Examination of Witnesses (Questions 40-59)
23 FEBRUARY 2005
RT HON
JOHN REID,
MP, MISS MELANIE
JOHNSON, MP AND
DR FIONA
ADSHEAD
Q40 Dr Naysmith: Can I just check on
what you have just said? Are you saying that if the Portman Group
had more funds available to them they would be able to do some
things that you would like them to do which they currently cannot
do at the moment because they have not got enough money?
Dr Reid: Yes. We have been talking
to them on precisely this. Look, you do not have to be a genius
to work out that the amount of money which is spent directly by
government, by individuals and by companies (including companies
which are involved in the drinks industry)—and I do not
for a moment forget that they pay a lot of taxation—
Q41 Dr Naysmith: They also make quite
a lot of profit, too, and they have got double or treble the amount
of money you will spend tomorrow.
Dr Reid: They may a lot of profit
and pay a lot of taxes, indeed. To be fair to them and in the
objective account we recognise they pay some taxation. However,
I think that if you look at the amount of money that is spent
on promoting drink—perfectly legitimately, I do not have
any complaints with that—and the amount that is spent on
promoting socially responsible drink and the avoidance and the
warnings about irresponsible drinking, there is no comparison
between the two. What we are doing is we are engaging with the
industry. I hope it will be constructive. It is only recently
that we have started to get intensely engaged with them, but we
are engaged with them in saying, "Look, help us to make sure
that you can have a flourishing industry, people can have a flourishing
social life, but we can reduce the binge-drinking or the unhealthy
drinking." Part of that, and that is what I am saying to
Miss McDonagh, is through the Portman Group. They can discharge
that, we think, with a little more money and a little more activity.
Chairman: I know Keith wants to come
in on smoking, but before he does, on the issue of alcohol can
I refer to the gender aspect of this because one of the things
which certainly concerns me is that I have got children, one nearly
twenty and one seventeen, whom occasionally I have to pick up
late at night from the city centre and it is very apparent to
me from my time when I was their age going out in the city centre
pubbing and clubbing—
Siobhain McDonagh: Did they have cars
then?
Q42 Chairman: Thank you, Siobhain. There
has been a fundamental change, in that although the male behaviour
is not dissimilar to what it was when I was their age, you see
far more girls out and in sometimes terrible states. What are
you doing to look at that aspect of your alcohol strategy, the
gender aspect, particularly the number of young women who do drink
excessively and become incapable as a consequence? That does obviously
tie in with some of the concerns that we have on the sexual health
inquiry about the link between alcohol misuse and sexual problems.
Miss Johnson: Just to go back,
I do not want to dwell only on what the Portman Group has done
because the sensible drinking messages will be rolling out, as
it were, and we will be campaigning. There will be leaflets, there
will be web stuff and other things going on from later on this
year. But what the Portman Group has done, for example, is that
the ad which is run uses young women and it is young women in
particular being out of control as a result of alcohol, which
is something which they know young women in particular do not
like to be. So we have got to get back to that.
Dr Reid: The simple answer, I
think, to your question is that we understand that in any information,
education campaign, whatever, persuasive campaign, the messages
in it have to be appropriate to the gender. There are certain
things which will work better with young women than with young
men.
Q43 Mr Bradley: I do want to go back
to smoking, you will be pleased to hear, Secretary of State, and
not the census in Manchester! Can I just preface my remarks by
just commenting on some of the answers on alcohol. I very much
welcome the fact that you are undertaking an audit of services.
As part of that process will you be disaggregating your expenditure
and as a consequence other departments' expenditure between the
amount of money that is spent on alcohol services and programmes
as opposed to other misuse of substances? What I have found is
that they are often in an aggregate pot and there is a disproportionate
amount of money, money that is well spent normally on other substances
and not on alcohol, and there has always been a sort of blurring
of that so there is not the focus on alcohol programmes that there
ought to be. I know from my own constituents we have had to battle
to keep alcohol services. We have just opened a new alcohol treatment
unit, which you would be very welcome to visit, but it has been
a battle all along because alcohol has been low on the list of
priorities as opposed to other programmes in this area.
Dr Reid: Yes, certainly. We are
just discussing what it was because we have got a figure of £15
million here, but that is additional. The expenditure disaggregated
on alcohol is about, from memory, £95 million. You may argue
that that is too low, too high, or whatever, but we now know roughly
what it is.
Q44 Mr Bradley: That is the important
point. We know now what the baseline is.
Dr Reid: Yes, and we think that
ought to be spent. But that is not ring-fenced.
Q45 Mr Bradley: That can often be the
problem, that money is taken away from alcohol services.
Dr Reid: Yes, it can. I accept
it is a problem, but it is no more of a problem than it is in
any other area because of (with a number of exceptions, which
are national targets) the vast amount of expenditure we are putting
into the health service and, as you know, a fortnight ago I mentioned
£135 billion and about one and a ½% of that I think
is public health additional. With very few exceptions, because
we are trying to get more local autonomy in decision-making, they
are not ring-fenced, but we hope that it will be spent and the
amount that is intended to be spent and given down is about £95
million, Mr Bradley.
Miss Johnson: There is another
point on this, which is where a lot of people have drug and drink
problems, and those people are currently receiving a lot of their
alcohol treatment services via drug treatment services, who accept
that they are going to have people with the dual problem and therefore
you need to treat both sides of it. So there are quite a lot of
people and some ring-fencing may not be helpful because we may
need to continue to develop services which deal with both, although
I entirely accept that some of the drink problem needs to be dealt
with separately and aside from drugs because it is not related
to it; the people are not taking drugs and that is not the issue.
But there is quite a large number of people currently in the services
who we know are principally getting their treatments as drug addicts
but who are also receiving treatment for their alcohol problems
at the same time.
Q46 Mr Bradley: Let us go briefly back
to smoking then. You seem from previous answers to accept the
evidence that passive smoking is dangerous for health?
Dr Reid: Yes. The evidence indicates,
and I accept—and it is largely based on living with a smoker—that
passive smoking in that situation increases the probability of
you ending up with a cancer or other serious disease by, I think
the figure is, about 24%.
Q47 Mr Bradley: It is also true that
passive smoking is dangerous within the workplace and therefore
is not a partial ban on smoking in pubs and other similar establishments
dangerous to those workers who have to work in a place where there
is not a ban?
Dr Reid: I think the expression
"partial ban" while technically correct underestimates
what has been done, Mr Bradley. All enclosed public spaces, other
than licensed premises, will be completely banned. That means
in all work places or unlicensed premises it will be completely
banned. In all restaurants, even though licensed, it will be completely
banned and in all pubs which prepare and sell food. Our estimate
is that it is about 75, 80% of pubs. So in about 97% of workplaces
it will in fact be banned. Now, that is partial, I accept, but
it is a very big part of 100%, 97, and I think that is an accurate
reflection of the total over all. In the three% there will nevertheless
be restrictions at the barrier area to minimise any degree of
damage from passive smoking. So all workers everywhere will be
better off than they are at present and in 97% of areas there
will be a complete ban on it. Now, that does not protect everyone
completely from carcinogenic elements and smoke, or whatever,
and as we were discussing earlier, drink itself is carcinogenic.
However, it is by any standards the most major step forward in
the protection of the public from passive smoking of any nation
of our size anywhere in the world, to my knowledge.
Q48 Mr Bradley: Okay, if we accept the
97% figure, you are not concerned that the three% who are left
in a dangerous situation might challenge you, even through the
courts, that they are put at risk because they have been left
in this (on your figures) tiny minority position of being subject
to passive smoking?
Dr Reid: So far as I can make
out the figures here, we are talking about the potential number
of deaths from passive smoking in the licensed industry—and
I will stand corrected by my Deputy Chief Medical Officer here—we
are not talking here of thousands of deaths or even hundreds of
deaths, we are talking about an estimated something like 40 to
50 deaths at present. If 97% of places and 80% of licensed premises
have been reduced, we are talking about the potential of an estimated
four or five deaths a year. That is what you are talking about.
That estimation would have to be reduced further because we are
taking into account the fact that we are protecting the bar area
from the effects of passive smoking by the ban, which is the only
thing the drinks industry and the bar trade at present are really
offering in terms of the staff, and in particular when you consider
that there is much more liable, I think, to be a far higher percentage
of people in the bar trade who smoke than the residual element
of those who will be in that situation. But every single person,
whether they smoke or do not smoke, will be in a position where
they are far better protected from passive smoking after this
legislation goes through than beforehand. There is no question
about it.
Q49 Mr Bradley: I just want to come in
on the Government's response to the Health Committee Report in
2000: "The government agrees that the health risks of passive
smoking are clear. Hundreds of people die every year in the UK
as a result of high levels of exposure to passive smoke."
Dr Reid: Yes, and in all those
places there will be a ban. That is the point I am making. The
only place where there is not going to be a complete ban in terms
of workplaces is a small percentage of the licensed trade premises,
and the figures I gave were for the licensed trade premises estimates.
Q50 Chairman: Can I just press you on
this point? You have used the figure that you could get down to
say four deaths a year as a consequence?
Dr Reid: Sorry, estimated. This
is all based on estimation, 24%.
Q51 Chairman: We understand that, but
the point—
Dr Reid: It is statistically insignificant
in terms of any individual person.
Q52 Chairman: The point I will put to
you is that death is one part of a range of serious problems that
arise through passive smoking. So I think just using death as
a measurement is not necessarily a good measurement. There is
a whole series of illnesses that people suffer. What I would put
to you and what I raised with you—I will bring Dr Adshead
in in a minute—when you made the announcement on the White
Paper is that while welcoming the step that you have taken—and
I genuinely welcome it; I think it is a very radical step and
it is something that many of us have wanted to see for a long
time—the practicality of what you are proposing I find difficult
to understand. If we can use an example, you are talking about
the bar area will be smoke-free in these minority establishments
which are non-food but licensed premises. Now, if we talk about
a spot that may be known to one or two people around this table,
which is the Strangers' Bar in the House of Commons (Mr Bradley
knows it), if we had a situation where we had this arrangement
there, that the bar area was smoke-free, anybody coming in through
the door to the Strangers' Bar would push the smoke forward to
the bar area. You are also excluding the fact that if you are
in the Strangers' Bar, the staff come out of the bar, in through
the side door to collect glasses. The assumption is that their
sole area of work is behind that bar. Anybody working in a public
house will frequently spend time tidying up ashtrays, tidying
up beer glasses, or whatever. Do you not think this is a rather
naíve policy?
Dr Reid: No, I do not think it
is. If it was naíve, Chairman, I would not have done it.
I think it is more sensible than those adopted elsewhere.
Q53 Chairman: It seems to me to be totally
impractical. I do not see how you can protect those people from
passive smoke in the kind of environment I have just described
in the Strangers' Bar in the House of Commons.
Dr Reid: Chairman, theoretically
we are bringing in passive smoking in this room. Theoretically,
indeed, we are breathing in some of Nelson's last breath because
of the distribution of molecules, and so on. So I am not saying
that we have got 100% purified atmosphere. I am not saying that.
What I said was that every worker will be better placed and better
protected after this than before and that in the vast majority
of cases there will be a complete absence of smoke other than
that smoke which is theoretically there but which results not
from people smoking in the area but from the atmosphere, and in
those cases where smoke is allowed by choice (because some of
these pubs and clubs may choose not to be smoking, remember; we
are not compelling them to be smoking pubs) we are saying that
in roughly 20% of pubs and in membership clubs (that is not clubs
where you can walk in off the street but where members can genuinely
make the rules of the clubs) in those areas they may make their
own decisions and in those areas where they do they will not be
able to say that there will be no protection for bar staff. Even
in those cases, which is about 3% of total workplaces, people
will be able to have a degree of protection, that is all I have
said, around the bar area. I have to say there are two other points
which have to be taken into account here. The first is that when
you constitute something like 95% of the licensed trade as smoke-free
there is a degree of choice for workers to go to the smoke-free
jobs which just does not exist at present. That is the first thing.
We know, of course, that there is liable to be a far higher %age
of workers than three% in the licensed trade who themselves smoke.
We are trying to persuade them by other means. The second thing
we have to take into account comes back to the balance of what
people want in protecting their own freedoms and the healthy outcomes
that we seek and all of the evidence that I have seen statistically
indicates that while people wanted a complete ban in non-licensed
workplaces and most people (80-odd%) wanted a ban in restaurants,
80% of people, or thereabouts, did not want a complete ban in
pubs. It is not possible to distinguish, in my view, between large
pubs which sell food on a restaurant scale and restaurants. So
what I distinguished was not what the public wanted, I went further
than the public wants, which is a ban in restaurants but not pubs,
and have said that we will have a ban in restaurants and all pubs
which prepare and sell food. So that is the second element, which
is taking into account what the public want rather than just telling
them, "We will tell you what you'll get."
Q54 Chairman: You, presumably, have completely
gone against the advice from the Chief Medical Officer on this
issue?
Dr Reid: I have reached a different
decision from my chief adviser on medical affairs, yes, because
as you know advisers in this country advise and ministers decide
precisely because we have to balance the health outcomes—which
I would not dream of disputing with my Deputy Chief Medical Office
or Chief Medical Officer in terms of their assessment. That is
their job, to tell me the health outcomes. My job, as Secretary
of State, is to balance that with my custodianship of the freedom
and the democratic society of our people. That is the primary
reason why I reached the decision that I reached on that. I have
to say to you the legislation is not there to prevent anybody
smoking; the legislation is there primarily to protect those who
do not smoke because in this country you ought to be entitled
to do that which is legal even if it is against our advice and
even if it damages your health. So you can climb mountains, you
can box, you can go in speed cars, and so on. What you are not
entitled to do is to damage someone else's health and that was
the purpose of the legislation.
Q55 Chairman: You have used the issue
of freedom frequently this afternoon. You have talked about freedom.
You had a better education, I think, than I did but there was
some philosopher in the 19th century who said, "Your freedom
to swing your stick ends where my nose begins,"—
Dr Reid: Absolutely.
Q56 Chairman: —which I think is
very interesting in terms of the smoking argument, because whose
freedoms are we talking about here?
Dr Reid: I am entirely agreeing
with you, Chairman. You are not free to hit somebody else on the
nose with a stick or your smoke, which is precisely why I have
brought in the legislation because nobody after this legislation
is in who wants to be in a smoke-free atmosphere needs to be in
anything other than a smoke-free atmosphere. Every restaurant,
every workplace, every enclosed public space and eighty% of public
houses will be smoke-free. So the only people who will be going
to the 20% are the people who choose to go, in other words the
legislation is protecting you. It is saying to you, "If you
want to do that which is legal and damage yourself in this country,
though we don't like you doing it we will protect your right to
do it. But what we will not do is allow you to damage Mr Bradley,"
and since 75% of people in this country are like Mr Bradley and
do not smoke then we are going to change the whole of the environment
in the direction of the seventy-5%. So 80% of pubs, 100% of restaurants,
100% of enclosed public spaces, 100% of workplaces other than
licensed premises are going to be protecting Mr Bradley and those
who do not smoke. Now, if you want to exercise your legal right
to damage yourself against our advice there will be a facility
for doing it, and incidentally it means that you do not have to
go home and damage to a greater extent those who live with you
because you cannot smoke outside so you bring drink home. That
is the basis of the legislation that we have passed. Then we say,
however, we are going to have an intense effort, Mr Hinchliffe,
to persuade you not to smoke. So we are going to give you a very
high level of taxation on cigarettes. We are going to give you
packets which tell you the horrible things in graphic pictures
that you are doing to yourself. We are going to give you a helpline
if you want to phone it. We are going to give you constant propaganda
or information which tells you what you are doing to yourself.
We are going to put a lot of money into smoking cessation clinics,
we are going to provide them nicotine-free and we are going to
make sure that the areas in which you smoke are restricted to
three% of the workplaces in this country. Now, that is the twin
combination we are doing. What is the effect of it? I do not know.
I think at present if you look at the figures after a lull in
the nineties we are beginning to have an effect again and we have
dropped now from 27%, or whatever, when I became Secretary of
State (I am not suggesting it is me) to about 25% now. We hope
to get down to 21%, but also to reduce by the same amount (though
to a higher level) manual and working-class smoking. I want it
right across all classes and I can assure you I am as absolutely
committed to reducing the number of smokers in this country as
I can possibly do within what I regard as the environment of a
democratic society, and I think we will be effective in it.
Q57 Chairman: Dr Adshead wanted to come
in briefly.
Dr Adshead: Just to pick up on
the Committee's point, the estimation of what the impact of the
different types of ban would have on the population is contained
in the partial regulatory impact assessment, which we are consulting
on at the moment, and as you have highlighted, it covers not only
mortality, deaths, but it also looks at NHS expenditure, reduced
sickness absence, so a range of factors. You might find that helpful
and we can provide that for you.
Q58 Mr Bradley: Just one final comment
really on this from me, Chairman. The purpose of the White Paper
is always to look at inequalities in health. Will you be mapping
the 20% of outlets which will still have smoking in them to match
that against potential sort of social, economic areas because
there is an argument that you are more likely to have non-food
outlet drinking pubs only in poorer areas because that has been
the pattern and the economic group do not necessarily match, so
that we can see whether there is an inequality impact of not having
all establishments smoke-free?
Dr Reid: I do not think you need
to map that to prove the point that you make. I would accept the
point you make, that you will get in working-class areas more
smokers and more pubs which may be smoking because there are more
smokers in those areas. I myself belief that with growing affluence—it
is the very point made by the Chairman at the beginning and I
think by Dr Naysmith and it was the change of social conditions—I
ultimately believe that people take themselves out of disadvantage
if given the opportunity and a large part of that opportunity
cannot be substituted for by prohibition; not only education but
social advance. So in many of these areas I would argue, and perhaps
I am a minority, that what you need accompanying all of the things
we are talking about in terms of prohibitions, persuasions, and
so on, is social advance and social affluence. I guess if you
tracked the increase of social affluence in a given area with
a graph showing the decline of smoking you would get a pretty
near correlation because I think there is a causal relationship
in it, and the more that people perceive themselves—and
this is the point I made and however controversial it was I stand
by it—as having other enjoyments and opportunities and pleasures,
and so on, the less liable they will be to regard the thing they
are doing which effectively kills them as one of the few remaining
pleasures. Therefore, I accept what you say but I believe that
by setting the target we have set, by putting in the amount of
effort, resources and money that we are putting in—and remember
that an awful lot of this money that we are putting in in public
health has been specifically directed right towards the areas
that you are talking about, Mr Bradley—we hope in those
areas not only will there be smoking cessation services up at
the National Health Service outlets but in the pubs. In places
like Hartlepool, for instance, we are already piloting it and
people are going into the pubs with smoking cessation services
and talking to people, "Have you thought about giving up?
Would you like to give up?" So I can assure you that this
is not a diminished effort that has been put into this, but it
is an effort commensurate as far as we can with people's love
in this country of having the freedom to decide their own lives.
Q59 Chairman: Minister, you wanted to
come in briefly?
Miss Johnson: I just wanted to
say, I think when all of this has been done we must not lose sight
of the fact that whilst we would not want to take legislation
to ban people smoking in their own homes, the biggest health risk
that will remain on second-hand smoke will undoubtedly be people
smoking where there are other family members who do not themselves
smoke, particularly children, and I think we should not lose sight
of that. We will be continuing to run advertising campaigns alerting
parents so that they can minimise that and try and encourage them
to give up, but I would hate us to concentrate on those three%
of the remaining workplaces when I think the messages about health
for families and what steps they can take and the impact on children
in the home is probably one of the most serious things that we
have still to tackle.
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