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1.18 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I am glad to have the opportunity to respond to the hon. Member for Wentworth (Mr. Hardy), who raised some important points. I have always respected his talents as an implacable pursuer of
causes that are dear to his heart--which certainly include bodies that are not democratically elected. Indeed, he is quite right to point out that it is precisely the function of Members of Parliament, who are democratically elected, to raise such matters. Incidentally, I am also glad to note that he paid particular tribute to the staff of Rotherham district general hospital, and I would like to associate myself with that tribute.
I understand that this debate is not so much about smoking policy or anti-smoking policy per se, but about what the hon. Member for Wentworth called the proper conduct of public business--in this case the conduct of the trust. None the less, before coming to that matter, I shall briefly comment on Government policy on smoking, since it was the origin of the problem.
The Government believe that people are entitled to breathe air unpolluted by tobacco smoke and that non-smoking should be the norm in buildings frequented by the public, with special provision for smoking where local managers feel that it is appropriate. National health service premises are required to be virtually smoke-free. Smoking is responsible for about 110,000 premature deaths in the United Kingdom each year, and the treatment of smoking-related diseases costs the NHS, and therefore the taxpayer, about £610 million a year.
As the largest employer in the United Kingdom, and as the manager of premises used by thousands of members of the public, the NHS has a responsibility to protect patients, visitors and staff from the health risks of smoking. I do not think that the hon. Gentleman would disagree with that. The NHS, precisely because it is the NHS, should and does develop an exemplary role, leading the way and providing the model for other employers to follow.
In July 1992, the White Paper "The Health of the Nation" set out a requirement for the NHS to work towards a virtually smoke-free environment for staff, patients and visitors as rapidly as possible. Soon after that, guidance was issued in October 1992, to which the hon. Gentleman has referred, which set out the action required of NHS hospitals and authorities. That guidance is called
"Towards Smoke-Free NHS Premises".
The Department co-operated with the Health Education Authority in the production and distribution of guidance on the design and implementation of smoking policies. That publication set out the basic requirements of an NHS policy, but left management free to tailor arrangements to suit local circumstances. Advice was also included on the responsibility of health authorities to specify that, wherever possible, NHS services should be provided in a smoke-free atmosphere.
It is worth remembering that the Government guidance issued to help implementation of that policy does not require hospitals to provide separate smoking facilities for staff and patients. It sets a minimum standard, which all parts of the NHS are expected to achieve. It is up to local managers--I emphasise that--to decide whether they feel that it is necessary or practicable to set aside such smoking rooms for staff and/or patients.
Following receipt of the Department of Health guidance, the Rotherham General Hospitals NHS trust set up a task group in 1993 to look at the question. On 4 October 1993, it sent out a letter, which was--to use the bureaucratic terminology--cascaded to staff via the team-brief network, and a policy statement, which I think that the hon. Gentleman has seen, setting out its
position on anti-smoking policy. The letter asked for comments or questions by the end of December of that year. The consultation lasted for three months from the beginning of October to the end of December 1993. I am told--the hon. Member for Wentworth has not controverted this--that only two members of staff individually made representations during that three-month period.
The first stage of the policy, which was issued to staff--I understand--in a letter with their pay packets, was implemented on 1 April 1994. It made it plain that to help staff, a smoking room would be set aside until 1 April 1995, after which--two years after the beginning of the process--the whole policy would come into force. That is the burden of the problem raised by the hon. Member for Wentworth.
I am also aware that in February 1995, a 500-name staff petition against banning smoking was considered by the trust board. I should point out that although the hon. Member for Wentworth said that the petition received substantial support, the trust employs 3,000 staff and the petition therefore represents quite a small proportion of employees--fewer than one in five.
Mr. Hardy:
I am sure that there would have been a much larger response to the petition had the people responsible for it been allowed to put a notice on the staff notice board and the administration had not been especially discouraging. Many staff work strange hours, including night shifts, and so on, and I am assured by those responsible for the petition that many more signatures would have been obtained had it been simple to do so.
Mr. Horam:
I hear what the hon. Gentleman says, but I can obviously go only on the facts in front of me.
Since April 1995, when its policy was introduced, the trust, which treats about 300,000 patients a year, has received only three formal complaints from patients about its smoking policy.
I shall deal with the effect on patients before I deal with the effect on staff. The trust decided to allow discretion for clinicians to designate smoking areas for wards where certain patients are allowed to smoke. Long-stay patients who are addicted to smoking are allowed to smoke, as are terminally ill patients, where the medical staff in charge of their care feel that it is in the patients' best interests. The trust is considering offering free nicotine patches to all in-patients for use during their stay. I am aware from the correspondence that some patients do indeed go outside the building to smoke, but they do so against medical and nursing advice. I stress to the hon. Member for Wentworth that about 500 deaths a year in Rotherham are attributed to smoking--that is one in five.
I understand that some staff reacted strongly when the trust removed the designated smoking room, although ample notice was given in the course of the procedure that I have described, and proper consultation was conducted. As the hon. Member for Wentworth has pointed out, the trust has adopted a lenient approach to staff smoking in hospital grounds. Although the trust cannot of course forbid smoking in private cars--that would be quite oppressive, to use the hon. Gentleman's word--it has every right to forbid smoking in its own vehicles.
The hon. Member for Wentworth kindly wrote to me on 13 January, raising a number of points related to the debate. He said:
Simply, my point is that that is a matter for local decision. It is a matter for the Rotherham General Hospitals NHS trust and it is not therefore in conflict with Government policy. It is simply exercising its right to carry it a step further than the Government guidance suggests.
The hon. Member for Wentworth also asked whether the Department knew about the 500-name petition. It is not clear from the chain of documentation whether we were fully aware of it. As far as my noble Friend Lady Cumberlege could determine from all the evidence, we were, however, fully aware that there was not a majority in favour of reversing the ban imposed by the trust. We have discussed the figures and the hon. Gentleman has made his point. None the less, the petition contained only about 500 signatures, and there are 3,000 employees of the trust.
The hon. Member for Wentworth went on to ask what arrangements had been made to enable patients to smoke where a clinician agreed that they should be able to do so. That is an important and practical point. An arrangement may be made between staff and a patient so that he or she may smoke at agreed times, for example after meals. In such a case, a single room off the main ward may be made available or a sister's office can be allocated for that purpose by agreement with staff. The trust has made it clear that there are no spare rooms and no specific rooms are designated for smoking.
The hon. Gentleman finally raised the question of smoking out of doors and in cars. I take his point that a general ban was imposed at first. However, in the light of experience and, perhaps, common sense, the trust now operates that aspect of the policy leniently.
All those matters were raised again by the acting chief executive and by the non-smoking policy group just before Christmas--in October or November--and the trust board considered them at its meeting in December. Various recommendations were made--
Madam Deputy Speaker (Dame Janet Fookes):
Order.
Mr. David Porter (Waveney):
I am grateful for this opportunity to raise the matter of the A12 trunk road in Waveney and to express some of my constituents' fears about the consequences of leaving it as it is, without development and without significant improvement.
When the roads programme was cut in the previous Budget, it was understood that all road schemes had to be reconsidered; no one argues against that. My hon. Friend the Minister for Railways and Roads and the Department of Transport can only do what they can with the money that the Treasury gives them. It is also now unfashionable in some quarters to build roads.
I hope, however, that my hon. Friend will understand the sense of betrayal and desertion that I feel on behalf of my constituents as a result of the fact that the commitment in the White Paper "Roads for Prosperity" to dual the A12 from London to Great Yarmouth by 1999 has been abandoned in the re-ordering of priorities. Such schemes are abandoned without hope when they are wiped out for ever instead of being put back. Putting back is not satisfactory, but expectation and community feeling are kept alive. Axing completely simply demoralises individuals, businesses and communities that trusted in that original hope.
I shall concentrate on two parts of the A12. The first is the A12 through Wrentham, an attractive village whose case for a bypass was established and settled many years ago, when the Department of Transport kept the A12 north of Ipswich as a trunk road and took over the Wrentham bypass scheme from Suffolk county council. On 27 November last, a child, Grace Wright, was almost killed crossing the A12 after school at 4.30 in the afternoon. By a miracle and as a result of intensive care in Addenbrooke's hospital, she is now recovering. There may be some traffic-calming measures, and there may be traffic controls and further speed restrictions, but what does it take to happen--how many lives will be put at risk--before a bypass, which was accepted when traffic volumes were lower than they are now, is built on road safety, environmental and quality of life grounds?
Surely when the Kessingland bypass was built, the Wrentham bypass should have been added to it. Having delayed the scheme with inquiries and arguments over routes, surely the most sensitive decision would have been to keep it in the active programme. Whatever the arguments about the stretch through Lowestoft, which I shall come to next, surely Wrentham was a stand-alone case with a watertight justification. I urge my hon. Friend the Minister to reinstate the scheme to a higher priority as so much money has already been spent on its preparation.
In Lowestoft, to the north of Wrentham, there is an even worse case. The Government have simply wiped out the spine road from Kessingland to Pleasurewood, roads on both sides of the river and the bridge that crosses Lake Lothing. The campaign for a third crossing at Lake Lothing began at the end of the first world war in 1918 and some of the approach corridors have been preserved since the mid-1960s. The two existing crossings, the crossing at Mutfordlock in Oulton Broad and the bascule bridge in Lowestoft harbour, have been variously replaced over the years. The Mutfordlock crossing was rebuilt most recently, but it is not a trunk road.
The existing bascule bridge is the only main link for the two halves of Lowestoft and beyond in either direction. To the north, there is Great Yarmouth where hundreds of my constituents travel to work. To the south, there are Ipswich, London and the channel tunnel. The bridge also provides a link to the A14 east-west link. That bridge is thus central and critical.
The bascule bridge is coming towards the end of its life. The previous bridge failed and for weeks, the town was cut in half. Business, cultural and social life almost died. The replacement was built in 1972 with an expected life span of 30 years, so we are only six years from its expected end, with no replacement in hand. Last summer, the bridge failed during a peak bank holiday period. The tailbacks were horrendous and life was literally rendered intolerable for thousands of people. I keep asking what plans the Government have in the event of permanent failure of that bridge. The answer seems to be that they have none. I ask again today what my hon. Friend will do if the bridge fails beyond repair.
In February 1991, I corresponded with Christopher Chope, who was then Minister for Roads and Traffic, about failures of the bridge in November 1990 and January 1991--failures of the same chaotic magnitude as last summer's. He replied:
Nothing has changed since then except that the traffic volume, the pollution and the inconvenience have got worse. The need is still there.
Even when the bridge is working properly, it causes problems. It opens to shipping, on average, 12 times a day. Each opening takes three to four minutes although if there is more than one vessel to go through, openings can take 10 minutes or more. Average tailbacks of traffic at bridge openings are three quarters of a mile in both directions. The hundreds of stationary vehicles often keep their engines running throughout.
Of course the bridge openings are vital to the economic well-being of the port and no one suggests that the bridge should not be opened. The area is trying to encourage tourists and there is a growing Dutch visitor element. Those Dutch visitors, who are, in effect, our competitors in Europe, are astonished that a town the size of Lowestoft, with 65,000 people, has to hold its breath and hope that the bridge, having opened, will close again to allow the vehicles across. In Holland, there is no question of bridges not working or not being replaced because they are a priority in keeping commerce going.
What other town of Lowestoft's size and importance--it is the second largest in Suffolk--has to have a trunk road going through its heart while being 80 miles from the nearest point of the motorway network? In the north of the town, the A12 is reduced to a single lane in several places although it carries more than 33,000 vehicles a day. In the south, where London road south runs through the Kirkley area, exhaust fumes were monitored last summer, with ghastly findings. The incidence of asthma around that part of the A12 is twice the frequency for Lowestoft in
general, which is itself higher than the national average. Drawing trunk traffic flow from those areas into the corridors that have been preserved is the only solution.
If there is any doubt, we need look no further than the circular, sent out every year by the Department of Transport, which advises local authorities on how to prepare their transport policies and programmes. The local authorities--I quote from instruction 25--are told:
What is good enough advice for local authorities should be good enough advice for the Department of Transport.
What of the corridors, the houses and the land that have been blighted and bought with taxpayers' money? Whole housing developments and minor roads have been built over the years which leave the A12 spine road corridors. Are the corridors to be allowed to go to development-- ribbon and odd-corner development--just because the spine road has been arbitrarily axed?
I was born and brought up in Lowestoft. For all my life--certainly all my political life--Lowestoft's traffic problems have been beyond any joke. There is an all-party consensus on the need for a bridge. There is agreement from industry and business, from the elderly and from young families that the third crossing is the solution. We call it the third crossing; the Department of Transport calls it the second crossing, implying that the bascule bridge will eventually go and that the new bridge will be built west of the inner harbour. Such joke as there was, was that the second coming would occur before the third crossing. As things stand now, that may well be so.
Those who did not want the new bridge are happy now. Some argued that the spine road was not a panacea and would encourage yet more vehicular traffic. There are those--I am certainly among them--who say, "If we cannot have a £80 million bridge up river, what can we have? What do we as a community want from our road layout which will improve the quality of our lives and our economic prospects?"
While we have been given a chance to rethink, there is a fear that nothing at all will be done to help Lowestoft solve its economic problems, which are being experienced deeply by many of my constituents. In recent years, Lowestoft has suffered a decline in its traditional industries, and jobs lost in food-related industries, shipbuilding and fishing have put local unemployment at about 11 per cent.
The existing A12 links are at best sub-standard and at worst wholly inadequate, given the economic pressures on the area. The area failed to get assisted area status, although nearby Great Yarmouth did. If the decision had been made a few weeks later, unemployment in Lowestoft would have been high enough to allow us to get assisted area status also. Lowestoft has been designated an EU objective 5b area, but so far we have not received approval for any big job creation ideas. That approval must come from the Government via the Government office for the eastern region, which includes my hon. Friend the Minister's Department.
Eighteen months ago, European Commission official Alfonso Gonzalez Finat visited Lowestoft and was shown the potential of the port. He pointed out that the road links create an unfair disadvantage for a port with such
excellent European sea links. In 1980, a British Road Federation report criticised the state of all road links to ports, and singled out Lowestoft. Since then, nothing has been done except for one small piece of work--the eastern relief road from the port. Despite that, a single carriageway trunk road still goes through the heart of the town. The relief road funnels the traffic instead of moving it. When the bridge is open, the eastern relief road is no more than an expensive temporary car park.
The promise of road improvements has helped investment in Lowestoft to some degree, but now that the hope following the 1989 promise has been removed, we fear relocations and closures. There is a feeling in East Anglia that the central corridor of Great Britain from the north through the middle of England and London to the channel tunnel is being developed. That is fair enough, and I will not argue with that. But as a consequence, the furthest edge of East Anglia is being sidelined. I hope that that is not being done deliberately, but that appears to be the case.
People often say to me that the charm of an isolated area such as north Suffolk is what brings in the tourists, and that is true. The Broads and the North sea are great natural assets that attract visitors, while the local bathing beaches are the finest in England. North Suffolk is one of the most appealing parts of the country. There are people who visit the area regularly for many years, and some end up retiring there. But a thriving tourist industry based on water, entertainment, history and indigenous charm must be accessible. There must be a thriving local economy, and not one that is simply choked by traffic.
We were awarded objective 5b status to ameliorate the deficiency in our communications and infrastructure that adversely affects local businesses and communities and which erects barriers preventing sustainable development. The A12 at Waveney is surely a classic candidate for priority treatment under that criterion.
Where do we go from here? What is to happen to the Wrentham bypass, the spine road and the bridge? What schemes is the Department of Transport now looking at to ease Lowestoft's traffic problems? What will happen when--not if--the bascule bridge fails for good? What plans has the Department made in the event of the bridge failing for a few days, weeks or months? Will a replacement be provided for that crossing?
"I do not entirely disagree with your comments about smoking. However, your letter overlooks several of the matters which I have raised.
The NHS guidelines do refer to the provision of smoking rooms. Rotherham has refused to provide these."
A12 (Waveney)
1.30 pm
"In November 1990 my Department announced the preferred route for the A12 Lowestoft Relief Road which incorporates a new crossing in the vicinity of the North Quay. Subject to completion of statutory procedures and the availability of funds construction could start in 1994 and would take about two years . . . I hope that we can avoid further failures of this kind but recognise that the long-term solution is the construction of a new harbour crossing."
"Authorities should pay particular attention to air quality in preparing transport plans especially through consideration of measures to reduce traffic levels in sensitive areas such as town centres."
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