The Parliamentary Under-Secretary of State for Health (Caroline Flint): We have had a very interesting debate, which very much reflects discussions not only in Cabinet, but among the public, about an issue that commands a range of arguments about personal choice and health. We have heard 25 Back-Bench speeches this evening. That is welcome. I absolutely respect the views of my colleagues who would like to see a total ban. I understand their passion, but I hope that, as I proceed, they will understand what we are trying to achieve with a focused package not just on smoking, but on tackling health inequalities across the piece.
Given the comments by the hon. Members for Westbury (Dr. Murrison) and for South Cambridgeshire (Mr. Lansley), who had some difficulty earlier in describing Conservative party policy, I am still not clear about their policy. [Hon. Members: "What policy?"] Exactlythey raised health inequality issues, but as far as I could see, they would leave such things to self-regulation and they had no immediate plan for any legislation whatsoever. We are going a lot further than that. Given the responses of many Conservative Back Benchersnot just the right hon. Member for Bromley and Chislehurst (Mr. Forth), but many othersit was clear that they were unsure about exactly what the hon. Member for South Cambridgeshire was suggesting.
We are debating the Bill in the context of a national health service that is providing faster treatment, with more nurses and more doctors. Survival rates for more major cancers are improving and more people are surviving heart attacks. If people need a heart operation, they will be treated within three months and usually much sooner. There is more choice about health.
Services such as NHS Direct and walk-in centres are all helping to turn the NHS from being just a service for sickness into a health service that is about prevention. That is why NHS stop smoking services have helped more than 500,000 people to quit and stay quit after four weeks. It is one of the reasons why we are considering how we can support families with a better diet. It is why 2 million children get a free apple, pear or satsuma every day through the school fruit and vegetable scheme. Such measures are part of a health service in its widest possible sense and, having succeeded in making progress in all those areas, the Bill will tackle issues surrounding patient safety, primary care and public health.
Let me deal first with issues that hon. Members have raised about measures in the Bill outside those on smoking. My hon. Friend the Member for Lewisham, Deptford (Joan Ruddock) and others talked about MRSA. I am pleased to hear that the rates are going down at Lewisham hospital. She made a good point about testing because many people who arrive at
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hospital are already infected. She also mentioned care homes and the co-operation of visitors, which will be important if we are to deal with MRSA rates. There is still a lot of work in progress. We are in discussion with the Healthcare Commission about how to make the code stronger, even though consultation indicated that the content was thorough. Another draft will be available before the Bill is passedit should be available early in 2006.
Hon. Members talked about the choice between controlling infections and closing wards. Decisions on ward closures are made locally. There must be a balance between the risk of patient infection and risks associated with clinical delivery. However, not closing wards could prevent the control of outbreaks, and thus be more of a risk to meeting other targets. The situation is not clear-cut.
My hon. Friend the Member for Lewisham, Deptford and the hon. Member for South Cambridgeshire asked about the private sector. We propose to consult on proposals next spring on, among other things, introducing provisions of the new code to regulations under the Care Standards Act 2000. There will also be a consideration of issues surrounding care homes and the voluntary sector.
My hon. Friend the Member for Thurrock (Andrew Mackinlay) asked about death certificates. They will be completed by doctors. It is doctors' responsibility to identify the underlying cause of death. However, patients with MRSA who die are often already seriously ill with other conditions, so it is sometimes difficult to identify that cause. However, the situation regarding death certificates is being examined.
Several questions were asked about ophthalmic services. The review is examining what scope there is to make greater use of the primary care sector when delivering such services and how to make the best use of available skills in primary care. My hon. Friend the Member for Stafford (Mr. Kidney) set out exactly the sort of services that are being provided in some areas. Such services could be provided further. There is no immediate change to the payment to practitioners and no change for patients. There will still be a central budget for reimbursement for local sight tests. I do not think that there will be any impact on rural areas. In reply to my hon. Friend the Member for Cardiff, North (Julie Morgan), the provisions will not impact on Wales.
My hon. Friend the Member for Dartford (Dr. Stoate) made a point about clause 18 and controlled drugs. We have held discussions with the Royal Pharmaceutical Society. There is already the power of entry into community pharmacies, but we can consider setting out in regulations other specific persons who could enter and inspect relevant organisations. The pharmacy provisions are all about bringing services closer to people. Our "Your health, your care, your say" consultation showed how much people valued their pharmacists and the health care that they provide.
On smoking, I say this from the outset. Several hon. Members talked about young people, especially teenage girls. I am pleased to inform the House that the prevalence of smoking among teenage girls has gone down. In 1996, 13 per cent. of 11 to 15-year-olds smoked, but the figure had gone down to 9 per cent. by
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2004. The figure for all women between the ages of 16 and 19 in Great Britain went down from 31 per cent. in 2001 to 25 per cent. in 2003. That is to be welcomed.
My hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) and I have had several discussions about raising the age at which people may smoke, and I am considering the matter. We need to examine some of the evidence that he presented to the House when he introduced his Bill.
"This Bill will be a big step forwards for public health. If passed into law, it will save thousands of lives every year, as vulnerable people are no longer exposed to dangerous second-hand smoke at work, and as thousands of smokers are encouraged to cut down or quit altogether."
"If self-regulation is no longer possible for the licensed trade industry, then legislation that offers both licensees and pub customers some degree of choice is certainly the next best thing. Although we acknowledge that the proposed non-food/food split will present some landlords with difficult decisions, nonetheless we feel that the distinction is relatively straightforward and workable as well as preserving some degree of choice."
The measures are a huge step forward. They will make enclosed workplaces covering more than 99 per cent. of the work force completely smoke-free. They will give choice to many millions of people in England. The number of smokers in England has fallen by 1.2 million since 1998. That is because of the considerable work done by the Government to tackle not only NHS services, but tobacco control, advertising and so forth.
Many hon. Members commented on the consultation. It is important to remember where the policy started. We consulted widely on "Choosing Health: making healthier choices easier", the most significant public health White Paper for generations. We learned that both smokers and non-smokers overwhelmingly wanted us to restrict smoking in public places, but the support was not as high for a total ban. Although support for that has increased, as my right hon. Friend the Member for Rother Valley (Mr. Barron) said, figures for the latest survey show that 31 per cent. of the public support it. There was, however, considerable support for banning smoking in places where there is food and in restaurants. We have had to grapple with the problem of reconciling health issues with what the public want in order to decide how to move forward.
Public opinion is important. It is not about popularity, but about taking the public with us. Several hon. Members talked about enforcement. That is important, but one reason why we know that voluntary bans, which we have seen for many years on transport, in restaurants and in other public places, have succeeded is because the publicsmokers and non-smokers alikesupported them. That is why enforcement of the proposalsthey are radical and far-reaching, but they have the support of the publicwill be light touch.
Many countries decided to have exemptions in the first instance, especially in the hospitality sector. It is not a case of simply jumping ahead. They did that for the very reason that they could command public support
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and take the public with them. That is why we have chosen to do the same thing. That goes for California, New York, Norway and practically every country in the European Union.
Let us not forget that Ireland also has exemptions. In response to hon. Members who mentioned Northern Ireland, I acknowledge that there was a consultation, but I have yet to see a public survey based on those conducted by the Government and ASH, through MORI and other companies, in which the public were directly asked for their views. [Interruption.] That was its choice.
We are working to tackle the things that affect health, in particular health inequalities. The biggest determinant of health outcomes is poverty. If I believed that a total smoking ban would affect the problems that I have seen in my constituency, in my life and as Minister with responsibility for public health, I would sign up to it tomorrow, but it is not as easy as that. We know that smoking takes place in the home. We know that people are affected by many other things that have an impact on their health inequalities. We have a package that will take us far further forward in reducing health inequalities and that shows that we are willing to act in an important area.