WEDNESDAY 9 FEBRUARY 2000
_________
Members present:
Mr David Hinchliffe, in the Chair
Mr David Amess
John Austin
Dr Peter Brand
Mr Simon Burns
Mrs Eileen Gordon
Mr John Gunnell
Mr Stephen Hesford
Dr Howard Stoate
Audrey Wise
_________
RT HON ALAN MILBURN, a Member of the House, Secretary of State for
Health, and YVETTE COOPER, a Member of the House, Parliamentary
Under-Secretary of State, Minister for Public Health, Department of
Health, examined.
Chairman
1241. Colleagues, may I welcome you to this session of the
Committee and particularly welcome the witnesses, Secretary of State and
Minister. 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 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
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 œ100 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 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 to be taken 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 œ10 million for potential
compensation, but which could be in the region of œ10 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 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 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) I think it was in 1971 - or 1970.
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.
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 a 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 requiring 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.
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
principle 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 professor one
day a week and on Professor Frank Fairweather and two days a week from another
scientific advisor 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 HSA 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 is 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 œ50 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 HAS areas (œ10 million). From 1 April we will
roll more money out into HASs 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 HAS of
course.
(Yvette Cooper) HAS 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 smoking, 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 œ15.50 or thereabouts.
Somebody smoking 20 cigarettes a day will be spending on average œ25 to œ30.
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 œ1,500 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.
1280. A final question: have you any assessment of what the costs
are going to be of what you are currently proposing, that is the one week free
for people on free prescriptions, and what it would cost were you to make it
available to everybody for a week on the NHS? Do you have any figures?
(Mr Milburn) The rough figure is our smoking cessation budget, as I
remember it, is œ60 million over the course of these three years. An element
of that is for free NRT and I think it is about œ12 to œ15 million of free
NRT. Our estimates suggest that if we are to make NRT available for everybody
then we could be talking - purely for the NRT, never mind the support services
that would need to go with it - of somewhere between œ80 and 100 million
before you start providing the comprehensive support services that you need
to go with it to make sure that it is properly effective.
Chairman
1281. That is for how long?
(Mr Milburn) A year.
Dr Stoate
1282. Do you envisage that being part of the programme in the
future?
(Mr Milburn) I think the important thing to remember is that as we
understand it, and the information that we have from the drugs companies who
manufacture NRT, there is no health care system in the world - we have been
informed - which provides NRT for free at the moment. We are well ahead of
the game here. We are world leaders. I am proud of that. I think it is the
right thing to do but there is always a danger in being world leaders and that
is you have to make sure that actually what you are doing is based on very
firm evidence. I want to assess very carefully how effective this is being and
I think that is the right thing to do.
Chairman
1283. The point you made about costs for a year for free NRT, can
you be specific about whether that is continuing the one week free or is that
over a period of a year free?
(Mr Milburn) No, no. I think the figures that we have suggest that if
we make NRT widely available for everybody on prescription ---
1284. Without a limit of a week?
(Mr Milburn) Without the limit.
(Yvette Cooper) At full cost.
(Mr Milburn) For a full cost which is on average, as Yvette rightly
says, around eight weeks.
Dr Stoate
1285. Three months actually.
(Mr Milburn) Is it three months. We would be talking about œ80 to œ100
million. Frankly, I would not want to be held to that particularly.
(Yvette Cooper) It depends on all kinds of assumptions about how many
people take it up.
Chairman
1286. If you want to come back in writing on that we would be very
happy. It is obviously important.
(Mr Milburn) We can give you some assumptions about that.
(Yvette Cooper) We cannot predict confidently on this.
(Mr Milburn) We cannot assume behavioral changes, for example.
Audrey Wise
1287. Ms Cooper has mentioned the monitoring of the smoking
cessation schemes in the Health Action Zones. You, Secretary of State, have
talked about solid evidence.
(Mr Milburn) Yes.
1288. Can you tell me, will you be monitoring what is done in the
rest of the country, the effectiveness of what is done in the rest of the
country, from April? Will you be collecting information? Have you told health
authorities they have a duty to supply you with information, and, if so, what
kind? In a year's time, if we start asking parliamentary questions will we
be told "This information is not collected centrally" or will you be able to
tell us how things are going?
(Yvette Cooper) The tightest monitoring, obviously, is about what is
happening in the Health Action Zones, partly because they are ahead of the
game and partly because we are putting additional resources in. As part of
the Health Improvement Programmes in general we are asking for a lot more, for
local areas themselves to monitor their own progress and to work out what is
effective. Also, as well as the Health Development Agency at a national
level, we are putting in place public health observatories at a local level
to monitor local public health problems. The answer is we are extending the
monitoring and evaluating in general. I think the best figures in terms of
what is working that we will be able to provide in a year's time will be based
on the Health Action Zones.
1289. But you will be collecting the information from places like
Preston and other places?
(Mr Milburn) To be honest, I do not know in what form we will collect
the information so perhaps I can come back to you. I think it is important,
as you rightly say, Mrs Wise, that we are able to assess the effectiveness of
the programme right across the country in HAZ and non HAZ areas. Perhaps I
can come back to you. I do not want you to be in a position where your
questions are not answered.
1290. I appreciate the emphasis on evidence but from where you are
now do either of you have any assumptions about what at the moment, if
pressed, you would say were the likely most useful tools? There is a whole
range of things: price, manipulation, etc., etc.. Not holding you to this if
evidence contradicts later but as you are now, what do you think each of you
would say are a couple of most important things?
(Mr Milburn) In terms of reducing smoking?
1291. Yes?
(Mr Milburn) Price. There is no doubt that price does have an effect
on consumption, as you are aware. We have been putting up the price of
cigarettes. In some quarters we have been criticised for doing so.
1292. We have noticed.
(Mr Milburn) There is a relationship between price and consumption, so
that is true. Also, I think that the more informed the public is and the more
information that smokers and potential smokers have about the hazards of
cigarettes, and indeed about the ingredients of cigarettes, the better we will
be in a position to achieve what we and the overwhelming majority of smokers
want and that is for smokers to stop. 70 per cent of smokers say that they
want to give up. Why do they not give up? They do not give up because it is
difficult to do so because cigarettes are addictive, tobacco is addictive,
nicotine is addictive. We have to have the appropriate programmes in place
to help and support people.
Mr Burns
1293. Can I just go back to the information that you gave
concerning NRT and the costs because, as I have understood it, you said if you
went to Boots, for example, in Victoria, you could get a course or supply for
œ15 and the NHS will supply for Income Support recipients one week's course.
I do not know if you have ever given up smoking or not in your life but one
week certainly is not enough time to give up smoking. It is a question of
taste but certainly some people have shown that patches are the most effective
way, as long as you do not peel them off to have a cigarette. The point is
that no way if you are addicted to cigarettes, and I agree with your analysis
that it is an addiction and that makes it all the more difficult to kick that
addiction, can you do it in a week. So what you are going to have if you are
not careful is that people will benefit for a week, and that will have helped
them on their way, but given it is an addiction I suspect if you monitor the
results thereafter there will be a large proportion of people who after the
week then become personally financially responsible for buying the patches or
the other form of therapy and they will not be able to on the level of Income
Support that they receive each week because of the other financial commitments
they have on either themselves or their household, if they are married or if
they have children. Surely it will be counter-productive, will it not, given
that you are making a step forward to help people, to limit it only to one
week because the financial cost of the course they are after will almost
certainly have a disproportionately high number of people who will then drop
out and make the whole thing a waste of money?
(Mr Milburn) Remember, nicotine replacement therapy only works if you
give up the cigarettes.
1294. Absolutely.
(Mr Milburn) It only works if you give up the cigarettes. The way that
the therapy works, as you know, is it reduces over time physically your
craving for the nicotine. Okay.
Mr Burns: Hang on. I have used it, you I suspect have not.
Chairman
1295. We have an expert here.
(Mr Milburn) Let me just finish the point and you can tell me why I am
wrong. You start out with a fairly heavy dosage and gradually you are weaned
off to a level your body can tolerate. The theory of this is basically it
will only work if you start giving up the cigarettes, it is pointless taking
it if you are still smoking, it has no effect. The idea behind this is pretty
straight forward, that as you give up the smoking as a consequence of taking
the nicotine replacement therapy, you then have whatever it is in terms of
personal disposable income that otherwise you would have been using on
cigarettes. I do not doubt for a moment in the short term physically it is
difficult, it is hard to give up, but financially there is a cost to bear in
the short term. In the long term the health benefits and financial benefits,
it seems to me, are overwhelming. Now why am I wrong?
Mr Burns
1296. In one way you may not be. The logic of your argument is 100
per cent accurate and right.
(Mr Milburn) Right.
1297. But in reality one week even with the heaviest level of patch
for an addicted smoker smoking, say, a packet of cigarettes a day or more, is
just not long enough. By the end of that week you will still be on the highest
level concentration of nicotine. Then, if they are on Income Support, after
that week, to then have to finance it themselves on the limited income they
are getting, people will peel off the scheme like nine pins because they will
not be able to afford it and the craving for a cigarette will still be so
great that they need more patches. The only point I am making is if you want
to get really good value for money for the NHS and for this scheme to work
effectively for people who do not have the money to continue a course in the
short term, but the short term cannot be governed in weeks per se because it
depends on the level of addiction of the individual and their willpower, then
I just think one week is too short and you will cost the health service more
overall because too many people will drop out.
(Mr Milburn) You are obviously speaking as a disenchanted consumer. Did
it not work for you?
1298. No. I am speaking from my own personal experience but the
fact is I am not on Income Support and I can take the patch off and have a
cigarette if I want, which is stupid.
(Yvette Cooper) It is worth saying we are certainly not saying one
week's NRT is the answer. NRT, for lots of people, will be something that
they will want to take for a long period of time for it to make a difference.
Plus, to go back to what you were saying before, what happens at the end of
that first week, actually that is why the smoking cessation service is so
important as well, to have that additional support, another week later to have
somebody to talk to a week later as part of the cessation support as well. The
financial arguments are that after that week of not smoking you will not have
been buying cigarettes for a week. The health inequalities issue is something
that we feel very strongly about. We know that people who are on low incomes
are both more likely to start smoking in the first place and also less likely
to give up. This is an area that we will keep evaluating and monitoring. We
feel very strongly about the inequalities aspect. I do not want you to feel
that we are misunderstanding the purpose of NRT because we are not at all.
1299. No, I do not feel that, I just think that you have put
forward a very good scheme, from the very best of intentions, but possibly
because you do not smoke or never have smoked you do not understand the hill
that has to be climbed. The trouble is we have had people telling us in this
Committee and elsewhere that nicotine addiction is greater to overcome than
heroin or cocaine. Now I am not qualified to judge on that but, if that is
true, the National Health Service also provides extremely good help for heroin
and other drug abusers who are addicted. It may be patchy or not, I am not
getting into that argument. If you are provided with a course to wean you off
those hard drugs it is a very good course, but it is not one week. A health
authority will send patients to specialist centres to try and get them off,
they could be there six weeks, eight weeks, 12 weeks, because you recognise
that in those areas they have got to be there until they have gone through
cold turkey, and everything else, and got off their addiction. It just seems
odd if you accept that nicotine addiction is much greater and much more
difficult to get off, that it is just simply a week of paid help for those
people who are the most vulnerable people to carry it on because of the level
of their Income Support. This is simply a plea to ask you to make it really
successful and not to possibly ruin the efforts you are making by only
restricting it to a week.
(Mr Milburn) I think these are all reasonable points. As Yvette said
earlier, what the Committee will recognise is that no-one in the world is
doing this. We are way, way, way ahead of anywhere else in the world. If you
like, we are engaged in an enormous public trial. That is what is happening,
affecting tens of thousands, and maybe beyond that, of people who are smoking
and want to give up. Yes, we will continue to assess its effectiveness,
absolutely, that is why we have precisely these tight monitoring arrangements
in place. What I do say from the evidence that we already know about in the
published literature, that the effectiveness of NRT is immeasurably increased
if not only people are getting access to NRT but they are getting access to
NRT services as well, certainly the evidence that was published by the British
Thoracic Society suggests that in terms of an increase in the percentage of
smokers stopping for six months or more, if you get very brief advice from
your clinician, from your GP and you get NRT then there is a two per cent
increase in the number of people giving up. If you get intensive support in
the way that we are providing in the Health Action Zones and once they are all
out across the whole country from April of this year that dramatically
increases to eight per cent, so it quadruples. Yes, it is right to ask these
questions about NRT, of course. We will continue to keep that under very close
supervision. We will continue to monitor but the provision of NRT is not just
the be all and end all, it is very important that there are a whole set of
services that are available to help people through what is pretty difficult.
It is not easy.
Chairman: I hate to break up this counselling session with Mr Burns.
John Gunnell has a question.
Mr Gunnell
1300. In my own local primary care unit, which is in South Leeds,
which encompasses an HAZ, one of the things they have found works most
successfully, or is working most successfully, is where a person has a
counsellor to whom they can constantly refer.
(Mr Milburn) Yes.
1301. They have tried giving the service of a counsellor and they
do not limit the time during which a person can be contacted. They have found
setting up a positive relationship like that, in which a person can keep
coming with questions and in which a counsellor can keep in touch, is
effective over a period and they say it is very helpful. It is backed up at
the moment by the television advertising campaign which you have got "Do not
give up giving up". They say that has strengthened their people. It is the
continuing availability of the person to go to for the counselling.
(Mr Milburn) I do think that is right. One of the things that people
find is that they try very hard to give up and then, as in Mr Burns' case,
they relapse and when they relapse they have to feel there is some help for
them to carry on. That is why I think some of these specialist services that
we are beginning to provide will produce their own dividends in time. We will
need to assess very carefully how well they are working. We will try to supply
what information we can to the Committee if that is helpful. We will try to
get some early evidence if that is helpful.
Audrey Wise
1302. Would you consider making some of the experiments a two week
experiment, say, because it did strike me, Secretary of State, when you had
your exchanges with Mr Burns that you were very much relying on logic and Mr
Burns said your logic is okay but if people are operating on logic they would
not be smoking anyway, so that is the drawback. Since financial gain can be
part of the motivation, it is expecting a considerable amount of very close
logical thinking that right from the first day the saving is going to be put
for more patches. I doubt if that would happen. I think somebody might go
and blow it on something. At one time my generation would have said, "Go and
buy a new hat", but people do not wear hats now, but the equivalent. Would
you consider perhaps asking the people who are engaged in the work on the
ground their opinion after a certain lapse of time? We met on Tyneside very
good people doing smoking cessation work and I would very much like to feel
that you were asking their opinions as to whether two weeks would be more cost
effective than one week, because that is what Simon Burns was really on about.
I am not asking you for a commitment to do it but will you just think this
over with that possibility in mind?
(Mr Milburn) We do and certainly will continue to talk to the people
who provide the services on the ground. It is very important since they have
the face-to-face contact and are having to provide these services, sometimes
in difficult situations, that we get an assessment back from them about what
is working and what is not. So there is no reason why we cannot ask that
question.
Mr Burns
1303. Can I move on to stopping children smoking? There is a lot
of anecdotal evidence that children up to about the age of 10 or 11, if they
have any views on smoking, seem to be violently anti; whether they learn that
from school or whatever I do not know. But the statistics available seem to
suggest that over the last ten, twelve years, in the age group 11-15 the
number of children smoking or who have smoked has risen from about 8 per cent
to 13 per cent. Has your Department commissioned any work on why that might
be and why children start smoking, the reasons for it and have they weighted
each factor to see which is more important than another in the whole thing?
(Mr Milburn) No, we have not, but I think we probably need to do that.
That is important. The figures are pretty stark. As I remember, in 1988
about one in five 15 year old girls was smoking, the figure in 1998 is that
one in three 15 year old girls is smoking. That is a very, very big increase.
There has been work done. From the Teenage Smoking Survey which was
undertaken, I think, in 1988 we do have some evidence about the reasons the
children themselves cite for taking up smoking. You will be aware of that
from the information which has been provided but, if not, I can tell you. 75
per cent of the teenagers surveyed in 1988 said they wanted to see what it was
like, 9 per cent said they wanted to fit in with friends, 8 per cent said that
friends suggested trying it, 3 per cent wanted to look more grown up and 2 per
cent said they wanted to be seen as a smoker. There was a very important
study in 1990 about the factors which would put at risk an individual in terms
of becoming a smoker, and the factors which Eileen Gordon listed in the study,
Why Children Start Smoking, were as follows: being a girl, because girls smoke
more than boys; having brothers or sisters who smoke; having parents who
smoke; living with a lone parent; having relatively less negative views about
smoking; not intending to stay on in full-time education after 16. That is
pretty old data, in all frankness, and I do think it is something we will need
to consider within the Department, and what we will probably be doing is
commissioning new research about why children are taking up smoking, and then
trying to unpick the reasons. You will know we have targeted a good part of
this œ50 million advertising campaign particularly at younger people, in large
part because, frankly, we believe the cigarette companies target at least part
of their advertising at young people, or it certainly seems to have an effect
on young people. The tobacco companies are putting millions and millions of
pounds into tobacco advertising, I am pleased to say for the first time the
Government is going to put millions and millions of pounds too into
advertising so that people learn perhaps it is not a good idea to start
smoking.
1304. There are lots of figures and we have both used some in the
last five minutes about the percentage of 11 to 15 year olds who may be
smoking. You, Secretary of State, used figures on the proportion of 15 year
old girls who smoke, but do you actually have precise figures on what is the
average age that people start smoking in this country; up-dated ones?
(Mr Milburn) I do not. What we do know is that the figures which are
available suggest that of 11 year olds approximately 1 per cent are smoking.
When I say "smoking", as I remember the methodology, it says that a regular
smoker should be classified as a person who has at least one cigarette per
week. By the time they get to 15, as I remember the figures, it is 19 per
cent of boys and 29 per cent of girls. So something happens between 11 and
15 based on those figures. Whether it is 12, 13 or 14, I do not know, but we
need to unpick some of that in order that we can best target our
interventions.
1305. Can I move on to the whole question of where children obtain
cigarettes from? I do not want to go into the whole question of retail
outlets, because my colleague, Mrs Gordon, will be raising that in a minute,
but perhaps I can go to the other areas. Has your Department done research
or got research on where children obtain cigarettes from? Also, one of the
loopholes in any law on any minimum age for buying cigarettes is the question
of vending machines because, of course, if they are in a public place then no
one can control who uses them unless you have somebody standing there the
whole time or enhanced technology to stop children from using them. Would you
consider banning vending machines to cut off that source of supply or making
the arrangements for the placement of vending machines different from the
almost carte blanche system we have at the moment?
(Mr Milburn) The figures suggest that 16 per cent of those 11 and 12
year olds I was talking about who smoke say they obtain cigarettes from these
machines compared to 29 per cent of 15 year olds. As far as the siting of
these machines is concerned, at the time we published the White Paper the
Department entered into discussions with the operating companies who supply
these vending machines, and we got an agreement from them that in future where
these machines were sited would take full account of the fact that too many
under-aged kids were getting their cigarettes from these machines and that
there should be proper monitoring, they should be sited within the vision of
the staff within the pub or wherever it was. It is also important to say that
there are very strong legal powers right now on the statute book which we
would like to see invoked more often, because it is clear that a lot of kids
get their cigarettes under age, illegally, from vending machines. It is also
the case that the law of the land in the Children and Young Persons Protection
of Tobacco Act, 1991, says that magistrates can order the removal of a machine
if it can be shown that it is being used by even one person under the age of
16. So, as with so many other things in this whole arena, people often call
for a toughening of the law or changes in the legal age, but the real issue
here is about enforcement and ensuring better enforcement. As you know, we
have entered into lengthy discussions with both the Local Government
Association and the organisation representing the trading standards officers
to ensure some of the things which should be being done under the law are
actually being done precisely in order to avoid this problem of young people
illegally obtaining access to cigarettes.
1306. Certainly research we have been supplied with suggests that
the largest proportion of packets of ten cigarettes are bought by younger
smokers. If your Department were to commission evidence or were to accept the
authenticity of existing evidence that that was the case, would you consider
in any shape or form banning the production of packets of ten cigarettes? I
understand that long before I was born you could buy individual cigarettes or
much smaller packets.
(Mr Milburn) That was stopped. You certainly could buy ones and twos,
any number.
Chairman: There is another division. We will have to adjourn.
The Committee suspended from 5.25 pm to 5.32 pm for a division in the House
Chairman: Colleagues, welcome back. Secretary of State, I am not sure
whether you had finished that last answer. You have probably forgotten what
the last question was.
Mr Burns
1307. It was about packets of ten cigarettes ---
(Mr Milburn) Yes, you were saying that you used to be able to get them
in ones and twos.
1308. If there was evidence to suggest that the evidence that is
available at the moment is accurate, that a large proportion of the people who
buy packets of ten are children or young people, would you consider banning
them or seeking to have them stopped from being produced in that format?
(Mr Milburn) I think we would need to look at that. I think we would
also need to look at whether or not forcing people to buy bigger packets of
more cigarettes would not have some perverse consequences. If we were forcing
people to buy 20 rather than tens that would seem to defeat the objective of
getting people to smoke less. Let us have a look at the evidence. The
important thing about this is that it is in statute so it would not require
primary legislation were we to make a change of that sort.
Audrey Wise
1309. We have had evidence that it has been the common practice of
licensing justices when giving permission for children's rooms in pubs to make
it a condition that these have to be smoke free. That seems very sensible.
It has been tested in court a number of times because sometimes licensees have
appealed and in all but one case the magistrates have won in the Crown Court.
We have had evidence that the Magistrates' Association has issued guidance to
magistrates that they should stop doing this, which seems quite extraordinary.
Are you aware of this as a controversial area? Would you have an opinion on
it? If you are not aware of it, will you look into it and preferably exert
whatever influence you have on the Magistrates' Association for them to stop
issuing such guidance?
(Mr Milburn) I am not aware of that and I am slightly surprised by it.
1310. By the way, the evidence we have had is absolutely
incontrovertible.
(Mr Milburn) I would be happy to look at that if the Chairman could
make that available to us. I am surprised at that for two reasons. We have
been in discussions with the so-called hospitality sector, the pubs, the
clubs, the restaurants and so on about how we can ensure that people who want
it can take advantage of a smoke free environment and the people who do not
want it can take advantage of a smoking environment. I would have thought it
is absolutely in the interests of the industry to provide precisely that sort
of choice to people and increasingly that is what people are demanding. It
seems to me to be a sensible thing to do. We have some very good outline
agreements with the industry in the Public Places Charter that we have been
negotiating which suggests ways that it can be beneficial either to segregate
smokers from non-smokers or else to provide suitably ventilated areas so that
people are not having to consume somebody else's smoke. That makes sense from
a public health point of view and probably from the sector's point of view.
They are going to attract customers if people feel that they are in an
environment that they choose to be in rather than one that they are forced to
be in. I will have a look at what the Magistrates' Association have had to
say about that.
Chairman
1311. Secretary of State, you made the point in relation to young
people and smoking that something happens between 11 and 15 that we are not
entirely clear about. Obviously one assumes what happens is that puberty
occurs. One of the areas that we have looked at in relation to concern over
girls and young women smoking is the extent to which this is determined by
their concern over their weight. Minister, do you want to respond on that
point and say whether you have looked at that? Clearly you have never had a
problem yourself, but some of us have! It seems to be an issue that genuinely
affects the choices of girls. We have had debates within the Committee and
I know Dr Stoate takes a different view from other medical colleagues as to
whether that is a factor or not. If it is a factor, and it certainly seems
to be, what strategies have you developed or are you developing to address
particularly girls in those circumstances?
(Yvette Cooper) It is certainly a theory and it sounds very plausible.
We have not got clear evidence. We were talking earlier about the fact that
what we need is more up-to-date research on what is happening now compared to
ten years ago because clearly cultural attitudes among teenagers move very
fast and so we do need up-to-date attitudes and I think that is one of the
things that we have to make sure is part of the research that we do into why
teenagers are smoking now. If it turns out to be an important factor then it
is something that we will need to pick up as part of the tobacco education
campaign. One of the challenges we have as part of the tobacco campaign in
terms of teenagers is finding evidence on what works for teenagers. We do
have evidence about different kinds of strategies and different kinds of
things that work in terms of helping adults give up, but there is not any
strong evidence about particular easy things that you can do that will just
help prevent teenagers starting in the first place. We need to make sure the
education campaign that we launch is as closely linked as possible to what we
know about why they are starting in the first place and if that is something
that comes out of the research we will take that on board as part of the
campaign.
1312. Have you looked at turning this whole thing the other way
around, that is if young women are concerned about their appearance perhaps
one might have a strategy that looks at the detrimental effects on appearance
in a number of ways arising from smoking. We have had evidence from a number
of sources about the effects on skin, breath, voice, a whole range of areas.
Is that something that you are looking into with a view to a positive strategy
of pressing young women because clearly that is an area that is very very
worrying at the present time?
(Yvette Cooper) That is certainly one of the kinds of strategies that
has been used by the HEA as part of their anti-smoking campaigns. I do not
know if you have seen the one that has a jar of skin cream and then a
cigarette being stubbed out in the jar of skin cream, which is exactly the
right kind of advert for women's magazines, picking up on exactly that theme.
It is certainly something we can consider as part of drawing up an effective
campaign.
Mrs Gordon
1313. We know if children are brought up in a family that smokes
they are more likely to smoke themselves. I think this would indicate that
any education programme should get at the adults around the children as well.
I was thinking especially of the role models that children have and partly the
super models and the pop stars. Has there been any move to involve them in
a health education campaign?
(Yvette Cooper) There was a recently completed programme, a Respect
programme, which was an education programme for teenagers, which does seem to
have been well-received by young people. It happened at the same time as a
drop in teenage smoking prevalence but what we do not know is whether there
was a causal link. Part of that approach was to involve role models,
especially sport and soap celebrities, to make it not about Government or
politicians talking about smoking but about role models. It also included
sponsors - Sega and Puma - and that is exactly the kind of thing we need to
evaluate and possibly build on the success of that. These are things which
have been tried and certain elements we need to look at building into the next
stage of the campaign in the future as well.
Mrs Gordon: Could I go back to the issue of retail sales? The
research indicates that children's main source of supply of tobacco products
is the small retail outlets - the shop on the corner, the local newsagents -
and we have received evidence of confused messages between health authorities
and magistrates on the priority to be given to tackling such illegal sales.
We were told by a trading standards officer in Newcastle that magistrates were
often reluctant to sentence retailers who sell cigarettes to children with the
toughest penalties available, and it was said that the Magistrates Association
had issued guidance to this effect. We are trying to get evidence of that for
the Committee from the Magistrates Association. I wonder if you could comment
on that? What are you doing to ensure there is more effective policing of
this area? What weight do you attach to the various industry-sponsored proof-
of-age card schemes?
Chairman
1314. I do not think Eileen was in the room when we touched on the
Magistrates Association issue. We are waiting for some information from them
on this general area.
(Mr Milburn) It is important to remind the Committee and various
enforcement agencies that there are quite stringent powers on the statute book
for repeated sales and indeed sales to children under 16 years of cigarettes.
The maximum fine is œ2,500. That is the fine on the statute book now. Sadly,
the average fine is about a tenth of that at œ250. So it is not as if the
power is not on the statute book, the problem is one of enforcement, and I do
think this is an area which the Committee might want to bear in mind and we
will certainly bear in mind too in our discussions with the Magistrates
Association following receipt of the information. So there are things which
can be done here. We also know that although local authorities are under an
obligation to carry out regular enforcement procedures as far as sales of
cigarettes are concerned, some do not. We know, for example, one of the
things which best works in detecting whether or not retailers are selling
cigarettes to under-age kids is by using children as tests - to send children
out on a properly defined basis, so to speak. But we know, from the evidence
we have, that just over half of the local authorities do that, even though it
is very effective in detecting which particular retailers are selling
cigarettes to under 16 year olds when they should not. It is precisely that
which we have been discussing with the Trading Standards Officers Association
and the Local Government Association to make sure the best of practice which
can detect all these problems and deal with them actually happens.
Mrs Gordon
1315. The half who are not doing this are not meeting their
statutory obligations, are they?
(Mr Milburn) Indeed.
1316. I have been in touch with my trading standards officers in
Havering and one of the things they mentioned to me was the variability of
ages for regulations - the Licensing Act is 18, for tobacco sales it is 16.
I wonder if you had thought about whether it would be a good idea to make a
standard age restriction?
(Mr Milburn) I heard with interest the fact that one of the companies
concerned had suggested that here, which frankly makes me rather suspicious.
I might be slightly old-fashioned about these sort of things. Sure, it is
worth considering, but the history of this, both in this country and elsewhere
in the world, is littered with getting powers on the statute book and then
them not being enforced. The issue from my point of view is about one of
enforcement and making sure that the range of powers which are already there
are properly enacted and dealt with. There is some way to go there. I do
believe there is a real willingness on the part of trading standards officers,
local authorities and others to really get to grips with this and start to
make a real difference out there. I do not under-estimate for a moment,
incidentally, how difficult it must be as a shop-keeper confronted with a
child who comes in and having to determine whether or not they are 15 or 16
in determining whether or not to sell cigarettes to them. I do think that the
proof of age card issue is one we need to look at very, very carefully. I do
think it would be advantageous all-round if the various proof of age card
schemes were perhaps integrated. There is the Portman Group scheme, there is
an ID scheme in Wales, there are other schemes, and I think it might be more
sensible from everybody's point of view and the retailers' point of view too
to have a single proof of age card scheme across the piece.
1317. I have had information about the Citizen Card scheme and
other schemes. They are all quite good but it is very, very patchy and
obviously there needs to be a national scheme so there is no argument when a
young person goes into a newsagent and asks for cigarettes and they are asked
for a proof of age card. If that was statutory, do you think it would make
it easier for enforcement?
(Mr Milburn) I am not sure there are any great advantages in whether
it is statutory or not, but I do think that what would be helpful is to co-
ordinate the number of proof of age card schemes around. That must be pretty
confusing and we would be looking to see what we can do to better integrate
these various schemes, so that perhaps in the future we can have one rather
than several competing against one another and in the process confusing
everybody.
1318. Would you talk to the Department of Education about making
these available through schools, for instance?
(Mr Milburn) Yes. The one you mentioned ---
1319. The Citizen Card.
(Mr Milburn) --- has been made available through schools. There are
about 3,000 schools registered with it. I cannot say that the up-take has
been brilliant and it is not just about making this available, it is about
making sure actively the teachers and the schools and the other organisations
promote it if it is going to work.
John Austin
1320. Cigarettes are neither food nor pharmaceutical products and
therefore they are not subject to the same sort of stringent safety
regulations, labelling, content information, et cetera. Nicotine replacement
therapy, because it is a pharmaceutical product, goes through a whole series
of stringent tests and regulations, whereas a cigarette - and the best
description we have had of it is a nicotine delivery vehicle; a very effective
one - does not. Does it not seem paradoxical that nicotine replacement
therapy, which is aimed to wean people off cigarettes, is highly regulated,
rightly so, but the product which, when used according to its manufacturers
instructions, kills half the people who use it, is virtually free of
regulation? It has been suggested to us that there may be a case for a
Nicotine Regulation Authority, either free-standing or part of some other
agency. How do you feel about that?
(Mr Milburn) I think the first point you make is an extremely telling
one. On the face of it, there is an enormous anomaly between nicotine
replacement therapy being registered as a medicine and having to pass all the
regulatory hurdles it has to go through in order to be made available to
people, in this case over the counter rather than through prescription on the
NHS, and cigarettes which, as you say, deliver nicotine pretty effectively and
in the process transform lots of people into people who need to have their
craving satisfied on a regular basis. That comes about as a consequence of
history. We have had 500 years of tobacco consumption in this country and
probably thousands of years of tobacco consumption across the world, so we are
where we are. I think what is undoubtedly necessary in my view are two
things; (1) better disclosure and (2) better regulation than we have at the
moment. I do not think there is any doubt about that. I think the issue for
debate is where best that should happen, whether it should be at the UK level
or at a European Union level. Let me give you an example of what I mean. As
you are probably aware, the previous Government in March 1997 entered into a
voluntary agreement with the tobacco industry about the disclosure of the
additives that went into tobacco. I think you are aware that there are around
600 additives that are added to tobacco. Incidently, Chairman, I do not think
it is any coincidence that until very recently, it probably coincided with
that Committee's inquiry into tobacco and cigarette consumption, the
Department of Health was not given information about which particular
additives were added to which particular brand of cigarettes. Indeed, we are
still not given that information. We are now given information on a coded
brand basis. That information under the provisions drawn up by the previous
Government with the industry is made available to us on a confidential basis.
So we now know for the first time what sort of additives are in certain
products of cigarettes. We cannot identify which brand of cigarette it is.
I thought I would give you a flavour of some of the additives that are going
into an individual cigarette. I do not know which brand it is, I have no
idea. These are some of the additives in one brand: sucrose and sucrose
syrup, which as I understand it is a form of sugar, it sweetens it; propylene
glycol, I have no idea what that is; glyceryl; calcium carbonate; cocoa; cocoa
shells and extract; cocoa distillate and butter, which again on the face of
it is a sweetener; liquorice root fluid extract and powder, flavourings and
then a whole host of things that I cannot even pronounce including ammonium
hydroxide, diammonium hydrogen phosphate, citric acid, sorbic acid, sodium
phosphate, 4-hydroxy benzoic acid and other forms of acid. We have that
information and it is provided to the Department under the confidential
arrangements drawn up by the previous Government. I think there is a very
strong obligation now on the tobacco companies who have supplied that
information to us to do three things. First of all, to supply the Department
of Health with the details of the brands for each of these additives.
Secondly, to supply this Committee with the brands for each of these additives
and, thirdly, and most importantly of all, to inform consumers of the
additives that go into the cigarettes that they are consuming. That does not
seem to me to be unreasonable. People do have a right to decide whether or
not to smoke, they can choose to do that, but they also have a right to know
what it is that they are smoking. This points to the need for much greater
disclosure in my view, first of all and it points to the need for much greater
regulation in future than we have had hitherto. I know this is a long answer,
but I do think the issue of what is happening at a European level is very
important because, as you are aware, we are now negotiating for a brand new
European Union directive on this. I can tell the Committee that we had our
officials over in Brussels on Monday negotiating on this. I think we are
about to see a very very important first step in Europe which will aid
disclosure and which will aid regulation. The discussions that are taking
place in Europe are about the new directive that will cover a host of issues,
including in draft form reducing the maximum tar content of cigarettes,
introducing a maximum nicotine level in cigarettes, introducing a maximum
level of carbon monoxide in cigarettes, allowing Member States to require
further tests of substances in tobacco, extending the space devoted to health
warnings and these are the two key things, requiring tobacco manufacturers and
importers to inform Member States of all the non-tobacco ingredients by brand
together with relevant toxicological information demonstrating that the
ingredients are safe and, finally, banning the use of terms such as "low tar",
"mild", etcetera which have the effect of conveying the impression that a
particular tobacco product is less harmful than others. That is the draft
directive. I want to see it strengthened and I want to see it strengthened
in two or three regards. First of all, I want to know that the public across
the whole of Europe and particularly in this country know which additives are
added to their cigarettes and why they are added because we do not know that
right now. So my view is that there should be full public disclosure around
this directive when it is implemented. Secondly, I think it is tremendously
important that, although this would be a good first step in requiring
disclosure and better regulation, we are able to review the directive so that
as new scientific information comes on line about how we should regulate
tobacco products we are able to amend the regulation. There is an argument
about whether regulated low tar, for example, has any effect at all. The jury
is out on that and at the moment we do not have in my view a viable
alternative in terms of regulation, but we may have and therefore it is very
important that we are able to amend the regulation in due course. Thirdly,
I think there has to be at a European level an independent scientific
committee that is able to monitor and assess the information that is received
precisely in order to deal with some of these issues that are raised by these
products. Until very, very, very recently indeed nobody knew about any of
this except the tobacco companies themselves. We now know. I do not want to
be the only person in the country other than the tobacco companies that knows
about this.
Dr Stoate
1321. I would like to thank the Secretary of State for such a full
and extremely reassuring answer. You gave a list of additives, but I could
give you information about what they are doing in there from what we have been
told as a Committee. Many of those are in fact innocuous substances, they are
sugars, chocolate, flavourings and so on. On the face of it they only do
relatively harmless things to people, but we have had evidence on this
Committee that it is quite likely that what they do is they make the smoke
less harsh, more palatable, nicer tasting and so can make smoking more
acceptable to young people and make it easier to take up the habit. We have
our severe doubts and reservations about what these additives do. We are
concerned on two levels. One is the possible ill-effects of the additives
themselves and, secondly, what the additives are doing in terms of increasing
the palatability of smoking and therefore the likelihood that people will take
it up and sustain the habit. Is the Government prepared to go further and
actually take unilateral action on this? You are telling us that you have got
confidential information as the Department about what the additives are.
Would you be prepared to go further and demand that the brands be revealed
both to you and to this Committee?
(Mr Milburn) That is precisely what I want to do. Frankly, if the
tobacco companies have got this information, which they have because they have
supplied it to us, then they are under an obligation to supply it to the
smokers who consume their products. I would hope the Committee would join
with me in pressing the tobacco companies very, very hard indeed to reveal
this information so that people who smoke cigarettes know exactly what it is
that they are smoking, because it is not just the individual products in
isolation, what we also need to know is what is the effect of the additives
in combination. At the moment, as you are aware, under the existing
arrangements, additives can be added for any reasonable purpose at all
providing they are shown to be safe, and it is desirable but not compulsory
for the manufacturers to detail the purpose of use, and I simply do not think
that is good enough.
1322. Having given that very reassuring answer, Secretary of State,
are you now prepared to demand rather than express your wish that these
companies will break their own code? What powers do you have to demand the
breaking of this code? What powers do you have to ensure that that
information is given on the packets and in literature available to patients?
(Mr Milburn) I am advised of two things. One, this was an arrangement
which was entered into not by me ---
1323. I accept that.
(Mr Milburn) --- not by me, for information which was provided in
confidence.
1324. What are you prepared to do now?
(Mr Milburn) Secondly, I am advised there are doubts about the legal
powers I have in order to make this sort of information available. I will
clarify the legal powers I have. If I have the legal powers, it seems to me
to be absolutely appropriate that as Secretary of State for Health I make
available to the public what information I have been provided with and which
the tobacco companies hold. If you want me to use the word "demand", I am
quite happy to say "demand". Sure, I demand that, I do not know whether that
has any effect at all. I think, more importantly, actually the tobacco
companies are under an obligation. Let us make no bones about this, this
information is not buried away anywhere, the tobacco companies have it, they
have made it available to me. Some tobacco companies, as I understand it,
have gone even further. In one or two cases under the confidential agreement
- and I have not seen this - at least one company has now identified a brand
and the particular additives. Well, if one company can do that, they can all
do that, and if they have the information they should put it in the public
domain. I ask nothing less. I do not think that is an unreasonable request.
People who are consuming any product, whether it be food or whatever, have
that right - when I go into a supermarket, like you, I look at the product,
I see what is in it, and I make a decision - and I do not believe smokers
should have any fewer rights than that.
1325. That is very reassuring but it raises two questions. One is,
if you are prepared to go that far, are you prepared if necessary to seek
legislation to force this? If you are told you have not got the powers, are
you prepared to seek further legislative powers to do that? The second
question, about additives in food in supermarkets, many people complain that
although they have the list of ingredients, they have no idea what the
ingredients are and what they are doing in there and whether they are good or
bad. So are you prepared to go further and demand there should be far fuller
information on exactly what those additives do and what they are doing in
there?
(Mr Milburn) I think that is where the European Directive is so
important, because that is precisely what it does. I am not abdicating
responsibility in any way at all, I just believe it is more sensible in this
case for this to happen at European level rather than UK level, and that is
for a very simple legal reason. That is that additives which are added in one
member country automatically under reciprocal legal arrangements have to be
added in this country. So if the Spanish authorities, the German or Greek
authorities decide that additives are going to be added in their countries,
then they can be legally added in this country. So the answer, it seems to
me, is to get this sorted out at a European Union or European Commission
level. We have the opportunity to do this through this new draft directive.
There will be all sorts of toing and froing, as there always is in these
negotiations, but our position is absolutely unequivocal on this, we are going
to be arguing very, very hard indeed not only for the directive as it is
drafted but also for full public disclosure, and I think that must be the
right thing to do. The tobacco companies have an unhappy history of not
making information available to the public. That was the very first question
I was asked in here today. They have an opportunity to put that behind them
actually, they have an opportunity to put that right and to do the decent
thing and I believe they are under an obligation to do so.
Mr Hesford
1326. Can I take up, what I consider to be one of the more vital
areas we have discussed this afternoon, and I am grateful for what you have
said so far, and can I link this to packaging? It became absolutely clear
when we saw the five chief executives of the companies that one of the vital
things they see as part of their marketing exercise is the packaging. The
idea, if you do not mind me saying, that we should have to wait for European
legislation fills me with dread because you have to go through a process ---
(Mr Milburn) As a point of information on that, and I understand that
fear - I understand it all too well because I have to negotiate it - as I
understand it, the Presidency held by the Portuguese at the moment are very,
very keen on this directive happening. Obviously there has to be agreement
between the Council, the Ministers and the European Parliament, but I am
hopeful there would be such agreement. If all goes well, I am hopeful by May
this year we can have made progress on this directive. So I do not want the
Committee to feel that this has somehow been shunted into the long grass. I
want both a tough directive and I want an early directive too.
1327. Just on the directive and the effectiveness of the directive,
it is not just a question of getting it on the European statute book, you have
a lead time and if this does not come in until 2010 - which is possible, we
have seen it dozens and dozens of times with these things - it is hopeless.
So I have to say that does sound like an abdication of responsibility, not by
you personally, not by anyone in this room necessarily, but an abdication of
governmental responsibility in what we have identified as being a crucial
area. Could I ask ministers to consider that as a distinct possibility? I
cannot understand at all why we cannot legislate ourselves on the question of
packaging. There are three issues about packaging a cigarette ---
(Mr Milburn) You are now not talking about the additives?
1328. I will link in the additives in a second. There are three
parts to the question of packaging. One is the brand, and the advertisers are
very keen on getting their brand over to the public - the Marlborough Man and
that sort of thing. I think in certain states in Canada they have taken the
brand off and we could legislate to do that, stop them having the brand on the
packaging. That should not be on. You have already said, helpfully, that the
implied health gain in light and low tar should not be on the package because
it is misleading and it is wrong. That should come off. So that is what
should not be on. The health warning, which has been touched on, should be
bigger. These things are for regulation and legislation.
(Mr Milburn) At the moment actually they are subject to voluntary
agreement, it is not even regulation.
1329. My point is that it can be done through the process of
regulation and legislation and it would remove Marlborough Man from the packet
and then there is lots of space on the packet to put on the health warning.
There is one packet, I think in Canada again, where they have put damaged
lungs on the packet, which sounds gross in terms of our present cultural
thinking on cigarettes, but it is an important question if you are seriously
trying to address the issue of youngsters picking up a packet of cigarettes
and thinking it is cool to smoke. The tar yield is appearing on the packaging
and is almost a meaningless concept, nobody knows what it is, and more should
be done on that and health people have already touched on that point. The
last point is the ingredients in additives. I could list the top ten either
additives or ingredients, and you have helpfully listed some before, but why
can we not legislate to have those on the packets? I know it will not
necessarily tell people what they are, but if they knew that cyanide was part
of a cigarette, I think that might be a fairly useful piece of information;
if they knew that lead was part of a cigarette, that would also be helpful;
likewise, carbon monoxide. The Health Education Council furnished us with
that information which no doubt you have seen and have well in mind. Apart
from nicotine, tar and carbon monoxide to some extent, consumers have no idea
there is any other ingredient in a cigarette, good or bad. What I am saying
is that whilst I can understand a European-wide approach, I am not sure the
Committee would be able to see either any reason why we cannot do some of
this, if not all of this, today in our own country. You have already said
voluntary agreements do not work and clearly they do not work. One of the
criticisms of Government since the 1940s and 1950s is that there has been a
too pally-pally relationship with the tobacco companies which only served one
part of the partnership and that was the tobacco companies, it did not serve
the Government or those that they represent. Why can we not just crack on
with these issues?
(Yvette Cooper) In a Single Market there are restrictions on some of
the things that we can do, especially on things like packaging, labelling and
things like that. As I understand it, because there are European Directives
which cover issues like labelling and packaging already that constrains our
ability to do things independently. In all of these fields there are things
that we can do independently on health grounds, but a Single Market product
is clearly something which is sold right across Europe and we have a directive
on the table at the moment and we have huge scope for making progress on this
directive at the moment and so this is clearly the right place for us to be
having this argument right now. One of the things is expanding the size of
the warning, certainly. The point about the Canadian warnings is very
interesting and we will have to look at the impact of that. Obviously the
purpose of the tobacco education campaign that we have run so far has been
very much about supporting smokers to give up and so it has been a case of
telling people not to give up giving up and that has been helping people. We
have not used the quite gory images that have been used in the Canadian
campaign and we will obviously keep an eye on that and monitor how that goes
down and what impact that has. The Canadian thing is not necessarily
portable. As to whether you should remove everything from the packaging
altogether and just have plain packets. I think one of the most important
things when they talk about the branding and the importance of the packaging
in terms of communicating the message or the ethos or the aspirational thing
about the cigarettes is the link between the packaging and the advertising.
So it is not simply what the packet looks like, it is the link between the
packet and the advertising, the way in which the brand is communicated to the
audience and sold as part of your aspiration, i.e. this is the kind of person
you want to be. By bringing in a tobacco advertising ban you break that link.
If we were to go further and try and take the label off the front of the
packet and make the packet generic, we are advised that there would be huge
legal problems with doing that kind of thing because there are all kinds of
intellectual property rights around owning the brand and so on. I understand
there are a lot of legal complications on this. The broader point you make
is absolutely right, which is that we will have to get more information out
and we will have to get more information out through things like the
packaging, through things like expanding the warnings and get it out to people
in a form that they will understand it and read as well. I think the idea
that we can just put a few little ingredients tucked at the bottom of a packet
is not going to communicate to people the huge risks that they are taking and
also quite what some of these additives involve.
(Mr Milburn) I think members of the Committee are aware that there are
around 600 additives that go into cigarettes. Members of the Committee are
probably not aware of what those 600 are. We can supply that information to
you. More importantly, it is our intention to put it on the Department of
Health's web site before too long so that not only Members of Parliament can
get access to it, smokers and non-smokers alike, but members of the public
can.
Chairman: I am conscious that we still have a number of areas we want
to explore. Can I appeal to my members to be brief with their questions and
to the witnesses to be brief with their answers.
John Austin
1330. Could I raise one other issue about this word "addiction"
because it seems to me that when the tobacco industry have come to see us they
have tried to down-play that and refer to it as a habit rather like the
Internet and shopping or doughnuts or whatever, whereas the evidence we have
had is that nicotine is a very powerful addictive drug. I think Professor
Donaldson in his evidence said that to use the word habit is to downgrade the
seriousness of the addiction. Do you think there is some merit in making the
public more aware of the addictive nature of nicotine either by labelling or
some other method?
(Mr Milburn) I think the evidence is pretty compelling. You will be
aware that the Royal College of Physicians just yesterday produced their
report which I am told makes out a very good case for precisely the argument
that nicotine is deeply addictive and that modern cigarettes deliver nicotine
in a very effective form indeed. I think that is right and I think that is
why the European Union draft directive is important, because it raises not
just the issues that we have known about and, frankly, have concentrated on,
low tar and carbon monoxide as issues of real health concern but also the
level of nicotine in the product as well. They have tried to set some bench
marks for that. Yes, I think we do need to get that message across more
cogently to the public.
1331. The other issue I wanted to pursue was this question of
advertising. It seems from the evidence we have seen from the advertising
agencies employed by the tobacco companies that they are already looking at
all sorts of ingenious ways of getting round an advertising ban and of using
images and logos in other advertisements and other promotions which are
associated in the public's eye with cigarettes. We also had evidence that
particular groups were being targeted, for example, at Spanish airports,
British holiday makers, advertisements in English language tabloids, in
Spanish holiday resorts, etcetera. Do you think there are some measures that
you can take beyond those already taken to undermine those sort of efforts?
(Yvette Cooper) Obviously what we have to do is monitor the ban as it
is implemented and as we see what happens. I think the evidence that you have
taken on this was extremely interesting. There are provisions in the
directive for things like brand sharing and things like using the brand.
Camel Boots is one that is often used. After a certain period, I think it is
2001, Camel Boots will have to be a distinctive brand for Camel cigarettes,
for example, so they will not be able to use that kind of brand sharing as a
way round the advertising ban. If there are ingenious ways in which the
industry gets round the ban we will just have to look at it again. It is hard
for us to anticipate now when the ban is not yet in place exactly what things
they may come up with. We have gone to a lot of lengths to try and anticipate
any possible problems like that and to try and make sure we avoid that, but
I think this is going to be an argument for monitoring it very closely if it
goes on.
Mr Gunnell
1332. Secretary of State, you have already mentioned your concern
about environmental tobacco smoking and passive smoking. In the White Paper
Smoking Kills you state that the Government does "not think a universal ban
on smoking in all public places is justified while we can make fast and
substantial progress in partnership with industry". It will not surprise you
at all to know that the tobacco industry people who talked to us on this same
matter said that it was important and we could proceed by voluntary
agreements. We found that in the United States they proceed much faster
without voluntary agreements. Do you think that voluntary agreements with the
hospitality industry or with smoking people in general are really delivering
smoke-free environments for non-smokers? Are non-smokers sufficiently
protected in the workplace? What do you think about the views put forward by
FOREST that smokers' rights and freedoms are under siege? What we found in
Washington was that there were smoke-free environments because they were
policed and because they had a very effective system and so when smoking
occurred in what should have been a non-smoking eating place they made sure
they put a fine on the proprietor of that eating place. The second time they
are caught with smoking going on in the same place, the fine is doubled, and
that happens every time, so that before long the establishment knows they
cannot afford another fine at double the previous one. They therefore police
it very effectively themselves. That is a much tougher way of dealing with
that and I wonder if you think it is time we decided we were not getting far
enough with voluntary agreements?
(Mr Milburn) I do not, in all frankness. I think banning smoking in
public places has been a pretty mixed bag, frankly. You say it works in
Washington, well, it certainly has not been particularly effective in Paris.
The French authorities have found the French public have not necessarily
reacted as positively as perhaps the American public have to the idea of
having their choice restricted in that way. The important thing here is that
we are not dealing with the tobacco industry, we are dealing with the
hospitality industry, which is a quite different industry, and it is one I am
prepared to give the benefit of the doubt to. I think the hospitality
industry wants to work in partnership with us in making these voluntary
agreements work. As I said earlier, I think in response to the Chairman, I
think it is in their interests to do so and in their commercial interests to
do so, to make this choice more widely available to people. Some people will
want to go down the pub and will want to smoke and non-smokers will want to
join them and will be happy to do so, and that seems to me to be perfectly
reasonable. Equally, there will be people who do not want to smoke and who
do not want to be bothered by smoky atmospheres. What we have to do is make
sure that we have the appropriate safeguards and mechanisms in place to ensure
that that happens. I think that is far more preferable, for all sorts of
reasons. To tell you the truth, I do not really want the police and the other
organisations who are already under pressure in terms of their workload to do
yet another big policing and monitoring exercise. We talked earlier about the
lack of enforcement around vending machines, for example, and point of sale,
and the difficulties we already have there, and I do not want to create yet
another barrage of activity which has to be monitored and policed. I would
far rather this worked on the basis of agreement. As I say, I think it is in
both our interests on public health grounds and in the industry's interests
on commercial grounds to make this happen. We have made good progress. I can
tell the Committee that before long - I think next month - my officials are
meeting with representatives of the pubs sector to talk about a definitive
setting of targets around some of these areas for making more non-smoking
areas available in pubs. If we can get that right in pubs, then we can roll
it out elsewhere, in restaurants and so on.
Mrs Gordon
1333. I think one of the most chilling things I have heard recently
about the effects of passive smoking is from the recent report into the
Confidential Enquiry into Stillbirths and Deaths in Infancy, which indicated
that Sudden Infant Death Syndrome was substantially more prevalent in houses
where an infant was exposed to tobacco smoke. Indeed, "the more hours the
infant was exposed to smoke the greater the risk." That is a really
frightening thing. I would like to ask what steps you are taking following
this evidence and, in particular, how you are going to get this information
out to parents and pregnant women?
(Mr Milburn) You are right, this is an extremely disturbing finding
indeed, and it is one we have got to try to act on. We are working with
various organisations, including the Foundation for the Study of Infant
Deaths, to target publicity at expectant mums, and there is a big effort going
in there, as the White Paper says, to persuade women who are pregnant not to
smoke during their pregnancy because of the adverse effects that has not just
on themselves but on the babies. But also we know that particularly in the
light of this cot death study there is much more we need to do. This is a
leaflet I have brought along which we are producing with the Foundation about
reducing the risk of cot death. It is due to be published very shortly,
sometime later this month. It does warn mums and dads about the risks
associated with smoking, particularly when there is a very young child in the
room. That will be made widely available. We will also look to see what we
can do in the context of our advertising campaign to make sure that parents
are fully aware of these facts. It seems to me extremely important that we
do that.
Audrey Wise
1334. A different tack altogether. In Brussels we discussed the
issue of subsidising in the EU tobacco growing, and we were told the current
tobacco subsidy amounts to 1 billion euros, which is approximately œ613
million at current exchange rates. This was presented to us as, "It is not
as bad as it sounds because it is only 7 per cent of the CAP total subsidy."
We did not look at the "only 7 per cent", we looked at the œ613 million and
thought, "This is part of our taxes." What is your view about that subsidy?
(Mr Milburn) My view, the Government's view, is that we strongly
disapprove of the CAP regime as it applies to tobacco growing. We disapprove
of it both on financial grounds, the cost of it, which as you say is
substantial, and on health grounds too. We have achieved some minor but
significant steps particularly in the 1998 agreement around the reform of the
Common Agricultural Policy. To be fair to the previous Government, they tried
to make some inroads into this in 1992. We have made some improvements but
there is a long way to go. So, for example, we are in a better position now
to buy out producers who no longer want to produce tobacco, we are in a better
position to recycle some of the money which goes into tobacco growing into the
Community Tobacco Fund which, amongst other things, provides precisely the
sort of information and education we have been talking about in the UK context
across the European Union. The whole thing will be reassessed in 2002 when
the Commission are due to come back and report to us on further changes which
might be necessary in the regime. But as it stands, it is completely and
utterly unacceptable.
1335. I would be grateful, and I think the Committee would, if you
could have set down on paper for us the improvements which you feel have
happened during the last few years.
(Mr Milburn) I would gladly do that.
1336. I noticed that Baroness Hayman in an answer in the Lords not
only listed the countries involved, the receiving countries, but also said
that tobacco "still attracts the highest premiums per hectare under the CAP
regime." So not only are they subsidised but they are subsidised at a higher
rate than the people producing useful products. We have also had evidence
that in any case tobacco is a valuable crop, so a valuable crop is being
subsidised at a higher rate than less valuable crops. It has been put to us
elsewhere that this makes it actually harder for people to switch from tobacco
growing to something else because that is going to be a lower value crop and
they are going to lose their subsidy. Can you make absolutely sure that this
is also tackled because that could be a half way house? A reduction per
hectare is not good enough for me but it would at least be an advance. Do you
favour that as a possible gradualist approach?
(Mr Milburn) That is possible. I certainly do not want to leave the
Committee in any doubt about the Government's resolve and determination in
this area. We know it is a hopeless and unacceptable regime and it is costing
a pretty penny and has adverse health consequences. So we will continue to
argue very, very strongly for very, very radical reform not just of this
particular element of the Common Agricultural Policy but of the CAP in
general, but as Committee members are aware, we are slightly up against it
because there are eight countries which are tobacco producers and it is just
possible they may take a very different view from ours. We have got to hammer
these things out, but I do think we will have another opportunity in two
years' time to look again at what the Commission proposes, but undoubtedly we
have got to make further progress in this area.
Audrey Wise: It completely undermines the argument. Apart from the
practicality of œ613 million going, there is the very simple argument, "Well,
if it is as bad as you say, why is it allowed? If it is as bad as we say why
do our taxes go to subsidise it?" If I were the tobacco companies I would be
making hay with that argument and I am quite sure they will at some stage.
Mr Amess
1337. Can you tell us what the latest position is regarding the
European Union advertising ban or are there problems with Mr Eccleston?
(Mr Milburn) Not that I am aware of. In terms of the advertising ban,
I think the Committee is aware that we are in pretty protracted legal
territory here. We initially lost the case in the High Court against the
tobacco companies. We won it in the Court of Appeal and subsequently the
industry then appealed that decision and they were successful in their appeal
to the House of Lords. As I understand it, the earliest date for a hearing
of the appeal in the Lords is likely to be towards the back end of May this
year and that means that we would not get a judgment probably until June and
that realistically in term means that, allowing Parliamentary time and so on
for regulation, we could not get these introduced until July, which is
extremely disappointing indeed. Of course, the industry has the right to
fight this in the courts if it wants to, but it ought to understand two things
in my view. One is that the public and smokers themselves, from all the
evidence we have seen, support the Government's position on the ban on tobacco
advertising and, secondly, there is a manifesto commitment and come what may
we are going to deliver it.
1338. Why does the draft directive stipulate a European Union
maximum tar yield of ten mg given the current scientific consensus that
compensatory smoking undermines any potential health benefits of lowered tar?
And was thought given to setting a maximum nicotine level lower than the
proposed one mg cigarette which merely matches current yields?
(Mr Milburn) I referred to this earlier. You are now talking about the
new draft directive?
1339. Yes.
(Mr Milburn) I think the Royal College of Physicians' report also
argues that for 20 or 30 years we may well have been chasing the wrong target
with low tar and persuading people to give up smoking and if they cannot to
give up, to switch from high tar to low tar brands. That might not
necessarily have produced the dividends that we had hoped for in terms of
health improvements because the evidence seems to me pretty compelling and you
have heard it in the Committee, the fact that smokers compensate for low tar
in the way that they smoke the cigarette. However, as I understand it we have
got to take the evidence from the scientists on this and from the medical
community. At the moment we do not have an alternative means of assessing
what the correct bench marks are for assessing tobacco. I think Liam
Donaldson, the Chief Medical Officer, was quite right when he came here and
urged some degree of caution around the idea that there can never be such a
thing as a safe cigarette. I think that is something that people have been
chasing for very many years indeed and it has proved to be erroneous. The
difficulty is the obvious one here and that is, even if we came up with a
better measurement of the way that cigarettes are impacting on people, in
truth we probably would not know for several decades whether that was right
or wrong and that is our problem around this. In terms of the directive, we
think that the reduction in the tar content may not be the best thing, but in
the absence of any alternative measures the view that I have expressed
strongly to officials who are negotiating this at the moment on our behalf is
that we should go with it because I do not want to hold the directive up.
Mr Hesford: The issue of smuggling has been highlighted recently in
the press. When we questioned the tobacco bosses there seemed to be some
support for the evidence in what I would call their evasive answers around
these issues. Gallaher and BAT certainly seemed to be implicated. What is
the Government's view of this and what is on offer to try and get at them for
whatever they may be doing? Ken Clarke, on behalf of BAT, calls it doing
everything they legally can in order to join what is in effect an illegal
market and to me that is a contradiction in terms. What can the Government
do and what is the Government doing?
Chairman
1340. Could I just add to the point in relation to Mr Clarke
because obviously the article he wrote in The Guardian a week last Monday was
of interest to us because as a former Chancellor and a former Secretary of
State for Health he appeared to be arguing that the consistent rises in the
taxation levels were a contributing factor in relation to the smuggling
problem which had harmful health effects. He did not say that at the time he
was Chancellor or Secretary of State for Health, but he is saying that now.
I wondered whether you had any thoughts on that particular point.
(Mr Milburn) I think he is fundamentally wrong and I think the evidence
worldwide, certainly from Europe, suggests that the smuggling problem, which
is a very very very big problem indeed, is not just a problem that is peculiar
to high tobacco tax countries - and ours is, I make no bones about that and
rightly so in my view - it is a problem that so-called low tax tobacco
countries also face in Europe. There is increasing evidence of smuggling
activity being very very well organised indeed. This is not just a fly-by-
night approach. The evidence would suggest that it is very very well
organised indeed and that is why the Chancellor, as you are aware, in the
Pre-Budget Report suggested a number of very helpful changes, e.g. the
introduction of X-ray machines, different markings on packs and the
possibility of changes in penalties which I think would be widely welcomed and
would make a real difference as far as smuggling is concerned. If that is
what Mr Clarke is suggesting - and I have not read his article in The Guardian
- then I think he is wrong and I think both his experience and ours and other
experiences elsewhere in Europe would suggest that he is wrong.
1341. I may have misrepresented what he is implying, but we will
have him before the Committee next week which should be interesting.
(Mr Milburn) You will get the verdict from the horse's mouth so to
speak. I have read the other Guardian report about the allegations and if
they are true then they are very very serious allegations indeed. Certainly,
from the Government's point of view, we abhor smuggling wherever it occurs,
it is an illegal activity and whoever undertakes it. I look forward to
hearing the conclusions of the hearing that you are due to have again with the
companies concerned.
Mr Hesford
1342. Companies have told us that the proposed advertising ban will
limit their opportunities to market what they want to describe as their new
form of safe cigarettes. There is a sort of irony there which is "They would
say that, wouldn't they?" We all want the ban to come in, but is there a role
for Government in facilitating the development of those cigarettes and, if
there is, what shape would it take?
(Mr Milburn) I am very very cautious about this whole debate. I think
you have taken evidence from one of the companies, Star, about the idea that
there is a safe cigarette. I start from a pretty fundamental premise not
based on my prejudices but based on scientific evidence that I have read very
very carefully and the advice that I receive which suggests that the pursuit
of a safe cigarette is going to be a pretty fruitless pursuit.
Mr Amess
1343. Customs and Excise has estimated that all forms of tobacco
smuggling will cost Britain œ2« billion in lost revenue this year, œ1« billion
of this arising due to organised container smuggling rather than cross-Channel
bootlegging. Given these facts, I wondered if the Secretary of State could
tell us, given his previous role, if he believes the œ35 million allocated by
the Comprehensive Spending Review over three years to combat tobacco and
alcohol fraud with the scanners and labels announced in the Pre-Budget Report
is a wholly adequate response to this very, very real problem?
(Mr Milburn) Thankfully, that is not a matter any longer for me! I
admit it used to be, but it is not any more. That is something which the
current Chief Secretary will admirably cope with, and the Chancellor will too.
In all seriousness, the measures which were announced by the Chancellor in the
PBR were extremely important. It followed Mark Taylor's inquiry into this
area which was an independent inquiry and he has made a number of
recommendations, some of which have already been actioned. I cannot say
whether there have been others because I have not seen his report but it is
clear the steps which are taken are going to be significant ones. These x-ray
scanners which we need to place in the most appropriate places will make a
real difference.
1344. You do not feel able to comment on the œ35 million and why it
is not more?
(Mr Milburn) I think it is wiser for me not to comment on anybody
else's budget.
Mrs Gordon
1345. Someone told me that they could go into their local pub and
buy cheap cigarettes and they know they are smuggled cigarettes because the
information is all in French, so we obviously know the origin of those.
(Mr Milburn) Bit of a give-away!
1346. You mentioned marks on packets, have you considered or would
you be in favour of some kind of bar code on each packet of cigarettes which
designates their origin?
(Mr Milburn) That is what the Chancellor proposed in the PBR, that is
what packets henceforth will have on them. There is going to be a mark on all
packets of cigarettes which will say, "UK duty paid", so it makes it
absolutely clear these are UK cigarettes. It will also have "Not to be sold
after a certain date". There are good reasons for doing that too because
there is some evidence to suggest that the companies have been in some way
managing to avoid the tax which otherwise they might have been liable to pay
by forestalling the way they deal with the supplies of cigarettes. So there
will be a double benefit, in my view, and this will be actioned I think fairly
shortly.
Audrey Wise
1347. I think it is clear and pretty obvious that if efforts in
Europe and North America are successful in continuing to cause a reduction in
smoking, tobacco companies will look elsewhere for their markets, notably the
Third World and hitherto fairly untapped places like China. I appreciate you
are Secretary of State for Health in the UK - or just England and Wales now
but ---
(Mr Milburn) England. I cannot deal with any more really!
1348. Diminishing by the second! Bearing that in mind, do you ever
give any thought, or does the Government give any thought, as to whether and
if so in what way the British Government can be of any help in thwarting the
tobacco companies' plans to cause deaths in the Third World if we succeed in
reducing our deaths?
(Mr Milburn) I think that is a very, very important point indeed. We
have a very high incidence of smoking in this country comparatively - I think
we have 12 or 13 million adult smokers in this country at the moment - but
literally the numbers of people smoking worldwide are well over 1 billion or
even more - I do not know - and many of those will be in poorer countries.
We are working quite closely with the World Health Organisation on some of
these issues and I think this is important too because this battle about
smoking and so on is not just about the UK or about the European Union, it is
a worldwide issue. There are efforts being undertaken led by the World Health
Organisation, quite commendably in my view, and we are taking a leading part
in those to try and do what we can to fulfil our international as well as our
national obligations. If it is helpful to the Committee, I will gladly send
you a note on what the World Health Organisation is planning.
Chairman: We are aware of the proposed Framework Convention which we
have in circulation and we appreciate it.
Mr Gunnell
1349. When we got on to the issue of passive smoking we went on to
a rather extremist aspect of it.
(Mr Milburn) I did?
Chairman: I think he said the Committee did.
Mr Gunnell
1350. I suggested the police and you had in mind the regular police
would be used. Are workers sufficiently protected in the workplace? Do you
have any view on legislation so far as the workplace goes?
(Mr Milburn) I think you know, Mr Gunnell, that in the White Paper we
announced our intention to look at an improved code of practice around this
LACOT that was referred to which the Health and Safety Executive have been
consulting on. Their consultation has now ended. I think they got 500
responses in total. It seems to me to be a sensible idea. Obviously we have
got to introduce it in an appropriate way. We have got to get the right level
of regulation in the system. I think it is certainly true that workers who
work in very smoky environments deserve the full protection of the law.
John Austin: Would it apply to the Palace of Westminster?
Chairman
1351. Think about that one, Secretary of State.
(Mr Milburn) I suspect it does not because this place has different
rules, as I think you are aware.
John Austin
1352. Perhaps you could talk to the Palace authorities.
(Mr Milburn) That is a very tempting prospect.
Chairman: Are there any further points from my colleagues?
Mr Gunnell
1353. Given that we have talked all night about cigarettes being
the most dangerous thing around that people can easily lay their hands on,
would there be a case for licensing the ability to sell cigarettes altogether
because then we would be able to remove the permission to sell them?
(Mr Milburn) I think I am right in saying that effectively it is
licensed at the moment expressly, but I think the problem is not so much the
sort of rules and regulations or the laws that you put around this area, it
is just how effectively you enforce them and I think there is a very big gap
there that we will just have to make up in the way that these things are dealt
with.
Chairman
1354. Do either of our witnesses have any final points you want to
make on areas that we have not covered that you anticipated we might?
(Mr Milburn) No.
Chairman: You have done a thorough job. Can I, on behalf of the
Committee, Secretary of State, Minister, thank you for your attendance. I am
sorry it has been such a long session, but we do appreciate your help with
this inquiry.
