Examination of witnesses (Questions 1241
- 1259)
WEDNESDAY 9 FEBRUARY 2000
RT HON
ALAN MILBURN
and MS YVETTE
COOPER
Chairman
1241. Colleagues,
may I welcome you to this session of the Committee and particularly
welcome the witnesses. I am very pleased to see you back, Secretary
of State, after a brief visit to the Treasury for a short period
of time. I would particularly like to welcome the Minister to
her first meeting. I wish you well in your new job. Could you
both briefly introduce yourselves to the Committee.
(Mr Milburn) Alan Milburn, Secretary of State for
Health.
(Yvette Cooper) Yvette Cooper, Minister for Public
Health.
1242. Thank you. May I begin by asking a similar
question to the one I asked the departmental officials at the
outset of this inquiry. We have established, and I am sure you
are well aware of the fact, that way back in the early 1950s one
of your predecessors made a statement to the House of Commons
indicating the distinct possibility of a connection between smoking
and lung cancer. I think it was in 1954. It seems to us extremely
strange that in nearly 50 years so little progress has been made
in addressing the health implications of smoking. I wondered,
as a general introductory question, what thoughts you have on
why in that time 6 million people have been allowed to die and
we have only just started to take this issue in any way seriously.
(Mr Milburn) That is a good question, Chairman. I
think, first of all, it is very welcome that the Committee is
undertaking this inquiry. It has already had benefits, if I may
say so, and I will come to some of those during the course of
questioning. It is a very important area, as you rightly say.
Smoking, and the effects that it has, affect tens of thousands
of our citizens. Our evidence to you suggests that it kills around
120,000 people a year. Indeed, there is some evidence to suggest
that the decline that we have seen in a number of number of adult
smokers, according to the most recent figures, has not continued.
There seems to be some growth amongst young smokers which is even
more worrying. As to why the incidence of smoking has not declined
even more steeply than it has, there is a complex series of reasons
for this, quite frankly, but the most important is that smoking
is deeply addictive.
1243. The point I was making is why is it only
relatively recently that despite these known problems over, effectively,
50 years, only recently have we seen any effective Government
action? I am probably being prejudicial in terms of what our thoughts
are now but only in recent times has Government started to take
the issue of smoking seriously. That is the point I am making.
What are the reasons why, despite all the knowledge that we have
had over these years, nothing has really been done by other Governments?
(Mr Milburn) To be fair to predecessors of all political
parties of those last four or five decades, efforts have been
made by successive Ministers in charge of the Department of Health
to do what they could to tackle the ill effects of tobacco consumption.
What the new recognition is from this Government's perspective,
is that tackling what is a deadly addiction requires a multi-pronged
approach. It does not require just one approach. The approach
that we take is that we want to provide more information to people
so that if people do choose to smoke, it is important to say to
people how bad its effects are. That has been well quantified
over the last 40 or fifty years and indeed there has been substantial
evidence in the public domain and from the scientific community
about the causal link between tobacco consumption and deadly diseases
like cancer for many years, and very possibly that information
has been available not just in the public domain but it has been
known to the producers of cigarettes over those 40 or 50 years.
But, at the end of the day, people do have a right to choose to
smoke. However, they also have some responsibilities to themselves
and to others. I believe the Government has a responsibility too.
We have a responsibility to make sure that if smokers do decide
they want to smoke, then they make that choice on an informed
basis. First, that they are fully aware of the facts. Secondly,
we have a duty and a responsibility, I believe, to protect non-smokers
from the effects of smoke. Particularly, we have a duty to protect
children. Thirdly, we also have a duty and a responsibility to
help people who wish to give up smoking to do so. What that calls
for is a multi-pronged approach which is about information, education,
and making available smoking cessation treatments to people. It
is that, that is the new recognition. That is why, when we launched
our White Paper in December 1998, the World Health Organisation
amongst others could say that this was a tremendous effort. It
is precisely this sort of thing which is needed.
1244. I get the impression from some of the
evidence we have had during this inquiry, rightly or wrongly,
that over the years that we are referring to, on a number of occasions
Chief Medical Officers in various Governments have given clear
advice on steps that might be taken by Ministers in previous Governments
and those steps, in many instances, have not been taken for whatever
reason. In the time that you have been in the Department, has
there been advice given by senior medical officials in the Department,
of steps that they believe should be taken in respect of tobacco
consumption, but for whatever reason have not been taken?
(Mr Milburn) Not that I know of. We listen very carefully.
I am not a scientist. A lot of this has to be informed by the
science. We have listened to what the medical community, what
the Chief Medical Officers and others have to say to us. Then
we take the appropriate steps. Now I think it is true to say that
for the first time we have a comprehensive action plan in place
that will make a substantial difference. We have set very tough
targets for getting smoking consumption down, to reduce the number
of smokers. In addition to that, as you know, we plan to ban tobacco
advertising. We have some legal difficulties there but we are
determined to do that. We have set in place a wide-ranging education
campaign; a smoking cessation campaign. We are spending £100
million over the next few years to enable us to do that. If you
like, we are putting our money where our mouth is. Now, I believe
that will pay dividends.
Chairman: I want to ask a specific question
on possible legal action in a moment or two but before I do Simon
Burns would like to ask a question.
Mr Burns
1245. Just on this question, the Secretary of
State mentioned the Chief Medical Officer giving advice to Ministers
and, of course, he is in this unusual position of both being independent
and, in effect, a civil servant. May I ask the Secretary of State,
on the question of the advice the current Chief Medical Officer
gave the Government, what were his views on the Government's proposals
on advertising in Formula One?
(Mr Milburn) As I understand it, you took evidence
from the Chief Medical Officer at one of your hearings. As I understand
it, he indicated that at the time the policy was formulated he
had just come into offices as the new CMO, pretty subsequent,
two weeks or so, after the policy was formulated. The best thing
to do is to ask the CMO about that. But I think what he did say
was that he, like other members of the medical community, have
supported the action that we are taking as the right action. That
is why we have had such wide-ranging support from the BMA and
others precisely to tackle these problems.
1246. He did not altogether. He did not disagree
with Government policy, which was quite right of him, but certainly
the way he spoke to us was that he gave the impression that he
would have been happier—as I say, he gave the impression—if
there had not been a loophole. But that is a matter for Ministers
to decide.
(Mr Milburn) It is worth recalling that prior to this
Government coming into office there was one very big loophole.
There was no effort to ban tobacco advertising or sponsorship.
That is what we are going to do. We have legal difficulties at
the moment but we are determined to see that through.
Chairman
1247. May I come back to focusing on the issues
of potential legal action against the tobacco companies. We have
looked into some of the details of that and you will be aware
of what has happened in the States. What has happened in the States
will obviously have significant implications for this country
from what we have been made aware of. The BAT stuff that has recently
been discussed publicly in the last week or so arises from information
that came out of the court action in the States. When we took
evidence last week from Martyn Day, who was one of the lawyers
responsible for the proposed action which failed against the companies
in the United Kingdom, he made clear his view that there was a
distinct possibility that a successful action could be taken in
this country by health authorities against the tobacco companies
for compensation, for the amount of money that the health service
has spent in dealing with tobacco-related diseases. He also made
clear that his understanding was that the Department of Health
had actually advised health authorities not to pursue legal action
against tobacco companies. Could you confirm that his understanding
is correct and, if so, on what basis was that advice given? I
appreciate that you are not a lawyer but you have a broader view
presumably.
(Mr Milburn) I am not a lawyer, nor a scientist, but
a politician. He is right, broadly, that this is the advice that
we made available to health authorities. We did so on the basis
of the legal advice that we had received. The legal advice which
we had received is that one of the likelihoods is that if health
authorities attempted those sorts of actions that you described—parallel
actions, if you like, to the ones undertaken in the States—they
would be unsuccessful. As a consequence, health authorities would
be wasting NHS money on court cases when they could be spending
it on treating patients.
1248. Have you had the opportunity to study
the Opinion that Martyn Day has obtained from a QC on the potential
for legal action? If you thought there was the possibility of
a successful action being taken—certainly, as he suggested,
for a potential outlay of around £10 million for potential
compensation, but which could be in the region of £10 billion—if
you thought there was a chance, would you encourage health authorities
to look at this, or would you still be uneasy about this possible
step being taken?
(Mr Milburn) We receive very strong legal advice but
I am very happy to look at the advice. I have not seen the words
of the advice that Mr Day has provided. I will look at it, but
look at it absolutely without prejudice.
1249. I get the impression that the action which
would be proposed is somewhat different from that which was taken
in the States. Obviously it is specific to the United Kingdom.
(Mr Milburn) I think that is absolutely right. It
is not that I am against it in principle. What I am interested
in is what works and what is a sensible use of public money. We
will look at what Mr Day said.
Chairman: Thank you very much.
Dr Brand
1250. Secretary of State, in America the individual
states initiated legal actions because they were the commissioners
of health care. Therefore, clearly they felt that money had been
well-spent. Now, if you use that parallel in this country, presumably
that would be you, yourself, as the head commissioner of health
care having such a role?
(Mr Milburn) Well, yes, in one sense, although, of
course, it is the health authorities who commission care.
1251. On your behalf.
(Mr Milburn) On my behalf, that is true.
1252. The other thing, going back to what the
Chairman said earlier, we have known since 1954 (or a bit earlier)
that there was this causal relationship between ill health and
tobacco. Can you remind us of when warnings first started appearing
on packets of cigarettes.
(Mr Milburn) Warnings first appeared on packs in 1971.
1253. So there really has been a substantial
length of time where Governments knew of the dangers but failed
to regulate an industry, which seems to be singularly unregulated.
It is not classed as a drug, it is not a food, it is not anything
really. There are no safety checks. There is no consumer protection.
Is one of the reasons why the Department is reluctant to support
legal action against the tobacco companies because the Government
themselves bear a liability for allowing a dangerous product to
be sold, knowing full well what the dangers were without adequately
informing the public?
(Mr Milburn) No, I do not think that is the case.
I cannot answer for previous Governments from 1954 to 1970 or
1971, but you are right. There was massive evidence; important
break-throughs in scientific evidence. As you are aware, the 1950s
suggested a casual link between tobacco and some of these appalling
diseases. The reason why we took the view that we did, around
the advice that we provided to health authorities, was precisely
because our very, very clear legal advice—and I will come
to precisely why, if you will allow me, in a second—was
that these actions would not be successful. The reason for this
is that our health care system, and indeed our legal system, are
completely different from the ones in the States, as you will
be aware. The 1977 Health Act stipulates that health care should
be provided free. That makes it more difficult then to petition
and get compensation for third parties for actions that may well
have resulted in additional cost to the National Health Service.
Having provided the care for free, it is then difficult, I am
advised legally, except on certain exceptional grounds—and
the one exception that members of the Committee will be aware
of is the one that we have legislated for around the Road Traffic
Act—but it is difficult, although not impossible, to be
able to win damages or compensation when care has already been
provided for free. That is their advice which we received. I am
very happy to look at what Mr Day says but I do think it is very,
very important in this domain that, of course, it is perfectly
right and proper to look back and learn the lessons from the past,
(and I will come to some of that in a moment or two), but it is
also important that learning the lessons from the past we correct
and we get on and make a difference to the future.
1254. Clearly you have promised to look at the
Opinion provided by John Melbur Williams on this matter because
there are other issues that could be looked at like the dangers
caused by lead in traffic fumes, for instance. That was successful
as a case. I think it is unfair of me to ask for evidence today
that the Department at no stage was advised that they might become
co-defendants in an action against the tobacco companies. However,
I would be grateful if you could give an undertaking to look through
legal advice given to Ministers, your predecessors, as to whether
this has, at any stage, been raised; because it strikes me as
potentially probably the reason why nothing has been done.
(Mr Milburn) If I may, Chairman, I will try to do
that since Dr Brand has raised it and I think it is a serious
issue. But I think he ought to be aware that I am bound by certain
difficulties because normally, when Governments change, we do
not normally get access to previous Government papers. But I will
look and see whether the advice that you request—
1255. In the new spirit of the freedom of information,
even though it is not going to be enshrined in law, I hope you
will do your best.
(Mr Milburn) I will do my very best.
Dr Stoate
1256. Just a very brief point about the parallel
with the Road Traffic situation. You have managed to legislate
to ensure that you can claim compensation back from insurance
companies where there have been costs incurred by the NHS in treating
road traffic victims. In principle, surely is it not the same
situation that the NHS has been damaged because many millions
of pounds, (billions of pounds possibly,) has been spent on treating
the effects of smoking-related illness? Could there not be the
same legislative framework to ensure that compensation could be
claimed back from those who directly or indirectly caused that
damage?
(Mr Milburn) In principle that might be right, but
you ought to be aware that once we start going down that particular
road, then it does raise some broader questions of principle too.
That is about whether or not the National Health Service should
continue to be a service which is broadly free. I happen to believe
that it should.
1257. To follow on from that, it does not affect
this particular situation because the health service is free and
yet you feel able to claim compensation from insurance companies
for road traffic accident victims. The health service could still
be free but you could still feel able, as a Government, to claim
compensation from the tobacco companies on the same basis. Surely
the fact that the NHS is free is not directly relevant in this
instance?
(Mr Milburn) I think it is. There has been a variety
of recommendations over the years, not least from the Law Commission.
You will be aware of the report that we received, which recommended
not only that we look at seeking compensation from insurance companies
in road traffic accident cases, but also that we seek compensation
from a whole variety of third parties when there are costs incurred
in the National Health Service. I think one was recommending that
when workers had accidents at work, as a consequence of breach
of Health and Safety regulations, that we should then seek compensation
from employers. Well, I think there is a debate to be had about
that but I do think there are some difficulties with it too. One
of the very great advantages that it is important to remember
about our health care system is that, unlike some of the social
insurance systems you see on the Continent, we do not impose those
extra burdens and extra taxes on jobs or on employers. So, of
course, on the first leg what you say seems to make commonsense,
but what I am saying is that advocating that principle has the
potential for damaging another principle.
Dr Stoate: Okay, fair enough.
Mr Burns
1258. Secretary of State, would you agree, to
add to your concerns about what Dr Stoate is suggesting, that
the question of this Government's legislation on road traffic
incidents was basically tightening up an existing law? It was
not retrospective. The trouble with a Government or a future Government
deciding to legislate in the way that Dr Stoate is suggesting,
is that the legislation could not be retrospective because it
would be a nonsense; and the reason why the case in America was
successful was dating back many years, not in the immediate recent
past; so the whole philosophy of any action by a British Government
for the current timeframe would actually not be relevant.
(Mr Milburn) As I have indicated, there are a number
of problems with this particular route. Since the Committee Chairman
has asked me to look at the evidence, which you have received
from Counsel, I will.
Mrs Gordon
1259. I was going to add on this point that
the frustration that the Committee feels on this, and speaking
for my colleagues, is that in the evidence from the tobacco companies
and the advertisers, they seem to have no moral responsibility
for what they are doing. We feel they should have some kind of
responsibility. At the moment, they have no moral or financial
responsibility for the damage they cause to people's health. As
we said, 120,000 people die in each year. Quite honestly they
are getting away with murder.
(Mr Milburn) Well, I think it is true to say that
the tobacco companies have a very, very strong case indeed to
answer. What I find depressing is the fact that even now, in front
of this Committee, some of the tobacco companies cannot admit
a causal link between the consumption of their product and cancer.
They refuse to admit, for example, that nicotine is addictive.
They refuse to admit that passive smoking is dangerous and causes
deaths. I would have thought that it was about time that the tobacco
companies came clean on some of these issues. I can tell the Committee,
because I know that you have been interested in this issue of
additives in cigarettes.
Chairman: We will come on to that. Two of my
colleagues are well versed on additives.
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