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The hon. Member for Woodspring (Dr. Fox) spoke about the new arrangements for protecting and representing patients' interests. I have been in this House since 1983 and have dealt with my community health council on many occasions. The remit that such councils have been given by Parliament over many years has been quite restrictive in many areas. I refer to their opinions about closing hospitals and different aspects of the national health service in their areas. To that extent, CHCs have been good sounding boards, and I hope that whatever replaces them will continue to provide a public sounding board.
Rotherham community health council has helped me with constituents' complaints over the years. It is to be congratulated. It is a strong body and an advocate for patients, but only after something has gone wrong for people in the acute sector of the health service. That may not be such a useful role in the years ahead.
We are introducing into the health service proper independent inspection of hospitals and primary care through the Commission for Health Improvement. It will help us to get to grips with the real issue for patients--the quality of clinical services--in a way in which community health councils, despite what we think about them, have been neither able nor equipped to do. This is an important and fundamental part of the Government's approach.
Community health councils have had no remit to inspect or monitor primary care, yet that is where, for the most part, the real interface with the health service is for our constituents. We ought to look at how the new patients forums, which will take over that part of the role of the CHCs, will apply to primary care. In that way, the community as a whole can be considered--primary care as well as the acute sector.
We have heard the Opposition's rhetoric about abolishing the community health councils, and about improving them instead. In a sense, that is what the Government are doing. They are trying to improve the national health service and how patients--our constituents--interact with it. There is not a great deal of difference between those approaches, if that is really what the hon. Member for Woodspring wants to do. Of course, if he is making the point because he is in opposition and that is what Opposition Members do, I can quite understand his position. However, nothing that I have heard Ministers say so far--and I have listened closely--will impact in a negative way on my constituents. I think that we will all want to make sure that that does not happen.
Dr. Fox: Does the hon. Gentleman accept that the changes that he suggests could be made by reforming CHCs; that the Commission for Health Improvement is not independent because, by the legislation passed in this
Mr. Barron: Ministers can speak for themselves on the hon. Gentleman's last point, but there is evidence that there has been public consultation on the future of CHCs, although it has not been widespread. [Hon. Members: "Ah!"] Conservative Members cannot say that there has been no consultation when they are nodding because it has not been widespread. Conservative Members should come clean: the consultation might not have been widespread, but it has taken place, and people have given their opinions. I have read copies of letters sent to the Department of Health--indeed, I have written to the Department on this issue--so saying that there has been no consultation is wrong.
Dr. Brand: I agree with the hon. Gentleman that there should be an inspection regime for primary care. Will he accept from me that relationships can be so positive between good CHCs and well-established primary care that this is now happening on a voluntary basis? Does that not show that there is good practice within the NHS? Are the Government not making a mistake in throwing away what can work and introducing a system that is much more fragmented?
Mr. Barron: On the hon. Gentleman's comment about bringing in something that is much more fragmented, the way in which community health councils work varies, and we must all accept that. From what I have read and from personal experience, I know that they vary greatly. Under those circumstances, as that is what we have now, we ought to improve that system. By and large, improving the system is what the Government are doing in order to look after patients' interests.
Dr. Stoate: The hon. Member for Isle of Wight (Dr. Brand) alluded to the fact that good community health councils have good relationships with good general practitioners, which is good news. That begs the question of what happens when that does not occur--when there are not good relations, there is not a good CHC and there is not a good practice. That is where the gaps occur. We all understand that good practice is to be applauded and should be rolled out throughout the country, but the Government must take account of the areas where it is not in place.
Mr. Barron: My hon. Friend is right. We must all see how the situation develops in the next three months and find out what is to be put in place. When I saw the proposal published in the national health service plan my first instinct was that I would rather that someone was an advocate for my constituents while they were in hospital. I hope that that will ensure that mistakes do not occur and things are not done wrongly, which will prevent a complaint later. Waiting for people to complain about the service that they received is not the way to look after patients' interests or those of the NHS. We must look at the matter in that light.
We must anticipate the reactions of the tobacco industry to any legislation to ban advertising and promotion. We must not only ban poster advertisements and those in the press--I believe that the posters have now gone--but anticipate the industry's reaction to a ban. Parliament must take pre-emptive action against the companies in the legislation.
The experience in other countries has shown what the industry can do when faced with a simple ban on advertising or a ban that contains loopholes. I will list some of the problems that I unearthed when I was attempting to promote my Bill and that I have encountered since. One such problem is indirect advertising. The tobacco companies resorted to that in Italy and Norway. They used the imagery associated with cigarette brands while purporting to advertise other goods.
In Norway, the issue was Camel cigarettes. We have all seen people wearing Camel boots and jackets carrying the Camel logo. The advertisements for those products were barely distinguishable from the previous Camel cigarette advertisements, and were accepted by the Norwegian Government only when the word "Camel" and the trade mark were dropped.
In Italy, as long ago as 1962, a ban on advertising was introduced, effectively to protect the beleaguered Italian tobacco industry. At the time, one long television advertisement focused on Marlboro billboards at a formula one motor race and on the Marlboro flashes on drivers' clothes. However, in the final shot, the small print revealed that the advert was not for cigarettes but for the driver's helmet. I have visited Italy a few times, but I have not seen many people walking about wearing formula one racing helmets--that does not seem to be part of their culture. That was one of the ways in which the tobacco industry tried to overcome the ban.
The industry also resorts to the closely related practice of brand stretching--finding legitimate merchandise on which to place tobacco brand names and trade marks. There have been many instances of that in this country over the years. I shall cite one of the thousands--there are now millions--of leaked documents from British American Tobacco in 1979. It was an internal document directed to the constituent parts of that massive multinational company, which operates throughout the world. It stated:
Another strategy is brand borrowing. If advertising is banned, the industry may introduce new brands of cigarettes that share an existing high profile brand name with non-tobacco goods--for example, Levis. Again, we must ensure that the tobacco industry does not get round the advertising and promotion ban in that way.
Direct mail may also be used by the industry. Many Members will have received petitions or letters from retail organisations--for example, at one time newsagents wrote to us about tobacco taxes. I am in favour of such taxes; indeed, the previous Conservative Government favoured increasing them for public health reasons--although the Opposition no longer appear to support that. No doubt we shall debate the matter in the future.
There has been a major collection of names and addresses at newsagents in relation to tobacco products. If the companies cannot advertise, they may use direct mailing--as they do in promotions. Catalogues and the saving of vouchers in exchange for what are, in effect, free goods offer another route for direct mail into people's homes. We all know about such promotions--they are advertising. When we consider a ban, we need to take into account those detailed forms of advertising and promotion.
I shall not say much about sponsorship, as measures are already in train to deal with that. I should have liked a shorter time scale for the banning of certain forms of sports sponsorship. However, it is being carried out in a balanced way, taking account of the points of view of the people involved in that debate. I hope that the practice will be ended as soon as practicable. As I pointed out in my earlier intervention, although cigarette products have not been advertised on television for more than 30 years, when people are asked if they have seen such advertising, the majority say yes. People take their information from television--whether it be NatWest cricket or formula one motor racing. It is important that we realise that.
When I introduced my private Member's Bill, we decided that rather than specifying what was not allowed, it should outlaw anything that could reasonably be considered to promote the smoking of tobacco. Obviously, someone must interpret the word "reasonable".
In a recent report, the all-party Select Committee on Health said that we should consider creating a tobacco regulation authority in this country. I believe that that proposal was supported by all the parties represented on the Committee. There is justification for creating such an authority, as it could interpret the word "reasonable" in the context of the promotion of cigarettes. Our close neighbours in Eire have an Office of Tobacco Control, so there is precedent. That office looks into all the issues relating to tobacco.
In the past two years, there was a European directive on which we were ready to pass regulations in this country. I understand that it was introduced by the Competition Commissioner because it concerned marketing. In the European Court, the tobacco companies argued that the Competition Commissioner was used to introduce a directive that was, ostensibly, about public health, and that it should have been a public health directive, not a competition directive. I am not a lawyer; I did not read the details. However, I know that that initiative failed in the end, and that the regulations that we proposed to introduce were never passed, as a result of the legal challenges.
There is a lesson there. I tell the Minister for Public Health, who has direct responsibility for these matters, that this issue is not about competition; it is not about product--it is about public health. On that basis, when the
My final argument arises from what has happened in a country that has very successfully banned tobacco advertising on television and so on. A packet of cigarettes was brought to me from Australia. It shows the way in which the cigarette companies try to promote their product when their sponsorship of sport has been banned. I have in my hand a packet of cigarettes in a neat clear plastic purse. It contains a little notebook and pen, designed to be attractive to young people, who will be able to use it as a purse. That is the level to which tobacco companies--in this case, Philip Morris--will sink as we restrict their promotion of tobacco products in and around this country.
We must ensure that we prevent such practices being repeated in this country. We can do so in the wording of the Bill or--more probably--of regulations. Such packaging attracts the very teenage girls among whom, as my hon. Friend the Member for Dartford (Dr. Stoate) said, smoking continues to increase even when it is, fortunately, decreasing by the year in most other age groups, especially adults.
The tobacco companies know how to market product. We should not deceive ourselves that, as long as there is a health warning on the packet, packaging does not matter. It matters in all sorts of ways. Some countries have even considered generic packaging, which would prevent anyone marketing cigarettes in a way that is especially attractive to young people. That is not a matter for the House, but it may be a matter for a tobacco regulation authority, if we ever create one. The authority could interpret the word "reasonable" in such a way as to give us the secure knowledge that the new legislation, which I hope that we shall pass this Session, will make its mark in improving public health for many years to come.