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Lynne Jones: On prisons, care homes and other places where people might reside involuntarily, the Bill provides for an exemption of such facilities from the ban. I accept that a total ban might not be in the best interests of prison officers, carers or residents, but does the hon. Gentleman accept that people who are in prisons or care homes, who might have mental health problems or learning difficulties, are among the most disadvantaged, and might also smoke heavily due to the regime that they are under and the boredom factor? What proposals has he to deal with those health inequalities?

Mr. Lansley: I am grateful to the hon. Lady, and she got the chance to make the point that she would have made to the Secretary of State. She will know that the Bill allows for the possibility of such exemptions, although, as on many other matters, it does not say what kind of exemptions the Government propose in respect of care homes, prisons or mental health institutions. Clearly, in many such instances, it will be necessary to construct a regime that protects staff as best one can while avoiding harm to inmates. If one were simply to introduce a smoking ban in mental health institutions tomorrow, for example, serious risk would be posed to some of the care and clinical plans for some of the people inside them.

Mrs. Jacqui Lait (Beckenham) (Con): My point is supplementary to what my hon. Friend said about mental health institutions. As he suggested, the damage to the health of people in such institutions would be
 
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great. Does he know whether the Government have made any provision for increased spending on mental health to try to repair that damage?

Mr. Lansley: I do not know of any specific allocation by the Government. I only know that, in South Cambridgeshire, a significant reduction in mental health resources is expected, and I imagine that that is reflected elsewhere. If my hon. Friend will forgive me, however, I will not proceed down that path.

The debate in which we have engaged during the past few minutes illustrates the difficulty. Even if the Government proposed a comprehensive smoking ban, it would be necessary to explore in detail how it would be applied in specific circumstances. I do not pretend that that would be easy, but we should at least be clear about the objective, which is to enable people to live in smoke-free environments and, wherever possible, to create such environments in order to reduce the prevalence of smoking.

Where does the issue of food come into the debate? I asked the Secretary of State that question, but I am afraid she did not reply. When the Scientific Committee on Tobacco and Health published its otherwise admirable report to the Government and the chief medical officer—it appeared alongside the public health White Paper in November last year—it was clearly deficient in not mentioning the instrumental relationship, in health terms, between the consumption of food and exposure to second-hand smoke. That must surely have motivated the Government's conclusion that second-hand smoke was dangerous where food was being prepared, but where no food—or only shelf staples and pre-packaged food—was being consumed, it was not dangerous at all.

What will be the consequences of the structure that the Government propose for future regulations? In September, the British Medical Journal published the report of a survey conducted in Telford and Wrekin. I do not think that my hon. Friend the Member for The Wrekin (Mark Pritchard) is here. I should have told him that I was going to mention this—I apologise. The survey covered pubs, and all licensed premises, in the borough. Those who conducted it tried to work out what proportion of premises would be exempt, and concluded—on the basis of what they found in Telford and Wrekin—that two thirds of English pubs in deprived areas would be exempt, whereas only a quarter would be exempt in affluent areas. Action on Smoking and Health has made not dissimilar observations; if anything, it has slightly underestimated the proportion of pubs in deprived areas that will continue to be exempt. The survey of all licensed premises, including members' clubs, found that two fifths of establishments in affluent areas and four fifths in deprived areas would be exempt.

Can the Government really imagine that their proposals will result in anything other than a worsening of health inequalities? I am not arguing that the prevalence of smoking would not be somewhat reduced, but we should not exaggerate that. Last year's report to the chief medical officer on smoking in workplaces revealed that there was no smoking in 50 per cent. of workplaces, in 36 per cent. smoking took place only in designated areas and in 5 per cent. people worked alone rather than with others, so only 9 per cent. of people at
 
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work would be exposed to second-hand smoke if they did not wish to be. However, the Government's proposal to discriminate between premises on the basis of whether food is prepared and served clearly drives to the issue of health inequalities. It means that health inequalities will widen, when inequalities in health and mortality expectations between the most affluent and the most deprived areas have widened already.

Steve Webb : I follow the hon. Gentleman's logic about health inequalities being exacerbated by the Government's approach, but does that not also apply to his own desire to keep the exemption for private members' clubs? Are they not too concentrated in less privileged places?

Mr. Lansley: Yes, I am not disputing that. There is a balance to be struck between continuing to give smokers the right to choose and protecting everybody else from smoke. I have never pretended otherwise. However, I do not understand where the distinction in relation to food has come from. It will entrench smoking in many clubs and pubs in deprived areas, with no expectation of that ever changing. The Secretary of State said that things would improve over time, but what pressures will there be? When we enact legislation we introduce hard and fast distinctions, and I suspect that this will be one of those.

Andrew Mackinlay : I would like to clear up some confusion in my understanding of the positions of those on both Front Benches with regard to private clubs. As I understand it, both the Opposition spokesman and the Secretary of State are saying that even in private clubs, people will not be able to smoke at the bar because of the duty of care to employees. But what about another point, which the hon. Member for South Cambridgeshire (Mr. Lansley) has already raised? What about the duty of care to children in clubs in working-class places? If there is a duty of care to one category of people—staff—surely there is a duty of care to children in private clubs. I thought that the hon. Gentleman was with me on that subject.

Mr. Lansley: Actually, I am with the hon. Gentleman. I said that we had three objectives, the first of which was that non-smokers should not be exposed to second-hand smoke. The second applies wherever children are present, so if a private members' club wants to admit children, it should have to choose whether to do that or whether to allow second-hand smoke. It should not be able to do both. I want to speak about other aspects of the Bill as well as smoking, so I shall finish talking about this issue now.

The Government know perfectly well not only that there is no evidence to support their supposition, but that 90 per cent. of the 57,000 responses to the consultation opposed their partial ban and wanted something more comprehensive, in many cases, or something more voluntary, in other cases. People on both sides of the argument regard the Government's proposal as the worst outcome. Astonishingly, when appearing before the Health Committee last week, even the chief medical officer made it clear that in terms of health inequalities this is the worst outcome—worse than no ban at all.

David Taylor rose—
 
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Mr. Lansley: This is the last time that I will give way on the subject of smoking.

David Taylor: Will the hon. Gentleman clarify something for the House and extend his earlier comments? It is true that more than 90 per cent. of the 57,000 responses were hostile to the proposed exemption—but he should have gone on to say that those people supported a simple, comprehensive, workable and enforceable ban.

Mr. Lansley: I thought that I did go on to say that most people said that, although some who opposed the Government's proposal wanted a more voluntary approach. However, that is not the point. The point is that people on both sides of the argument do not see any merit in the Government's proposals.

It is for that reason, and considering the range of views in the House, that my right hon. and hon. Friends have agreed to have a free vote on this issue. This is a genuine issue of judgment, which Members of Parliament are perfectly capable of dealing with, and it is not proper to use whipping to try to constrain people to exercise their judgment contrary to their conscience. The official Opposition will have a free vote, and I hope that the Secretary of State will take the opportunity to say that she has thought hard and concluded that there should be a free vote on the Government side as well. [Interruption.] Apparently not.

I now come to the other measures in the Bill. On infection control—a curious theme appears to be emerging—the chief medical officer told Ministers in October 2004 that they should act, through legislation, to provide additional statutory backing. It was not that the Government did not already have the powers, as the Health and Social Care (Community Health and Standards) Act 2003 more or less gives Ministers the power to set standards and it is possible to proceed in a similar way with respect to standards in the codes of practice. In 2004, however, the CMO said that we needed additional focus then, but Ministers did nothing about it that year. I cannot blame the Secretary of State for that as she did not hold her present position then, but action could have been taken earlier.

Many things might have been done earlier. The story of MRSA and infection control over the past few years has been one of continuous failure to take the urgent action that is required. I shall provide just one example. The Secretary of State is fond of making a comparison between food hygiene legislation and the responsibilities that should be met in the NHS. The CMO, in "Winning Ways", published in December 2003, said:

"The new Inspector of Microbiology and the National Patient Safety Agency will work jointly to ensure that the techniques of 'root cause analysis' and the methodology of Hazard Analysis and Critical Control Point . . . are developed for healthcare associated infection and applied in every local NHS organisation."

That is a direct transfer of experience from food hygiene legislation into infection control. I have searched for any   evidence to demonstrate that the inspector of microbiology at the NPSA has acted on that or that it is being applied in any local NHS organisation, but I simply have not found it.

When the Secretary of State arrived in office after the election, she discovered that there was a big difference between food hygiene legislation and what went on in
 
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the NHS. Anyone could have told her that and anyone could have told her that things could have been done about it. We know that some measures will make a difference: hand hygiene, isolation facilities, clear lines of management accountability, pre-admission screening before operations, post-discharge surveillance after operations, accurate reporting of infection data by clinical departments, optimum bed occupancy—the Secretary of State appeared not to know that the number of beds in the NHS was reducing—24/7 access to high standards of cleaning and expert infection control teams. We know that all those things work, but we also know that, in too many cases, those measures are not being taken.

The Government say that they will bring in a code of practice, so let us look at the draft code to see whether any of those actions that will make a difference are reflected in it. There is no requirement for one board member to have responsibility for infection control and cleanliness. There is no requirement for the standards of cleaning to be in line with the model cleaning contract. There is no requirement for access to 24/7 cleaning on wards. There is no quantitative measure for the availability of isolation facilities. There is no specific requirement for the number of infection control nurses. There is no specific requirement for pre-admission screening before operations. There is no reference at all to post-discharge surveillance. There is no requirement to reduce excessive bed occupancy rates, although we know that there is a strong correlation between that factor and infection rates. There is no requirement for the comprehensive recording and reporting of infections in the terms recommended by the National Audit Office report of more than five years ago.

Although it has many other elements that are laudable in themselves, the code is not actually about outcomes or enforcing actions that we know will have effect. It is actually about processes and policies. Time and again, we have seen what the Government approach to infection control amounts to—a tick box to say that the policies are in place or that the appropriate processes are being undertaken, but too little emphasis on the actions that will make a difference. Patients have a right to know that action that has been demonstrated to work is being actively pursued within the NHS.

We need to know—I note that the Secretary of State refused to answer a question on this matter—that targets and financial pressures will not lead to the compromising of patient safety. We must be sure that the NHS is putting infection control at the forefront of its priorities because all the evidence now shows that that is at the forefront of the public's priorities. If it is to deliver, the draft code must be made stronger. The Government's draft code will not survive. At the moment, the Government propose not to supply us with the final code of practice, which would facilitate debate as the Bill passes through Parliament, but to delay it until after the Bill has been passed. That, frankly, is unacceptable to the House.

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