Pandemic Flu
The next item of business is a statement by Nicola Sturgeon, on pandemic flu. The cabinet secretary will take questions at the end of her statement, so there should be no interruptions.
I am grateful for the opportunity to update Parliament on the steps that the Scottish Government is taking to prepare Scotland for a possible flu pandemic.
Given that a flu pandemic will not respect national or regional boundaries, our preparations are being carefully co-ordinated with those in England, Wales and Northern Ireland; indeed, this statement coincides with one that was made by the Secretary of State for Health in the House of Commons earlier today.
As members will be aware, pandemic flu is one of the most serious risks facing the world. There were three pandemics in the 20th century and, although I stress that we are working closely with the international community to reduce the risk, we must be aware of the World Health Organization's warning that another pandemic is "inevitable". A pandemic will be global in scale, but the consequences will be felt at local level. It could touch every family, so we must take the threat seriously and prepare for it as well as we possibly can.
Once a pandemic has started, the Scottish Government's objective will be to reduce illness and save lives. There will also be a clear need to minimise the inevitable wider impact on society and on our economy. I announce today the publication of a revised Scottish framework for responding to a flu pandemic to guide us in meeting those objectives. Copies are available in the Scottish Parliament information centre. I acknowledge the extensive preparatory work on it that was carried out under the previous Administration.
The framework sets out the Scottish Government's approach to dealing with a flu pandemic: it explains what we are doing to prepare, the roles of key players and how our response will be co-ordinated. For the first time, planning across a range of sectors has been brought together in one document. Many sectors are already well advanced in their preparations for a pandemic, and multi-agency planning is being taken forward by Scotland's strategic co-ordinating groups, with the full support of the Scottish Government. It is vital that all local partners get involved and that planning is robust. There must be a clear understanding of the impact of a pandemic on matters such as education, transport and utilities, and there must be full appreciation of how it will affect wider society.
Given my ministerial responsibilities, I acknowledge and welcome the considerable progress that has been made by Scotland's national health service boards. It is inevitable that our health and community care services will bear the biggest burden of a pandemic, so it is reassuring to see how much work has already been done. To further support the vital work of our health services, I am today also publishing supplementary guidance for community care providers and for those who work in primary care. We are, at the same time, issuing for public discussion guidance on mental health services and human resources in health care. The guidance will help planners to understand the complex challenges that are faced by those services. The publication of the framework and the accompanying guidance is an important step, but it is equally important to stress that the process does not end there: we must ensure that plans are tested, so that any gaps in our preparations can be identified.
Members will be aware that Scotland participated in the United Kingdom national pandemic flu exercise in February. It was a substantial exercise that involved a range of local and national partners. The outcomes of the exercise have proved valuable and have influenced the development of the current framework. The Scottish Government is now planning a Scotland-wide pandemic flu exercise for towards the end of 2008, so that we can assess then how well the lessons that have been learned to date have been applied.
In addition to the guidance that we are issuing and my comments about the plans for a Scotland-wide exercise, I would now like to talk about the other measures that we are taking forward as part of our pandemic flu strategy. Members will be aware that we have already signed advance contracts with pharmaceutical companies to guarantee supplies of vaccine when there will be significant international demand. However, a vaccine against the specific pandemic flu strain can be developed only once the virus strain has been identified. We will continue to fund those contracts, but because we might be three to six months into a pandemic before a vaccine becomes available, we must also look at other options for protecting the Scottish population.
I therefore announce today that, over the next three years—and subject to parliamentary approval of our budget—we will invest more than £100 million on additional stockpiles of clinical countermeasures to protect the public and workers who will care for people who are ill. Those measures will include antiviral medicines, antibiotics, surgical masks and disposable respirators.
Antiviral medicines will be the first important line of defence against pandemic flu, which is why we intend to increase the Scottish antiviral medicine stockpile from 25 per cent to 60 per cent population coverage. That will mean that, even if the pandemic virus is particularly severe, we will be able to provide treatment for everyone who requires it. We will also consider any further scientific advice, and decide whether we need in the future to go further and increase the size of the stockpile. Research has shown that antiviral medicines can reduce the duration and severity of seasonal flu. Treatment with antiviral medicines should also reduce complications. As well as safeguarding the health of some of the most vulnerable people in our society, that will go some way towards easing the pressure on our health services, which will be coping with a vast increase in demand during a pandemic.
Despite the use of antiviral medicines, some patients will still be unfortunate enough to catch pneumonia and similar infections. To save lives, we must therefore also ensure that there are enough antibiotics to treat those people effectively. It will be too late to start stockpiling medicines after a pandemic has broken out; we must do it now.
The World Health Organization has recommended stockpiling of a range of antibiotics, not least because it is likely that the global supply chain will be severely disrupted during a pandemic. To reduce deaths and treat complications, we are planning to establish a stockpile of antibiotics for an influenza pandemic.
As part of the wider pandemic flu strategy, the Scottish Government is also looking at how best to maintain health and community care services during a pandemic. To save lives, it will be vital to protect those who work in the health and community care sectors: they will be in the front line caring for people with flu, so we must do what we can to ensure that they are suitably protected so that services can continue.
The World Health Organization advises that health workers should wear face-masks when they are caring for patients with flu and that they should use disposable respirators when they are carrying out certain clinical procedures. I can advise, therefore, that we plan to stockpile disposable respirators and surgical face-masks for health and community care workers.
In addition to the measures that we are announcing today, we are also reviewing, and will continue to review, the latest scientific developments to see whether we can and should go further to improve our flu pandemic response. The science that underpins development and potential use of pre-pandemic vaccine has recently been reviewed by experts from around the world. A vaccine's success will depend on how much protection it gives against the specific pandemic virus. At the moment the Scottish Government has a stockpile of 270,000 doses of H5N1 vaccine for healthcare workers. We will consider the ongoing work in that area and consider whether it would be beneficial to increase our stockpile to cover other sections of the population.
I assure Parliament that the Government is focusing on long-term measures to protect the Scottish population and we will continue to review and develop our plans for preparing for a flu pandemic. I am confident that the package of measures that I have outlined today will ensure that Scotland is in the best possible position to respond to a pandemic. I commend my statement to Parliament.
The cabinet secretary will now take questions on the issues that were raised in her statement. I intend to allow about 20 minutes for questions, after which we will move to the next item of business. I request that those who wish to ask the cabinet secretary a question press their request-to-speak buttons now.
I thank the cabinet secretary for the advance copy of her statement, which I welcome, and for her gracious remarks about the previous Administration. Clearly, this cannot be a party-political matter and must be non-partisan. I also welcome Alan Johnson's broadly similar statement at Westminster this morning. The disease knows no boundaries, so integrity of approach across the United Kingdom and across the world is vital. However, the time has now come to move beyond strategic planning to detailed and local planning. I know that exercise winter willow was extremely useful in that regard.
I actually prepared 35 questions in anticipation of the cabinet secretary's statement—some of those have already been answered—so I ask the cabinet secretary for the opportunity to meet her and her officials. As she may remember, I have a particular interest in the matter as I wrote a report on pandemic flu in 2000, when Margaret Smith was convener of the Health and Community Care Committee. I think that that report put Scotland ahead of the game.
First, what progress has been made on immunising older and vulnerable people against pneumococcal infection, given that more people are likely to die from secondary infection? The cabinet secretary mentioned stockpiling of antibiotics, which I welcome, but we need to deliver pneumococcal immunisation as part of the on-going programme that the previous and current Administrations have developed.
Secondly, I know that the Red Cross has been involved at United Kingdom strategic level, but what discussions has the Scottish Executive had with the Red Cross, WRVS, churches and other voluntary organisations? Will the cabinet secretary ensure that all local plans involve clear discussions with the voluntary organisations, which will have a major role to play in sustaining cohesion in our communities?
Lastly, one of the recommendations in my report, which was endorsed by the Health and Community Care Committee, was for the creation of lists of retirees and for the involvement of medical students. Will the cabinet secretary ensure that, in the local plans, such lists are now created on a proper database? I know that such a proposal is in the plans—I have read most of them—but I want particular databases to be established now. Will she also talk to NHS Education Scotland to provide the appropriate training for retirees, which could be delivered online, to ensure that their role is clear and that we are well ahead of the game in preparing?
I thank Richard Simpson for those questions, although I am thankful that he did not ask all 35. If he wants to submit any other questions to me in writing, I will ensure that he receives full and detailed answers. I am also more than happy to meet any member who wants to discuss matters in greater detail. I agree with Dr Simpson; we may disagree about many things in health and other areas, but this issue should unite Parliament. I know that Richard Simpson has an interest in the issue and I will certainly be happy to draw on his expertise.
Richard Simpson is absolutely right to have said that
"The disease knows no boundaries",
which is why we are co-operating with England, Wales and Northern Ireland. Indeed, the Minister for Public Health attended the recent UK Cabinet sub-committee on pandemic flu. We will continue to have a presence on that sub-committee to ensure that we are fully integrated in those plans.
Richard Simpson was also correct about secondary infection. That is why I spent so much time today talking about antibiotics. On immunisation, I can assure him that we are making progress. I will be happy to provide him with a much fuller update on progress.
The voluntary sector will be crucial to our plans and preparedness, and in dealing with a pandemic. It is important that the voluntary sector be fully involved in both the development and—if required—implementation of local plans.
I will consider further the specific suggestion about lists of medical students and retirees. Dr Simpson is right that NHS Education Scotland would have a role in that. I talk to NES often—we will continue to discuss that matter.
We are indeed fortunate that Parliament has Richard Simpson's expertise on many health issues.
The cabinet secretary mentioned the involvement of local partners. What role will local pharmacists play in the case of a flu pandemic? Will others who have medical skills, such as optometrists, be trained to support medical practitioners in a pandemic?
Does the minister agree that it could be in the interests of people in Scotland for the Government to stockpile Relenza, which happens to be made in Montrose, at the same level as Tamiflu, so that it does not put all its eggs in one basket? What is the Government's view on the risk of resistance to Tamiflu developing if it is consistently and widely used?
Mary Scanlon raises important issues. She mentioned local partners. I reiterate what I said in my statement: all partners in primary care teams have an essential role to play. That is why today we are issuing guidance to the primary care sector, to ensure that it is doing what it needs to do to ensure that everyone involved is as prepared as they can be. The other professions that the member mentioned have a role to play in planning and implementation of our strategies and plans.
Mary Scanlon mentioned a particular brand of antiviral. It is true that our current stockpile consists of Tamiflu but, as we seek to increase the stockpile from 25 per cent to 60 per cent population coverage, we will consider other drugs including Relenza. The member also asked about development of resistance to Tamiflu: that is a risk with any such drug and must be considered carefully. We must ensure that what we are doing to increase stockpiles gives us the protection that we need.
I, too, thank the cabinet secretary for providing advance notice of her statement. I welcome the publication of the framework document and agree whole-heartedly with the cabinet secretary, with Richard Simpson and with Mary Scanlon that the matter is of national importance and transcends party-political boundaries.
The detailed framework document includes a huge amount of material. In her statement, the cabinet secretary referred to deployment of vaccination, antiviral material and antibiotics. Does she intend to spell out a little more clearly and in simple form to the public the order in which those would be deployed, so that public concerns can be allayed? I am not suggesting that the information is not included in the statement, but rather that it should be made available in a form that the public will understand.
Richard Simpson dealt effectively with the next issue that I want to raise, but I would like the cabinet secretary to clarify it further. She makes it clear in her statement—it is also very clear in the document—that, as is self-evident, people who work in health care will be in the front line and are potentially most at risk. It would assist the public if she would spell out what the contingency arrangements will be if, regrettably, infection spreads among health care workers.
Finally, I note with interest that the framework document includes a clear reference to avian influenza and to the limited risk that it poses of a pandemic. I hope that the cabinet secretary shares with me a continuing disappointment that, unfortunately, the recent outbreak of avian influenza, or bird flu, in England attracted commentary that suggested that there was a more immediate risk of a flu pandemic. Will she take the opportunity to clarify the matter and to put it in the proper perspective?
I will deal with Ross Finnie's first and last questions together, because they are related. As other members are, I am aware that as we take the steps that it is incumbent on us to take to prepare as well as we can for the possibility of an outbreak, we must take care not to alarm the public unduly and must do what we can to allay understandable concerns that people have when they hear me and other members talk about the issues that we are discussing this afternoon. Ross Finnie made the important point that we must find ways of communicating messages to the public in simple and understandable terms. Communication about pandemic flu is vital. We are already engaged in a communication strategy for pandemic flu, which will get even more important in future phases. I take the point in the spirit in which it was intended; we will do all that we can to ensure that messages are communicated properly.
Ross Finnie made an equally important point about avian flu that is related to the issue of public concern. The truth is that we do not know what strain of flu we will face in a pandemic. There are clearly concerns about avian flu, but it is incumbent on all of us to point out that recent or previous outbreaks of avian flu do not mean that a pandemic outbreak is any more imminent than it was previously. We all have a duty to communicate such messages.
Ross Finnie also made a crucial point about the health care workforce. We must do what we can to protect people in the front line of our health service and to minimise the risk of their being infected, because they are vital to ensuring that the rest of our plans work. Of course, some members of our health care teams will not avoid being infected, so we must ensure that the NHS and other parts of the public sector have in place contingency plans to deal with staff shortages as a result of flu. Members will see from the framework document that plans are in place and are developing. Those plans involve strategies such as ensuring that as many people as possible can be treated in their homes and communities rather than in hospitals. During a flu pandemic, it is likely that non-emergency admissions to hospitals will cease so that emergencies can be focused on. All such plans are essential, and I hope that members will be reassured that the plans are afoot when they get the opportunity to read the framework document and its accompanying documents.
I thank the Cabinet Secretary for Health and Wellbeing and her predecessors for, and congratulate them on, the state of preparedness that obviously exists.
I may be being too specific in asking this, but has the cabinet secretary considered the fact that a great programme lies ahead for the construction industry? I appreciate that she has emphasised the preventive role of health care workers and her communication strategies, but perhaps she ought also to bear that programme in mind when it comes to drawing together the people who will make local plans. The construction programme is important not only to the economy, but to the feeling of well-being in Scotland.
Margo MacDonald makes a vital point. A flu pandemic will affect all sectors of Scottish society: it will affect every part of the public sector and the private sector and the wider economy. That is why it is important that we involve all sectors in our planning for a pandemic. Our job should be to plan as well as we can to ensure that, during a pandemic, business can be as close as possible to business as usual. However, we must also be realistic and acknowledge that a pandemic will lead to disruption. There is no avoiding that.
I am glad that Margo MacDonald and other members have acknowledged the extent of our planning, the purpose of which is to minimise disruption. If we are to succeed in that, all sections of the community must be involved and we must ensure that the messages that we have discussed are communicated to all sections of the community.
I, too, welcome the cabinet secretary's statement, particularly what she said about multi-agency planning, which is not only essential but is common sense. I also welcome the special attention to the mental health services.
Paragraph 8.3 of the framework document is headed "Isolation, voluntary quarantine and social distancing". It states:
"While it might be possible to isolate initial cases and quarantine their immediate contacts, such an approach will become unsustainable after the first few hundred or so cases."
How can the cabinet secretary reassure patients who are already in hospital that they will be safeguarded if isolation is not viable?
Christine Grahame has asked a question that is clearly important. The strategy makes it clear that isolation has a part to play, but it will not on its own do what we need. That is why we have announced all the other measures. Those measures are as important to people who are already in hospital as they are to other members of the community. During a pandemic, we will want to ensure that as many people as possible are treated at home, rather than in hospitals. That approach is central and integral to our planning. I hope that Christine Grahame and other members will be assured by what the framework says about that.
In the light of the cabinet secretary's answer to the last question, I ask her to consider special measures for carers, who perform a vital role in our communities.
What arrangements has the Scottish Executive made to ensure continuity of fuel supplies to essential users such as hospitals and emergency services?
Cathy Peattie makes an important point about carers. We must also consider people who work in the community care sector. As I said in my statement, to accompany the framework we have today issued guidance for people who work in the community care sector, who will be extremely important in helping to care for and deal with people who become infected with flu. I hope that the member will take the opportunity to read that guidance. If she has more detailed questions on it, I will be happy to answer them.
I congratulate the cabinet secretary on her statement and associate myself with Richard Simpson's remarks, especially what he said about the role that retirees could play in treatment. I am sure that when the hour comes, Richard Simpson, Nanette Milne and I will probably head for the Highlands—but we will see what happens.
On a more serious note, given that the Government has already signed advance contracts with pharmaceutical companies to guarantee a supply of vaccine that will only be available months after the strain of virus has been identified, what arrangements has the Scottish Government put in place to ensure that distribution of vaccine is quick, efficient and effective?
I assure Ian McKee that his name and those of Richard Simpson and Nanette Milne appear at the very top of my growing list of retirees, so he will have plenty to do, should it be necessary.
I said that we have already signed contracts with pharmaceutical companies to guarantee supplies of vaccine. As Ian McKee said, the vaccine will only become available some three to six months into an outbreak, which is why the other measures that I have announced today are important in providing defence. It is clear that distribution issues arise. To some extent, those are dealt with in the contractual arrangements but, as supplies come on stream, there will also be a need to ensure that distribution of vaccine to patients can be prioritised on a clinical basis. All those matters will be kept under constant review and if our plans require to be updated or developed, they will be.
On behalf of the younger members of Parliament—or those who are clinging on desperately to youth, to get the gag in first—I will ask one of the 35 questions that Richard Simpson would have liked to ask. What discussions has the Scottish Government had with the Scottish centre for healthy working lives about how well prepared small and medium-sized businesses, in particular, are to meet the challenge of pandemic flu? Will the cabinet secretary seek to encourage larger businesses to provide advice and assistance to small and medium-sized businesses, especially those that form part of the supply chain to those larger institutions?
We have not yet decided what Frank McAveety's role will be in the event of an outbreak. It is good that we can still manage to find something to joke about when we are discussing such serious matters.
Discussions are continuing between the Scottish centre for healthy working lives and small and larger companies, which obviously have a key role to play, not just during a flu pandemic, but beforehand. General messages on good health and infection control are crucial. The hand hygiene campaign that is important in the immediate battle against infection will become increasingly important as we try to minimise the spread of infection during an outbreak. I assure the member that we will continue to have those important discussions.
I would like to fit in the last two members who have questions, so I ask everyone to be brief.
As a younger member of Parliament, I welcome the cabinet secretary's statement. She will acknowledge that it is important to ensure during a pandemic that there is sufficient surveillance of entry points into the country as possible routes in for infection. What measures will be taken to ensure that additional surveillance operations are put in place at entry points such as our seaports and airports?
Regulations are being developed that will outline particular measures that can be undertaken at Scottish ports to help protect us from the international spread of infectious disease and contamination. We will continue to work with colleagues in other parts of the UK because it is important to ensure consistency of approach at points of entry to the UK, where that should prove necessary.
I have two brief points. First, at a meeting of the cross-party group on funerals and bereavement earlier this week, funeral directors expressed concern that they were not clear what progress was being made in planning for their involvement in dealing with the inevitable increase in mortality during a flu pandemic. Indeed, planning for that appears to be fairly patchy throughout Scotland. Can the minister give me any idea of current planning in that respect? If not, will she get back to me with the appropriate information?
Secondly, in the previous session we were told that face-masks would not be effective in protecting against infection in a flu pandemic because of their mesh size. They are now recommended, so has there been a welcome improvement in design?
On dealing with the increased number of deaths that will, sadly, inevitably occur during an outbreak, planning is under way. Further guidance will be issued on that in due course. If funeral directors have concerns about their degree of involvement, I undertake to address those concerns. If Nanette Milne has any further detailed points, I will be happy to respond to them.
As I said in my statement, the action that we are taking on face-masks is based on advice from the World Health Organization, which recommends the particular types that are most effective. It will be those types that we seek to purchase.