'Everybody knows somebody who has had it'

With permission Madam Speaker I would like to make a statement on the outbreak of influenza that is gripping the country and the impact it is having on NHS services.

As the House will be aware the last few weeks have seen a particular strain of influenza - Sydney A - affecting thousands of people in all parts of the country. According to the public health laboratory service which monitors the incidence of flu it has been rising in all regions over recent weeks.

The worst affected regions to date have been the north and central. Nationally in early December the numbers of people consulting their GP for the first time with flu-like symptoms stood at 40 per 100,000 population. Today I can tell the House that the latest provisional figure had more than quadrupled to 197 per 100,000. The CMO professor Liam Donaldson has advised that the official figures only reflect the people who have consulted their doctor and undoubtedly understate the true size of the outbreak.

That is because heavy usage of the new service, NHS Direct, and the number of patients going to their pharmacist means many patients will not show up on the conventional GP-based tracking system. The previous highest levels of influenza seen since monitoring began were in1968/69 and 1989/90. The CMO believes that the present epidemic will not reach these levels.

He considers that there are people who are missing from official statistics, because instead of consulting their GP they have used alternative routes of advice. This means that, unless present levels of influenza activity peak soon, we could be heading for the worst epidemic in the last decade.

That certainly chimes with most people's experiences. There can hardly be a family in the land that has not been affected by the flu. Everybody knows somebody who has had it. People also know that it is particularly severe in its effects. Professor Brian Duerdon, deputy director of the PHLS, says that "it is a more prolonged illness, at 10 to 12 days before people start to feel better rather than four or five."

It is also having a particular impact on elderly people some of whom have developed serious complications such as bronchitis and pneumonia. In addition to influenza other viruses such as respiratory syncytial virus (RSV) are contributing to acute respiratory illness. I am advised that RSV illness is at its peak at present.

Emergency admissions to hospital have risen as a result with over 200,000 such admissions to hospitals in the last three weeks alone - an increase of almost 30% over the last two months. The evidence that we are receiving from hospitals is that the patients who are being admitted are more ill than normal and are staying longer than normal. This serious flu outbreak has placed additional strain on local health services in many parts of the country.

In the last three weeks the number of people attending accident and emergency departments in hospitals has risen to over 600,000. There have been a quarter of a million calls to ambulance services - up almost one third on last year - and a similar number of calls to NHS Direct over the last 3 weeks, many of them flu related.

According to Professor Mike Pringle, chairman of the Royal College of GPs, over the millennium GP co-operatives had 50% more calls than last year mainly due to the flu. These figures demonstrate very clearly that the flu outbreak has put very real pressure on NHS services.

There is no doubt about that. Equally the evidence suggests that the NHS is dealing with these pressures. All acute hospitals across the country have remained open throughout the winter period. Of course both GP surgeries and hospitals are both very busy. The highest priority is being given to patients who are most seriously ill.

As is usual and as had been planned, most hospitals have been undertaking little routine elective surgery over the last few weeks in order to be able to concentrate their efforts on emergency cases. The number of emergency admissions remained unusually high last week because of the flu outbreak and many hospitals which had planned to start surgery today have decided to delay until the immediate emergency pressures subside.

Hospital managers and clinicians will make judgements about how best to balance their workload in light of local experience over the next few weeks. This approach represents a sensible deployment of NHS staff and resources. It is allowing the health Service to cope with the surge in emergency demand that the flu outbreak has brought.

Thanks to the staff who are running critical care services they too are coping with the demands being placed on them despite the fact that intensive care is under very real pressure. About half of the patients being admitted to intensive care have flu or flu-like illnesses resulting in pneumonia or less commonly septicaemia leading to multiple organ failure.

This year the government has provided a record number of intensive care and high dependency beds. We have worked very closely with the intensive care sdociety to plan critical care facilities in hospitals. Patients who need acute and critical care are being looked after.

There has been an increase of 100 critical care beds this year and with exceptional demand, staff and facilities are being used flexibly to ensure patients receive the care they need. Staff are doing an excellent job in difficult circumstances. The number of beds available fluctuates by the hour but I can tell the House that as of mid morning today there were 22 beds available.

Local surges in demand - particularly as the flu moves around the country -will however continue to place particular pressures on critical care facilities. Where appropriate local NHS hospitals have made arrangements with local independent hospitals for critical care.

Where transfers between intensive care units are required as a matter of last resort the chief executives of NHS trusts have been asked to ensure that the arrangements run smoothly and that clinical staff are given as mush support as possible.

So the influenza outbreak has put particular pressure on the NHS. But the NHS is coping. As the chairman of the BMA, Dr Ian Bogle, said earlier today "all parts of the NHS have been put under pressure but doctors and nurses are coping well from GP services to intensive care. The incidence of new cases of flu is uneven but wherever it is occurring it is a particularly nasty strain.

Thanks to the high level of planning across the country we are coping." Of course the NHS is under severe pressure. Winter is always the busiest time of year for the NHS. This winter the NHS and social services have also had to deal with the special pressures brought by the extended millennium period.

That is why planning for this winter began earlier than ever before. Local winter planning groups were established in April 1999 in every part of England to co-ordinate the planning and provision of health and social services over the winter and millennium period.

Each group includes health authorities, social services, NHS trusts, primary care groups, out of hours and deputising services, NHS Direct, police and fire services, CHCs and other local authority departments, and the voluntary and private sector.

Each local group submitted its plans for dealing with winter pressures by the end of September 1999. These were followed by visits from health and social care professionals from the department of health's millennium executive team to ensure the robustness of the plans.

We have extended the capacity of local health services to deal with winter pressures. Extra beds have been opened, and over the millennium period for example there were 45% more ambulance staff on duty than the year before winter planning has also included a major public information campaign.

The aim of the campaign has been to encourage the public to use the most appropriate service for their needs - whether that be the local pharmacy and NHS Direct or indeed self care as a complement to GP or hospital services. The campaign was backed by the BMA, the RCN and the patients association amongst others.

All of the evidence we have received to date suggests that the public have responded positively to this campaign by recognising that health services should be used responsibly and appropriately. The campaign was also supported by a large increase in flu vaccinations made available to the public through family doctors. Flu vaccine can never eradicate flu but it can help to provide further protection for vulnerable groups.

This winter 8.6 million doses of influenza vaccine were made available: a million up on last year. We do not as yet have uptake levels for flu vaccine this year but we will be reviewing them when they do become available. I have asked the chief medical officer to look at ways to enhance uptake in future years. Increased use of computerised call up systems is one possibility.