Health Secretary Nicola Sturgeon
Statement to the Scottish Parliament on A(H1N1)
October 29, 2009
There have been a number of developments since my last statement to Parliament on the H1N1 flu virus. Many of these developments were covered in the update letter 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.
Current Situation
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 week ending 26 October. The report, which is based on information from the All Scotland Reporting system covering 86% of all GP practices, indicates that in the last week GP consultations for influenza-like illness were 111 per 100,000 of the population, an increase of 27% on the previous week. It is estimated that around 19,200 people contracted H1N1 over the last week, compared to around 14,600 in the previous week.
It is important to stress that in the vast majority of cases, this virus remains relatively mild and self-limiting. However, some people are experiencing serious complications and requiring hospital treatment as a result.
Hospitalisations and admissions to critical care for H1N1 have increased significantly over the past three weeks. Today's HPS report confirms that there have been a total of 556 people with H1N1 admitted to hospital since the outbreak began. 176 of these have been in the last week and 384 since the end of September.
As of yesterday, there were 65 people in hospital confirmed as having H1N1. 23 of them were receiving treatment in ICU.
As Members are aware, there have now been a total of 25 deaths in Scotland associated with the virus. 4 of these deaths have occurred in the past week.
I am sure that all Members will join with me in expressing sympathy to those who have lost a loved one as a result of the virus. These deaths underline the importance of the vaccination programme in protecting the most vulnerable from this virus and I will say a little more about this shortly.
NHS Preparations and Contingency Planning
Members will appreciate that the increase in admissions to critical care has put our services under additional pressure.
Increasing pressure was of course a key consideration in our contingency planning arrangements and that is why all Boards were asked to put plans in place to increase critical care capacity by 100% should that be necessary.
Those plans are in place and ready to be activated as and when necessary. As I announced previously, the Scottish Government has supported these plans with the purchase of an additional 43 adult ventilators, 15 paediatric ventilators and 9 neonatal ventilators. These will be used as and where demand arises throughout Scotland.
Let me turn now to the subject of ECMO.
In recent weeks there has been considerable media coverage on the benefits of ECMO treatment. Only last week, I had an opportunity to meet with Sharon Pentleton and her newborn son. As Members will recall, Sharon was transferred for ECMO treatment to Sweden 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 UK's nationally commissioned ECMO centre in Leicester, and in the accredited European centre in Stockholm.
Clearly, the H1N1 pandemic is having a significant impact on demand and existing capacity for ECMO. For that reason, UK Health Ministers agreed to double the ECMO capacity at Glenfield Hospital in Leicester. Doubling will be achieved by the end of this week.
However, I can confirm today that over the past week, adult respiratory ECMO has been provided at Aberdeen Royal Infirmary on 2 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 by Leicester in their use. The decision to provide ECMO for the two patients in Aberdeen was taken after close clinical consultation with the Leicester team and indeed these consultations are ongoing.
In light of what we are seeing in terms of increased demand across critical care, I asked the Scottish Expert Group on ECMO for interim recommendations on the immediate capacity of NHS Scotland to provide adult ECMO facilities and the contribution that Aberdeen might be able to make on an ongoing basis during the flu pandemic.
The Group has recommended that while Leicester should remain the 'front door' for access to adult ECMO provision at this stage and that all referrals should be discussed and agreed with them, ECMO treatment can be provided in Aberdeen in future but only on occasions where additional capacity is required. The decision to treat patients in Aberdeen will be subject to both agreement and clinical support from Leicester.
The Expert Group will report to me over the next few weeks with its recommendations for longer term provision of adult ECMO in Scotland.
Presiding Officer,
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 critical care services and it is also true of 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 which they face. These pressures have, at times, been considerable. NHS 24, for example, has dealt with call demand that, on occasion, has been as much as 50% higher than forecast demand for this time of year. NHS 24 and other primary care services have coped admirably.
We are not complacent, however, and I am very aware of the potential for winter pressures to further increase demand on primary care services. However, taking into account the ability of NHS 24 to increase their capacity if necessary, I am confident that Scotland's primary care services will continue to cope over the winter period.
We do, of course, retain the option of joining the National Pandemic Flu Service - which we have been developing with our UK colleagues - when and if we think this is necessary.
The advice remains that people in Scotland who are worried about flu-like symptoms should continue to contact their GP or NHS 24.
Vaccination Programme
Let me turn now to the vaccination programme which began its roll-out last week.
As I have said repeatedly, and 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 vaccine in the early weeks of the programme will be limited and therefore the programme will proceed on a phased basis. Clearly the supply of vaccine is subject to the volume that the manufacturers can supply us with in the initial weeks, but I can assure colleagues that vaccine is being distributed as soon as it is available.
Indeed, I can report that, to date, 165,000 doses of the vaccine have been supplied to NHS Boards across Scotland.
By Monday, we will have received in Scotland almost a quarter of a million doses of vaccine and by next Friday we will have received 367,000 doses. This is in line with our expected delivery schedules.
As members are aware, the first supplies of vaccine have been used to vaccinate vulnerable patients in acute settings and to begin the vaccination of frontline health and social care workers.
However, from this week, GP practices in Scotland have also begun to receive initial supplies of vaccine to allow them to begin vaccination of the priority groups as soon as possible.
I expect all GP Practices to have received their initial supplies of 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 vaccine in the early weeks, we have provided guidance to NHS Boards on how to make best use of their initial supplies.
I can confirm, however, that we expect all of the 1.3 million people in the priority groups to have been offered vaccination by Christmas.
I can also report today that early anecdotal evidence suggests that uptake so far of the vaccine by frontline health and social care staff is good. Over the next few weeks we will, of course, begin to report the actual uptake figures. I am sure members will agree that it is important that our frontline health and social care workers protect not only themselves, but also those vulnerable patients and clients with whom they are in contact.
A UK communication campaign will also begin soon to encourage uptake of the vaccine within the clinical at-risk groups. This includes the establishment of a new dedicated NHS24 information helpline - which is already up and running - to provide members of the public with up-to-date information on the vaccination programme.
Planning Assumptions
Presiding Officer,
The last issue I would like to update members on today is the publication on 22 October of the latest version of the UK planning assumptions. Members will be aware that these are not definite predictions. However, they use our developing data on the virus to give the NHS and other sectors the best basis on which to plan.
The planning assumptions indicate a consistent but gradual increase in the incidence of H1N1 in Scotland and across the UK.
The scientists consider that the overall clinical attack rate in a worst case scenario might now affect 12% of the population. This is down from the 30% figure in the previous planning assumptions. Furthermore, workplace absences are now projected to be 5%, down from 12%.
While this 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.
Presiding Officer,
Over the coming winter months, we anticipate that pressure across the NHS as a whole will increase. 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 which 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 they are doing to ensure that this is the case.