§ 3.23 p.m.
§ The Earl of Courtownasked Her Majesty's Government:
Whether, in the light of the influenza epidemic, they will reconsider their decision not to allow Relenza to be prescribed on the National Health Service.
§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)No, my Lords. The guidance from the National Institute for Clinical Excellence advising clinicians not to prescribe Relenza during this winter's flu season was based on a careful and thorough review of all the clinical evidence then available. The institute will be reviewing the position later this year.
§ The Earl of CourtownMy Lords, I thank the Minister for his reply. However, does he agree that this drug is widely used in other countries? In the United States of America, more than 400,000 prescriptions are 1242 given out; 160,000 in Italy; and a great many in other European countries. The drug passed clinical ability tests and regulatory bodies; it alleviates the symptoms of flu. Does not the Minister agree that if it were widely available it would reduce the pressure and costs on the National Health Service?
§ Lord Hunt of Kings HeathMy Lords, I am not convinced of that. The noble Earl will be aware that the advice received from the National Institute for Clinical Excellence was based on the most authoritative analysis available. The purpose of establishing NICE was to ensure that in the NHS we use the best treatments possible. The advice from NICE was that if Relenza is taken within 36 hours of the symptoms appearing, the benefit is limited to reducing the average length of illness from six to five days. On that basis, and on the evidence so far that Relenza does not provide specific benefit to older people who are the most vulnerable from the effects of flu, NICE gave that advice to the National Health Service.
The US Food and Drug Agency, in giving advice to prescribers of Relenza, said that it had been shown not to be effective in high risk patients, and that it should be used with caution in patients with pre-existing respiratory diseases.
§ Baroness TrumpingtonMy Lords, would it help the National Health Service to overcome the problems it has endured during the present flu crisis if all flu vaccinations were free?
§ Lord Hunt of Kings HeathMy Lords, just over 8 million doses of flu vaccination were made available to the NHS. We then encouraged GPs to advise members of the public who were particularly susceptible to flu to receive those vaccinations. In the high risk group—those aged 75 and over—44 per cent received flu vaccinations. Whether or not one wishes the whole country to be flu vaccinated is a much wider issue and one on which we shall clearly need to take advice. We need to be careful before taking the view that a panacea for the pressures at this time is complete vaccination across all groups in the population.
§ Baroness TrumpingtonMy Lords, can I come back to the Minister—
§ Lord EltonMy Lords, I apologise for asking a question without notice requiring figures which the Minister's brief may not include. However, in order to make it possible to evaluate his earlier answer, can he say what is the highest number of beds occupied in the National Health Service by patients diagnosed as 1243 having influenza during the current so called epidemic? What were the comparative figures in each of the last five such series of events?
§ Lord Hunt of Kings HeathMy Lords, I do not have that information available. I shall see whether or not it is available.
§ The Earl of OnslowMy Lords, the Minister has just shown that he is formidably well briefed. Will he please lecture the noble Lord, Lord Bassam, on how to be well briefed as opposed to being badly briefed?
§ Lord Hunt of Kings HeathMy Lords, my noble friend Lord Bassam answered his questions very well indeed.
§ Baroness TrumpingtonMy Lords, can I come back to my question?
§ Lord MarlesfordMy Lords, what is the net cost to the taxpayer of giving a working person a flu jab, after they have paid the prescription charge? Also, what is the cost to the national economy of somebody being off work for five days? What implication is there in that comparison?
§ Lord Hunt of Kings HeathMy Lords, vaccines given through the NHS are given free of charge. My understanding is that the vaccine costs around £4 a dose. The other questions will need further consideration.
§ Baroness TrumpingtonMy Lords, may I come back to my question?
§ Baroness Thomas of WalliswoodMy Lords, what advice is the Minister giving to hospitals as to the good sense of ensuring that all their employees are vaccinated against flu? Is it not the case that a number of beds have been "lost" because there are not the nurses to staff them, they themselves being ill?
§ Lord Hunt of Kings HeathMy Lords, the noble Baroness raises an important point. We allowed NHS trusts to offer vaccinations to NHS staff. I am not entirely sure of the number who took up the offer. Clearly, we shall want to evaluate that information to see what effect it had on the general level of staffing within a particular hospital. It is worth making the point that influenza is not the only illness that has struck staff during the past few weeks. I am keen to share with noble Lords the point I made earlier; namely, that while the flu vaccine is one element in an approach which tries 1244 to relieve pressure on the healthcare system, one cannot use it, wave a magic wand and all the pressures will then go away. That is not the case.
§ Baroness TrumpingtonMy Lords, is the—
§ Baroness TrumpingtonMy Lords, is it my turn, or not?
§ Lord Stoddart of SwindonMy Lords, if I may, I return to the question asked by the noble Lord, Lord Elton, as the Question refers to the flu epidemic. Perhaps my noble friend will correct me if I am wrong, but I understand that the present rate of new, reported cases is 235 per 100,000 whereas an epidemic constitutes 400 cases per 100,000. If those figures are correct, we do not have an epidemic. Does not my noble friend agree that these loose terms cause panic and problems among the general public and for the medical profession? In future can we use these terms less loosely?
§ Lord Hunt of Kings HeathMy Lords, I believe that my noble friend refers to the formal definition of a flu epidemic which is 400 new patients per 100,000. In the latest week for which I have statistics the figure was 236 per 100,000. I believe that that could be termed in the range of a modest epidemic.
§ Lord Hunt of Kings HeathLet us start with the word "modest" as a baseline. In addition, we must consider the advice which the health service has given people; namely, to call their doctor only if necessary and to stay at home. Further, we have encouraged community pharmacists to offer advice rather than patients having necessarily to visit their general practitioner. Thousands of people have contacted NHS Direct every week. That service has permitted people to receive advice without having to visit their GP. It seems clear that the definition in terms of numbers of people consulting their GP is no longer satisfactory to describe what has been happening in the NHS. Anyone who has talked to people working on the front line in the health service will know that the pressure on them has been enormous.
§ Lord BlakerMy Lords, in view of the chaos that has been caused by what is, apparently, only halfway to an epidemic, what will it be like when there is an epidemic?
§ Lord Hunt of Kings HeathMy Lords, what has clearly emerged over the past few weeks is that the health service has been under pressure. There is no question about that. However, we should also pay tribute to the remarkable way in which people in the NHS—doctors, nurses, ambulance crews and other 1245 staff—have responded to that pressure. I have great confidence in the future of our service because no matter what pressure arises, people respond to it. As we modernise the health service we hope that we shall be able to ease some of that pressure as well as provide always the kind of service that people want.
§ Lord AcknerMy Lords, what is the rate of success of the flu jab? I raise this question because years ago I used to advise GPs on their biannual application for increased pay. A consultation took place every January. On one occasion I asked why only three rather than 12 doctors were present. I was told that they were down with flu. I asked, "Don't any of you chaps get injected?" They replied, "We're not going to have some dirty great needle stuck into our arms." What is the rate of success of flu jabs?
§ Lord Hunt of Kings HeathMy Lords, I cannot give the precise percentage figure as regards the success rate of the flu vaccination. I suspect that it is difficult to give precise figures. Certainly, I believe that many members of the public have found it advantageous to be given the flu vaccination. Therefore the Government have encouraged the health service to give vaccinations to members of staff and to ensure that those vulnerable members of the public who need to receive the flu vaccination actually receive it.