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12.20 pm

The Parliamentary Under-Secretary of State for the Environment, Transport and the Regions (Mr. Keith Hill): I congratulate the hon. Member for Carshalton and Wallington (Mr. Brake) on securing a debate on one of the most important environmental challenges facing the world. He raised several important issues during his interesting speech. I shall deal with them at various points in my reply. I thank him for his courtesy in having given me notice of his main areas of concern.

The debate has been notable for the high level of participation by representatives of the Principality. My right hon. Friend the Member for Alyn and Deeside (Mr. Jones) is always a powerful advocate of the steel industry. He referred to the climate change levy, as did my hon. Friends the Members for Vale of Glamorgan (Mr. Smith) and for Stoke-on-Trent, Central (Mr. Fisher), and the hon. Member for Ceredigion (Mr. Dafis). We have also heard exceptionally well-informed speeches from my hon. Friends the Members for East Carmarthen and Dinefwr (Mr. Williams) and for Bury, North (Mr. Chaytor), as well as a thought-provoking contribution from the hon. Member for Truro and St. Austell (Mr. Taylor). I am also grateful for the highly environmental contribution of the hon. Member for Ashford (Mr. Green), who represents, if I may say so, the green wing of the Conservative Front-Bench environment and transport team. I hope that he is not too isolated there.

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The debate is timely, coinciding with the fifth conference of the parties to the UN framework convention of climate change in Bonn. If climate change is allowed to proceed in the absence of policies to limit greenhouse gas emissions, serious damage is expected, threatening global food production, leading to the loss of ecosystems and forcing millions of people to move from our coastal communities. To improve our understanding of such dangerous levels of climate change, last week we published a report on the global impacts of climate change. Compiled by the Hadley centre and other researchers, the report explores the impacts that we might expect if levels of carbon dioxide in the atmosphere were stabilised at 550 parts per million and 750 parts per million--in other words at about twice pre-industrial and present day levels respectively. To reach those levels, global emissions of greenhouse gases would have to be cut significantly. This is the first time that climate predictions from such action have been used to assess global impacts and vulnerability.

The results make worrying reading. Without limits on emissions of greenhouse gases, many parts of the world will suffer severe consequences during the next century. As is often the case, the poorest and least developed countries will be the most vulnerable and the least able to respond. Climate change will add to the problems that many countries already face, such as flooding, hunger and water shortages.

Despite those stark projections, the research shows that there is still time to act. If we can limit emissions, we can slow the rate of change and minimise many of the worst impacts. By stabilising carbon dioxide at 550 parts per million--the level proposed by the European Union to guide emissions reduction efforts--we can limit future temperature rise to an additional 2 deg C, avoid the loss of tropical forests in northern Brazil, prevent 2 billion people experiencing increased water shortages by the 2080s and reduce by about 75 million the number of people flooded each year.

The message from the research is clear: we must take early action if we are to avoid the worst effects of climate change and buy time to adapt. However, without early action to limit emissions of greenhouse gases, the rate of change will increase throughout the next century. Those changes will impact on society in unprecedented ways. Fortunately, the international community has begun to respond to the threats.

The UK has been at the forefront of international negotiations on climate change. We were instrumental in securing the deal at Kyoto in 1997. That was a truly historic step, when, for the first time, developed countries committed themselves to reducing their combined greenhouse gas emissions by an average of 5.2 per cent. below 1990 levels by 2008-12. The European Union agreed to reduce emissions by 8 per cent. and the subsequent redistribution of the Kyoto target in the EU was agreed under the UK's presidency. Under that agreement, the UK's target is a 12.5 per cent. cut. We have gone further by setting ourselves a challenging domestic goal of a 20 per cent. cut in CO 2 emissions by 2010.

Our immediate priority is to make Kyoto work. Last year in Buenos Aires, we agreed an ambitious work

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programme that set the sixth conference of the parties--COP 6--as the deadline for reaching decisions onmany of the outstanding issues including the Kyoto mechanisms. COP 6 is not far away. It will be held at the end of 2000 or early in 2001. There is still a lot of work to be completed if we are to meet the deadline.

Over the next week or so, COP 5 will concentrate on making as much technical progress as possible. My right hon. Friends the Deputy Prime Minister and the Minister for the Environment are attending the ministerial segment in the middle of COP 5, which is intended to review progress and help give a renewed political impetus to negotiations.

The Government remain committed to ensuring that the UK meets its climate change targets. We are developing a new climate change programme that will set out how we plan to meet our Kyoto target and move towards our domestic goal. We aim to publish our draft programme for consultation around the turn of the year and to have a final programme in place by mid-2000. The climate change levy will be one of the key elements of our draft programme. Details of the design of the levy are still under consideration following a period of consultation. My right hon. Friend the Chancellor will make further announcements in the pre-Budget statement on9 November. However, the House will be aware that the Government made it clear that we intend to negotiate agreements with energy-intensive sectors for reduced rates of the levy. At the same time we have said that an additional £50 million will be recycled from the proceeds of the levy to support renewables and energy efficiency.

Mr. Win Griffiths (Bridgend): Will my hon. Friend give way?

Mr. Hill: I regret that I cannot because I am so pressed for time.

I hope that the House agrees that we have adopted a properly balanced approach. We have been keen to stress that action to tackle climate change can bring gain, not pain. A more energy-efficient industry will be more competitive. A better transport system will be good for the economy and for society. Better insulated homes will be more comfortable and cheaper to live in. There are tremendous opportunities for business and for jobs in the traditional and emerging environmental technologies.

Actions speak louder than words. Policies already introduced show that we mean business. Our new integrated transport policy provides a framework for a range of measures that will deliver a better-quality transport system with lower CO 2 emissions. Changes announced by my right hon. Friend the Chancellor to transport taxation will cut emissions. The new climate change levy will encourage businesses to use energy more efficiently. In March this year, we published a consultation paper on "New and Renewable Energy: Prospects for the 21st Century", which outlines the options for providing 10 per cent. of UK electricity supplies from renewable sources as soon as possible. We are working with business to develop a domestic emissions trading scheme which will give UK firms valuable experience in advance of the launch of an international scheme. We are committed to publishing our first report on whether to set a national road traffic reduction programme target by the end of this year.

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Climate change is a multi-disciplinary issue which will impinge on all regions and sectors. It is a global problem which will ultimately require substantial global action to reduce emissions. However, we all have a part to play in raising awareness about climate change and tackling its causes. I thank hon. Members for their contributions to this instructive and interesting debate.

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Flu Vaccine (Southern Derbyshire)

12.30 pm

Liz Blackman (Erewash): I am grateful for the opportunity to raise the subject of flu vaccine, with particular reference to southern Derbyshire, especially in flu awareness week.

We have just returned from our summer recess, but October is nearly over and we must start to consider the risk to a certain percentage of the population who may well contact flu and other associated diseases during the coming months.

On an average winter day, family doctors will write more than 100,000 more prescriptions than they do in summer. In December alone, the national health service expects 15 per cent. more emergency hospital admissions than in August and local peaks can be much higher, especially when people stay at home longer and have increased close contact with family and friends over the winter holiday period. This year, the situation could well be compounded by the millennium celebrations.

The Government are to be congratulated on their winter pressures approach and the substantial extra resources they provided last winter. My local health authority received £40,000 to enable primary care groups to use nursing home beds and thus reduce in-patient admissions and care for people in the most appropriate setting. That was most welcome.

The winter pressures initiative has developed considerably since its inception. In southern Derbyshire, which includes my constituency, managers have been incredibly proactive in addressing the issue. The winter pressures plan, requested by the Department of Health, is a collaboration between social services acute trusts, local general practitioners and primary care groups to plan for increased demand over the winter period. Southern Derbyshire, along with every other health authority, has identified the need to be better prepared in light of the millennium. It has linked the millennium planning process with the public sector relations group, bringing together many agencies to combat the projected problems.

Southern Derbyshire health authority, along with the Department of Health, has identified that targeting flu vaccination is a vital strategy in alleviating winter pressures. The virus has the potential of presenting as lethargy, a cold, a sore throat or wheezing, requiring a visit to the GP or chemist. The results can vary from minor disruption at home or work to serious, life-threatening epidemics which can have disastrous effects on the NHS, which attempts to treat sufferers and prevent the disruption of other services. Even in a non-epidemic year, the sector of the population whose resistance is poor can suffer numerous deaths as a direct result of flu and related complications. Rightly, that sector has been divided into high-risk groups: people withheart disease, lung disease, asthma, diabetes and immunosuppression; those in long-stay residential care; and those aged 75 and over, who the Government identified as a risk category in 1998.

Why do we regard the vaccine as effective in reducing flu in those groups? It is designed using the strains of virus closely related to those expected to be circulating in any particular year. The World Health Organisation co-ordinates global surveillance, which means that in

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most years there is a good match. The vaccines are 70 to 80 per cent. effective--they are not as effective as some, but they are pretty good.

It is also worth considering the cost of not vaccinating effectively. When I asked a parliamentary question last July, I learned that no figures relating to the cost of the flu epidemic last winter were available centrally. We must try to calculate the expenditure on treatment of this acute disease. We must consider the cost of suffering and lives when complications set in or flu exacerbates an underlying condition, and also the loss of wages and lifetime earnings due to morbidity and mortality.

So what is the cost of targeting groups at risk? Of course, there is the cost of the vaccine. According to the latest figures, it will cost between £5.07 and £5.70 per dose. There are also costs associated with administering the vaccine, treating any adverse effects and implementing the immunisation programme and health promotion. On Monday, at the press conference launching flu awareness week, an initiative sponsored by the Association for Influenza Monitoring, the Public Health Laboratory Service and the Royal College of General Practitioners, the chief medical officer and the Minister agreed that immunisation of high-risk groups is their best defence against flu. So we are all saying that prevention is better than cure.

So is this effective measure a success? Apparently, the take-up is not as good as it could be. In southern Derbyshire, estimated target population figures for those in high-risk groups requiring the influenza vaccine have been set at 140,000, yet last winter just over half that number--73,000--were given or claimed the vaccine. However, it is impossible to say what percentage were in the high-risk group. According to Dr. Van Tam, a senior lecturer in public health medicine at Nottingham medical school, who is regarded as something of an expert, the figure could be as low as 12 per cent. or as high as 25 per cent. That is not particular to my area. An article by the Public Health Laboratory Service in 1997, which gave information on the uptake of the influenza vaccine in high-risk groups, noted that the overall uptake was estimated to be low--about 23 per cent.--and was particularly poor in younger members of the group. About 44 per cent. of those aged over 65 and 13 per cent. of those aged between 34 and 49 were estimated to have received the vaccine.

Since 1998, when those aged 75 and over were identified as a high-risk group, new figures should show a substantial increase in the uptake of the vaccine. However, many are still falling through the safety net of adequate preventive provision by way of a simple flu vaccine. The statistics are estimates as the data count the number of vaccinations given or claimed for. There is no routinely collected or available data showing which people in which risk group have been vaccinated.

Individual practices should keep details of who has been given the vaccine and when, but they are not required to report this information. Does the Minister agree that a more coherent and co-ordinated way of collecting, recording, analysing and reporting data would ensure a better understanding of the national picture. Could such a body as the Public Health Laboratory Service be resourced to monitor coverage and uptake of vaccines in risk groups?

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Undoubtedly, however, the uptake of the flu vaccination by the target group could be improved. The Department of Health does not currently set targets for increasing the percentage of people in risk groups receiving influenza vaccinations because of the difficulty of accurately assessing denominators for the risk groups. Will the Minister look again at the issue of target setting and consider whether it is possible to set targets, especially in the 75-plus age group and for those in long-term care?

At the heart of flu awareness week is the crucial role that GPs and other health professionals are expected to play. That is the expectation of the chief medical officer, the Government and local health authorities and the overall message of the flu awareness campaign. They rightly focus on the key role of GPs because patient surveys show that the single most important factor affecting whether an individual is immunised or not is whether the doctor or nurse recommended it. However, practice in my constituency varies, as I am sure it does across the country.

Some GPs target the high-risk groups in a rigorous way, as they would if they were calling in women for smears. Others rely on posters or leaflets, or both. Some practices have the information technology and resources to identify the risk groups, but others appear not to have them. The ability of IT to identify and target risk groups is variable. Sometimes the data may be on the system, but not in a way that they can be used. There are also training needs to be considered.

Does my hon. Friend the Minister see any improvements that could be made to ensure a more consistent approach? There is no national target payment, although I understand that payments are made to GPs in some regions for giving out the flu vaccine. Would she consider incentivising GPs to vaccinate at-risk groups?

I noted that one London practice had a very good take-up rate because of a more co-ordinated approach by all the health professionals: doctors, nurses, health visitors and pharmacists. Is my hon. Friend aware of GP practices or health authorities that have a better success rate and would she consider disseminating their best practice?

Is there an opportunity, as the focus widens in health action zones, to incorporate some of those related issue into their remit? Health promotion is a vital part of increasing uptake, and there needs to be an on-going process. There is a timing factor involved in when the flu vaccine is administered, but the overall message about prevention and year-on-year uptake needs to be continually reinforced, as is done in child immunisation programmes.

I applaud the Government's tremendous efforts to be proactive with their winter pressures policy and their endorsement of flu awareness week. The local public health co-ordinator for southern Derbyshire has been publicly very positive about the campaign and the progress being made with the Government's support. I accept that much of the framework for monitoring, targeting and co-ordinating the flu vaccine is historic: we have inherited it.

Given the known effectiveness of the vaccine in the target groups, will my hon. Friend consider the issues that I have raised and whether there is any scope for reconsidering the rationale behind the 75-year-plus group? Will she consider the many countries that target people

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over 65 on the basis that that broader group contains the majority of at-risk people? Risk groups overlap, especially in the higher age range. Perhaps she could consider the percentage of deaths attributed to influenza in that category.

The World Bank has described targeted immunisation as one of the most cost-effective public health interventions. Is there scope for further improvement in our approach in the United Kingdom? I look forward to hearing my hon. Friend's views and thoughts.

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