Ebola

Jeremy Hunt Excerpts

Monday 13th October 2014 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Mr Speaker, I would like to update the House on the Government’s response to the Ebola epidemic in west Africa.

I shall start with the chief medical officer’s assessment of the current situation in the affected countries. As of today, there have been 4,033 confirmed deaths and 8,399 confirmed, probable and suspected cases of Ebola recorded in seven countries, although widespread transmission is confined to Liberia, Sierra Leone and Guinea. The number is doubling every three to four weeks. The United Nations has declared the outbreak an international public health emergency.

The Government’s first priority is the safety of the British people. Playing our part in halting the rise of the disease in west Africa is the single most important way of preventing Ebola from infecting people in the UK, so I would like to start by paying tribute to the courage of all those involved in this effort, including military, public health, development and diplomatic staff. I would particularly like to commend the 659 NHS front-line staff and the 130 Public Health England staff who have volunteered to go out to Sierra Leone to help our efforts on the ground. You are the best of our country and we are deeply proud of your service.

Among the three most affected countries, the UK has taken particular responsibility for Sierra Leone, with the US leading on Liberia and France focusing on Guinea. British military medics and engineers began work in August on a 92-bed Ebola treatment facility in Kerry Town, including 12 beds for international health workers. In total we will support more than 700 beds across the country, more than tripling Sierra Leone’s capability. With the World Health Organisation, we are training more than 120 health workers a week and piloting a new community approach to Ebola care to reduce and, hopefully, stop the transmission rate. We are also building and providing laboratory services and supporting an information campaign in-country.

We are now deploying the Royal Navy’s RFA Argus and its Merlin helicopters along with highly skilled military personnel, bringing our military deployment to 750. They will support the construction of the Kerry Town Ebola treatment centre and other facilities, provide logistics and planning support, and help establish and staff a World Health Organisation-led Ebola training facility to increase training for health workers.

Taken together, the UK contribution stands at £125 million, plus invaluable human expertise: that is the second highest bilateral contribution after the US’s. However, we do need other countries to do more to complement our efforts and those of the US and France. On 2 October, the Foreign Secretary held an international conference on defeating Ebola in Sierra Leone during which more than £100 million and hundreds of additional health care workers were pledged.

I now move on to the risks to the general public in the UK. The chief medical officer, who takes advice from Public Health England and the Scientific Advisory Group for Emergencies, has this morning confirmed that it is likely that we will see a case of Ebola in the UK. This could be a handful of cases over the next three months. She confirms that the public health risk in the UK remains low and that measures currently in place, including exit screening in all three affected countries, offer the correct level of protection. However, while the response to global health emergencies should always be proportionate, she also advises the Government to make preparations for a possible increase in the risk level. I can today announce that the following additional measures will take place.

On screening and monitoring, rapid access to health care services for anyone who may be infected with Ebola is important not only for their own health, but to reduce the risk of transmission to others. Although there are no direct flights from the affected region, there are indirect routes into the UK, so next week Public Health England will start screening and monitoring UK-bound air passengers identified by the Border Force as coming in on the main routes from Liberia, Sierra Leone and Guinea. This will allow potential Ebola virus carriers arriving in the UK to be identified, tracked and given rapid access to expert health advice should they develop symptoms. These measures will start tomorrow at Heathrow terminal 1, which receives about 85% of all such arrivals across the whole airport. By the end of next week, they will be expanded to other terminals at Heathrow and Gatwick, and to the Eurostar, which connects to Paris and Brussels-bound arrivals from west Africa.

Passengers will have their temperature taken and will complete a questionnaire about their current health, their recent travel history and whether they might be at potential risk through contact with Ebola patients. They will also be required to provide contact details. If neither the questionnaire nor the temperature reading raises any concerns, passengers will be told how to make contact with the NHS should they develop Ebola symptoms within the 21-day incubation period, and allowed to continue on their journey. It is important to stress that a person with Ebola is infectious only if they are displaying symptoms. Any passenger who reports recent exposure to people who may have Ebola or symptoms, and any passenger who has a raised temperature will undergo a clinical assessment and, if necessary, be transferred to hospital. Passengers identified as having any level of increased risk of Ebola but without any symptoms, will be given a Public Health England contact number to call should they develop any symptoms consistent with Ebola within the 21-day incubation period. Higher risk individuals will be contacted daily by PHE. Should they develop symptoms, they will have the reassurance of knowing that this system will get them first-class medical care—as the NHS demonstrated with nurse William Pooley—and the best possible chance of survival.

We expect these measures to reach 89% of the travellers we know have come to the UK from the affected region on tickets booked directly through to the UK, but it is important to note that no screening and monitoring procedure can identify 100% of people arriving from Ebola-affected countries, not least because some passengers leaving those countries will not be ticketed directly through to the UK. Today, I can therefore announce that the Government, working with the devolved Administrations, will ensure that highly visible information is displayed at all entry points to the UK, asking passengers, in their own best interests, to identify themselves if they have travelled to the affected region in the past 21 days. This information for travellers will be available by the end of this week.

We are taking other important measures. We tested operational resilience with the comprehensive exercise that took place on Saturday, which modelled cases in London and the north-east of England. Local emergency services across England will hold their own exercises this week and share lessons learned. It is vital that the right decisions on Ebola are made following any first contact with the NHS, so we have put in place a process for all call handlers on NHS 111 to ask people who report respiratory symptoms about their recent travel history so that appropriate help can be given to higher risk patients as quickly as possible. During recent months, the chief medical officer has issued a series of alerts to doctors, nurses and pharmacists setting out what to do when someone presents with relevant symptoms. We will also send out guidance to hospital and GP receptionists.

The international profile of the UK as a favoured destination inevitably increases the risk that someone with Ebola will arrive here so, working closely with the devolved Administrations, a great deal of planning has gone into procedures for dealing with potential Ebola patients in the UK. All ambulances are equipped with personal protective equipment. If a patient is suspected of having Ebola, they will be transported to the nearest hospital and put in an isolation room. A blood sample will be sent to Public Health England’s specialist laboratory for rapid testing. If they test positive for Ebola, they will be transferred to the Royal Free hospital in north London, which is the UK’s specialist centre for treating the most dangerous infectious diseases. We also have plans to surge Ebola bed capacity in Newcastle, Liverpool and Sheffield, making a total of 26 beds available in the UK.

I will always follow medical advice on whether any measures that we adopt are likely to be effective and are a proportionate response to the risk. However, I believe that we are among the best and most prepared countries in the world.

Lastly, we are harnessing the UK’s expertise in life sciences to counter the threat from Ebola. The UK Government, alongside the Wellcome Trust and the Medical Research Council, have co-funded clinical trials of a potential vaccine, which might be pivotal in the prevention effort. We are working actively with international partners to explore how we might appropriately make further vaccine available.

We should remember that the international community has shown that if we act decisively, we can defeat serious new infectious disease threats such as SARS and pandemic flu. The situation will get worse before it gets better, but we should not flinch in our resolve to defeat Ebola both for the safety of the British population and as part of our responsibility to some of the poorest countries on the planet. Our response will continue to develop in the weeks and months to come, guided by advice from the chief medical officer, Public Health England and the Scientific Advisory Group for Emergencies.

I commend the statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for the advance copy of his statement and commend him for making it at the first opportunity.

We have all been horrified by the devastating scenes from west Africa and our hearts go out to the communities that are confronting this threat on a daily basis. Public concern about Ebola is rising here and it is important that people have reliable facts and regular updates.

There are parallels between the current situation and the 2009 swine flu pandemic with which I dealt. I was grateful for the helpful approach of the then Opposition, particularly the right hon. Member for South Cambridgeshire (Mr Lansley), and I aim to provide the Secretary of State with the same approach. However, we do have a role in scrutinising the Government’s approach and I will do that today in a constructive spirit.

I echo the Secretary of State’s tribute to the many NHS staff, Public Health England staff and members of the armed forces who have helped on the ground in west Africa. We have a duty to protect them in any way we can. I want to start with the advice that is given to those who are treating people with the disease. People will be worried by the reports of a second case of Ebola in a health worker, this time in Dallas. We have seen protests in Spain by clinical staff who feel that a colleague has been unfairly exposed to infection. In the light of that, will the Secretary of State say whether he has confidence in the official advice that is being given to those who are treating the disease, and whether it needs to be reviewed?

Let me turn to the risk to the public here. The Secretary of State says that it remains low and the chief medical officer predicts a handful of cases. A handful is not a very scientific term. Will he be more precise and give the House the full range of figures that the advisory group has considered, including the worst case scenario? I recall agonising over whether to publish the official predictions for swine flu and about the risk of worrying the public unnecessarily. However, I think that the public interest lies in openness. Will the Secretary of State confirm that he is planning for the worst case scenario, so that there is no sense of complacency?

Let me turn to our preparedness to deal with an outbreak. There has been confusion about screening at point of entry. Last Thursday, the Department of Health said:

“Entry screening in the UK is not recommended by the World Health Organization, and there are no plans to introduce entry screening for Ebola in the UK.”

Screening was also ruled out by the Secretary of State for Defence. However, just 24 hours later, we were told that screening was to be introduced. Will the right hon. Gentleman say what prompted that about-turn? What official advice has he received from the chief medical officer and Public Health England on entry screening? Based on the science, do they think that it is necessary? Do the arrangements he has announced for temperature checks fully comply with that advice?

As there are currently no direct flights from the affected countries, will the Secretary of State say exactly who will be screened? Will it be all arrivals from those countries? How many people a day or week do we expect that to be, and how will they be identified? Have front-line Border Force staff been properly briefed about what is expected of them, and are they being trained in what to look for and in screening procedures? Why is there only partial coverage of ports of entry? What about sea ports and other UK airports? Will he say where the checks will take place on Eurostar, given that it stops at a number of places en route to London?

On the exercise this weekend, as the Secretary of State will know, a patient was transferred from Newcastle where there are beds in negative pressure isolation units to the Royal Free hospital, which has Trexler isolators. Do the Government believe that Ebola is better handled in Trexler beds, and is the Secretary of State satisfied that the two NHS beds—both at the Royal Free—are sufficient? Given that in addition to the two Trexler beds there are already 24 negative pressure isolation beds, which make up the 26 beds he referred to, will he say what he means by “surge Ebola bed capacity”? If it becomes necessary to treat Ebola cases more widely in isolation beds, is he satisfied that there is adequate provision across England? Is he satisfied that all relevant NHS staff, including GPs, ambulance and 111 staff, know how to identify Ebola, the precautions to take in any potential presentation, and the protocols for handling it? He mentioned symptoms a few times in his statement. For the public watching this statement, will he tell the House simply what those symptoms are?

On treatment, the British nurse who was successfully treated here was offered and took an experimental medication called ZMapp. Will it be standard practice to offer all affected patients ZMapp, and if so, are there sufficient supplies in the NHS to do that? The Secretary of State rightly focused on a vaccine, which would of course be the best reassurance we could give the public. During the swine flu pandemic, huge effort went into compressing the timetable for the development of a vaccine. Is he confident that everything that can be done is being done to speed that up?

Finally, as the Secretary of State said, the best way to protect people here is to stop Ebola at source. The UK has rightly pledged £125 million to assist Sierra Leone, but with cases doubling every three to four weeks there is wide agreement that the response of the wider international community has been slow and inadequate. The window to halt Ebola before it runs out of control altogether is closing fast. What assessment has been made of the resilience of neighbouring countries such as Guinea and Liberia, and what help is being offered to them? The International Development Committee report was clear that the lack of proper health coverage allowed the outbreak to grow unchecked for so long. Does the right hon. Gentleman accept that improving global health systems is the best way to prevent these outbreaks, or at least ensure that they are caught before they get out of control? Many countries support placing universal health coverage at the centre of global development, yet the UK is currently opposing such plans at the UN. Will he say a little more about the Government’s position on that, and whether they are prepared to reconsider it in the light of recent events? Knowing from my experience how difficult these situations are, I assure the Secretary of State that the offer of help is genuine, but on behalf of the House I ask him for regular updates and maximum openness in the weeks and months to come.

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his comments. That is totally appropriate and I am grateful. I will start with the point on which he finished, because the most crucial thing we can do to protect the UK population is deal with the disease at source and contain it in west Africa. That is why I am working extremely closely with the International Development Secretary, and she is working closely with me because the role of NHS volunteers is important. The right hon. Gentleman is absolutely right: the initial international response has focused on taking the three worst affected countries and giving them a partner country in the developed world to help them—we are helping Sierra Leone, America is helping Liberia, and France is helping Guinea.

That has worked up to a point, but we need more help from the rest of the international community. I had a conversation earlier today with US Health Secretary Burwell. We talked about a co-ordinated international response for the whole of west Africa, because we will not defeat this disease if we operate in silos. We need to recognise that this disease does not recognise international boundaries; the right hon. Gentleman was absolutely right to make that point.

Let me try to give the right hon. Gentleman some of the information he requested. First, he is absolutely right to raise the issue of the protection of health workers. That has to be our No. 1 priority both here in the UK and abroad. That is why we are building a dedicated 12-bed facility in Sierra Leone that will give the highest standards of care, equivalent to NHS standards of care, for health care workers taking part in the international effort to contain the disease there. That is also very relevant to health care workers here: events in both Spain and the US will have caused great concern.

I am satisfied that the official advice to health care workers is correct. The Centers for Disease Control and Prevention in the US, the US equivalent of Public Health England, believes that breaches in protocol led to the infection of the US nurse—the case we have seen in the media recently—but it is investigating that. The advice is always kept under review and if that advice changes we would, of course, respect that. It is important that we follow the scientific advice we have, but that the scientists themselves keep an open mind on the basis of new evidence as it emerges. I know that they are doing that.

The right hon. Gentleman talked about the full range of figures. He is absolutely right to say that we will maintain public confidence in the handling of this by being totally open about what we know. The reason we have stuck carefully to the formula of “a handful of cases” is because it is genuinely very difficult to predict an accurate exact number. Let me say this: we would not have used the formula of “a handful of cases” if we thought that the number of cases over the next three months would reach double figures. However, it is also important to say that that was a current assessment. That assessment may change on the basis of the evidence. I will, of course, keep the House informed if it does change.

The right hon. Gentleman talked about screening. It is important to deal with a misunderstanding. Why did the policy change on Thursday? The answer is that it changed because the clinical advice from the chief medical officer changed on Thursday. Her advice changed not on the basis that the risk level in the UK had changed—she still considers it to be low—but because she said that we should prepare for the risk level going up. That is why we started to put in place measures, but they are not measures primarily intended to pick up people arriving in the UK who are displaying symptoms of Ebola. We think that most of those people should be prevented from flying in the first place. The measures are designed to identify people who may be at risk within the incubation period of developing the disease, so that we can track them and make sure they get access to the right medical care quickly.

As I mentioned, we think we will reach 89% of people arriving in the UK from the affected countries. We will continue to review that. If the numbers increase and the risk level justifies it, we have contingency plans to expand the screening, for example to Birmingham and Manchester. The reason we have included Eurostar at this early stage is because there are direct flights from those three countries to Paris and Brussels, from where it is easy to connect to Eurostar. We will use the tracking system for people who are ticketed directly through to the UK in order to identify, where we can, people who then independently get a Eurostar ticket. It is important to say that because they are changing the mode of transport in Paris and Brussels, tracking is not as robust as it would be for people taking a direct flight to the UK. We will not be able to identify everyone, which is why we need to win the support of people arriving in the UK from those countries, so that they self-present, in their own interest, to give us the best possible chance of helping them if they start contracting symptoms.

I am satisfied that the Trexler beds and the negative isolation rooms are safe both for health care workers and in preventing onward transmission. They use different systems—one of them is a tented system and the other is based on people wearing personal protective equipment —but I am satisfied that both of them are safe. I will continue to take advice on that. It is very important that ambulance staff know that someone is a potential Ebola case, so that they wear the PP equipment.

As we will not be able to identify everyone who comes from the affected countries, it is important that the 111 service knows to ask people exhibiting the symptoms of Ebola whether they have travelled to those affected areas. The right hon. Gentleman asked what those symptoms are. They are essentially flu-like symptoms, but they are not dissimilar to the symptoms someone might exhibit if they had, for example, malaria. That is why it is important to ask for people’s travel history and whether they have had or may have had contact with people who have had Ebola, in order to identify the risk level.

We would like to continue using ZMapp for people in the UK who contract the disease, but that is subject to international availability. It might not be possible to get it for everyone, because there is such high international demand, but we will certainly try.

In terms of the development of a vaccine, we are doing everything we can to work with GSK to bring forward the date when a vaccine is available. Indeed, we are considering potentially giving indemnities if the full clinical trials have not been conducted.

[Dr Sarah Wollaston (Totnes) (Con)]

May I welcome the Secretary of State’s statement and pay tribute to all the staff who are giving him professional detailed scientific advice? I join him in paying tribute to all the NHS personnel, our forces personnel and diplomatic staff putting their own lives at risk in west Africa.

I am particularly pleased to hear that those individuals returning to the UK or coming to the UK from west Africa will be able to access support in a timely manner and in a manner that does not put other individuals at risk in crowded health care settings. Will the Secretary of State say more about the testing arrangements, which I hear are going to be at Porton Down? Does he have any plans to make further testing centres available so that testing can happen more rapidly?

[Mr Hunt]

I thank my hon. Friend for her comments and her support for the statement. I want to pay particular tribute to the chief medical officer and Dr Paul Cosford at Public Health England, who have done an enormous amount to make sure we develop the right policies, which are both proportionate and enable us to prepare for the future. The Government are hugely grateful for their contribution.

We are satisfied that the testing arrangements at the PHE facility at Porton Down are adequate to the level of risk, but one of the reasons why I wanted to announce to the House the current estimate of the number of Ebola cases we are dealing with in the UK was to make the point that we will continually keep those arrangements under review should the situation change. We need to recognise in a fast-moving situation such as this that it might well change, and I will keep the House updated, but in such situations the resilience of all those very important parts of the process will be checked.

[John McDonnell (Hayes and Harlington) (Lab)]

In May the Government announced the closure of the health control unit at Heathrow airport in my constituency. It contained the staff who undertook the monitoring, screening and treatment of passengers who were sick. I believe many of those staff have now been made redundant, so can the Secretary of State tell me what the staffing arrangements will now be at Heathrow airport? Also, will a training programme be developed for airport staff themselves, including cabin crew and others?

[Mr Hunt]

The hon. Gentleman makes a very important point. In terms of the staffing arrangements, a total of about 200 people will be employed in the screening process, working at both Heathrow and Gatwick airports in the hours when they are open, and potentially at other airports if we expand the screening. It is a comprehensive facility.

The hon. Gentleman’s most important point is that we must make sure that those who might come into contact with people who might have Ebola—airport staff and people working on aeroplanes, and people working at receptions at GPs’ surgeries, at A and E departments and at hospitals—have basic information about how the virus spreads, so that we can avoid any situations of panic. The virus is transmitted through exchange of bodily fluids. It is not an airborne virus, so it is not transmitted as easily as something like swine flu. The advice is that those doing physical examinations of patients need to wear the protective equipment, but that that is not necessary when having a conversation with a patient, for example. That advice will always be kept under review, but the hon. Gentleman is absolutely right to say that we need to make sure everyone knows that advice.

[Sir Malcolm Bruce (Gordon) (LD)]

The work that the British Government have done in Sierra Leone and Liberia to build health systems has been extremely important, but those systems were clearly inadequately developed to cope with this kind of problem. I welcome the joined-up thinking across government, but will the Secretary of State give me an assurance that the legacy of this situation will be not only that we have contained Ebola but that we have built health systems in those countries that are capable of dealing with future outbreaks? The long-term legacy must be stronger health systems, as well as the protection of British citizens, which is of course important.

[Mr Hunt]

I remember working with the right hon. Gentleman on the International Development Select Committee many years ago, when we had many conversations about strengthening the resilience of local health care systems. He is absolutely right to say that that must be our long-term goal, and I will ask the Secretary of State for International Development to write to him to explain how our efforts in Sierra Leone will help to strengthen its local health care system in the long run. The simple point I would make is that this illustrates the dual purpose of our aid budget more powerfully than any example I can remember. First, our aid budget gives humanitarian assistance to some of the poorest countries in the world and, secondly, it protects the population at home in the UK. Those two aims go hand in hand.

[Ian Paisley (North Antrim) (DUP)]

I welcome the Secretary of State’s statement and I appreciate having been given an advance copy of it. He mentioned the devolved regions. First, will he tell us which Minister in Northern Ireland will take personal responsibility for this matter? Secondly, he will know that the main point of entry for potential victims of this terrible disease is the Republic of Ireland. What special measures are being put in place to stop people using those points of entry to travel from the Republic to Northern Ireland when there are no apparent protective measures in place?

[Mr Hunt]

The Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has been in touch with Jim Wells in the Northern Ireland Assembly and she will take up that issue. The broader point that the hon. Member for North Antrim (Ian Paisley) makes is that there are many points of entry into the UK, and it is important for us to recognise that our screening and monitoring process will not catch absolutely everyone who comes from the affected regions. That is why we need to have other plans in place, such as the 111 service, and to have encouragement at every border entry point for people to self-present so that we can protect them better, should they develop symptoms.

[Mr Andrew Lansley (South Cambridgeshire) (Con)]

I welcome the Secretary of State’s statement to the House, and I am also grateful to the shadow Secretary of State for what he said. All Members share the Secretary of State’s admiration for the staff of the NHS and Public Health England who are assisting in the front-line treatment and care of those in west Africa. In that context, he is right to try to tackle the virus in west Africa, but this is not just about the availability of much better treatment facilities; it is also about working in the community in short order to try to stem the continuing transmission of the disease. Work has clearly been done on that; will he tell us how we might scale it up?

[Mr Hunt]

My right hon. Friend makes an important point. I discussed this with United States Secretary Burwell today. The US is piloting a programme in Liberia, and we are doing the same thing in Sierra Leone. We are both providing the same response, which is to tackle the disease at source. We know that, if we can get 70% of the people who develop Ebola symptoms into treatment and care, we will contain the disease. At the moment, the disease is replicating at a rate of 1.7, which means that every 10 people infected are going on to infect another 17 people. That is why the virus is spreading so fast, and we can halt it only if we get people into treatment very rapidly. Community treatment centres are therefore an important part of the Department for International Development’s strategy to help to contain the virus, and that is why we are supporting the development of 700 beds in Sierra Leone.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

May I beg the Secretary of State to work across Europe and all the countries that can help? I have a daughter who has just returned from west Africa and she has reported to me and the family that the situation is critical—it is desperate. There is a lack of any kind of facility to control this disease. Parents are dying, leaving children with nobody to care for them. The situation is very grave, so will he redouble his efforts to persuade Europe, the World Health Organisation, the UN—all of us—to do something more significant and to do it now?

[Mr Hunt]

The hon. Gentleman speaks movingly and well about the incredible gravity of the situation, and he rightly says that we need full international support on it. In such a situation there are a number of things we are much better tackling as part of an international effort; we are very proud of our 659 NHS volunteers, but volunteers from the whole of Europe could go out and play a part. They need reassurance that they will be safe if they end up contracting the virus, because the truth is that there is no 100% guarantee of safety, even for people who follow the correct procedures—that is why these people are so brave. The hon. Gentleman is absolutely right in what he says, and I reassure him that that is exactly the conversation I have been having with international colleagues: we do need a co-ordinated effort.

[Bob Stewart (Beckenham) (Con)]

The military have superb experience of dealing with contaminated areas. Are contingency plans in place to bring the military services into line to help, should that be required?

[Mr Hunt]

We are doing that already: we have made a commitment of 750 military personnel, who will be going to the affected region to help; we have military engineers helping to build the 92-bed facility in Kerry Town; and Royal Fleet Auxiliary Argus is on the way to Sierra Leone. We are tapping into that expertise, and it has a vital role to play.

[Michael Connarty (Linlithgow and East Falkirk) (Lab)]

Following on from the question put by my colleague from Northern Ireland, the hon. Member for North Antrim (Ian Paisley), clearly the nearest hospital to Scotland with provision is in Newcastle. Who is the responsible person with whom the Secretary of State has been working in Scotland? What arrangements are taking priority in Scottish towns, because someone who has 21 days to travel in the UK might not wish to stay in England alone?

[Mr Hunt]

The hon. Gentleman is right in what he says. This morning, my hon. Friend the Under-Secretary spoke to Alex Neil, the Scottish health Minister, and on Wednesday we will have a Cobra meeting with the devolved Administrations to test how resilient the structures are between the constituent parts of the UK. That is a very important part of our effort.

[Martin Horwood (Cheltenham) (LD)]

Perhaps I should declare a non-pecuniary interest, Mr Speaker, as my wife works for Public Health England. I join the Secretary of State in applauding all of her colleagues and the others who are putting themselves in harm’s way in the front-line battle against Ebola. Given his predecessor’s reorganisation of the NHS and of public health, does the Secretary of State need to check whether there are now sufficient local directors of public health in post and whether they have sufficient resources, qualified staff and seniority within local authorities to take a local lead, should that be necessary, in the fight against Ebola?

[Mr Hunt]

We are absolutely checking that, and it is all in hand.

[Fiona O'Donnell (East Lothian) (Lab)]

I do not know whether the Secretary of State has any plans to speak to the hon. Member for Clacton (Douglas Carswell), but if he does will he ask him why he now supports a party that would decimate the UK’s aid budget? Does the Secretary of State, like me, feel a great sense of pride in being part of a family of nations whose aid budget is saving lives in Liberia and Sierra Leone, and, in turn, keeping people in the UK safe?

[Mr Hunt]

The hon. Lady speaks extremely wisely and there is cross-party agreement on that matter. That shows why it is so wrong to make an artificial division between helping people abroad and helping people at home. I think we have a moral responsibility to help people in the poorest countries abroad in any case, but in my time in this House there has been no better example than this one of how doing so is in the interests of people in the UK, too. It helps to make us more secure, and we can be incredibly proud of the work we are doing as a result.

[Mr Nigel Evans (Ribble Valley) (Con)]

The Secretary of State has spoken about multiple points of entry, and major connection points are via Schiphol, Charles de Gaulle, Madrid and Frankfurt. Has he spoken to his opposite numbers in those countries to see whether they are following the best practice that is being rolled out in the United Kingdom? Will he ensure that those who are manning the points of entry in the UK have the ability to deal with children, because if a parent is detected with symptoms, their children will have to be properly looked after?

--- Later in debate ---

[Mr Hunt]

My hon. Friend makes an important point. I am sure that those arrangements are already in place, but I will ensure that they are. Yes, we are in touch with colleagues in other countries. It is important to say that there are only a very few direct flights to Europe from the affected region, and indeed there are none to the UK. At the moment, it is possible to be fairly confident that we will reach the vast majority of people who come from those affected areas. But part of what I am trying to convey in this afternoon’s statement is that the risk level could change—for example, there could be a breakdown in public order in the affected countries—which is why we need to be prepared for a much more porous situation, with people coming from many different points of entry.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Is the Secretary of State talking to our universities, as a number of them must have overseas students from west Africa returning for their studies in October? Is he focusing on them in particular, and what provisions are we making to cater for them?

[Mr Hunt]

The hon. Lady makes a very important point. Clearly, it is important that anyone who comes from those countries, whether a student or a visitor, is treated with the same screening and monitoring process. Screening and monitoring people simply on the basis of their passport would not work. There will be people who have indefinite leave to remain in the UK but who have a Sierra Leonean passport, and it would not be appropriate to put them through that process. It is most important that we have a system in place in which we can check and find out who has been to the Ebola-affected areas in the past three weeks, so that we can give them help if they need it.

[Jason McCartney (Colne Valley) (Con)]

My right hon. Friend has given details of plans for extra Ebola bed capacity in regional centres such as Sheffield. Will he confirm that those regional centres will be used alongside the Royal Free hospital in London, or will they be used only when capacity there has been reached?

[Mr Hunt]

Essentially, the plan is to start with the Royal Free, which has capacity to go from two beds to four. Then we have six beds available in Newcastle and Liverpool and two beds available in Sheffield. Following that we can further expand capacity at the Royal Free.

[Fiona Mactaggart (Slough) (Lab)]

Will the Secretary of State ensure that British citizens fleeing Ebola-affected countries are not left destitute and homeless? My constituents Mr and Mrs Mahmood have been working in Sierra Leone for the past four years. When they returned, they were told that they were not eligible for income-based jobseeker’s allowance or housing benefit. Will the Secretary of State speak to his counterparts at the Department for Work and Pensions to ensure that no British citizen is left in such a state when they have to flee a country that is affected by Ebola?

[Mr Hunt]

If the hon. Lady lets me know the details of the individuals concerned, I will happily take up the case.

[John Hemming (Birmingham, Yardley) (LD)]

A systemic lacuna in the Government’s proposals relates to the lack of monitoring of lower-risk travellers. Will the Secretary of State consider having daily contacts with such travellers on the basis that identifying erroneous risk assessments at the first stage is the key to bringing things under control in the interests of the travellers as well?

[Mr Hunt]

The judgment on how effective we are at identifying higher-risk passengers must be made by the scientists and the doctors involved. Their view is that we are currently going further than we need to given the current risk level, but that it is prudent to do what we are doing because that risk level might increase. I will always listen to their advice.

[Ms Margaret Ritchie (South Down) (SDLP)]

I thank the Secretary of State for his statement on Ebola. Given that one of the busiest air routes within these islands is that between London and Dublin—the hon. Member for North Antrim (Ian Paisley) has already referred to the role of the Republic of Ireland—will he outline what discussions have taken place between him and his officials and the Minister for Health and his officials in the Republic of Ireland?

[Mr Hunt]

The hon. Lady makes an important point. The Under-Secretary of State for Health, my hon. Friend the Member for Battersea, has been in contact with the Northern Ireland Health Minister, and we will pursue discussions with the Republic of Ireland. Although the hon. Lady’s concern is legitimate and it is right that she has asked the question, it is important to say that the current assessment is that the risk level to the UK is low. I would imagine that the risk level in Ireland is similarly low, but that is ultimately a matter for the Irish authorities. At the moment, we are following a precautionary process just in case the risk level increases. We will of course involve colleagues in the Irish Republic in our assessment of those risks.

[David Rutley (Macclesfield) (Con)]

I am pleased that my right hon. Friend is focusing on the protection of health care workers in the vital work he is taking forward. Given that lessons are still being learned from cases in Texas and Madrid, what mechanisms are in place to update procedures when any new findings are brought into the public domain?

[Mr Hunt]

My hon. Friend is absolutely right that what happened in Dallas is of great concern. We need to listen to our colleagues in the Centre for Disease Control in the US as they try to understand exactly what happened. If they decide that we need to change the protocols for protecting health care workers, we will of course take that advice extremely seriously. At the moment, their scientific assessment is that there was a breach in protocol, not that the protocols were wrong. Until we identify what those breaches were, we cannot be 100% sure. We are working very closely with them and we have a good and close working relationship. We will update our advice to UK health care workers accordingly.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the Secretary of State for the answers he has given so far, but my right hon. Friend the Member for Leigh (Andy Burnham) asked whether he was satisfied that all relevant NHS staff, including all GPs, know how to identify Ebola, know the precautions to take with patients presenting, and know the protocols for handling Ebola. I did not get a sense from the Secretary of State’s reply of how complete that knowledge is. He has talked a lot about receptionists, and that is important as they are in the front line of risk, but hospital cleaning staff and cleaning staff in GP practices are also at risk if such patients present.

[Mr Hunt]

The hon. Lady makes an important point, but I reiterate the point I made earlier to another hon. Member. The risk level to the UK general population remains low, so the measures we are taking are precautionary because of a possible increase in that risk level. As part of that, we are sending advice to everyone we think might be in contact with anyone who says that they have recently travelled to the Ebola-affected areas and who displays those symptoms. That is why alerts have gone out to hospitals, GP surgeries and ambulance services to ensure that they know the signs to look for and are equipped with that important advice.

[Mr Philip Hollobone (Kettering) (Con)]

To cross a typical western international border illegally, one needs a passport and passports are meant to have stamps in them. What steps are we taking with the seven most affected west African countries to ensure that they stamp the passports of people who go into and leave those countries so that we can readily identify the stamps in their passports should they come to the UK? What extra resources is Border Force putting into checking the stamps in people’s passports when they come to the United Kingdom?

[Mr Hunt]

I will get back to my hon. Friend with the exact details of what is happening with passport stamps, but I reassure him that we are working very closely with Border Force officials and we have a high degree of confidence that we will be able to identify the vast majority of people who travel from the most directly affected countries within the recent incubation period of the virus. It is important to remember that that incubation period is 21 days, so we are looking at the previous three weeks. We have a high degree of confidence, but I will get my hon. Friend information on whether passport stamps could be an additional source of security.

[Keith Vaz (Leicester East) (Lab)]

I join others in congratulating the Secretary of State on initiating screening, as he did on Thursday. That is the right approach, as is targeting it at certain ports. As he knows, viruses do not wait for direct flights and it is extremely important that there is a synergy between our screening processes and those of Sierra Leone and other west African countries. Did we supply the screening equipment, and if we did not, is he satisfied that it is fit for purpose? The same goes for the screening in other hubs throughout Europe.

[Mr Hunt]

We have absolutely checked the screening equipment that is being used in those three countries, and in Sierra Leone, which is our more direct responsibility, that is being done by Public Health England officials. The reports that we are getting back say that people are checked not just once, but several times. It is really important to say that the main purpose of the screening that we are introducing—I call it screening and monitoring, rather than screening—is to identify passengers who may be at higher risk. We are not particularly expecting to identify people showing symptoms because they should have been prevented from leaving the country in the first place, but we want to keep tabs on them while they are in the UK, in their own interests, and that is the purpose of the process.

[Mr David Nuttall (Bury North) (Con)]

I thank the Secretary of State for his statement. Given the large number of languages in use in that part of west Africa and the consequent practical difficulties in producing notices and posters that travellers can actually read for the purposes of self-presenting, may I ask my right hon. Friend in what circumstances he would reconsider the decision not to introduce the screening and monitoring of passengers arriving at Manchester airport?

[Mr Hunt]

We have not yet made a decision on Birmingham and Manchester, and we will continue to review the risk advice from the chief medical officer and PHE on whether such action would be appropriate. It is important to say that the measures we take must be proportionate, but they must also look forward to potential changes in the risk, so that we can react very quickly were that risk to increase dramatically, and that is exactly what we are doing at other UK airports.

[Jeremy Corbyn (Islington North) (Lab)]

I thank the Secretary of State for his statement and for the support given to health services in west Africa, but does he not agree that this terrible time shows the massive health inequalities that exist all around the world and that, although there will be a big international effort to deal with Ebola, it calls into question the effectiveness of the millennium goals on preventive health measures, not just in west Africa, but in a much wider sense? Do we not need to redouble our efforts to reduce health inequalities around the world for the protection of everyone?

[Mr Hunt]

The hon. Gentleman is right, although the millennium development goals have been successful in making a start on the process of reducing health inequalities. We can see that in other areas, such as the provision of antiretroviral drugs to HIV-positive patients in Africa, and that has been completely transformed in the past decade. But he is right: while some countries have very underdeveloped health care systems, the risk of such public health emergencies is much higher and therefore the risk to the UK is higher.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

I should like to echo the tributes paid to our NHS volunteers and to all health workers. Today of all days, it is important to recognise the sacrifices that they make. The Secretary of State has indicated that Newcastle’s Royal Victoria infirmary in my constituency is next in line after the Royal Free to receive Ebola victims. Will he say a little more about what measures are or will be in place for public awareness, training, equipment, staffing and basic hygiene procedures to enable that to happen?

[Mr Hunt]

I am happy to let the hon. Lady have full details of what is being planned at the RVI, which is an excellent hospital. It was one of the hospitals that was part of the exercise that we did on Saturday to test preparedness. In that exercise, we modelled what would happen if someone became sick and vomited in the Metro centre and was then transferred to the RVI. We modelled the decisions about whether they would be kept there or transferred to the Royal Free, and so on. I am very satisfied with the measures in place at that hospital, but I will happily send her the details.

[Roberta Blackman-Woods (City of Durham) (Lab)]

I am one of a group of parliamentarians who returned from a visit to west Africa on Friday. We were quite surprised to be asked no questions about where we had travelled, and to be offered no screening at either the EU or UK border; I came back to Newcastle from Brussels. Will the Secretary of State reassure us that all regional airports will offer screening and advice to people who might be affected? Will he redouble his efforts, in partnership with other agencies, to stop the spread of this disease, which is devastating parts of west Africa?

[Mr Hunt]

We are absolutely redoubling our efforts, and we are looking at what screening procedures are needed at regional airports. The screening and monitoring procedures that I outlined are starting at Heathrow terminal 1 tomorrow; they will be rolled out progressively across Heathrow, Gatwick and Eurostar terminals over the next two weeks. We are satisfied that that will reach the vast majority of people travelling from the affected countries. Any decision to expand those arrangements to other regional airports will be taken on the basis of the scientific advice that we receive about risk.

[Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)]

Liverpool university’s Institute of Infection and Global Health, and the Liverpool School of Tropical Medicine, have done a great deal of work to address the problem of the transmission of Ebola. Does the Secretary of State’s work involve their recommendations, and do his proposals for combating Ebola, particularly as regards international travel, address the issues that those institutions raise?

[Mr Hunt]

The hon. Lady is absolutely right to say that we have fantastic research on the spread of infectious diseases at a number of institutions in this country, including in Liverpool, and we are not only using that research in the battle that we are leading in Sierra Leone, but making it available to partner countries leading the battle in other parts of west Africa. The advice that I get from my experts, from Public Health England and from the chief medical officer takes full account of the research done in places such as Liverpool.

[Kevin Brennan (Cardiff West) (Lab)]

In his statement, the Secretary of State said that the screening measures would reach 89% of passengers from the three affected countries; it is therefore hoped that one in 10 will self-identify. Will he tell the House the numbers that the estimate is based on, not just the percentage, so that we have an idea of how many people will be involved in these screening measures?

[Mr Hunt]

For the month that we looked at, September, we are talking about around 1,000 people arriving from the directly affected countries, which is about 0.03% of all Heathrow travellers for that month. It is important to say that the vast majority of those will be low-risk passengers, but those are the people with whom, initially, we would want to have a conversation, so that we could understand whether they had been in contact with Ebola patients or had been in the areas particularly affected by Ebola, and so that we could decide whether we needed to put in place tracking procedures to allow us to contact them quickly, should they develop symptoms.

[Heidi Alexander (Lewisham East) (Lab)]

The Secretary of State may be aware that this weekend Lewisham hospital dealt with a suspected Ebola case. Thankfully, tests have shown that the individual is free from the virus, but may I press the Secretary of State further on the advice given to staff on the NHS front line? When was the guidance to NHS hospital and general practitioner receptionists sent out, and what steps have been taken to ensure that the guidance has been read and understood, and will be acted on?

[Mr Hunt]

First, on what happened in Lewisham hospital, the moment the individual was identified as a potential Ebola case, he was put into isolation. We learned, from what happened there, the importance of making sure that the guidance is widely understood. Making sure that everyone on the NHS front line knows what happens is an ongoing process. It is important to say, as I did in my statement, that the chief medical officer is satisfied that the arrangements in place right now are correct for the level of risk. The additional processes that I talked about are to make sure that we are ready for an increase in that risk.

[Mr Iain McKenzie (Inverclyde) (Lab)]

Did I hear correctly that the Secretary of State said that 21 days is quite a lengthy time for the incubation of this particular disease? Will he commit to putting a further screening in place towards the end of that 21 days so that he can be assured that those entering the country are free of Ebola?

[Mr Hunt]

I am not sure that I entirely understood the hon. Gentleman’s question, but the incubation period is 21 days, so if we identify through the screening and monitoring process someone who is higher risk, we will want to stay in touch with them for that period of 21 days on a daily basis to make sure that we are monitoring their temperature and that we get help to them as quickly as possible if they need it.

[Mr Stephen Hepburn (Jarrow) (Lab)]

I welcome the introduction of screening at various London locations, but what about Newcastle, which runs numerous flights every day to the airports that act as hubs for these west African countries, and obviously there is passage that way?

[Mr Hunt]

The hon. Gentleman is absolutely right. We have numerous ports of entry to the UK. We are one of the most international countries in the world, and London is one of the most international cities in the world, so the actions that we take must be proportionate to the risk. The risk is currently low, so the advice is that having no screening procedures at those airports is proportionate to the risk now, but we are taking this precautionary approach, starting with the Heathrow, Gatwick and Eurostar terminals, because we want to prepare for a possible increase in that level. Were that to happen we would of course look at whether that screening process should be expanded to regional airports.

[Andy Sawford (Corby) (Lab/Co-op)]

In a recent film of medical workers treating people in west Africa with Ebola, a young doctor said that the one benefit of her protective mask was that people could not see her cry. Even as the media focus inevitably moves on, we know that this will go on for months and months, so will the Secretary of State give us all an absolute assurance that we will continue, even though we cannot see her cry, to hear her voice and do whatever we can to help people in west Africa?

[Mr Hunt]

If that is the last question today, it is a fitting one on which to end. The hon. Gentleman is absolutely right: this is an appalling human tragedy. There have been more than 4,000 deaths so far, in countries that are already, in many ways, the unluckiest in the world in terms of the levels of poverty that they already have to cope with daily. We can be incredibly proud of the 659 NHS volunteers, and the military, diplomatic and development staff who are stepping up to the plate, and we should always remember our humanitarian responsibility never to forget those countries’ plight.