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Lord Colwyn: My Lords, I thank the noble Baroness for that Answer. I am sure that pharmacists throughout the country will be delighted to hear that the Government endorse the fact that they are professionals providing a professional service. In view of her reply, would it be appropriate for the Government to consider providing some direct funding for this initiative? Would it be possible for a three or four-year period to make the campaign more effective and to allow fuller development of the programmes and take even more pressure from general practitioners with a view to allowing them to act as an effective filter to the secondary system and perhaps take some of the strain from hospital admissions?

Baroness Jay of Paddington: My Lords, under an initiative from the British Medical Association a number of health authorities are already contributing about £1,000 a year from their patient publicity funds to fund a national co-ordinator for this programme and support a range of shared initiatives. I also point out that the

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Government are investing in the United Kingdom over £40 million this year in an out-of-hours development fund which will meet some of the requirements to which the noble Lord refers.

Lord Walton of Detchant: My Lords, I warmly commend the establishment of the Doctor-Patient Partnership and the principles outlined in the Question of the noble Lord, Lord Colwyn, subject to the provisos mentioned by the Minister. Nevertheless, does the Minister agree that it is important not to discourage patients from seeking medical advice for serious 'flu-like symptoms such as headache and fever which may be the first manifestations of meningitis, a condition requiring urgent medical treatment and one which even the most skilled and dedicated medical practitioners sometimes find difficult to diagnose?

Baroness Jay of Paddington: My Lords, I am grateful to the noble Lord for offering us that very authoritative view. It is indeed the case that the Chief Medical Officer, in recommending to all GPs that they should be using influenza vaccine, names a number of conditions where, regardless of age, people should look for an influenza vaccine rather than self-medication. I can list those to the House if any noble Lords feel that they themselves are at risk but they cover a large number of chronic and other diseases.

Lord Winston: My Lords, does my noble friend agree that, rather than spending public money on such a campaign, it might be a good idea to devote resources to preventive medicine, perhaps methods of hygiene such as washing hands and, if your Lordships will forgive me, preventing people picking their noses, especially during the winter months?

Baroness Jay of Paddington: My Lords, that is another authoritative question from one of my distinguished medical colleagues in your Lordships' House. Given that my noble friend has given me encouragement, perhaps I may draw attention to a wonderful booklet, circulated widely by general practices and health authorities, called What Should I do? It is not for general reference, I may say. The sub-title is, Do I Need to go to the Doctor? I am not sure whether the two situations that my noble friend described fall into that category. But I take his point.

Baroness Miller of Hendon: My Lords, I welcome the Minister's agreement that the independent pharmacist has a role to play. But does she know of the initiative of High Speed Health which we started in Barnet some six years ago? Further, if the Government are interested in promoting the work of the independent pharmacists, how do they think they will be helped by the clause in the Competition Bill which will remove from the independent pharmacist the exemption for retail price maintenance?

Baroness Jay of Paddington: My Lords, I am grateful to the noble Baroness for drawing attention to what I am sure was a very successful local initiative.

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I am afraid that I am not immediately familiar with it, but I know that all the local initiatives which apply the concepts of high street medication are often very successful. With regard to the Competition Bill, the Department of Health is at the moment neutral on the issue of how the RPM clause in the Competition Bill will affect over-the-counter medicines and community pharmacies. If the Competition Act does result in smaller pharmacies going out of business, the Department of Health already has the essential small pharmacy scheme which subsidises small pharmacies, for example, in rural areas, to allow access for the public in areas which might otherwise be difficult and that model, if necessary, could be developed.

The Countess of Mar: My Lords, is it not the case that the vast majority of patients are very considerate of their GPs, as I understand a recent survey showed, but there are a few troublesome families who repeatedly appear in GP surgeries? If money is to be spent on education, would it be better to concentrate on the troublesome ones?

Baroness Jay of Paddington: My Lords, I am not sure that I would necessarily be competent about describing any group of patients as "troublesome". But the noble Baroness refers to a point which is very close to my interests; namely, promoting the concept of patients' responsibilities about healthcare as well as their rights to it. I have been intrigued by the numbers of local patients' charters I have seen in the past few weeks. Perhaps I may quote from one in Lancashire: a doctor states in his local charter that patients should learn how to treat their own minor illnesses and keep some basic household medicines in a safe place. The doctor also asks patients not to bring bicycles into the surgery or enter wearing dirty boots.

Carbon Dioxide Emissions

3.38 p.m.

Lord Ezra asked Her Majesty's Government:

    What practical measures they have in mind to achieve the target of reducing emissions of carbon dioxide by 20 per cent. by the year 2010, and how soon these measures will be introduced.

The Parliamentary Under-Secretary of State, Department of the Environment, Transport and the Regions (Baroness Hayman): My Lords, the Government are convinced of the need to tackle climate change, as stressed by the Deputy Prime Minister in his evidence to the Select Committee in another place yesterday. For our ambitious proposals for reducing carbon dioxide emissions in the UK to have maximum impact globally, it is essential that all developed countries sign up to significant reduction targets at Kyoto. The Prime Minister has asked my right honourable friend the Secretary of State for the Environment, Transport and the Regions, Mr. Prescott, to take the lead in visiting the key players in the negotiations in order to assess their positions.

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We have already started to take action to reduce carbon dioxide emissions at home. The Chancellor's announcement in the last Budget that the real increase in fuel duty would be raised to 6 per cent. a year is an important first step. We are currently developing a new climate change programme on which we will consult next year. Measures likely to be included are improvements to business and domestic energy efficiency, an integrated transport strategy and a large increase in the amount of electricity generated from renewables and combined heat and power schemes.

Lord Ezra: My Lords, I thank the noble Baroness for that very encouraging and positive report. I wish the Government well in their forthcoming programme. However, is she aware that there is considerable concern among many people about the present operation of the regulatory system in the electricity and gas industries? Is it not the case that the impact of the way in which that system works is that, far from encouraging more efficient use of those two fuels, it encourages greater use of them? That applies particularly to the gas industry where the present regulator withdrew the energy efficiency measures introduced by her predecessor.

Baroness Hayman: My Lords, I am aware of the concerns that the noble Lord expresses and I am grateful for his general welcome of the measures that the Government are introducing. It is important that we deliver big improvements in domestic energy efficiency, as he points out. It would help in delivering important environmental and social objectives, cut fuel bills and improve comfort in poor housing. We are looking at a variety of options, one of which is a self-financing energy efficiency scheme to be run by the energy supply companies. Another would see a standards of performance scheme run by the gas and electricity regulators. The Government's review of utility regulation is looking at and considering those options.

Lord Hardy of Wath : My Lords, will my noble friend and her ministerial colleagues reconsider the use of petrocoke for power combustion? Does she think that that would in any way provide the help that is obviously necessary, given the present inadequacy of the systems for clean combustion, to attain the targets mentioned in the noble Lord's Question?

Baroness Hayman: My Lords, I am aware that National Power has put in an application to vary authorisation in regard to petrocoke. It is an issue which will have to be decided by the Environment Agency, which has responsibility in those matters. My right honourable friend the Minister for the Environment, Mr. Meacher, is taking a close interest in the issue.

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