Francie Molloy (Sinn Féin)

I inform Members that the Speaker has received notice from the Minister of Health, Social Services and Public Safety that he wishes to make a statement regarding swine flu.

Michael McGimpsey (UUP)

I take this opportunity to provide an update for Members on the Northern Ireland response to the swine flu virus. There have been a number of developments during the summer recess. During the summer months, I have continued to participate in regular Cabinet Office meetings with ministerial colleagues from across the UK. My Department remains in regular contact with officials in the Republic of Ireland.

Worldwide, there have been more than 275,000 cases and more than 3,000 deaths. In the UK, there have been more than 70 deaths. In the main, the illness continues to be mild and self-limiting, although, for some people, it can be severe. To date in Northern Ireland, we have had 217 laboratory-confirmed cases. However, the actual number of cases is much higher, with almost 9,000 courses of antivirals having been prescribed to people who have been clinically diagnosed as having swine flu. In addition, the number of people who are consulting their GPs with flu-like symptoms is significantly higher than in previous years at this time.

Until now, 94 people have been hospitalised with swine flu in Northern Ireland. I have also been informed of a second death that was possibly associated with swine flu. Obviously, every death is tragic, and my thoughts and sympathies are with the family. Members will understand and respect that it is not appropriate for me to make any further comment at this time.

Although the levels of flu have been decreasing since their peak at the end of July, we should not be complacent. The scientific experts have advised that it is unlikely that that downward trend will continue. We are preparing for a surge in cases later this year and potentially for a more severe pandemic strain.

We now know more about the virus and its effects, and we have been able to revise our planning assumptions. We have gathered more information from experiences of the pandemic in the UK and internationally, which has allowed us to refine our reasonable worst-case scenario. The timing of a possible pandemic wave has also been reassessed. In the worst-case scenario, we can still expect around 30% of the Northern Ireland population to be affected by the virus in a future wave. That means that approximately 500,000 people or one third of the population may become ill with swine flu over the course of the next wave. In addition, 5,000 people could be hospitalised owing to the virus, and up to 525 could die. During the peak week, as many as 113,000 people could be affected. Those are not predictions; rather, they are assumptions that enable us to plan for the very worst that could happen. Scientists have advised that a substantial peak in the virus may occur in mid- or late October.

I announced during the summer that advice had been received from the Joint Committee on Vaccination and Immunisation (JCVI) on which groups should be prioritised for vaccine. When the vaccine is licensed, it will initially be offered to individuals aged between six months and 65 years in the current seasonal flu clinical at-risk groups; all pregnant women, subject to licensing considerations; household contacts of immunocom­promised individuals; and people aged 65 and over who are in the current seasonal flu clinical at-risk groups.

Those priority groups have been selected because they are at higher risk of severe illness from swine flu. Prioritising them ensures that we make best use of our initial quantities of vaccine. Front-line health and social care workers will also be among the first to be vaccinated. The close contact that they have with patients means that they are at additional risk of contracting and transmitting the virus.

I expect to have sufficient vaccine for all those in the initial priority groups by the end of November. I anticipate that a licence will be granted in October; however, that is the responsibility of the European Medicines Agency (EMEA), and I await its decision. I will continue to monitor the emerging evidence and the expert scientific and medical advice before taking any decisions on extending the programme beyond those initial priority groups. Planning assumptions will also need to be revised to take into account the impact of the vaccination programme.

I am pleased to announce that a UK-wide deal has been agreed with the General Practitioners Committee (GPC) on administration of the vaccine this autumn. The Department has agreed that GPs will receive £5·25 per dose of vaccine given and that district nurses will assist by vaccinating housebound people, in line with existing seasonal flu arrangements.

I am grateful to GPs for their willingness to take on that major vaccination programme. I am satisfied that their co-operation represents value for money in delivering the programme. Preparations for GPs to immunise the priority groups once the vaccine is licensed will now begin. Vaccination is our best defence in the battle against swine flu, but we must also be prepared for a significant increase in hospitalised cases. Experience elsewhere has shown that up to a quarter of hospitalised cases may require intensive care. Plans are in place locally and nationally to increase critical care capacity to cope with the potential demands of swine flu. I intend to more than double capacity in adult critical care. To provide that capacity in Northern Ireland, 47 adult ventilators are being procured.

The Department also plans to increase substantially the number of paediatric critical care beds and recognises that some older children may need to be cared for in adult critical care facilities, while receiving the necessary support from paediatric staff. The number of appropriately trained staff must be increased to support that additional capacity, plans for which have been developed.

Doubling critical care capacity will allow many more people to benefit from critical care than would otherwise be the case. To achieve such a significant increase, hospitals must deploy their trained workforce differently, and they may also have to postpone non-urgent, planned operations to concentrate staff and resources on the most seriously ill patients.

Keeping the public informed is a key element of our preparations. To that end, I have a major communications programme planned for the autumn and winter to maintain public confidence and awareness. That programme will build on the work that has been done to date, including the very effective bus panel advertisements that use the “sneezing man” image, which stresses the need for good hand hygiene. To reinforce the message that people should stay at home if they are experiencing swine flu symptoms, I ran a local advertising campaign. My Department is developing leaflets and other public information to accompany the swine flu vaccination programme.

In the summer, England launched the National Pandemic Flu Service in response to significant pressures experienced by GPs there. However, the number of cases to date in Northern Ireland and the fact that our primary care services have been coping well has not merited its introduction here. The situation is constantly under review and, should the need arise, that facility can be introduced quickly.

To date, most of the focus in the pandemic response has centred on the Health Service. However, if a more severe pandemic wave is experienced later this year, we can expect to see significant pressure on schools and local services. Recently, I met my ministerial colleagues from the Department of Education and the Department for Employment and Learning to stress the need for business as usual as far as possible during the pandemic, and I am pleased to note that children have returned to school as normal following the summer break. The Public Health Agency continues to work closely with schools to ensure that local risk assessments are provided if significant absentee rates are reported. Now that schools have reopened and with the onset of the autumn/winter flu season, I do not expect the recent decline in the number of cases to be sustained.

Yesterday, I met the Minister of Enterprise, Trade and Investment. A future pandemic wave could have a very disruptive effect on businesses due to absences and difficulties with delivering normal services.

I also met the Finance Minister to discuss funding for the swine flu pandemic; later this week, I will meet him to continue those discussions. The bill for dealing with the pandemic could be £80 million or higher. To date, we have spent almost £30 million, most of which relates to national initiatives, such as antivirals, vaccines, personal protection equipment and antibiotics. That figure does not include costs such as the delivery of vaccinations, antiviral distribution, staff backfill for sickness absences and extra capacity in intensive care. There can be absolutely no doubt that costs will rise.

My officials have developed and costed three possible scenarios: a relatively benign estimate, assuming a moderate peak in demand; a reasonably prudent estimate, factoring in our best assessment of the extent and place of the pandemic; and a reasonable worst-case scenario. I have placed a bid of £77 million for scenario 2 on the basis that it represents the most realistic estimate of the costs that are likely to be incurred. Against that, I can find a total of £27 million, which is more than one third of the cost. I must remind the House that without funding there will be serious consequences for the health and social care service, patients and the public.

Regular hand washing and respiratory hygiene remains the single most important thing that people can do to protect themselves and prevent the spread of the disease. If people have flu-like symptoms, they should stay at home and call their GP, who will provide advice. People should not go to their GP surgery or to a hospital, as they may spread the disease to others.

We cannot predict with certainty when the pandemic will peak in Northern Ireland or the number of people who will need hospital treatment. However, our robust preparations enable us to ensure that we can respond to any scenario, even the worst case that I outlined at the beginning of my statement.

We must not be complacent. Although this is not a killer virus, it can kill; therefore we must continue to put plans in place that are proportionate to the threat. I am confident that our Health Service will cope with any increase in the number of cases in the coming months. I will continue to keep Members updated on a regular basis, and I commend the statement to the House.

Jim Wells (DUP)

I thank the Minister for his statement, and I also thank his staff for the regular updates that Members of the House and members of the Committee have been receiving.

As the Minister knows, the Chief Medical Officer and his assistant briefed the Committee on this issue. Indeed, during quite a long meeting, they also briefed the Deputy Chairperson and me. Openness and transparency throughout the process will reassure the community, so I hope that that trend will continue.

I extend my sympathy to the family of the baby who apparently — we are not yet certain — died as a result of swine flu, the second victim in Northern Ireland. I am sure that the House will join me in extending our sympathies to that family.

I am, however, concerned about the decision that was taken on a UK-wide basis to pay GPs £5·25 for administering each swine flu vaccine. If everyone in Northern Ireland is vaccinated, the bill will be almost £9 million. Given that GPs secured an extremely generous pay review three years ago, which has led to a 50% increase in their pay to an average of £108,000 per annum, it is a bit rich of the BMA to ask for further payments for the administration of vaccines. Frankly, GPs should have agreed to do that as part as their contract.

My questions about that decision are as follows: first, is it binding on Northern Ireland, or do we have any choice in the matter; and, secondly, has that figure of £9 million been built into the Minister’s assumptions for the future cost of the swine flu pandemic, which has gone up from £55 million to approximately £70 million? Will the £9 million be included in that figure, or are we expecting that some form of grant aid will become available from the mainland? Finally, on a minor point, will the Minister reassure us that student nurses will be included on the front-line services priority list for vaccination?

Michael McGimpsey (UUP)

I assure Mr Wells that all front-line Health Service staff will be vaccinated as a matter of priority. Without the staff, we obviously cannot continue to operate our hospitals and Health Service.

On the substantial point that Mr Wells made about GPs, Members will be aware that the GP contract is negotiated nationally and applies to England, Scotland, Wales and Northern Ireland. Although I was kept informed throughout, this negotiation was carried out in London with the GPs’ contractors. GPs are independent contractors who operate in the Health Service through the GPs’ contract that is agreed nationally. They provide two essential work streams: essential services and additional services. Part of the additional services is referred to as directed enhanced services, and that is where this negotiation and deal comes from, because it is work outwith their normal workload.

Whether the contract negotiated three years ago was prudent is not a matter for me at this stage; I was not involved in that. In general, GPs in Northern Ireland provide an extremely good service for our patients. The front line is moving forward towards primary care, and our focus — the shift left of the Health Service in Northern Ireland — is about prevention being better than cure. Our GPs are very much in the front line of that, and their services are increasing all the time. People are aware that, when they go to the GP now, it is not simply a doctor; a whole range of services is being provided. I anticipate that GP services will increase. It is clear that this is an additional service that GPs provide.

We want GPs to administer the vaccinations because they have their patients’ records and know who is in the priority risk groups. GPs can easily identify priority risks and deal with them accordingly.

Sue Ramsey (Sinn Féin)

Go raibh maith agat, speaker is in charge of proceedings of the House of Commons in..." class="glossary">Deputy Speaker. I thank the Minister for his statement and for the updates that we get on a regular basis. I also thank all those who have been working either directly or indirectly on the issue of swine flu. We should recognise that hard work has been done on swine flu by the health sector.

Like the Minister, I extend my sympathy to the family of the child whose death, it seems, is the second associated with swine flu. It is unwise for the Minister to make any additional statement at this point, but it would be useful to have further details through time.

The Minister indicated that 94 people had been hospitalised. It will be useful to have an idea of how many of those 94 people were in intensive care. I am hearing reports that people have been ill enough to go into intensive care.

The Minister went on to say that people who have symptoms that they think are associated with swine flu should not go to their GP or their local hospital. I am still hearing reports of people ringing GPs’ surgeries and being asked to come to the surgery, even though they say that they have the symptoms that are associated with swine flu. There is an issue with that. Has the Minister heard any of those reports? If so, what can we do to ensure that GPs’ surgeries do not allow that to happen? If those people have swine flu and they end up in surgeries or in hospitals, the purpose of the measures that the Minister is advising in his public statements is being defeated.

Michael McGimpsey (UUP)

I am surprised at the Member’s second point about people phoning their GPs and being told to come to the surgery; that should not be happening. Perhaps there is confusion over the symptoms being reported or what the proper response should be, but the proper response is for people to stay at home and not come out and spread the swine flu.

A number of people are in intensive care. I do not have to hand the number of people who went to hospital and ended up in intensive care, but it is a substantial portion of those whom the Member mentioned. I will determine what that number is and respond to the Member in writing.

John McCallister (UUP)

I thank the Minister for his statement, which he made immediately upon coming back for the new term. I associate myself and my party with the Minister’s remarks about the death of the small child. It is very sad that a family is in mourning. It would be useful to receive any further details if they become available. Our thoughts and prayers are very much with the family at this time.

The Minister spoke about a future surge in cases. That will, of course, create extra costs for and pressure points on the Health Service. When does the Minister think those pressure points will arise, if the financial arrangements as to who is paying for the associated costs are not sorted out quickly? Where will that hit? As we go into the autumn and winter, knock-on effects will be felt. In his statement, the Minister mentioned the effects on services. If the finance is not sorted out quickly, when will those effects start to bite?

Michael McGimpsey (UUP)

I have given a robust and realistic estimate of the costs, and that is the middle scenario. To date, we have expended around £30 million, with more to come. That is what is required to protect the population. In my budget settlement letter, along with the other parts of the settlement, I stated that I will bid for resources to deal with pandemic flu. That is what I am doing at the minute, and I am discussing that bid with the Finance Minister. It is clear that if we do not live up to our budget settlement, there will be issues not only for the Health Service, but for every Department and for all of us. Discussion on that is still going on.

With regard to a white knight coming from the Treasury, I listened to Mrs Robinson’s optimistic response to me that the Treasury was going to pay the swine flu costs. I still have no knowledge of that, so I am waiting to hear of any developments.

Jim Wells made a point about the costs. All the estimates for the costs, as far as the GPs are concerned, are contained in the amount. I am trying to hold the money and the costs as best and low as I can alongside achieving value for money and so on. Ultimately, however, we have a responsibility to protect our population, many of whom will come to harm if we do not take the steps that we are taking.

Carmel Hanna (Social Democratic and Labour Party)

I thank the Minister for his statement. I extend my sympathy to the baby’s family. It is a sad time for them.

I share the Health Committee Chairperson’s concern about remunerating the GPs individually for each vaccination. They do a good job, but they are well paid already, and this situation is a health crisis.

Does the Minister have a particular communications strategy in place for ethnic minorities, who may not be so aware of or understand our public health system and issues around health and safety?

Michael McGimpsey (UUP)

I understand what Mrs Hanna has said about GP remuneration. However, as I have said, those payments are being made as part of a national deal and contract of which we are very much part and, frankly, one from which we benefit more than we lose.

As far as ethnic minorities are concerned, the Department will be making every effort to ensure that everyone receives the proper and correct information. I am re-examining that for the autumn, and the Department will continue to upgrade and refresh that information as we go along. The Department has already made considerable efforts in the production of a guide to the Health Service for ethnic minorities who come from a different linguistic tradition and who are not completely fluent in English. I will continue to re-examine that, because it is very important that people receive the necessary information and that the Department provide that information to them.

Kieran Deeny (Independent)

I thank the Minister for his statement. I also thank him and his Department for their work since this major health issue became a global one. The Minister’s statement has answered some of the questions that I intended to ask him, and I am delighted to see that the priority groups will be vaccinated by the end of November.

Is the Minister happy that the vaccine safety checks have been completed and that the safety profile of the vaccine will be good enough? I am aware that that is a European issue, but what is the view locally? Furthermore, will any surplus vaccine be made available to the general public after the priority groups have been vaccinated? Moreover, will regulations be made that will mean, for example, that we cannot vaccinate the general public until priority groups have been covered?

Michael McGimpsey (UUP)

As far as priority groups are concerned, decisions are very much determined by the Joint Committee on Vaccination and Immunisation. That committee advises COBRA — the civil contingencies committee — on those issues, and the groups that I have detailed are the groups that COBRA considers to be most at risk. However, that will be only the initial phase of the vaccination programme, and, as I said, we should be in a position to have all the initial priority groups vaccinated by the end of November. We also have a delivery schedule for vaccines, and we will move through the general population after the priority groups have been vaccinated. Again, the Joint Committee on Vaccination and Immunisation, after taking expert advice from the Scientific Advisory Group for Emergencies (SAGE), will determine the steps to be taken.

By the end of December, we anticipate having almost 1·5 million individual doses of vaccine to hand. The current plan is that everyone will receive two doses of the vaccine, although I understand that in China the entire population is being vaccinated on a one-dose strategy. That is something that the Department will monitor carefully, and it will take the advice that is offered.

Vaccine safety is governed by the European Medicines Agency, which is examining the safety of the new vaccine, just as it does for other medicines and vaccines. As I understand it, the vaccine will not involve injecting a live virus into anyone. The H1N1 vaccine will be very similar to the H5N1 vaccine that is used to treat seasonal flu, with some modifications made to take account of the new virus. Therefore, tried and proven medical and scientific technology, knowledge and expertise will be applied as it is every year with seasonal flu. That should provide comfort for everyone.

Alex Easton (DUP)

I praise the Minister’s Department for the good work that it continues to carry out.

Will the Minister commit to being the first man in Northern Ireland to receive the vaccine? That would show goodwill to the people here and would demonstrate that the vaccine is safe. Furthermore, the Committee for Health, Social Services and Public Safety was told last week that around 9,000 people here have received Tamiflu, and I also understand that quite a number of people diagnosed with swine flu has not been given antiviral drugs. Will the Minister give the accurate figure for the number of people in Northern Ireland who have had swine flu? Does having had swine flu mean that those people do not need to get the vaccine?

Michael McGimpsey (UUP)

I do not fall into the priority risk groups for those who will receive the vaccine and, therefore, I am not entitled to it. However, if I believe that public confidence requires it, I will be happy to be the first person to step forward and take the vaccine, because I will be absolutely certain that it is safe. Based on my knowledge, I will also advise members of my family to take the vaccine.

Prescriptions for over 9,000 antivirals have been issued so far, and that is a good indication of the number of people who have taken the swine flu medication. We do not know whether those who have had swine flu will be free from the risk of getting it again. We do not know how the virus will perform, so I think that the advice would be that those people should be vaccinated. The advice is also that those people may have immunity for a year or two, but we cannot be certain: therefore, we will always put safety first.

Claire McGill (Sinn Féin)

Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his statement and commend his Department for the work that has been done.

One of the difficulties is that so much is based on speculation and assumption about what might happen. The Minister said that there has been a decrease in the number of cases since July. We expect that there will be a peak week in mid-October, but the vaccine will not be licensed until late October and will not be available until November. How can we reconcile that chronology to ensure that what is happening will be an effective means of dealing with the swine flu pandemic?

Michael McGimpsey (UUP)

We can have confidence because, as the knowledge of the virus increases with experience, so the planning assumptions can be modified, and that is the case. We are working on assumptions and not on predictions, but those assumptions inform us as to how we model what will happen. The assumptions now tell us that there has been a reduction in the estimate of the number of fatalities involved and the number of hospitalisations. Nevertheless, the numbers are substantial. Those numbers will be revised again, and they may move upwards or downwards. The situation is based on international, national and regional experience.

The vaccine will be available for use in a vaccination programme once the licensing process is complete. We will always put patient safety first. The licensing process will take place in October. We will then be able to go forward and give the population the protection that it requires.

Michael McGimpsey (UUP)

As far as the necessary resource is concerned, as I outlined in my statement, a robust estimate of the amount needed has been made, and I am having discussions with the Finance Minister. As everyone is aware, the budget settlement included provision for pandemic flu.

The response is a national response: the approach being taken in England, Scotland, Wales and Northern Ireland is the same, and I will be having another discussion with the Finance Minister in due course. The swine flu pandemic is a serious challenge to the health of the population of Northern Ireland, and the Health Service has a duty to meet that challenge. Obviously, there will be a resource implication for whatever steps are taken. I have outlined that from the beginning, and I anticipate that the House will not be found wanting as far as protecting our people is concerned.

Dolores Kelly (Social Democratic and Labour Party)

I thank the Minister for his statement. At all times he has tried to bring us as much information as possible, but sometimes we are concerned about some of the detail that we do not know.

In his statement, the Minister said that he hopes to increase the number of critical care beds and train up staff. I welcome that because even in normal times there are not enough beds to meet the needs. In my constituency, two children had to be transferred to England and Scotland during the Christmas and New Year period last year. In relation to children and young people, in particular, how many new beds will be provided and where will they be located? Is the budget for the provision of critical care capacity included in the Minister’s bid, or is it additional? The Minister stated that £27 million could be found: are any other services being impacted adversely because of the need to move money around?

Michael McGimpsey (UUP)

As far as the challenge ahead is concerned, hospitalisation in many cases will require critical care capacity, a point made by Sue Ramsey. I anticipate that critical care capacity, as far as beds are concerned, will more than double and that paediatric critical care beds will follow suit. Clearly, there is an issue regarding associated staffing, and we are planning for that at the moment. Robust plans are in place, and the trusts have worked very hard to get those plans in place. It will have an effect on other activities in hospitals, and I have outlined those possible effects in my statement.

The amount of money needed is included in my estimate of costs, as it properly should be. That is part of the response as we work our way through vaccinations, medical countermeasures, workforce planning, the steps being taken nationally as well as regionally, and the steps that we are taking on critical care capacity. All of those steps must be taken to ensure that the Health Service is able to cope with the anticipated demand. We expect, and the modelling shows, that the period will last for around 15 weeks and will peak roughly halfway through that 15 weeks. There could be more than 100,000 cases during that critical period. That will present a huge challenge to primary and secondary care in our hospitals and will affect the capacity to treat people through critical care, particularly priority risk groups such as young people and the elderly.

The £27 million that I have contributed is money that I have been able to identify in the health budget. Obviously, I would rather spend it on something else, but we all have to prioritise. When money is short, the thing to do is prioritise what is most needed.

Stephen Farry (Alliance)

I thank the Minister for his statement. I want to ask about communication and the impact of swine flu on the management of the Health Service. The Minister has rightly pointed out the advice to people not to go to hospitals or GPs if they have flu-like symptoms. How does that sit with one of the other stated objectives of the Health Service, which is that of trying to manage the level of people keeping appointments, particularly at hospitals? I have come across cases of people who have cancelled appointments being lectured and warned that if they cancel further appointments they may miss their opportunity to see a specialist. How can we reconcile the different messages that are being given out?

Michael McGimpsey (UUP)

This is an emergency; we are not dealing with our normal situation. Cancelled appointments represent a considerable expense for the Health Service, and we are trying to reduce them as much as possible. The percentage of people who do not up for appointments is running at around 10%. That represents a large number of people, and it costs the Health Service a lot of money.

Against that, however, we are asking people to be responsible and to exercise some personal judgement, and that involves not turning up at the doctor’s surgery or the hospital if they believe that they have symptoms of swine flu. Those symptoms are available for all to see through the various strands of the communication strategy that we have been involved in. That communication strategy is about keeping the general public as informed as possible. We have done that to date, and we will continue to do that because, as far as our population is concerned, keeping them informed is crucial.