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Mr. Joyce: My hon. Friend mentioned in passing the question of displacement, but she did not give it sufficient attention. If we are to measure the effect on health of a complete ban on smoking, we must also take into account the effect that such a ban would have on displacing smoking into the home. Some people will be discouraged from going to pubs and clubs and will therefore smoke and drink more at home. Should not that be taken into account when we consider the effects of this legislation?
My hon. Friend is correct to say that that matter should be taken into account. However, the evidence shows that stopping smoking in public places does not increase smoking in the home. Indeed, it encourages people to stop smoking, wherever they are. On those grounds alone, we should encourage the Government to drop these exemptions. I hope that, during our deliberations on the Bill in Committee, the Government will reconsider the whole question of
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exemptions. They should consider their workability and inequity, and I hope that they will decide not to introduce exemptions that will increase health inequalities. I hope that that will apply across the whole country. If the Government cannot do thatI hope that that will not be the caseperhaps they will look carefully at the example that is being set in Liverpool.
This is not the first time that Liverpool will have set an example in relation to public health. Indeed, the first public health legislation to be introduced related to Liverpool. The very first medical officer of health was appointed there in 1848, and that initiative was then copied throughout the rest of the country to very good effect. So Liverpool has a record of setting a good example, specifically in the field of public health, and Smoke-Free Liverpool is a current example of Liverpool leading the way.
The Government have spoken a great deal about the importance of devolution when asked why a complete ban will not be introduced in England when smoking is to be banned in enclosed public places and workplaces in Scotland, Wales and Northern Ireland. We might not have devolution for the north-west of EnglandI wish we didbut would the Government consider running a pilot scheme in the city of Liverpool, which has, after all, introduced its own private Bill for a smoke-free city?
Mrs. Jacqui Lait (Beckenham) (Con): All my life, I have been chary of having good done unto me, and I am afraid that I put the part of the Bill that relates to smoking into that category. That part of the Bill is all that we appear to be talking about tonight. I have always been uneasy about a nanny state. I loathe smokingI have never smokedyet I am having to come to terms with an attempt to stop people doing something that they have every right to do. The hon. Member for Derby, North (Mr. Laxton) made a much better speech in favour of the partial ban than the Secretary of State, who did not do at all well in persuading anyone of its merits. Indeed, apart from the hon. Gentleman's rather good speech in support of her argument, most of the contributions from Labour Members will, ironically, probably give her a headache. Unfortunately, she is no longer here to listen to the sad tales that are being told.
I do not want to talk about smoking; I want to move on to a subject that has not been explored in great enough detail. An optician in my constituency has explained to me the problems that that profession fears will result from the Bill. The Bill, rather than a public health Bill, seems to be a rag-bag of ideas that the Department has been trying to get off its chest for many years. This is probably the first legislative slot that it has had in which to achieve that.
On the August bank holiday, the Government announced a review of the general ophthalmic service. Usually, when a Government sneak out such an announcement, it comes under the category of burying bad news. I understand from members of the profession that subsequently there has been absolutely no information on how the review is to be conducted, who is to conduct and chair it, who is to be invited to give evidence, what the time scale will be, whether it is to be an independent review, and when the outcome can be expected.
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At the same time, the Bill is trying to change the terms of practice for a profession that is probably unique in the health service in that it has no waiting lists at all. Anyone who wants an eye appointment with a fully qualified eye specialist can get one at their convenience. If anyone can think of any other part of the national health service where that holds true, I would be interested to know what it is, because I cannot think of one.
Dr. Stoate : To answer the hon. Lady's question, another part of the health service in which a person can get an appointment there and then is with a community pharmacist. Such pharmacists are front-line providers of extremely high-quality services, and the new pharmacy contract has enabled them to extend their range of services far wider than ever before. I know of no one who had to wait to see their community pharmacistand they are often open for extended hours and at weekends.
We can make an appointment with an optometrist to get a full eye test using the most modern technology, and such tests are provided free for certain categories of people. The review of the general ophthalmic service is talking about ensuring that the service remains non-cash-limited, and that any properly qualified practitioner can continue to practise. Meanwhile, the Bill is proposing that the primary care trusts should take over the management of the general ophthalmic service. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) made the point very clearly that, because the PCTs are cash-strapped, it is likely that budgets that are now non-cash-limited will become cash-limited and that the PCTs will restrict the number of practitioners and transfer the money to other parts of the service that they provide.
It would be useful if the Minister could put on record the details, timing and process of the review, so that those who are interested can give evidence. Will she guarantee that the GOS will continue not to be cash-limited, and that the PCTs will not in any circumstances restrict access to the wide variety of optical services that are currently available? If she can do that, this part of the Bill will be acceptable. If she cannot, I fear that many people in the profession will find it exceedingly difficult to live with the proposals in the Bill.
Joan Ruddock (Lewisham, Deptford) (Lab): I welcome the Bill. My constituency suffers from grave multi-deprivation, and in the most deprived wards life expectancy is five to six years lower than the national averageso anything that we can do to bring about health improvements is extremely welcome.
In my experience, it is extremely difficult. A hospital can have floors so clean that one can eat off them and still have MRSA. There is a huge need to introduce a new raft of measures, many of which are being pioneered at Lewisham hospital as part of a campaign waged by the Deptford Action Group for the Elderly led by Harry Heyward, me and others to get MRSA rates down. I am delighted to say that rates are now going down. We need to take account of the fact that one in 10 people are found to be already infected in hospital pre-entry testing, and of those who are infected, 40 per cent. come from nursing homes.
The wide range of measures that the hospital has introduced require a constant battlea battle to keep infection control regimes in place, maintain the vigilance of health care staff and get the co-operation of visitors. I therefore very much support the proposal for a statutory code of practice and its associated protocols. I am also pleased to note that while the Bill does not cover care homes, the Government have expressed their intention to apply similar measures to cover such bodies.
My welcome for part 1 of the Bill, however, is not as enthusiastic. When I was growing up in south Wales, I did not know anyone who did not smoke. I started smoking at the age of 14. Fortunately, I did not get addicted, and when I learned the health messages I gave up, as did the rest of my family, with the exception of my father. He was a man who worked in a factory but came home every day to his garden. He got plenty of exercise, was never overweight and had the most healthy diet, having grown his own fruit and vegetables. He died when he was just a few years older than I am today, of an entirely preventable smoking-related disease.
Today, thousands of my constituents face the same chronic illnesses and eventual premature death as a result of their smoking habit. Twenty-seven per cent. of the people of Lewisham smokethankfully, it is no longer the majority that it was in the borough as a whole. As we have heard from others, the incidence is higher in the most deprived communities. Alarmingly, the highest incidence of smoking in my population is among those between the ages of 16 and 34. Interestingly, twice as many white people as black people smoke, and substantially more women smoke. As is the case everywhere, more manual workers smoke. My primary care trust has made huge efforts on smoking cessation and will continue to do so. It can deal with but a few thousand people each year, however, and the problem is so much greater than that. That is why it supports a complete ban on smoking in workplaces.
The toll of deaths from entirely preventable smoking-related disease is a scandal. In London as a whole, there are more than 10,000 such deaths each yearthat is one death every hour in this city, and 120 hospital admissions every day, at a cost of £105 million to the NHS per annum. As others have said, we have known of the hazards of smoking for a very long time. It is gratifying that the majority of smokers now want to give up because of those messages.
Our willingness to protect others from the effects of second-hand smoking has been much slower to gain public approval. When I entered the House in 1987, at the first meeting with the Whipswho were less kind, of course, than the Whips todayI asked whether it would be possible to have a non-smoking office. They looked
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at me askance and said that I would be jolly luckythey did not use those words exactlyto get an office at all. A decade later, one of my colleagues, Anne Campbell, who was suffering from asthma, was heard to protest one day that we should not have smoking in our dining rooms. She attracted a huge amount of hostility. Many of us have had to fight hard to introduce the sensible and basic no smoking measures that we have in this place today. How much more difficult will it be in those areas where establishments are supposed to be non-food bars, bars that serve a bit of food, bars without smoke around the bar, or bars with a bit of smoke at the back of the room? It will be extremely difficult, and the Bill as drafted is unworkable.
One of the most telling statistics that many of us have received came in a briefing from the Trades Union Congress, which compared the 235 deaths at work from accidents with the estimated 700 deaths of non-smokers from second-hand smoking. In the case of accidents, the first thing that we ask is, "Could this accident have been prevented?" Well, smoking can be prevented. The second question that we usually ask is, "Was the employer negligent?" It is my view that, in future, any employer who exposes his or her workers to second-hand smoking will indeed be negligent.
My right hon. Friend the Secretary of State stressed the limited nature of the exemptions in the Bill. She also stated her passion for legislating for public health. Therein lies a contradiction. We cannot legislate to protect the majority of people and choose not to protect a minority, however small. We will also ill serve those customers who might wish to be protected in continuing to go to the non-food pub that is their local and that they would like to use in the same way as everyone else. As local consultations and other hon. Members have indicated, it is also clear that a proportion of those pubs that currently serve minimal food will cease to do so in future and become smoking pubs. We want them to keep offering food, not to give it up, because giving it up will exacerbate the difficulties that we have with our drinking culture.
For all those reasons, I and many Members will seek every opportunity to remove exemptions for licensed premises and private clubs from the Bill, and to establish a total ban that will protect all employees and the public at large and further encourage the many people of this country who are seeking to give up smoking.
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