We've had more answers to questions that Andy Burnham didn't get round to in last week's chat, and there are more to follow, hopefully later today.
MORE SWINE FLU QUESTIONS
Grendle: I would like to know what he thinks of the RCOG/RCM guidelines on swine flu and pregnancy. In particular, as access to homebirths can be so variable anyway, will their advice that if services are stretched generally then homebirth services may be cancelled be used as an excuse to deny women the choices they want in birthing? What will be done to ensure this isn't the case?
Also, if services get really stretched due to staff illness, how will they make sure that breastfeeding and other postnatal needs are fully supported? Particularly if as RCOG/RCM suggest women may be encouraged out of hospital faster and not receive postnatal home visits from midwives. Will all hospitals be actively promoting referrals to the voluntary breastfeeding helplines as a backup?
Please could more information about relenza and any flu vaccine and pregnancy be provided in order that pregnant women can make informed decisions about whether or not to take up these options. Simply saying 'this is what we recommend, there's no evidence of harm' isn't really reassuring enough, nor enough info on which to make a judgement. Pregnant women are not sheep.
blondieminx: please could you also outline what continuity planning is being undertaken in hospitals to ensure that this country's already overstretched midwifery service gets support so that midwives are there when we need them when the time comes to deliver our babies? Also please could you confirm whether hospitals will be given guidance to offer reassurance scans to mothers-to-be who have taken Relenza (bearing in mind the lack of data about this drug)?
Response
Thanks Grendle and blondieminx, you both hit on some important issues. I know swine flu is a big concern for expectant parents, which is why we've been working closely with the Royal Colleges to give joined up advice.
On Grendle?s question about Relenza and vaccines, we do want to be as open as possible in the information available. The last thing I want to do is to tell pregnant women 'you must do this, you must do that'. It should be up to the individual to decide ? but it needs to be an informed decision, based on an awareness of all the pros and cons.
You can find a lot more information about Relenza on our website (www.dh.gov.uk), and I?d also urge you to speak to your GP or midwife if you have any concerns about taking Relenza.
On the vaccine front, I?m clear that we do need to make sure vaccinations are safe, and we?re working with the licensing authorities to ensure the appropriate checks are carried out.
Turning to the issue of maternity services, I do want to stress that the NHS has been planning for a pandemic for many years, and this includes plans for how maternity services should respond. The guidelines we?ve sent out to the NHS make clear that maternity units should do everything possible to allow women to choose the type of birth they want.
Equally, maternity services will make every effort to ensure Swine Flu does not compromise the quality of care and support that new Mums receive immediately after giving birth.
As I say, there are detailed plans in place to minimise the impact this pandemic has on all kinds of health services. We?re acknowledged as being global leaders in our preparations.
But even so, I?m afraid I can?t guarantee there won?t be local cases where staff illness or short term pressures mean that some women will not have a home birth. What I can guarantee is that we will do everything we can to keep those instances to a minimum ? wherever possible, we need the NHS to function as normal during the pandemic.
TallulahToo: Swine flu not only a particular hazard to pregnant mums but also to the under 5's. Why then does the government not advocate closing of school nurseries when a case is found?
Response
TallulahToo, thanks for your question. We originally had a policy of closing schools and nurseries when we were in the ?containment? phase of our response to swine flu; that was when we were trying to stop the spread of swine flu for as long as possible so we had time to study the disease and make significant progress towards developing a vaccine. No one could stop the spread indefinitely and, following advice from scientific experts, we reached the conclusion that it wouldn?t be right to close nurseries or schools every time a child or a member of staff fell ill with Swine Flu.
But we have said that nurseries and schools could close if local circumstances required it ? for instance, if a number of staff all fell ill with Swine Flu. We?ve also asked nurseries to be particularly hot on cleaning hard surfaces, which can harbour the virus, and isolating children who show symptoms.
At the moment, Swine Flu is proving to be mild for most people, including the under 5s, so we do need to take a proportionate response. However, we are monitoring the situation closely and will make any changes to our position as and when we need to.
thegrammerpolice: I believe that there is vast over-diagnosis of Swine Flu going on in hot spot areas. Children who have the slightest temperature and any two other symptoms are diagnosed with it and handed Tamiflu which many of them probably don't need. Surely this means the figures are over-estimates of the true spread of the disease? I'd like to know what proportion of swabbed suspected cases have actually tested positive for SF (I believe that small numbers are still being swabbed) and what proportion actually had other illnesses.
Response
Grammerpolice, thanks. You?re right to say that the figures we publish every week are an estimate. The reality is that at the moment there are thousands of suspected cases every day. That is why we stopped the policy of swabbing everyone who may have swine flu.
Instead, the Health Protection Agency swabs a small number of patients as a sample, and then we use this along with the number of cases reported by GPs to produce an overall estimate. They do this every year with seasonal flu so have experience in giving us a good picture of how the virus is spreading across the country.
studentmummy: Hello and welcome Mr Burnham - Can you tell me why ?under threes? do not make it onto Professor Salisbury?s priority list for the vaccination program in the autumn. I completely fail to comprehend the reason for this given that ?under-fives? are the highest risk group in terms of being the most affected category, possessing highest proportional number of hospitalisations and highest projected mortality rates? According to Salisbury?s priority list, ?under threes? come at the very end of the queue together with the rest of the population instead of amongst other children (three and over) who are somewhat near the top of the list. Is there an explanation for this? If so it might need disseminating to the parental population to help us make informed choices.
Frasersmum123: How will you insure that those who are at most risk will get the Vaccine? Will it be the case that you will have to prove hom asthmatic you are for example, or will it be a blanket vaccination for everyone that has a condition that puts them in the 'at risk' category?
BrightShinySun: Hi, sorry am I am late to this discussion. Just two simple questions really..
- Are the under 5's (as they seem to be hit the hardest when they do contract SF) going to be priority when the vacination does arrive?
- Bearing in mind it does not seem to be affecting the elderly as hard as the young why is there still talk of them being priority (no offence to the elderly of course) would it not make more sense to prioritise the 15-50(ish) yr olds that make up most of the country workforce and basically keep the country moving?
Thanks
Response
Thank you all for these questions on vaccinations, which I?ll respond to together. And I'm afraid the honest answer is that we haven?t yet reached a decision on who is going to receive the vaccine first. The list that ?studentmummy? refers to was not in any order and was simply a list of possible groups that had been identified to assist the NHS with its planning.
There will be limited supplies of the vaccine at first, and prioritising vaccinations is going to be a very tough call. However, we are discussing this with scientific experts and we'll make a decision, using the most up-to-date evidence about the severity and spread of the disease, once we've got a clearer idea of exactly how much vaccine will be available in the months ahead.
There is not enough experience of swine flu in children under the age of 5 in the UK yet. Other countries have not yet included young children as an at risk group but we have decided to take a precautionary approach and consider children under 5 as being at increased risk until further information makes this clearer. If a child under 5 has flu like symptoms you should contact the National Pandemic Flu Service.
studentmummy: Mr Burnham - The underlying causes theme seems to be one of the most dominant discussion threads here. If these details were released it would be helpful on a number of levels.
One - to help individuals assess their own relative degree of risk with regard to swine flu and promptness of treatment.
Two - it would help dispel rumours that the underlying causes is all a government cover up story to avert panic.
There seems to be real concern that almost anyone could be made retrospectively to fit into an underlying causes scenario and I am not altogether convinced by the tonsillitis story by the way!!
Response
Studentmummy, thanks for this. I?m afraid patient confidentiality means we can?t give out details of specific underlying conditions that people who have died with swine flu have suffered from.
What I can say is that we have to put swine flu into some perspective. For the vast majority of people it is a mild illness, but in some cases the symptoms can be more severe, and in rare cases it can be fatal.
We do know that people with serious health problems such as heart disease, a recent history of serious asthma, and compromised immune systems (eg HIV patients, or those going through chemotherapy) and children under one are at greater risk. They should contact their GP and take Tamiflu as soon as they get Swine Flu symptoms.
Of course, pregnancy can also weaken your immune system, so it?s important that pregnant women with swine flu also talk to their doctor or midwife who will be able to advise whether they need to take Relenza.
HEALTH SERVICES GENERALLY
1dilemma: Would anyone like to ask him why it is so hard to get an appointment? I am currently proofreading my complaint letter to the chief exec because I was refused a 24 week scan (I admit I turned up 15 mins late but I was kept waiting over an hour for my 12 week scan and tube delays aren't my fault) I was disconnected from the GP 4 times this morning in an attempt to get my next antenatal appointment and I have pretty much given up trying to get my kids their routine jabs I am fed up of being told there are no appointments left and I have to phone back between 8.45 and 8.50 in 3.5 weeks time on any day except one with a y in it!
JimmyMcNulty: Why can I not get an appointment to see a GP at my local practice (except for WEEKS in advance) except by ringing up at 8am on the dot for an 'emergency' appointment on the day? This was the same at my last GP practice as well before we moved area and I'm told it's so that they hit targets. Are you looking at fixing this?
Response
1dilemma, JimmyMcNulty ? I?m really sorry to hear about your experiences.
I?ve made it very clear to local health authorities that everyone should be able to see their GP at a time that fits around their lives. That doesn?t just mean accessing appointments at short notice, but also being able to book them in advance.
The latest figures suggest that about three-quarters of those who wanted to book ahead for an appointment with a GP said they could do so. This is an improvement on the past, but it?s still not good enough.
I want to aim for a situation where all GPs can offer patients an appointment within the next two days, and allow them to book further ahead. If this isn?t happening in your area, you should take this up with your local Primary Care Trust, who are responsible for overseeing GP services.
CMOTdibbler: When Alan Johnston came to visit us, he promised that there would be a review of miscarriage and pregnancy loss services, having heard the heartbreaking stories here of how women were mistreated by the NHS (I'm sure Carrie and Justine will be glad to link you to the Miscarriage code of practice threads). I know you are a bit busy at the moment smile but could you let us know the status of this?
Response
Thanks CMOTdibbler. Yes it is a busy time! But I?m still very keen to pick up where Alan left off because I know the NHS can do a lot better in helping women deal with the physical and psychological effects of miscarriage.
Since Alan?s appearance on Mumsnet last year, we?ve been working very closely with the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM), and there has been some progress.
We?ve put money into RCOG?s new Standards for Gynaecology, which now sets out clear standards on how the NHS should help patients who have experienced miscarriage, ectopic pregnancy and recurrent miscarriages.
Last August, we also published advice on how the NHS needs to improve facilities for families suffering pregnancy loss ? at such a traumatic time, hospitals should do everything they can to ensure women can have their loved ones around them, and that?s where things like overnight stay rooms become very important.
I think it is encouraging that 97% of maternity services now have an Early Pregnancy Assessment Unit to manage problems in early pregnancy, such as vaginal bleeding and abdominal pain, and to provide ongoing advice and support.
But I?m under no illusion there?s more to do ? and over the coming months, we?ll be working with the Royal College of General Practitioners to improve the role that GPs can play in pregnancy care, and this should include bereavement counselling and building long term relationships with families who suffer the loss of a pregnancy.
herbietea: Why are those of us in England still having to pay for prescriptions when the rest of the UK don't?
Response
Herbietea, thanks for your question. We want all NHS services to be affordable and accessible ? and that includes prescriptions.
From April this year, cancer patients became eligible for free prescriptions, and we are currently looking into extending this exemption for people with long term conditions ? we?re expecting to make a decision on this in the autumn.
And help is already available for people who need extensive or frequent prescriptions. If you need more than 4 prescription items in any three month period or more than 14 items during a period of 12 months then it?s worth getting a Pre Payment Certificate. This means you can then get as many prescribed items as you need for £2.00 per week ? and the cost can be spread by direct debit.
Herbietea: is it only English women's cervixs that show changes between 20-25? It must be as Scotland and Wales pay for the smears to be done during this time.
On cervical screening, I?m afraid we have taken a different view to our counterparts in the devolved administrations.
Last year, we asked an independent panel of experts to review the pros and cons of offering cervical screening in women under 25.
They unanimously concluded that the screening age should not be lowered. Treating women for abnormal cervical cell changes can increase premature birth. Cervical cancer is very rare among women under 25 and they are over three times more likely to produce false positives so it is the committee?s advice that screening at this age causes more harm than good.
This is a view that?s shared internationally. The World Health Organisation has recommended that screening starts at 25 since 2005. France, Belgium and Italy also begin screening at this age while the Netherlands start at 30.
BREASTFEEDING
elkiedee: What do you think the government could do to improve support within the NHS for those women who want to breastfeed but give up much earlier than they expected or planned to? Could someone ask about breastfeeding in public and protecting the right of all women to feed their babies/young children in public (and not just up to 6 months either). Can't quite put the words together properly, sorry!
Response
Elkiedee, thanks for taking part in the discussion. I agree with you that women should get all the advice and support they need to encourage them to breastfeed. There is clear evidence that breastfeeding your baby does have health benefits.
In terms of what we?re doing, the Government has put a lot of money behind the Baby Friendly Initiative. This is helping maternity units and other community settings like Sure Start Children?s Centres to provide help to mothers to start breastfeeding, and continued support in the community to sustain breastfeeding for longer.
I also agree with your point about protecting mother?s rights to breastfeed in public. There?s already strong protection for mums under the Sex Discrimination Act, which makes it unlawful to treat someone less favourably because she is breastfeeding ? and this is the case whatever the age of her baby.
So a woman should have complete confidence that it is unlawful for a café owner or restauranteur, for example, to ask them to leave the premises because they are breastfeeding.
grendle: Why has all formula advertising including follow-on formula not yet been banned? These products are used and needed by lots of people, but they don't need to be advertised. Impartial information on formula and bottle feeding would be better than marketing.
Response
Grendle, there is a review already underway to look at whether we need to take further action on the way infant formula and follow-on formula is presented and advertised. It will also explore whether babies under six months are being fed follow on formula, and if so why.
This report is due at the end of this year, and we?ll take a decision once we?ve looked at the evidence. So rest assured, this is something that?s on our radar!