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Julie Morgan (Cardiff, North) (Lab): Thank you very much, Madam Deputy Speaker, for calling me to speak in the debate on the Second Reading of this very important Bill, which will improve the well-being and health of women, men and children in the UK. I want briefly to concentrate on two aspects of the Bill: smoking in public places and the proposals for the ophthalmology service.
I was fortunate enough to be drawn fourth in the ballot for private Members' Bills in the last Session of the previous Parliament. In fact, I think that mine was
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the last Bill to be debated on Second Reading before the general election was called. The title of my Bill was Smoking in Public Places (Wales), and I was aided in proposing it by my right hon. Friend the Member for Rother Valley (Mr. Barron), who is Chairman of the Select Committee on Health, and my hon. Friend the Member for Conwy (Mrs. Williams), who is not in the Chamber. The purpose of my Bill was to call on the Westminster Government to enable the National Assembly for Wales to make its own decision about any smoking restriction that would apply in Wales. I am very pleased indeed that that is proposed in the Bill. Under part 1, decisions about smoking in Wales will be delegated to the Assembly, which will be able to determine its own restrictions, so I warmly welcome that delegation of power to the Assembly.
The Welsh Assembly has a long-standing commitment to ban smoking in workplaces and public places. It first debated and voted on the subject almost four years ago, when the Culture Minister in Wales, Alan Pugh, AM, proposed that
"the National Assembly for Wales . . . calls upon the UK Government to bring forward a public Bill relating to Wales which would provide that the Assembly could . . . prohibit all smoking with tobacco in . . . public buildings . . . The purpose and effect of any such Bill . . . would be to reduce the exposure of employees and members of the public to the well-documented and proven life-threatening dangers caused by environmental tobacco smoke".
The motion was passed by 39 votes to 10 and received the support of all parties. Four years later, we are enacting such a Bill.
Subsequent to that vote, and after the introduction of private Members' Bills in the other place by Baroness Finlay, a well-known palliative care consultant in Cardiff, and Lord Faulkner, who has already been mentioned, the Assembly set up the Committee on Smoking in Public Places, which was chaired by the Swansea, East Assembly Member, Val Lloyd. The purpose of the Committee was to examine developments in Ireland and other countries in which a ban had been enacted and to look at the debate in the UK. The Committee reported in May and the Assembly debated its report on 25 May. A motion in support of the report was carried by 40 votes to nine. I thus have absolute confidence that smoking will be banned in all public places and workplaces in Wales after consultation and an introductory period. I am pleased that that will be able to happen as a result of the Bill.
The Committee asked for powers to introduce a Bill to ban smoking in all enclosed workplaces and public places within two to three years. It recommended several exceptions, some of which have been mentioned today, such as
"private dwellings, which may also be a place of work; . . . designated areas in long-stay hospital units . . . residential and nursing homes . . . prisons"
That is what happens in Ireland. I am glad that Wales will be able to go its own way on smoking.
I hope that the Government will rethink their proposals for a partial ban in England. There is overwhelming evidence in support of a total ban and the weight of opinion is in favour of that. The Government
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have a unique opportunity to use the Bill to help to prevent some of the misery that is inflicted by smoking. Why wait? I know that my right hon. Friend the Secretary of State has said that most countries have progressed to a complete ban by stages, starting with a partial ban. However, we have the experience of those countries behind us. Why do we have to wait until more people die because of smoking-related illnesses that could have been avoided? We also know about the example of Ireland, which I visited a year ago with the all-party group on smoking and health. In Ireland, we have a near neighbour that had the vision to move ahead with a complete ban. The Government want to be bold and radical, so this is their opportunity to move ahead with a complete ban.
As other hon. Members have said, the hospitality industry wants a level playing field with no exemptions. The protection for people who work in pubs in which a ban will not be in place will obviously not be the same as that for people who work in places in which there is a ban. There is a suggestion that smoking will be banned in the bar areas of pubs in which food is not served, but it is impossible to draw a line around a bar across which smoke may not pass. The proposal is unworkable.
The Bill, as it stands, will not protect the health of all bar staff. Such a disparity cannot be fair. A partial ban would cause smokers to move from pubs to clubs and some pubs will stop serving food. The hospitality industry says that the proposal is unworkable. I think of city centre pubs in which no food is served and to which lots of young people go. Those young people are the ones who will continue to be exposed to cigarette smoke under the present proposals. I am sure that that is not what my right hon. Friend the Secretary of State wants.
Hon. Members have mentioned health inequalities. The health arguments for a complete ban are overwhelming. The fact that Liam Donaldson told the Health Committee that he considered resigning when his advice was not accepted is overwhelming evidence that the Government should not go ahead with their present plans.
My first job was in Sully hospital, a heart and chest hospital in the Vale of Glamorgan, south Wales. Many people coughed their lives away in those wards and I clearly remember their painful deaths. We cannot stop people smoking—indeed, one could say that they have the right to do so—but we can stop them inflicting their smoke on other people so that in public places, at least, people will not have to breathe other people's smoke.
The debate and public opinion has moved ahead rapidly. What would have been inconceivable five years ago is now, I think, totally acceptable. The Government have to move too, so I urge them to reconsider and, at the very least, allow Labour Members a free vote on the issue.
On optometry, I visited a community optometrist and a representative of the community optometric committee, at his request, in Pontprennau in my constituency last week. He wanted me to mention the concern felt by opticians and ophthalmologists in Wales about the proposals. They will not affect Welsh practitioners as things stand, but he was concerned about devolving the budget to primary care trusts. The opticians think that that will inevitably be capped and
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allow the PCT to select the people with whom they wish to contract. They fear that that could lead to a restricted service to patients.
Huge progress has been made in ophthalmology in Wales. Optometric practitioners can refer eye patients directly to consultants and surgeons in the hospital without going via the GP. They fear that the progress will be affected by the proposals if they go ahead in England. I ask the Minister to consider the implications of those on ophthalmology and to reconsider the proposals on smoking.
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Dr. Richard Taylor (Wyre Forest) (Ind): I have to admit that I am one of those described by the hon. Member for Sunderland, North (Bill Etherington) as a zealot in favour of the total ban. I am in good company because I join the right hon. Members for Holborn and St. Pancras (Frank Dobson), for Rother Valley (Mr. Barron) and for North-West Hampshire (Sir George Young), and other right hon. and hon. Members.
We must face up to the fact that the reason for a ban on smoking in public places is to protect the health of all workers. All workers have equal rights to a healthy environment. That is the answer to Ministers who claim that, because we are protecting 99 per cent. of workers, we are doing all right. The problem is that the 1 per cent. we are not protecting work in the most smoke-filled environments. People do not go to work in a factory or a shop to smoke, but many of them go to the pub to smoke. It is the 1 per cent. who are not protected who are the most worthy of protection.
The Health Committee had to face the libertarian argument. A reader in biomedical ethics at Imperial college was asked, "How do we defend the fact that we are attacking people's liberty?" He said:
"It is a simple idea, first set out most clearly by John Stuart Mill in the mid-19th century, the idea that the main way in which you can justify restricting someone's liberty is where they are causing harm to others."
Much as I object to restricting people's liberty, if it causes demonstrable harm to others, it is justified.
In relation to the trip to Dublin, I want to add some figures to facts that were mentioned by other hon. Members. Support for the total smoking ban in Dublin before it was introduced was 67 per cent., which included 40 per cent. of smokers. Within a year after its introduction, 93 per cent. said it was a good idea, 80 per cent. of whom were smokers. A total ban can be popular. Compliance is high. It is easily understood and enforceable, and it is now a pleasure to go into pubs in Dublin.
The arguments against the partial ban have been mentioned at length. They include the worsening health inequalities and the fact that it is illogical and unenforceable. The people who impressed me in the Health Committee were representatives of the Bingo Association. We all have a lot of little old ladies in our constituencies whose only outing in the week is to go to the bingo hall. They probably smoke and drink while playing bingo. However, the Bingo Association wants a level playing field. Without a level playing field, bingo
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would move to other places such as pubs that do not serve food and where smoking is allowed, which would be quite wrong.
On our visit to Dublin, members of the Health Committee met a chest physician, Professor Luke Clancy, who reminded us of the effect of the Clean Air Act 1956 on London. I was a senior house officer at St. Stephen's hospital when that Act was enforced piecemeal by different local authorities. Professor Clancy reminded us that it took a decade effectively to lower levels of smog and produce health benefits. Ireland has adopted a big bang approach to a ban, which has worked, and it is the only way forward for us.
I shall take a leaf out of the book of the hon. Member for Southend, West (Mr. Amess) and look at other equally important parts of the Bill. I am glad that the Government are going to issue a code of practice with related sanctions on the prevention and control of health care-associated infections. I welcome the Secretary of State's comments that the code will be based on existing good practice and that waiting list targets will not compete with infection control. However, there are some points that must be included in that code. Yesterday, with the right hon. Member for Rother Valley, who chairs the Health Committee, we met members of MRSA Action UK and MRSA Support, who expressed vitriolic anger about the lack of communication. One of my criticisms of the health service, particularly hospitals, is that communication between staff—nurses and doctors—and patients, is sadly lacking, possibly as a result of overwork. Members of those groups had relatives who had died of MRSA, but they had not been told that that was the cause of death. One of them alleged that they had received an unacceptable death certificate that just said, "Multi-organ failure due to sepsis." In my day, no registrar would accept such a certificate, because one had to say what had caused the sepsis.
Openness with the patient and the family is therefore needed, and to help with that, it may be necessary to formalise notification of those illnesses and make it mandatory. The list of notifiable diseases is under review, but diseases such as smallpox which, hopefully, has been eradicated, are still included. Hepatitis C and Legionnaire's disease are not on the list, and hospital-acquired infections and bugs, including MRSA and Clostridium difficile, which are serious pests, have never been included. There is an MRSA surveillance scheme, but it is not tough enough, so will the Minister consider introducing formal notification of those illnesses? If that is too cumbersome and slow, can another method be used?
As for the code of practice, most hospitals, if not all, have infection control teams, many of which follow protocols. During a previous Health Committee inquiry, our attention was drawn to the formulary used by University College hospital in London. Page 280 of the 2002 edition includes protocols for the eradication of staphylococcal infection and refers to protocols for the management of patients and staff with MRSA. I hope that such publications will inform the code of practice. The Healthcare Commission prepared a submission for our debate, which says:
"It will be vital that the code of practice is fully workable in practice and the Healthcare Commission urges that due time, consideration and consultation be taken over its content."
Part 3 deals with drugs, medicines and pharmacies. There is no place for lax management of controlled drugs. When I was a house physician a quarter of a mile from here at old Westminster hospital, the control of scheduled drugs was lax. Much has happened since then, and controls must be tightened up. However, pharmacists have considerable worries about the Bill, as the hon. Member for Romsey (Sandra Gidley) will know. I hope that in Committee those worries will be taken on in detail. Pharmacists do not know in detail the supervision requirements. How many pharmacies will one pharmacist be able to supervise? They are worried that the Bill may exacerbate the shortage of pharmacists.
To conclude, there are good parts and bad parts in the Bill. Returning to the subject of smoking, at the large cancer conference last week, an oncologist from Glasgow, who is very lucky to have the complete ban, said loud and clear that the one most important thing to improve the prevention of cancer was the total ban. Everything else, he said, was lip service.
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