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Sir George Young (Ealing, Acton) : I am grateful to my hon. Friend the Member for Hexham (Mr. Amos) for allowing me to contribute to his Adjournment debate. I commend the sensible and balanced way that he spoke. Public opinion is shifting and my hon. Friend has captured the changing mood more accurately than did the hon. Member for Ashfield (Mr. Haynes).

I hope that every hon. Member hopes to reduce the 100,000 premature deaths caused by smoking every year. Progress has been made in the past few years, and the Government deserve some credit for their role in securing a reduction in the number of deaths. However, we must do more. We need a coherent strategy that embraces all Government Departments, including the Treasury, because excise duty has an influence on consumption, and there has been no increase in duty in the last two Budgets. I hope that that will be put right so that there is a firm fiscal boost for the preventive strategy that we all want.

The Department of Trade and Industry has a role to play : there is no point in the Government's providing grants for the building of factories to manufacture cigarettes if they adopt a posture in favour of a reduction in smoking. Sports Ministers have their role to play : there is also no point in the Department of Health putting across the message that smoking is unhealthy if the Department of the Environment allows sport--a healthy activity--to be associated, through sponsorship, with smoking.

My hon. Friend's Department has a key role in this regard. I remember that, when I was given the job that he now holds, I observed two things when I entered the building : a no-smoking sign and, behind it, a chain-smoking doorkeeper. It took me a long time to establish the correct priority, and to disengage the latter from the former. I hope that the Department is now doing what it can to discourage smoking in hospitals, and at

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district health authority meetings, for instance, and that there are plenty of smoke-free zones at Richmond house, the Department's new headquarters.

What an individual does in his own home is of course a matter for him. My hon. Friend's point was this : why should we have to inhale polluted air in places that we have to visit, such as post offices and railway stations? Do we not have a right to breathe unpolluted air? What my hon. Friend the Member for Birmingham, Selly Oak (Mr. Beaumont-Dark) does with his pipe in private affects no one ; what he does with it in public affects many of us. The hon. Member for Ashfield may like the flavour that follows my hon. Friend, but I must say that, although I am happy to tolerate his company and conversation, I do not like the smoke, and my wife does not like the smell of my clothes when I go home after a discussion with my hon. Friend.

We can play a role by choosing to patronise institutions that have already made progress. We can stay at hotels with no-smoking bedrooms ; we can visit pubs and no-smoking bars and restaurants with no-smoking zones ; and- -as my hon. Friend pointed out--we can support airlines that have banned smoking. We can get the message across to producers and suppliers that public opinion is shifting, and that they can attract more customers by reponding to the changing mood than by listening to the rather reactionary voices that we have just heard.

My hon. Friend spoke of the "nanny state", but so far the no-smoking rule has been self-policing. There is little smoking on the Underground now, not because we have a nanny state but because people accept the rule. As far as I know, no one has been prosecuted for smoking on the Underground, although there may have been one or two prosecutions. Exactly the same would happen if the policy was extended to discouraging smoking in public places : the prohibition would become self-enforcing. We are asking the Government to nudge the shift in public opinion even further by giving a lead along the imaginative lines suggested by my hon. Friend.

10.12 pm

The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman) : I congratulate my hon. Friend the Member for Hexham (Mr. Amos) on introducing such an important debate. I shall keep my remarks brief, as I know that other hon. Members may wish to contribute if there is time.

My hon. Friend the Member for Acton (Sir G. Young) is entirely right : a reduction in cigarette smoking will unquestionably save lives. Of 1,000 young adults who are regular smokers, 250 will die before their time from smoking cigarettes ; six will die in road accidents. I agree with my hon. Friend the Member for Ealing, Acton that we ignore such statistics at our peril. Smoking cigarettes is dangerous, and, as a health Minister, I have a responsibility--as, indeed, we all have--to draw that fact to the attention of the public.

I agree with my hon. Friend the Member for Hexham that passive smoking is also dangerous, although not as dangerous as cigarette smoking itself. My hon. Friend cited the 1988 Independent Scientific Committee on Smoking and Health. To be fair, we should quote its findings a little more accurately : it identified an increase of

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between 10 and 30 per cent. in the risk of contracting lung cancer for non-smokers who were habitually exposed to cigarette smoke, as opposed to people who were exposed to it by chance in public places. However, my hon. Friend was right to draw the committee's report to the attention of the House. He was also right to say that on good medical advice the Department of Health accepts it.

My hon. Friend also said that smoking by others in public places can sometimes be a nuisance. Recently I visited a restaurant with my wife. We were greatly annoyed when the couple who were sitting at an adjacent table started to smoke before we had even ordered our meal. The fact that people sitting adjacent to us in a public restaurant chose to smoke cigarettes ruined the prospect of our meal. It was obvious that the other people in that relatively small restaurant did not enjoy cigarette smoke, either. Smoking can be a nuisance. As for the points made by my hon. Friend the Member for Hexham, it is important to recognise that smokers have rights, too. I defend the right to smoke pipes, cigarettes and cigars, but that right should not be exercised at the expense of those who do not smoke. It ought not to be exercised in public places. We must take every step possible to protect the rights of non-smokers. They are in the majority.

My hon. Friend said that there should be legislation to prohibit smoking on public transport. Smoking is already banned on the Underground, for safety reasons. As for aircraft, I join my hon. Friend in welcoming what British Airways and Air UK have done on domestic routes. Carriers have the right to ban all forms of smoking, if they so wish. The railways also have that power. I note that 80 per cent. of Network SouthEast trains already prohibit smoking, which is a higher proportion than on the rest of British Rail's network. Bus carriers also have the power to prohibit smoking. However, it would be difficult for them to enforce such a ban on the top deck of a double decker bus, particularly if there were only a driver and no conductor. My hon. Friend also referred to public eating places. An owner can ban cigarette smoking in his restaurant, if he so wishes. I agree with my hon. Friend the Member for Acton that it is up to public pressure ; legislation is not appropriate.

As for places of public entertainment, cigarette smoking has largely been prohibited in cinemas. Employers already have the power in workplaces to prohibit smoking by employees. They can enforce that ban through the contract of employment. In schools, it is up to the local education authority. By agreement with staff, smoking can be prohibited in staff rooms.

I agree with the thrust of my hon. Friend's case. He has my sympathy. However, I have to admit that I am a smoker. I smoke a pipe and I enjoy a good cigar, but I do not smoke in public places. I have stopped smoking in the Department of Health, at Richmond house. Although I still enjoy smoking, I do so in private--either in my own house, through the tolerance of my wife, or out of doors. I do not smoke in public places because I am concerned about the effect on other people, and their reaction. In public places it is good manners to refrain from smoking. The general thrust of my hon. Friend's debate is not unwelcome. The points that he has made are wise and sensible, and we should all heed them.

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Schizophrenia (Constituency Case)

10.18 pm

Mr. Michael Jack (Fylde) : I am grateful to you, Mr. Speaker, for allowing me this opportunity to raise briefly a serious issue on behalf of my Fylde constituents. I want to raise with my hon. Friend the Under- Secretary of State for Health one of the most difficult constituency cases that I have had to deal with since I became a Member of Parliament. It concerns a young man who, for the sake of the debate, I shall call David, a schizohphrenic, and the problems that his mother faces in looking after him.

I shall never forget, when I first met David's mother, her asking, "What will he do when I am gone? Who will look after David?" She was referring to facilities in the community available to look after her son. He is schizophrenic, irrational, sometimes subject to the influence of alcohol and drugs and imagines that people will murder him. He finds it difficult to live in the community. He tries hard, but his condition is serious. He repels some of the help available to him such as day care, and even the community psychiatric nurse has had difficulty.

When I first encountered the case, I felt that I was in some sort of game of pass-the-parcel. I raised the matter with the district health authority which referred me to social services ; I raised it with social services which referred me to the district health authority. I found it a most difficult case to make progress with. I am raising it tonight because I know that my hon. Friend the Under-Secretary takes a keen interest in mental health matters. I have letters from David's mother, one of which reads :

"I have nightmares about what the future holds for both David and myself--I love him dearly and have sorely tried from the beginning to be a prop' to him, but at my age which is 68, I wonder what happens when I die."

This Christmas she went to his flat. He had had some surplus milk bottles which he had flung all over the place. She walked in on a carpet of glass. He had had a bad schizophrenic attack and had crushed his collection of records and cassettes.

David's mother is 68 and tries her best. She has commented favourably on the efforts that have been made since I intervened and asked Lancashire social services to help. It has provided a home help with whom he has formed some kind of relationship, but much of the help is somewhat tenuous. I asked the district health authority what might be done to help, but was confronted with a picture almost of despair. When I asked what it could do to help the seriously mentally ill or people with serious behavioural difficulties, I was told, "I am afraid that we do not have a facility to help a young man such as this. The best we can do is send him to a facility in Northampton. We have three people on whom we are spending some hundreds of thousands of pounds in providing care. Could there not be some funds for a supra-regional unit to look after people who suffer from this kind of condition?"

The White Paper on caring for people might be a blueprint for hope for mentally ill people in the community. I showed it to the local social services department for comment and was told, "We have ideas. We would like respite care, one-to-one care in the community and the opportunity to put a social worker or community worker at the young man's disposal, but where

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are the resources? Can we be sure that in future the Government will give us the resources necessary to provide the intensive care which this type of person requires?"

The example that I have given, albeit briefly, is not unique. Schizophrenia is a widespread problem. Only today the Daily Mail wrote about it in human terms. It is a condition that many people find difficult to face. Margaret Wallace, a champion of schizophrenics and a journalist of note, recently presented an excellent television programme which showed that, to deal with schizophrenics in New York, warehouses with 750 iron beds in them are available to "look after" such people. That is a nightmare which haunts the mother of this young man.

I should like to hear from my hon. Friend the Under-Secretary what hope he can offer David's mother and many others that the future will not be so bleak for those who suffer from this terrible condition. 10.24 pm

The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman) : My hon. Friend the Member for Fylde (Mr. Jack) has done the House a great service by raising this subject. I very much hope that the House will have the opportunity to return to it at greater length and in greater depth than is possible tonight. In the time available I shall make five brief and simple points.

First, I do not believe that there is as deep an understanding of the affliction of schizophrenia as there should be in society and in the medical profession, particularly among general practitioners and primary care services. Early diagnosis means that early help is available to the family and the individual suffering. There should be a far greater understanding of how individuals can relapse throughout their lives. Schizophrenia can arise in the late teens. I have met a number of families who, to their great despair and amazement, have seen their children lapse into schizophrenia, sometimes diagnosed too late. The children then spend time in and out of psychiatric hospitals and then perhaps relapse into a chronic condition later in life, sometimes physically assaulting their parents, which is incredibly distressing.

I share with my hon. Friend a desire to bring out into the open this terrible disease so that, whether we are politicians, consultants or GPs, we are aware of the scale of the problem. Secondly, the Government have continued the long-standing policy of seeking to care for those with mental illness as far as possible in the community. That is a humanitarian policy, but there are limits to the degree to which we can care for those with a mental illness, in their own homes, with their parents, sharing flats or in hostels. In my judgment, there will always be a need for state provision for asylum care which can be short and long term. There will always be a need for some provision of institutional care for those with a mental illness. I do not think that it is fair to portray our policy as moving entirely away from an institutional setting to a community setting. Therefore, for my hon. Friend's constituent there will always be a need for some hospital care.

Thirdly, from 1 April 1991 the Government will be introducing a new grant payable through regional health authorities to social services departments to help them to improve facilities available in the community for the mentally ill. We recognise that social services departments

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do not spend enough of their resources on the care of the mentally ill in the community. It is 3 per cent. of their budgets. That is not sufficient. Therefore, the new grant will help in pump -priming--in the construction of new facilities, and in hiring additional social workers to care for those in the community. I frankly admit that in certain parts of the country the service is less than adequate. It is a function of historic policies and decision taken in good faith in the past.

Fourthly, from 1 April 1991 we shall be requiring all district health authorities, before they discharge any schizophrenic patient, to ensure that there is a proper plan for caring for that individual so that the health authority, the hospital and the consultant may know where the patient is going, how he can be contacted, who his friends are and what is his method of medical and social support in the community. That is most important, and I commend

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the Royal College of Psychiatrists for producing a code of practice broadly similar to our discharge policy for hospitals.

Finally, it is most important that the Government facilitate the construction of more community care facilities. I am very pleased to repeat the announcement which my right hon. and learned Friend the Secretary of State for Health made a few weeks ago about the creation of a capital loan fund. It is a major new initiative, and £50 million will be available to district health authorities to borrow from the loan fund to construct facilities in the community now and repay the money when the facilities which they replace are sold when they become empty and are no longer used. I hope that that will bring to fruition a much earlier construction of facilities in the community. I hope that that will help my hon. Friend and all those who suffer from mental illness.

Question put and agreed to.

Adjourned accordingly at half-past Ten o'clock.

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