repeated throughout the United Kingdom and in many other parts of the world, in Europe and the USA.
Why has this year's outbreak been so severe? Flu and flu-like illnesses are an annual occurrence, but this year a number of factors have combined. Flu comes in many strains. First, those suffering from flu are experiencing the debilitating
effects of the virus for far longer than normal—for as long, perhaps, as 10 or 12 days rather than the normal four or five. Secondly, the number of related respiratory viruses is contributing to severe chest infections, especially among the frail elderly and other vulnerable groups. As a result, pressure on the NHS has been exceptional.
The NHS expects the winter to be its busiest period. It plans and prepares for extra illness and colder weather. This year it has also planned— very successfully—for the twin challenges of the millennium bug and the biggest ever new year celebrations. Still, however, huge numbers of patients have been coming through the doors of our GP surgeries and hospitals.
I shall give members an indication of just how intense activity has been. In Lothian, there were 50 per cent more emergency hospital admissions in one week than in any previous seven-day period. In Glasgow and Ayrshire, admissions have been 25 per cent higher than would normally be expected. A similar pattern has been repeated all across the country. On top of that, the service itself has faced higher than normal levels of staff sickness absence.
Despite the exceptional pressures, the NHS is coping. It is managing and it is caring. That has been achieved through better preparation and contingency planning; increased resources; better co-operation within the service and between the NHS and other agencies; and, above all, the exceptionally hard work and outstanding commitment of NHS staff.
Let me talk about preparation. The Scottish Executive, health boards and NHS trusts have planned earlier and better for winter than ever before. Additional wards and more beds have been provided. For example, there are an extra 140 beds in Lothian this winter and an additional 50 beds have been provided in three hospitals in Argyll and Clyde. We have invested in more nursing home places. An extra 50 places are funded in Ayrshire and Arran and there are 11 new places in West Lothian.
Intensive care beds have been under severe pressure due to the nature of respiratory disease and the number of elderly patients who have been affected. NHS trusts have been managing the situation by putting in place contingency plans, including opening more beds. The priority has been to ensure that everyone who needs emergency care receives it. That is why, sensibly, many trusts planned ahead this winter to reschedule elective surgery over this period so they could concentrate resources on those most in need.
The level of intensive care beds is kept under constant review. Extra funding for more intensive care beds was made available following the last audit of intensive care provision. We will continue to review intensive care capacity to ensure it meets Scotland's needs. The results of further audit are expected shortly and will inform future planning of intensive care provision.
Our approach is in line with the experience of health professionals. Dr Cameron Howie, president of the Scottish Intensive Care Society says:
"Across Scotland, intensive care units have been under sustained pressure to care for very sick people. We had expected an upsurge in work this winter, but the scale of the challenge has been unprecedented. Hospital teams are helping one another, and that includes the transfer of patients to receive the best care in other hospitals where necessary.
Medical teams have been working incredibly hard to manage the number of sick patients coming into hospital, and a proportion of them need our help. We will continue to work with others to review the intensive care requirement for Scotland and complete plans to organise resources using a ‘bed bureau' information system."
Preparation has also involved ensuring that those who do not require hospitalisation are given the care that they need at home or in another setting. I have seen for myself the efforts of local authority social work departments in supporting vulnerable people in their own homes and in planning and working with the NHS at a local level.
The public, too, have played their part. Many heeded the advice issued locally and nationally to stay at home, keep warm, and help themselves with over-the-counter advice and remedies. They in turn have been helped and advised by community pharmacists across the country. Pharmacists, too, have responded magnificently to the extra demands that have been placed upon them and they have made a major contribution to tackling the situation.
A further element of the winter planning process was the flu vaccination programme. We have invested nearly £2 million in flu vaccination for vulnerable groups, provided free of charge through GPs, and targeted at the frail elderly and those with chronic disease. The chief medical officer issued guidelines to the NHS and to every GP in Scotland at the beginning of October advising them to take steps to immunise vulnerable groups, such as the elderly, against flu. The vaccine programme is paid for by the Scottish Executive and stocks have been supplied to GPs free of charge. Vaccine has been made available to GPs since the autumn and there has been no restriction on supplies.
Important as the vaccination programme is, it is essential to put it in context. I quote Dr Colin Hunter, chairman of the Royal College of General Practitioners Scottish Council.
"The Royal College welcomed the CMO's professional advice on the at-risk groups for flu vaccination issued in early October 1999. It gave clear, evidence-based guidance to GPs on those patients who would benefit most from being vaccinated. However, vaccination is not the complete answer, as many of the flu-like illnesses currently affecting patients in the community could not have been prevented by vaccination. Despite the exceptional pressure on GPs, nurses, pharmacists and hospitals, the NHS is coping well."
I will now deal with resources. The Executive has backed the NHS with record levels of investment—more than £300 million of additional money for the NHS in Scotland this year—and there will be further real-terms increases for the NHS for the next two financial years. In all, an extra £1.8 billion will be provided by 2002. It is not just a case of spending more; it is also a case of doing better. This is the first winter since the abolition of the internal market. The NHS has worked together to meet patients' needs as never before. This year, managers and NHS staff have worked in partnership for patients across regions, rather than in wasteful competition.
No one, least of all me, underestimates the pressures that the NHS has faced, and will continue to face, as a result of this record outbreak of illness. I pay tribute to the NHS staff who have been working flat out to ensure that patients' needs are met. They deserve our thanks and they will get our continued support.
The NHS has matched exceptional pressures with exceptional effort. It has coped with unprecedented levels of activity. It has ensured, and is ensuring, that everyone who requires emergency treatment receives it. However, I assure members that there is no complacency, either in the Executive or in the NHS. We can always improve. We can always get better. We can always learn from experience.
The problems caused by illness and flu will not go away quickly. It will take some weeks for the outbreak to subside, even if the number of new cases is now at its peak. This is a situation to be managed, not a crisis to be manufactured. The Executive will continue to work tirelessly with NHS staff across Scotland to ensure that the health needs of the people of Scotland are met now and in the future.
I welcome the opportunity to make this statement, and I will be pleased to answer members' questions.
I thank the minister for her statement. Unfortunately, it raises more questions than it answers. Contrary to the minister's assertion, we have just heard yet more complacency and still more self- congratulation—and, of course, still no mention of a crisis. Is everybody out of step but our Susan?
The minister talks about the NHS coping. Will she have the humility to accept that the health service is coping only because of the dedication and good will of NHS staff—staff who are prepared to work back-to-back shifts—because retired nurses have been willing to come in to help out, because makeshift wards have been prepared and because of the widespread cancellation of non-emergency surgery? That is not what I call coping; that is what I call crisis management.
Can the minister explain why there was no nationwide public information campaign to encourage the take-up of flu vaccination? Why was the campaign to give advice over the holiday period so late appearing? It appeared on 29 December, when we were all wished a merry Christmas, and so inaccurate was it that it omitted to mention pharmacists.
On what recommendation was the vaccination campaign restricted to over-75s, when most countries vaccinate everyone over 65?
Can the minister explain the lack of intensive care beds throughout Scotland? That lack is illustrated by the fact that a seriously ill patient was driven from Inverness to Glasgow for an intensive care bed. A clinical director in Inverness has today said that she goes to bed praying that there will not be a major road traffic accident because the service would not have the intensive care beds to cope. Will the minister outline her plans for increasing the number of intensive care beds in Scotland, bearing it in mind that their number has been cut by 27 per cent in the past two years?
Finally, given that the NHS in Scotland has lost around 1,700 beds in the past three years, will the minister give a commitment today that the Executive will ensure that funding is made available immediately, so that local authorities can fund residential and nursing care for the 2,000 elderly patients who have been assessed as being in need of that type of accommodation? Those 2,000 people now languish in acute NHS beds because councils do not have the funding necessary to provide the most appropriate accommodation.
We have to manage a serious situation that affects families, employers and the NHS in Scotland. In such circumstances, it would be helpful if the Opposition could engage in this debate responsibly and effectively. With regard to many of the points that Mrs Ullrich has raised, might I respectfully suggest that in future she listen more carefully to my statement and that she read her advance copy of it. Perhaps she would like to refer to what I have said in the Official Report, when it is produced.
I shall touch on some of the points that Mrs Ullrich raised, but on which I have not already
commented. First is the issue of an information campaign. This might come as a surprise to the Scottish National party, but we live in a devolved Scotland—sometimes we organise things differently here. The NHS in England—to which Mrs Ullrich has repeatedly referred recently— organised a campaign around its arrangements for NHS Direct. We will introduce NHS Direct in Scotland this year, and it will be designed to meet Scotland's needs.
We have put in place information arrangements to meet Scotland's needs at local and national level. At local level, local health boards have arranged newspaper advertisements, leaflets and posters, and pamphlets have been delivered through doors. That has been supplemented by national advertising. If the SNP has a problem with our doing things differently in Scotland, it is, perhaps, about time the Scottish people were told that.
Mrs Ullrich mentioned pharmacists, as did I in my statement. Rather than ask members to believe me, I will quote from a letter to me from George Romanes, who is chairman of the Scottish Pharmaceutical General Council. The SPGC represents the whole pharmacy profession in negotiations with the Scottish Executive and is involved in setting standards for the profession. Mr Romanes said:
"Adverse publicity has been misplaced, misleading and unhelpful . . . Our profession has striven to make the storage and distribution of vaccine a seamless process and has been aided in its promotion through the use of information leaflets, posters and professional knowledge."
The Executive has worked with pharmacists and other groups throughout the process and we will continue to work with them in future for the benefit of patients.
I also covered intensive care unit beds in some detail in my statement. As I said, that is a matter for sensible planning on the basis of professional advice so that we meet the needs of the people of Scotland—[Interruption.] I am attempting to answer the omnibus question that I was asked by the SNP's spokesperson and I will continue to do that.
We have heard many comparisons with the number of ICU beds 10 years ago. A more relevant comparison for me is with the number of beds in 1997, since when there has been a 13 per cent increase in the provision of intensive care beds. I hope Mrs Ullrich appreciates that I will not be held responsible for the actions of the Conservatives. We will continue to plan provision effectively for the future.
I have said throughout that we are facing an exceptional situation in Scotland. There are exceptional pressures on the NHS. I have recognised that the NHS has been able to cope not least because of the unparalleled efforts of NHS staff. I do not believe that the morale of staff, or the interests of patients, is best served by the extremes of language that we have heard from the SNP. Words such as crisis, chaos and shambles do not describe the NHS in Scotland. That is not the language that I will use.
I do not want the minister to take responsibility for what the Conservatives did in relation to the NHS; I want her, for once, to take responsibility for what Labour is doing to the NHS. Labour has been in government for three years and it is time it started to take responsibility.
The minister says that there is no crisis and that the problem is being addressed. That is because of the good will and hard work of NHS staff. Labour cut 670 beds in Scotland in its first year in government and, last year, the British Medical Association described Edinburgh's accident and emergency department as a war zone. Surely some lessons should have been learned from that, yet at one point this year Inverness's nearest intensive care bed was in Birmingham.
Many flu cases are unreported, which renders the minister's figure of 793 cases per 100,000 meaningless. Flu is at twice epidemic levels in Scotland, compared with English figures. On that basis, the minister's assurances are less than worthless.
I have asked 10 written and oral questions. I have repeatedly mentioned winter pressures and bed blocking in debates, yet the minister has never addressed those issues. I asked my first question on 10 June, yet we still have this arrogant, complacent and scornful dismissal of anyone who dared to ask the minister about those issues in anticipation of this crisis.
Why was the flu vaccine slow to arrive at GP practices? Why do GPs in England receive a payment for administering the vaccine, yet GPs in Scotland receive none? This flu has not brought the health service to its knees. The flu has proved that the health service is on its knees. It has proved that the NHS in Scotland is not safe in Labour's hands.
How much longer will patients have to wait because their operations have been cancelled so that the crisis can be coped with? When will the minister address the 2,000 beds in Scotland that are blocked by patients who should be cared for in the community?
Given her arrogant and complacent response to those concerns, will the minister now apologise to the people of Scotland? Will she break the habit of eight months and, as she said in her statement, listen and learn from this experience by working
with health professionals to set out a clear prevention strategy to deal with winter pressures in future years?
It is always easier to trade in personal insults than it is to engage in the real issues. There are few people throughout Scotland who can take seriously the comments of the Tory party in Scotland when it suggests that it has the interests of the NHS at heart.
We built the health service.
Perhaps Mr Gallie should be reminded of history. It was a partnership between a Liberal, William Beveridge, and a Labour MP, Nye Bevan, which built the health service. That same partnership will take the NHS forward in the 21st century. We will engage in issues effectively and we will take actions, rather than just mouthing words.
I am lectured by Mrs Scanlon on learning lessons. The planning and organisation that went into preparing the NHS for this winter were based on just that—learning lessons from previous winters and, at a national level, learning lessons on how to manage the health service. That will be done not by squandering millions of pounds on needless and divisive bureaucracy, but by investing in an NHS that works in partnership.
I have seen partnership working at close quarters. If they have not already done so, I recommend that members go to their local trust and see for themselves the partnership working between hospitals and NHS trusts in the newly reorganised NHS—all of which has benefited patients.
I will address the issue of flu vaccine, which Mary Scanlon has raised once again. I make a plea—not for the first time—that Mrs Scanlon get her facts right. The system in England for the supply of flu vaccine—which is entirely different from the system in Scotland, as indeed are the arrangements for the supply of drugs and medical appliances—does not involve payments to general practitioners. GPs in England purchase the flu vaccine and are reimbursed by the Department of Health. Because GPs themselves negotiate the purchase arrangements for the flu vaccine, that can involve a surplus being generated. In contrast, we here in Scotland purchase the flu vaccine centrally. There has been no problem supplying stocks to GPs on request.
We will continue to look at ways of improving the arrangements for the flu vaccination programme; we will continue to look at ways of planning better for winter. We will do that by working with GPs and other health professionals, and we will always be guided by what is best for patients and by what are the right arrangements here in Scotland.
Will the minister assure us that she is now confident that the crisis is under control and that the downward tendency that we have seen in the figures will allow the NHS to cope in future weeks? Given that any organisation of the NHS will have to deal with ups and downs of flow and demand, can the minister assure us on two particular aspects of pre-flu vaccination?
In her statement, the minister referred to the health service itself suffering from
"higher than normal levels of staff sickness absence."
Was a flu vaccine made available to medical staff? Were arrangements made for that to be done throughout the country?
Is the minister satisfied with the arrangements for making the vaccine available to the elderly? Is she satisfied that the campaign to ensure proper take-up across the country was adequate? Criticisms have been made about that.
I will deal first with Robert Brown's point about where the service is now. As I said in my statement, the medical and scientific advice suggests that the number of new cases will peak this week but—for the reasons that I gave earlier—there will be high levels of illness and therefore high levels of pressure in the service for a number of weeks.
I believe that the service has planned effectively to deal with the pressure. The contingency plans that have been brought into play in recent weeks are evidence of that. I have visited several NHS hospitals and community facilities in recent weeks and I have seen the evidence that the service is continuing to manage the pressures to ensure that those who require emergency care and treatment receive it.
When considering NHS staff and vaccination in general, it is important to stress that our policies on vaccine programmes are guided by clinical advice. There is a United Kingdom expert advisory group on immunisation and vaccination. It advises us and the three other UK health departments. That advisory group has concluded that there is no conclusive evidence that vaccination of NHS staff would be beneficial to staff or patients.
Indeed, the group has said that it is inadvisable to vaccinate healthy people who are not in at-risk groups. We will ask the group to reconsider the issue and we will continue to review our practices, but we will act on the basis of clinical advice.
Mrs Scanlon mentioned the age group that is recommended in the chief medical officer's advice. This is not a decision made by politicians, but one that is based on the advice we receive from the expert group and the chief medical officer. We will examine continuously how we can improve in the
future. I am happy to echo Dr John Garner, the chairman of the British Medical Association in Scotland, when he says that he wants to work together across NHS professional groups, with the Government, to ensure that we get better in the future. I will work for improvements with a range of professional bodies. Nevertheless, the service is managing well with the current situation.
What impact will the flu outbreak have on resources in the NHS in Scotland? What steps are being taken to ensure that the outbreak has no continuing effect on other treatments?
Maureen Macmillan raises an important point. We know that many of the winter arrangements were planned, but we also know that because of the increased incidence of illness, many NHS trusts have had to extend their contingency planning arrangements for longer than expected. It is too early for us to assess the impact of that, but we will assess it carefully and work with the NHS across Scotland to plan for the provision of the service now and into the future. The fact that we are doing that in the context of a period of record levels of investment in the service will assist us to plan effectively.
We must protect the time for this afternoon's shortened debate. As we have a second statement I will not be able to call any more members. Shorter statements and shorter questions would enable more people to be called.