Examination of witnesses (Questions 1260
- 1279)
WEDNESDAY 9 FEBRUARY 2000
RT HON
ALAN MILBURN
and MS YVETTE
COOPER
Mr Amess
1260. Obviously all Governments have priorities.
First of all, how big a priority is it for this Government to
discourage the general public from smoking?
(Yvette Cooper) A huge priority. We have made it very
clear that from the health point of view cancer, heart disease,
mental health, are the big priorities and saving lives in those
areas. Smoking, we know, is one of the biggest causes of cancer
and heart disease. So we are also taking the perspective of looking
at the disease, not just in terms of what happens to people once
they become ill, but preventing their becoming ill in the first
place. That is where smoking really fits into an over-arching
strategy to save lives from the big killers. We set targets. We
have had a White Paper on tobacco. We have put together the biggest
tobacco education campaign ever on this, and we have just rolled
out smoking cessation services to support this. It is not simply
about the education campaign, it is also about giving people the
support they need when they want to give up. We know that 70 per
cent of smokers say they want to give up but giving up is extremely
hard, especially when nicotine is addictive. So the responsibility
of the Government is to give people the support they need when
they want to give up.
1261. I made this point genuinely. This is a
very tricky subject for yourself and for your Minister of State
because you have 500 jobs dependent on the industry in your constituency,
and 888 jobs in the Minister of State's constituency. Now I remember
when I was the Member of Parliament for Basildon I lost 1,200
jobs—you were not the MP then—but to your constituency
and to Spennymoor. Genuinely this is a very, very difficult thing
to reconcile as a constituency Member of Parliament because I
know how angry my constituents were that we lost 1,200 jobs. I
wonder whether or not you want to comment on that, but is there
any philosophy here as to how these people who work in the industry—and,
my goodness, we are short of jobs in Southend—but is there
any strategy about by which they could be redeployed?
(Mr Milburn) I am grateful for your empathy, Mr Amess,
and I will take it as heartfelt. Actually, there are not 500 jobs
in my constituency, there are over 600 people employed in the
Rothmans factory. However, I also have people in my constituency
who are dying from cancer, heart disease, and so on. They are
dying as a direct consequence of smoking cigarettes. So you ask
me whether there is a problem. No, there is not a problem. We
have to do absolutely the right thing here and that is what we
are going to do. We are going to better inform the public. We
are going to make more information available to the public. We
are going to educate the public. We are also going to take the
statutory steps which are necessary, including the enforcement
of a ban on tobacco advertising, precisely so that the public
are better informed, children are better protected, and we have
fewer smokers in the future. As far as the issue of the workers
are concerned, I talk to the trade unions regularly about this
issue. What has actually destroyed jobs in the tobacco industry
is a long-running trend, which has been here for 30 or 40 years,
and that is automation and mechanisation. These factories produce
millions and, in some cases, literally billions of cigarettes
like there is no tomorrow. Sadly that is true for some people.
Of course, that is a problem. Sure, the tobacco unions and others
have looked in the past at potential diversification in terms
of employment. That is something we all need to consider extremely
seriously because the factory in Basildon closed, the factory
in Spennymoor is now closing. Of course there are doubts about
the future of these factories.
Chairman
1262. May I ask a further question arising from
the legal action in the States. I know you are familiar with the
documentation available through BAT. Has the Department looked
at exercising any powers to require the other United Kingdom tobacco
companies to make available their own documentation and archives
in a similar way to the BAT depository in Guildford?
(Mr Milburn) I am not sure that BAT entered into the
establishment of their depository voluntarily.
1263. They did not have much choice, as I understand.
(Mr Milburn) I think that is absolutely right. They
did not have a lot of choice. First of all, there are things which
BAT could do right now and I urge them to do so. They should improve
access to the depository. They should make copying access much
easier to the documentation that is available. They should waive
charges for reproducing the information that is available there
in order that the public can be better informed about the information
that that company holds. I would also urge the other tobacco companies
to do precisely the same if they have information of that sort.
It is very important, in my view, that this information should
be made available to the public. I will tell you why, Chairman.
As I said earlier, I believe that smokers in the end have a right
to smoke. That is their choice.
Chairman: We will adjourn for ten minutes to
vote.
The Committee suspended from 16.27 pm to
16.36 pm for a division in the House.
Chairman
1264. I know that the only member who is missing
is in another Committee at the moment so can we resume. We were
discussing the archives of the companies. I am trying to recall
the answer you gave. The specific question I asked was whether
it would be right for the other British companies' records to
be made public, whether the Department had any powers, and perhaps
I ought to add as well whether you feel in the context of this
inquiry that the Committee can be of any help in securing documents
that are not currently in the public domain?
(Mr Milburn) I was saying that I think the tobacco
companies, all tobacco companies, should put the information that
they have at their disposal into the public domain. I think that
is right. I would have thought there is an opportunity for the
Committee, since it has undertaken this inquiry, to request, and
if not request subpoena, the information you require from the
BAT depository. It is perfectly within your powers to do that.
I would want to encourage the industry to put as much information
as it can into the public domain. As I was saying before the division,
it seems to me there is a good principled reason for doing this.
If you believe, as I do, that in the end people have got the right
to decide whether or not they wish to smoke, they also have the
right to know exactly what it is they are smoking. I believe firmly
that the tobacco companies need to do a lot more than they have
done hitherto to make information available to the public about
precisely what the component parts of cigarettes are and what
the effect might be of individual component parts, but also of
the cigarette in totality.
Chairman: John Gunnell?
Mr Gunnell
1265. We were a bit concerned, Secretary of
State, at some of the oral evidence we heard from the departmental
officials which suggested that you did not have a great deal of
resource to deal with this. I am very glad that you are obviously
taking it so seriously but it was suggested to us that the Department
relied on Dr Dawn Milner who is a Senior Medical Officer, who
is a full-time civil servant and on Professor Frank Fairweather
for one day a week and an another scientific advisor for two days
a week to analyse the technical composition of cigarettes. Surely
if that is all the resource it is not a very large amount of manpower
and not adequate, I would have thought, to analyse other people's
research into the area let alone conducting research yourself.
(Mr Milburn) I understand that and I understand the
concerns that have been expressed. It is true that there is a
quite a small tobacco team in the Department, I think about 11
posts in total. That is not to say that there are not resources
in the National Health Service; there are. For example, the money
we have put into the Health Action Zones for smoking cessation
is in the business at the moment of creating a further 137 posts
dealing with the consequences of smoking. That is something I
hope the Committee would welcome. We have scientific advice that
we can draw on, both in terms of our scientific consultants, if
you like, and we also have the advice we can draw on from the
Scientific Committee on Tobacco and Health. It is a very useful
organisation, in my view. As you know, it too has had its trials
and tribulations as far as the tobacco companies are concerned.
Thankfully they won legal proceedings, quite rightly in my view.
There is a mass of scientific evidence out there too, more and
more scientific evidence by the day, and we can draw on that.
I do say that aside from the evidence that is already available,
we need to see further disclosure from the tobacco companies.
1266. We would certainly be glad to have some
details of the additional staffing which you have put in that
area which has been added to that area in recent times because
it seems to us important and we felt too when we visited the EU,
that we had only got one official connected out there, John Ryan,
and he was designated to deal with smoking and health issues but
that was only part of his brief. I wonder whether you would take
steps to ensure that a greater proportion of public health resources
goes to dealing with what is obviously the major cause of preventable
disease in the community and whether his team, too, could be strengthened.
(Mr Milburn) I am not sure I want to be in the business
of advising the European Commission to add more bureaucrats to
what some would say is quite a large bureaucracy anyway, but I
recognise the problem there. I think it is true, Mr Gunnell, that
there is just one official dealing with tobacco in Europe and
I think personally what is needed as far as European institutions
are concerned—perhaps we will come to this in later questions—I
do think it is very, very important that we are able to draw on
the best of scientific opinion cross the whole of Europe in a
rather more structured way than perhaps we have at the moment.
As far as the United Kingdom is concerned, there is always an
issue to be resolved about where best to put the resources. My
view about that is very clear. I want to get resources out into
the NHS. I have been aided and abetted, if you like, in that aim
by the fact that departmental running costs in the Department
of Health for a number of years have been either static or in
decline. I do not say that is particularly a bad thing because
that means we get more money out into the services where they
are most needed and that seems to me to be a good thing. We can
certainly provide information about the new posts that are being
created. Half the posts in the 137 Health Action Zones have been
filled and obviously we will see more and more by the week.
1267. Mr Ryan seemed very focused and very concerned
about the issue he had got, but he did not have the back-up in
terms of people which might be necessary to do the work needed
to make sure the work was more effective.
(Mr Milburn) I think there will be concerns about
that. I think it is equally true to say that, with the best will
in the world, we will never match the resources of the tobacco
companies. We just will not. Thankfully the scientific and medical
communities, in my view, have matched the resources of the tobacco
companies because they have won the medical and scientific argument.
They have won it despite the opposition from the tobacco companies
who still do not accept the overwhelming scientific consensus
that exists out there, which is that smoking kills, that passive
smoking is deeply dangerous, and nicotine is addictive.
Mr Gunnell: We very much hope that you will
manage the legal means to be able to follow the pattern in the
United States where much of the work that is being done is actually
funded by the tobacco companies and is used against them.
Dr Stoate
1268. As you know, Secretary of State, we took
evidence from Department officials on 18 November last year and
at the time that they came to see us they were joined by members
of the Health Education Authority. As I understand it, since then
the HEA has been disbanded. Who will now take responsibility for
the health education programme and the rolling out of this programme
to the public?
(Yvette Cooper) We are in the process of transition
at the moment with the new Health Development Agency getting up
and running at the moment. There are various things that the HEA
used to do in the smoking field. On the campaign side we are already
doing far more. We have massively increased the budget for campaigning
as part of launching the tobacco education campaign. So we are
picking up that and expanding it. That smoking campaign is currently
being run from the Department which is spread over the next three
years to encourage people to give up smoking or to prevent them
starting smoking in the first place. Although we had the first
national launch of it just before Christmas and the first wave
of it with the television ads and bill boards and so on, we have
got a whole series of further developments as part of that overarching
campaign (which is about £50 million) which will include
a lot more local targeting, targeting particular groups, young
people and developing an education campaign there. All of that
side is being picked up. On other areas, things like the research
and evidence base, what works, that kind of thing, the whole ethos
behind the new HDA is to expand the evidence-based approach to
make sure we know what works in public health and we also have
best practice to spread nationwide. Smoking is obviously one of
the big areas of public health so obviously all of that side of
things has got to be picked up by the HDA as well. There is the
issue of the network of alliances around the country. We strongly
depend on the work of the local alliances to promote the work
at a local level. All of that will be picked up as well. I think
all of the elements of the commitment to the work on tobacco control
will be picked up and actually strengthened by the new arrangements
rather than the way that the HEA had to work in the past.
1269. I would like to look a bit more at Health
Action Zones. I appreciate that a lot of time, effort and money
has gone into action zones and it is a very welcome development.
What assessment have you made of the effectiveness of the tobacco
cessation campaign within the action zones? Have you got any research
on that? Have you got any figures?
(Yvette Cooper) They are still at an early stage.
There is a process of evaluation going on. We are monitoring what
is happening at each stage. They are still at a very early stage
of development so the smoking cessation services are getting going.
We do not have long-term figures about the numbers of people successfully
quitting yet and we would not expect to at this stage. We have
got the framework in place to do the evaluation because obviously
what we have got to do is make sure that we are putting the money
where it is most effective but also learning from some of the
things the Health Action Zones are doing. If they are trying particular
projects or particular ideas in particular areas and those are
most effective, making sure we can spread those out across the
country.
1270. Initially the Health Action Zones are
funded for three years. What will happen after that three years
to continue the funding of long-term programmes that are going
to be needed to make sure that this is a success?
(Mr Milburn) That is something we will need to assess.
We will need to assess the effectiveness of the Health Action
Zones. Broadly, they are the right thing to do. It is a means
of tackling the particular health problems in some of the most
deprived health communities in the country where there is a higher
incidence of ill-health than elsewhere. They get additional resources
to do the job but I am determined, just like everything else in
the Health Service, that we should assess how effective they have
been, what their value for money has given us and most importantly
of all what health outcomes they have achieved. They have got
three years funding. There is money going out there. We have put
money, as Yvette was saying, for this first year into tobacco
cessation purely in the HAZ areas (£10 million). From 1 April
we will roll more money out into HAZs and indeed into other deprived
communities.
1271. You have concentrated on the deprived
communities which is the first thing to do initially, but do you
have any plans to roll those out across the rest of the country?
(Mr Milburn) Health Action Zones?
1272. The same sort of programmes that you are
putting into place in Health Action Zones, clearly other parts
of the country would benefit from the same sorts of circumstances
and programmes. Do you have plans to roll out the same type of
programmes?
(Yvette Cooper) Yes. For example, the week's free
nicotine replacement therapy for people on low income will be
rolled out across the country from 1 April. At the moment that
is just available in Health Action Zones; in April that will go
national. We are also making smoking a priority as part of the
health improvement programmes that every health authority in every
area is drawing up. As to whether we want to roll out specific
things that are currently being done in Health Action Zones, that
is going to depend on how effective they are. The broad approach
of providing smoking cessation services, which includes the nicotine
replacement therapy, is something that we support right across
the country.
1273. I am very pleased to hear about your plans
to roll out across the country but have you got any evaluation
so far of the effectiveness of the NRT part of the programme?
Do you have any figures to base that on?
(Yvette Cooper) There is evaluation of NRT and the
evaluation shows, I think, that it doubles somebody's chance of
giving up. For any particular individual it doubles their chance
of giving up. The difficulty of evaluating NRT as a broad programme
is that we have some evidence that it is more effective when it
is supported by other smoking cessation services whether it is
counselling, support, advice, alternative support services as
well. Also we know that motivation matters for quitting as well,
so it is not simply about providing people with nicotine replacement
therapy in the same way as you provide people with a drug to cure
an illness where you can assess it in a particular way. With NRT
because the motivation of the smoker matters as well as it is
more complex in terms of evaluation. What we are doing with NRT
is unprecedented. What we are doing is setting up effectively
a huge trial of NRT across the country which is why we are monitoring
it and doing the evaluation in order to see how effective it is
on a population basis and not simply for an individual who wants
to quit.
Dr Stoate: You have already mentioned that there
is going to be one week free. Do you have any evidence at the
moment, for example, that one week is better than no weeks and
more weeks might be better than one week? Is there any evidence
so far to suggest that one week is effective as compared to, for
example, two weeks or four weeks?
Chairman
1274. Can you just clarify, is it one week free
for just those on income support?
(Yvette Cooper) People who are entitled to free prescriptions.
One week free for people who are entitled to free prescriptions.
1275. So it is a very limited area of provision
and within a HAZ of course.
(Yvette Cooper) HAZ up until April; after April nationwide.
Dr Stoate
1276. It is important to get that clear. To
get back to the question, can you give any evidence that giving
one week is effective? Have you any evidence, for example, that
if it were increased to two weeks it would be more effective?
(Yvette Cooper) I think the average amount of time
people take NRT for is about eight weeks. It is not simply that
we are saying one week will work. That is not the argument at
all. The argument is simply what can you do to help people give
up as a whole? If you look at one week of free NRT where people,
especially on low income, might not be able to afford to buy NRT
upfront before they quit HAZ, so before they stop buying cigarettes,
that is exactly where you need to target the help first. So once
people stop smoking and are actually not buying cigarettes each
week, obviously they make big savings from not buying cigarettes
and roughly the price of buying a week's NRT is comparable to
a week buying cigarettes. That is why it is important to put the
NRT for that first week to get people going before they get the
savings back not simply for those weeks while they are taking
NRT but, if they are successful, savings throughout their lives
from not smoking as well.
(Mr Milburn) You should not advertise but you can
go to Boots the Chemist in Victoria Street and buy today NRT for
£15.50 or thereabouts. Somebody smoking 20 cigarettes a day
will be spending on average £25 to £30. The reason we
supply it for the first week to people who are entitled to free
prescriptions is that everybody knows that if you are going to
give up smoking the first week is probably the toughest week that
you will go through. That is why it is important to get people
kick started. It is worth winning this argument with people, that
not only is it good for people's health if they give up smoking
and cigarettes; it is good for their pockets too. If you give
up over a year and you were smoking 20 cigarettes a day, you are
£1,500 better off. So these are expensive items.
1277. That is a very important argument.
(Mr Milburn) It is a very important argument particularly
for people on lower incomes about the apparent up-front cost of
NRT. There is an apparent up-front cost but it produces major
benefits providing it is effective. However, nobody should get
carried away with the idea that NRT is foolproof because it is
not.
The evidence seems to suggest that you need
to be properly motivated. It is better, as Yvette says, where
NRT treatment is undertaken within a structured programme and
even within a structured programme the evidence suggests that
it will benefit a maximum of around 25 per cent of people who
give up smoking.
1278. That is really important because, as you
quite rightly point out, Secretary of State, it is part of a smoking
cessation programme. If you are going to make it available across
the whole country for people on free prescriptions what other
resources can you put into other areas, whether it is smoking
cessation clinics or support for GPs or nurses or whatever, to
make sure the whole programme works?
(Mr Milburn) That is precisely what you have to do.
Back to the Chairman's earlier question, what has not worked in
the past. What has not worked in the past is that we never had
in this country a comprehensive dealing with smoking programme
and that is what we have now got. It is not just the supplying
of the patches or the NRT treatment, it is also the infrastructure
that goes with that. Particularly for people who are heavily dependent
on cigarettes, who have smoked for many years and have a heavy
habit, or a heavy addiction is probably a better way of putting
it, then the evidence seems to suggest that counselling, face
to face advice, sometimes done not just one to one but with others
is one of the best ways forward. That is precisely the sort of
service that we are seeking to roll out across the Health Action
Zones, first of all, but as from 1st April we want to provide
smoking cessation treatments more generally across the National
Health Service and indeed, as you have probably seen in the National
Priorities Guidance that we issued to the local NHS back in December,
I think it was, one of the key priorities is smoking cessation.
1279. You are going to ask health authorities
to introduce this as part of their programme from April in conjunction
with NRT?
(Mr Milburn) That is basically what we want to do.
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