Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 40-59)

23 FEBRUARY 2005


  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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