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Martin Horwood (Cheltenham) (LD): There is an instance of that in my constituency, where one pub is considering redesignating itself as a membership club. Does my hon. Friend agree that one of the perverse results of such a potentially powerful ban is that establishments will market themselves as smoker friendly, thereby undermining much of the health promotion activity in recent years?

Steve Webb: My hon. Friend helpfully illustrates my point. The ban will be easy to circumvent and therefore possibly ineffective.

The issue of unfair competition may appeal to Conservative Members. With a partial ban, which the hon. Member for South Cambridgeshire seems to support, a private membership club can have smoking, but that may not be possible for the pub down the road. If they are the only two establishments in a town, the private membership club has an unfair advantage over the pub, which is covered by different and broader legislation. That is unfair competition. It is neither logical nor fair.

Colin Challen (Morley and Rothwell) (Lab): There is another problem with the partial ban. A disabled person—registered or not; it does not matter—who has a debilitating respiratory disease may feel entitled to use measures in the Disability Discrimination Act 1995 and
 
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take a case against a landlord or licensee who enables smokers to use their premises. The disabled person may feel discriminated against by not being able to use those premises because it could further damage their health. Does the hon. Gentleman agree with that assessment?

Steve Webb: That possibility has been raised in the context of employment rights. Provided that there continue to be smoking pubs, a disabled person who might otherwise be able to work in a smoke-free environment will be effectively debarred from applying for a job in those pubs. The implications for people who have those sorts of disabilities need to be considered.

We touched on health inequalities. There is a danger that we think of the problem as a north-south issue, but even in relatively prosperous areas it is clear that the inequalities in health will be exacerbated by the Bill. My director of public health in south Gloucestershire—a relatively prosperous area—tabulated the pubs that do and do not serve food across the authority. The director found that all the pubs in the most prosperous fifth serve food, but 41 per cent. of the so-called wet pubs are in the poorest fifth of the area. So the partial ban will increase inequalities within areas and between areas, not just across the country as a whole.

Stephen Williams : I draw my hon. Friend's attention to the initiative undertaken recently by Smoke Free Bristol. The city is next to south Gloucestershire. It found that only 12 per cent. of people in the Henleaze ward in my constituency smoke. However, just a quarter of a mile away in the Southmead ward in the constituency of the hon. Member for Bristol, North-West (Dr. Naysmith), smoking is at nearly 50 per cent. Those health inequalities, in a relatively small area, will be perpetuated and expanded if the Bill goes through.

Steve Webb: My hon. Friend is right. For the Government to say that tackling health inequalities is a key priority and then to put in place a measure that will make them worse does not stack up. When they launched the embarrassing statistics in the summer that showed that health inequalities had risen under them, the answer was, "We have these things called spearhead primary care trusts, which deal particularly with deprived areas." When the spearhead PCTs responded to the consultation, they said:

In reflecting on the comment on conflicting targets, we have one bit of the Government setting targets for relatively deprived areas to reduce inequality while another bit of the same Department is making it harder for them to reduce inequality.

We have heard, and the Health Select Committee was advised in its oral evidence, that enforcement is more difficult with a partial ban. Presumably, I will have to go up to the bar and ask the barmaid whether she sells pre-packaged ambient shelf-stable snacks before I can decide whether to light up. That is the criterion. It is absurd to have separate categories. We heard about Ireland, and if the other customers do the enforcement, they need to be clear about the legislation. If a place
 
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serves food at lunchtime but not in the evening, a customer who uses it in the evening is supposed to know that to determine whether he can smoke.

Stephen Williams: I notice that the Minister is trying to be helpful by saying, from a sedentary position, that signs will help people in such circumstances. May I relate my experience as a director of the Watershed Media Centre in Bristol? We tried to ban smoking from a large part of the café bar by, at one time, placing signs on every table. As there is a mix of where people can and cannot smoke, people use the element of doubt to ignore the signs and carry on smoking. Signs are not always the right answer.

Steve Webb: My hon. Friend is right. Essentially, we are partly talking about a cultural shift towards smoke-free workplaces. That message will be hampered by the phased introduction of the Bill and by different rules for different establishments. The picture will be confusing and will not make a clear statement about the rights of the people who work in such environments.

On phasing, there will be confusion if certain establishments have a ban first, if others follow on later and if some are not covered by the legislation. The Secretary of State said that she expects a total ban and that we will get there eventually. We heard that the chief medical officer used the phrase to the Select Committee about states around Europe and beyond falling like dominoes towards a total ban. The Secretary of State said that the people who introduced total bans often did so in stages, but in many cases they realised that it was unworkable to do it partially and got on with it. Why do we have to repeat their mistakes?

The Chairman of the Select Committee, the right hon. Member for Rother Valley, put his finger on it when he said that the Government have not introduced a total ban because they are afraid. They are afraid to lead public opinion and want to follow it. We need a courageous visionary Government, who are willing to take the lead and set an example. I imagine that the full ban will come into effect and, two or three years later, no one will conceive of turning the clock back.

Tim Farron (Westmorland and Lonsdale) (LD): Does my hon. Friend acknowledge the research by groups such as Action on Smoking and Health which recognises that four in five smokers wish that they did not smoke? We are talking largely about liberty and freedom. Many people think that an addiction is an encumbrance on their freedom and would welcome the opportunity to go to work or to a social setting where smoking is not rammed down their throat and temptation is removed.

Steve Webb: My hon. Friend makes an interesting point about the liberty argument, which our party considered. We are primarily concerned with the liberty of those who work in such environments, but where addiction is involved, we may, in many cases, going with the grain. Individuals who want to give up but who have found it difficult might appreciate such a measure. It is not patronising or nannying. It could assist people to do something that they want to do. Perhaps the most appropriate day to introduce the ban is 1 January, although midnight might create operational problems if everyone had to stub out their cigarettes halfway
 
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through the evening. Noon on 1 January might be a better time because it would assist those who want to make a new year's resolution to follow the grain of that decision.

I asked the Secretary of State what she had said to the Cabinet and did not get the straightest of answers. However, we are reliably informed that she pressed for a total ban. If she wants that, then I agree with her. However, it means that her argument that the Labour manifesto said that there would be only a fudgy ban falls down. If she pressed to go beyond that, how did she justify going beyond the terms of the manifesto? She did so because it was right and the best policy to adopt. On smoking, the Westminster Government have got it right, but only for Northern Ireland, where there is a total ban. How, therefore, can they adopt a different approach for England? I can see nothing about the situation in Northern Ireland that would warrant its workers having a different level of protection from those in England.

The Bill deals with other important subjects. On health care-acquired infections, a group of people who had been bereaved by MRSA held a lobby yesterday. That group—MRSA Action UK—presented a petition to Downing street. I think hon. Members on both sides of the House joined them. I laid a wreath with them at Westminster abbey in commemoration of their friends, relatives and loved ones who had died.

One thing that the group is calling for is mandatory national reporting of all health care-acquired infections, which we do not have. The estimate is that only 6 per cent. of all infections have to be reported. That relates to bloodstream MRSA only—not all cases of MRSA have to be reported. I hope that the Minister explains why there is not more mandatory national reporting. The scale of the problem is immense and although we heard reassuring words from the Secretary of State about the progress that is being made, across Europe we have one of the worst rates of Staphylococcus aureus infection. It is about 40 per cent. in the UK—one of the highest in Europe—and the right hon. Lady's reassurances were complacent on that front. Having met relatives of those who have died from MRSA, I urge her to listen carefully to what they say and to take much more serious steps.

I echo the question of the Public Accounts Committee—how can the 80 per cent. or so of infections not covered by the Department's mandatory surveillance programme be measured and managed? If they have not even been reported, how does the Department of Health know what is going on?

We have already heard about things that can be done to tackle infection and about infection control. As for bed occupancy rates, my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) pressed the Secretary of State on what trusts will do if they have two conflicting targets. The answer was "Meet both". I accept that that is the ideal solution, but what if one target conflicts with the other? As the hon. Member for South Cambridgeshire rightly said, what if there is pressure to close a ward because of infection, but that decision is overruled by the trust managers? There is nothing in the Bill to prevent such conflicts, so the Government must make it clear that infection control is a priority.
 
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The right hon. Member for Rother Valley, the Chair of the Health Select Committee, spoke about the Shipman inquiry, and said that the Bill will improve current practices, which we welcome.

The Bill includes some worrying provisions on ophthalmology. All I can say is that if dentistry is the precedent, heaven help us. If access to ophthalmology services is cash-limited and restricted, as Opposition Members have said, many of our constituents will be concerned. The Bill was originally to be called the Health Improvement and Protection Bill. The Government dropped the words "Health Improvement" and "Protection", because this is a missed opportunity to do far more of both.

6.21 pm


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