Influenza A(H1N1)
Good morning. The first item of business this morning is a statement by Nicola Sturgeon on influenza A(H1N1). The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions. This is a 10-minute statement.
There have been a number of developments since my last statement to Parliament on the H1N1 influenza virus. Many of those developments were covered in the update letter that I sent to all members on 22 October. However, I am grateful for this further opportunity to update Parliament on the current situation and, in particular, on the commencement of the vaccination programme.
The H1N1 virus is continuing to circulate in Scotland, and it appears that we are now experiencing the predicted second wave. Today's weekly report from Health Protection Scotland reports on the situation in the week ending 26 October. The report, which is based on information from the all-Scotland reporting system that covers 86 per cent of all general practices indicates that, in the past week, the number of general practitioner consultations for influenza-like illness was 111 per 100,000 of the population—an increase of 27 per cent on the previous week. It is estimated that about 19,200 people contracted H1N1 over the past week, compared to around 14,600 in the previous week.
It is important to stress that, in the vast majority of cases, the virus remains relatively mild and self-limiting. However, some people are experiencing serious complications and require hospital treatment as a result. The number of hospitalisations and admissions to critical care for H1N1 has increased significantly over the past three weeks. Today's HPS report confirms that a total of 556 people with H1N1 have been admitted to hospital since the outbreak began—176 of those in the past week and 384 since the end of September. As of yesterday, there were 65 people in hospital who were confirmed as having H1N1, 23 of whom were receiving treatment in intensive care units.
As members are aware, in Scotland there has been a total of 25 deaths associated with the virus, four of which have occurred in the past week. I am sure that all members will join me in expressing sympathy for those who have lost loved ones as a result of the virus. Those deaths underline the importance of the vaccination programme in protecting the most vulnerable people from the virus. I will say a little more about that shortly.
Members will appreciate that the increase in the number of admissions to critical care has put our services under additional pressure. Increasing pressure was a key consideration in our contingency planning arrangements, which is why all health boards were asked to put in place plans to increase critical care capacity by 100 per cent, should it be necessary. Those plans are in place and are ready to be activated as and when necessary. As I announced previously, the Scottish Government has supported the plans with the purchase of an additional 43 adult ventilators, 15 paediatric ventilators and nine neonatal ventilators, which will be used as and where demand arises throughout Scotland.
I turn now to the subject of extracorporeal membrane oxygenation. In recent weeks, there has been considerable media coverage of the benefits of ECMO treatment. Only last week, I had an opportunity to meet Sharon Pentleton and her newborn son. As members will recall, Sharon was transferred to Sweden for ECMO treatment during the summer. I am delighted to report that both Sharon and her son are in excellent health. Scotland already has ECMO provision for heart surgery patients and respiratory ECMO provision for children. Respiratory ECMO for adults—which is not yet a fully established treatment—is available to Scottish patients though the United Kingdom's nationally commissioned ECMO centre in Leicester and the accredited European centre in Stockholm.
Clearly, the H1N1 pandemic is having a significant impact on the demand and the existing capacity for ECMO. For that reason, UK health ministers agreed to double the ECMO capacity at Glenfield hospital in Leicester, which will be achieved by the end of this week. Nonetheless, I confirm today that, over the past week, adult respiratory ECMO has been provided at Aberdeen royal infirmary on two occasions. Aberdeen royal infirmary is currently the only site in Scotland where there are both respiratory adult ECMO machines and staff who have been trained in their use by the team in Leicester. The decision to provide ECMO for the two patients in Aberdeen was made after close clinical consultation with the Leicester team; those consultations are continuing.
In the light of the increased demand that we are seeing across critical care, I asked the Scottish expert group on ECMO for interim recommendations on the immediate capacity of the national health service in Scotland to provide adult ECMO facilities and on the contribution that Aberdeen might be able to make on a continuing basis during the flu pandemic. The group has recommended that although Leicester should at this stage remain the front door for access to adult ECMO provision, with all referrals being discussed and agreed with the Leicester team, ECMO treatment can be provided in Aberdeen in the future, but only when additional capacity is required. The decision to treat patients in Aberdeen will be subject to both agreement and clinical support from Leicester. Over the next few weeks, the expert group will report to me its recommendations for longer-term provision of adult ECMO in Scotland.
Despite the significant pressures that are being experienced, the NHS as a whole continues to respond well to the challenge of the flu pandemic. That is true of our critical care services and our primary care services. Scotland's GPs, supported by NHS 24 and the Scottish flu response centre, continue to respond extremely well to the demands that they face. The pressures have, at times, been considerable. For example, NHS 24 has dealt with call demand that has, on occasion, been as much as 50 per cent higher than the forecast demand for this time of year. NHS 24 and other primary care services have coped admirably.
Nevertheless, we are not complacent and I am aware of the potential for winter pressures further to increase demand on primary care services. However, taking into account the ability of NHS 24 to increase its capacity if necessary, I am confident that Scotland's primary care services will continue to cope over the winter. We retain the option of joining the national pandemic flu service when and if we think that is necessary. The advice remains that people in Scotland who are worried about flu-like symptoms should continue to contact their GPs or NHS 24.
I turn now to the vaccination programme, which began its roll-out last week. As I have said repeatedly—I make no apology for doing so again—vaccination is the best line of defence against the virus. As I have also said previously, supplies of the vaccine in the early weeks of the programme will be limited; therefore, the programme will proceed on a phased basis. The supply of vaccine is subject to the volume that the manufacturers can supply to us in the initial weeks, but I assure colleagues that the vaccine is being distributed as soon as it is available. Indeed, to date, 165,000 doses of the vaccine have been supplied to NHS boards throughout Scotland. By Monday, we will have received in Scotland almost 250,000 doses of vaccine, and by next Friday we will have received 367,000 doses. That is in line with our expected delivery schedules.
As members are aware, the first supplies of the vaccine have been used to vaccinate vulnerable patients in acute settings and to begin the vaccination of front-line health and social care workers. However, from this week, GP practices in Scotland have also begun to receive initial supplies of the vaccine to allow them to begin, as soon as possible, vaccination of the priority groups. I expect all GP practices to have received their initial supplies of the vaccine by the end of next week. Individuals in the priority groups will, therefore, shortly begin to receive invitations to receive a vaccination from their GP. Given the limited supply of the vaccine in the early weeks, we have provided guidance to NHS boards on how to make best use of their initial supplies. I confirm, however, that we expect all 1.3 million people in the priority groups to have been offered vaccination by Christmas.
Early anecdotal evidence suggests that, so far, uptake of the vaccine by front-line health and social care staff has been good. Over the next few weeks, we will begin to report the actual uptake figures. I am sure that members will agree that it is important that our front-line health and social care workers protect not only themselves, but the vulnerable patients and clients with whom they are in contact. A UK communication campaign will also soon begin to encourage uptake of the vaccine within the clinical at-risk groups. That includes the establishment of a new dedicated NHS 24 information helpline, which is already up and running and is providing members of the public with up-to-date information on the vaccination programme.
The final issue on which I will update members today is the publication on 22 October of the latest version of the UK planning assumptions. Members will be aware from previous discussions that those are not definite predictions; however, they use our developing data on the virus to give the NHS and other key sectors the best bases on which to plan. The planning assumptions indicate a consistent but gradual increase in the incidence of H1N1 both in Scotland and throughout the UK. The scientists consider that the overall clinical attack rate in a worst-case scenario might now be 12 per cent of the population. That is down from the figure of 30 per cent in the previous planning assumptions. Furthermore, the rate of workplace absences is now projected to be 5 per cent, rather than the 12 per cent that was previously projected. Although that is clearly good news, as the events of the past couple of weeks have shown, we cannot afford to drop our guard—nor will we.
We anticipate that pressure across the NHS will increase over the coming winter months. I fully expect that this winter will be the most difficult that the NHS has faced in many years. However, I believe that, because of the high level of advanced planning that we have put in place and the additional resources that we have secured, the NHS is well prepared to meet whatever challenges we face. I would like to take this opportunity to once again thank all NHS staff for the hard work that they are doing to ensure that that is the case.
The cabinet secretary will now take questions on her statement. We have around 20 minutes for such questions.
I thank the cabinet secretary for the advance copy of her statement. I look forward to working with her on the full range of issues facing the NHS in Scotland. I also join her in sending condolences to the families who have lost loved ones to the H1N1 flu virus, and in thanking the NHS staff who have worked hard to mitigate the effects of the flu.
I have no doubt that the virus has the potential to be one of the most significant public health issues to face the country as we move into winter.
The cabinet secretary will, of course, be aware of the concerns that have been raised by some GPs about delays in receiving the vaccine. She launched the vaccination programme on 21 October, but many GPs will not start to receive supplies until 2 November and it has been suggested that the amount will, even then, be insufficient. In Lothian, for example, one GP reports that he will receive barely one tenth of the needs of his practice. Similarly, a GP in Midlothian reports that he will receive a 50-dose vial next week, with no information on when further supplies will be received, although he has among his patients 70 pregnant women who all require the vaccination, and considerably more patients in the other risk categories.
Is the cabinet secretary aware of patients being told to call their GPs almost daily because the practices do not appear to know what is happening?
On 3 September, the cabinet secretary advised Parliament that 300,000 to 350,000 doses of the vaccine would be delivered each and every week from the date when the vaccine was licensed. Can she confirm that the figure of 367,000 doses from the end of next week is, therefore, barely one third of what she previously anticipated? What impact does she think that will have?
In a letter to MSPs on 22 October, the cabinet secretary told us that modelling had showed that the peak of H1N1 cases will occur from the end of October to mid-November. That, of course, is now. I therefore ask the cabinet secretary what urgent action she will take to ensure that, rather than risk a descent into chaos, delivery of the vaccine will be better co-ordinated so that it can be done more quickly. My concern, which, I am sure, the cabinet secretary shares, is that we might just run the risk of missing the boat with each and every day of delay.
I welcome Jackie Baillie to her post and I look forward to working with her. I record my thanks to Cathy Jamieson, who took a constructive approach to all matters, particularly the important issue that we are discussing today, which has united the chamber over the past weeks and will, I hope, continue to do so.
Jackie Baillie raised some important issues. At the outset, I must state clearly that there are no delays in the vaccination programme or in the delivery of vaccine. At the weekend, the Scottish general practitioners committee said that the vaccine programme remains on track. As Jackie Baillie will appreciate, however, we are very much in the hands of the manufacturers in terms of supply of vaccine: we have to wait to get the supply before it can be distributed throughout Scotland to NHS boards. In my statement, I gave Parliament an update on the supplies that we have in Scotland today—165,000 doses—and an indication of the supplies that we know, with certainty, will come to Scotland over the course of next week. We will continue to ensure that, as soon as supplies are available from the manufacturers, they are distributed throughout Scotland. As we move through the initial weeks of the programme, we hope that the rate of supply from the manufacturers will gather even more pace.
At the outset of the vaccination programme, I said that it was our intention to be able to offer vaccination to all 1.3 million people in the priority groups by Christmas. That remains our intention and it remains our firm expectation that that will be delivered.
On Jackie Baillie's comment about people phoning their GPs, we have been clear that people should wait to be called for vaccination by their GP, and health boards are giving GPs as much information as they are able to, based on what I have said about manufacturers and supply of the vaccine. As I said in my statement, an NHS 24 helpline has been established to give people information about the vaccination programme.
I am absolutely firm in my belief that vaccination is our best defence against this virus. We have always said that we want to vaccinate the people in the priority groups as quickly as possible. That remains our intention, and we will do that as soon as supplies from manufacturers allow.
This country is one of the most advanced countries in the world in terms of vaccination. Many other countries, such as the United States of America, are experiencing significant problems with getting any supplies of vaccine.
All of us want the programme to be complete as soon as possible and all of us want it to gather pace. I assure all members that the vaccine supplies will be distributed as quickly as possible and that those who are at risk will be vaccinated as quickly as possible.
I thank the minister for making her statement. It is appropriate that she has done so. I also thank her for the advance copies of both of this morning's statements, which were received 35 minutes prior to the start of this morning's business. I also congratulate Jackie Baillie on her new post and look forward to working with her.
It is important to acknowledge the excellent working relationship that has been developed with UK ministers to double the ECMO capacity in Leicester, and their commitment to train NHS staff in Aberdeen. I commend all NHS staff, but I particularly commend those in NHS 24, who have risen to the challenge of swine flu.
Does the cabinet secretary appreciate why so many people are calling and pressuring their doctors? They are doing so against a background of increased hospitalisation of flu patients and the fact that more than 19,000 people were diagnosed with swine flu last week, as well as the fact that, tragically, 25 people have died. There is no doubt that all that is leading to increased anxiety to get the vaccine.
Can the cabinet secretary give pregnant women the advice that they need to reassure them about the safety of the vaccine for their own health and that of their unborn babies? Will she also give advice about the potential age immunity for swine flu, given that many reports are stating that a similar strain of flu was around in the 1950s, which might mean that people over 60 or 65 might be immune? That clarity is critical if we are to ensure that all those who would benefit from the vaccine come forward to get it.
I thank Mary Scanlon for her on-going co-operation on this issue. She is right to point to the good working relationship that has developed between health ministers across the UK. I speak to my fellow health ministers regularly—we last spoke yesterday afternoon. All countries in the UK are in the same position with regard to trying to get the supplies of vaccine from the manufacturers and out into the system as quickly as possible.
I take the opportunity to echo Mary Scanlon's comments about NHS 24. All NHS staff have worked hard over the past months to respond to this crisis, and NHS 24 has been exemplary and has done a fantastic job. As I said in my statement, the service has sometimes had to deal with call demand that has been 50 per cent above what it would expect at this time of year, but has met all its key performance indicators in doing so. I warmly pay tribute to the staff.
Mary Scanlon is right to talk about public concern. I absolutely appreciate the reasons for public concern. As she knows, I have been at pains to encourage people to take the outbreak seriously—at times over the past few months, it has been suggested that I have been overreacting because it is a mild illness that people do not have to take seriously. However, I have been, and remain, firmly of the view that it is serious. That is why I continue to encourage people who are offered vaccination to take up the opportunity.
The vaccine has been licensed for pregnant women and assurances have been given about the safety of the GlaxoSmithKline vaccine and the vaccine from Baxter Vaccines, which will be used at a later stage. Any pregnant woman—and anyone in the wider population—who has concerns should seek advice from their GP or from NHS 24.
With regard to Mary Scanlon's point about immunity, it has, during the current outbreak, been thought that people in the over-65 group or slightly younger have a background immunity to the virus that other members of the population do not have. That is still thought to be likely. There is also a growing view, which lies behind some of the downward estimates in the planning assumptions, that there is a greater background immunity among the population than was previously thought to have been the case. Nevertheless, I strongly encourage anyone who is in the over-65 group, or in any of the priority groups, to get vaccinated. That is a much better defence against the virus than any assumptions—accurate or otherwise—about levels of immunity in the population.
I thank the cabinet secretary for the advance copy of her statement. Liberal Democrats join her in extending our sympathy and condolences to those who have been affected by the disease, and in congratulating all members of the NHS staff, who have performed so admirably during this difficult time. I, too, congratulate Jackie Baillie on her appointment, which has, I understand, caused a frisson of excitement at NHS Greater Glasgow and Clyde.
I will pick up on the remarks that the cabinet secretary made in response to Mary Scanlon, about the balance between your well-expressed view—
Sorry, Mr Finnie—I must ask you to speak through the chair rather than directly to the cabinet secretary.
Cabinet secretary, I want to pick up on the points that Mary Scanlon made about the balance between remaining somewhat calm on the one hand, and stressing the importance of the situation on the other. Although at the beginning of your statement you referred to the disease as being "relatively mild and self-limiting" in most cases, you nevertheless—if I have read the statement correctly—reported a significant increase in the number of persons who are being hospitalised and, sadly, in the number of persons who have died as a result of the virus.
Do you have any concerns that the increase in the level of hospitalisation and the number of deaths is attributable to any change or mutation of the disease? Is the situation now slightly more serious than you have otherwise been able to report?
I thank Ross Finnie for his very serious question, and assure him that there is absolutely no evidence at this stage to suggest that the virus has mutated in any way or that it is any more serious than it has been since it was first discovered back in April.
Ross Finnie is right to point out, as I did in my statement, that during the past three weeks in particular there has been a sharp rise in the number of people who have been hospitalised and, unfortunately, a sharp rise in the number of deaths from the virus. I stress that that is a reflection of the increased number of cases of the virus in the community: as the number of people who are contracting H1N1 has risen, so has the number of those who need hospital treatment and, sadly, the number who are dying from it. The important point is that that does not indicate a rise in the proportion of people who are experiencing complications or losing their lives due to H1N1.
For the vast majority of people, the disease is still very mild—well, no flu is very mild, but it is a relatively mild illness. It remains the case, however, that for a minority of people the virus can result in serious complications, and it is not possible to predict with certainty who is likely to experience those complications. It will be mainly people who have underlying conditions, but not exclusively so. I return to the point that the best defence is vaccination; when people are offered the vaccination, they should take that opportunity.
We come to open questions. There are just over five minutes available, so I ask members for one short question followed by one short answer.
The cabinet secretary tells us that a Scottish expert group has been set up to examine the possibility of establishing regular ECMO facilities in Scotland. Can she give a more specific estimate of when that group is due to report back?
The ECMO expert group is due to report back to me in December, and that report will contain recommendations on medium-term to longer-term provision of ECMO in Scotland. The provisions at Aberdeen royal infirmary and the doubling of capacity in Leicester that I mentioned in my statement are interim responses to deal with the increased demand as a result of the flu pandemic, but it is right that we make considered judgments about how we provide a treatment that still divides opinion in the critical care community and which is still not fully established in terms of its efficacy. We should make those decisions in a considered way. The expert group will allow us to do so.
It is clear that the logistical problem is, as was to be expected, a major issue. Does the cabinet secretary agree that the broad-brush at-risk group that includes front-line health and social care staff, which was announced in report 56 on those at risk, from the Scottish Government resilience room, is now too broad for this first week or 10 days in which vaccine supplies are limited? Will she therefore consider issuing a refined list of priorities that includes, for example, young pregnant women in late pregnancy rather than all pregnant women, and children who are seriously at risk rather than all children? That would allow the vaccine supply to match the actual risk needs and prevent every person who is in the at-risk group from phoning up.
That is a perfectly legitimate question. As a politician and as a minister, I follow advice on matters that relate to vaccination, as Dr Simpson will appreciate, from bodies such as the scientific advisory group on emergencies and the Joint Committee on Vaccination and Immunisation. All UK ministers have followed that advice, and that is why the priority groups have been set as they are.
It is important that we vaccinate front-line health and social care workers in order to secure the services of the NHS. As I indicated earlier, GPs have been given guidance about how they should prioritise the use of limited supplies of vaccine in the early weeks. During the next few weeks, as vaccine supplies increase, greater numbers of people will come forward for vaccination. We are on track to vaccinate—or to offer vaccination to—1.3 million people in the priority groups by Christmas.
As the cabinet secretary acknowledged in her statement, it appears that we are now experiencing the predicted second wave. Can she reassure us that, in Scotland and in other countries that are experiencing the second wave, the widely held fears that the virus might mutate into a more virulent virus have not as yet been realised?
Yes, I can give that assurance. As I said in response to Ross Finnie, there is no evidence of mutation of the virus, although experts continue to monitor it very carefully. The revised planning assumptions that I mentioned in my statement have been revised partly in the light of the experience of H1N1 in this country, but also in light of the experience of the southern hemisphere countries such as Australia during their winter. That has allowed the experts to develop a much greater understanding and to predict with greater certainty how the virus might spread during the winter months. I repeat that the virus is not becoming more serious; it is just that as more people get it, more people will develop complications.
It is certain that for people who live in very remote areas, access to transport impinges on provision of health services. What consideration has been given to including people who drive buses and post buses, and volunteer drivers who provide hospital transport, in the priority group for vaccination?
We have prioritised front-line health and social care workers, and health boards will have a degree of flexibility about determining who satisfies that definition with regard to the delivery of their services. Beyond that, our very firm expert advice at this stage is to focus on the clinical at-risk groups, and that is what we will do during the following number of weeks. We will take advice, and discussions are already on-going, about what the later stage of the vaccination programme may involve.
Ministers will consider that advice in due course during the next few weeks and take decisions at an appropriate time, but the current priorities are front-line health and social care workers, in order that we can maintain NHS services, and the clinical at-risk groups, so that we can deal with those who are most at risk of developing complications.
The minister has already been reminded about her previous expectation that the high point might be experienced soon. Can she give an idea of the current expected profile for the development of the disease?
As I said in my statement, the latest planning assumptions and expert opinion are that we are now in the second wave, and that the spread of the virus has increased more steadily and gradually than might have been expected earlier in the year when, based on experience in the first wave, we expected a very sharp spike in cases by now. That has not happened yet, although it might happen in the next few weeks. At present, the profile of the virus is a steady and gradual increase. Experts say that it could peak in the next few weeks but could, equally, continue to spread gradually throughout the entire winter. The situation is being monitored carefully. We now have much better information on which to base predictions or assumptions about how the virus will spread, but we still cannot do that with absolute certainty.
I apologise to the members whom I am unable to call, but I must move to the next item of business, as our timetabling today is extremely tight.