Select Committee on Health First Report

Conclusions and recommendations

1.  We are convinced by the evidence of experts, including the Chief Medical Officer, the Royal College of Physicians, SCOTH, the US Surgeon General and the World Health Organisation, that secondhand smoke is a serious and preventable cause of death and ill-health. (Paragraph 24)

2.  We are not convinced that ventilation offers a practical means of reducing SHS to safe levels. The scientific evidence is clear that there is no safe level of SHS. The expert evidence we have heard suggests that at best ventilation can only dilute or partially displace contaminates. Ventilation offers cosmetic improvements but does not represent a sufficient response to the health and safety risks inherent in SHS. (Paragraph 33)

3.  The only solution to the problem of SHS exposure is to prohibit smoking in public places and workplaces, including licensed premises. This approach has found increasing favour with governments around the world, and public opinion in the UK is moving very quickly in its favour. Moreover, the experience of the Republic of Ireland shows that smoke-free legislation becomes even more popular once it has been introduced. (Paragraph 40)

4.  In balancing the economic effects on businesses and smokers' rights against workers' rights, we have to weigh up the likely effect on each group. The experience in Ireland suggests that the economic consequences of the ban on the hospitality industry have been slight and that smokers' suffering has been relatively trivial: if smokers want to smoke they go outside and do not seem to mind too much. In contrast, there is strong evidence that smoking in the workplace has significant effects. As we have seen, it is estimated that about 500 non-smokers each year die prematurely from inhaling secondhand smoke in the workplace; this is surely too high a price to pay for the right to smoke. We cannot accept that the right to smoke can justify these deaths. Workers have a right to be protected from harmful substances unless there is an overwhelming reason for undertaking the risk. (Paragraph 51)

5.  We find the assertions in Choosing Health, supposedly based on the evidence of opinion polls, misleading and unhelpful to the debate about public support. Moreover, recent research, detailed in Annex 2, shows that public support is moving rapidly and decisively in favour of a comprehensive ban on smoking in public places and workplaces. (Paragraph 54)

6.  We recommend that two draft regulations be laid before Parliament: one to deal with exemptions for licensed premises and clubs, the other to provide for premises where a person has his home or is living. (Paragraph 61)

7.  Neither the Department of Health nor any other Government witnesses made reference to the issue of Crown immunity during our inquiry. It is not mentioned in the Explanatory Notes to the Bill nor was any reference made by Ministers at the Bill's second reading. We find these omissions extraordinary especially as Crown Immunity removes the necessity for exempting many premises. (Paragraph 62)

8.  We acknowledge that prisons represent a particular challenge in terms of smoke-free legislation due to the nature of the prison population. We are not, however, persuaded that preventing SHS exposure in prisons is any less a priority than any other workplace, or that the high prevalence of smoking among prison inmates is either a justification for exemption from the legislation or justification for the continued exposure of staff or prisoners to SHS. Rather, we see the high prevalence of smoking as evidence of a substantial and currently unmet need for effective smoking cessation services in prisons, and a possible failure of duty of care to both prisoners and staff. Furthermore, simply exempting prisons from the decision that workplaces should be smoke-free is unsatisfactory since it will provide no impetus for the Prison Service to go further in working towards increasingly smoke-free environments within prisons. (Paragraph 72)

9.  We recognise HM Prison Service's intention to work towards a smoke-free environment within prisons but are not persuaded that there is any reason why the policies applied in most prisons should be any less comprehensive, or implemented any later, than those for any other workplace. However, we also recognise that compliance may be difficult to achieve in some circumstances. From the date that the legislation comes into force in England, all smoking at work by prison staff should cease and the Home Office should set a target of making the interior of all prisons smoke-free. Prisons should maintain the power to make special provisions for individual prisoners in high-security institutions who are particularly difficult to manage, but this provision must not involve the exposure or staff or other prisoners to SHS. Smoke-free policy in prisons should be supported by the provision of full smoking cessation support to all smokers who want to stop smoking. (Paragraph 73)

10.  We see no justification for any exemption for Young Offenders' Institutions. HMYOI Wetherby is an example of good practice which should be applied throughout all similar institutions. The Home Office should set an early target date for making all Young Offenders' Institutions smoke-free. (Paragraph 74)

11.  High levels of smoking in psychiatric institutions are not inevitable. The experience in Norfolk and Waveney is an example of what can be achieved by a creative and positive approach in a difficult environment, and a model of good practice which can be applied to all other institutions. Therefore psychiatric institutions should not be granted a simple exemption from the smoke-free provisions of the Health Bill. An early target date should be set for making such establishments smoke-free, with separate outdoor areas (secure if need be) set aside for patients to smoke at the minimum risk to staff and other patients. In addition, measures should be put in place to tackle the high prevalence of smoking and challenging targets set for its reduction. Psychiatric institutions should become smoke-free workplaces for staff along with other NHS premises by the end of 2006. (Paragraph 80)

12.  We welcome the Ministry of Defence's commitment to controlling smoking in the workplace, and recognise that the MOD is already working towards creating more smoke-free environments. We also welcome the MOD's 'golden rule' that non-smokers should not be exposed to other people's smoke. However, we are not persuaded that MOD workplaces should be treated any differently from other workplaces, and are concerned that exemptions in, for example, submarines will lead to continued, avoidable and unnecessary exposure of service personnel to SHS. (Paragraph 86)

13.  The Ministry of Defence should eliminate all smoking in the workplace and in public places. Smoking should not be permitted in shared living accommodation or in communal areas of living quarters in any circumstances. Smokers should be allowed to smoke only in individual private quarters. (Paragraph 87)

14.  We recognise that there are difficulties. Nevertheless, staff in hospices should be afforded the same protection from SHS as workers in any other sector. Hospices should not be exempt from smoke-free legislation. Compliance with a smoke-free policy should be a condition of admission to hospices and there should be a comprehensive programme of smoking cessation support. Similarly, the staff of nursing homes should be afforded the same protection, and these premises should therefore be smoke-free. (Paragraph 90)

15.  We agree with the Royal College of Nursing that care workers who visit patients in their own homes should be protected as far as possible from the harmful effects of SHS. To that end, employers should seek to ensure that patients are aware that they should not smoke while being visited, and that care workers should have the right to refuse to enter a home or room in which a patient is smoking. (Paragraph 92)

16.  The Government's proposals for a ban which exempts 'drink-only' pubs and membership clubs are unfair, unjust, inefficient and unworkable, because:

  • all workers should be protected from SHS;
  • children, who have access to clubs, should not be exposed to SHS;
  • it is likely that a partial ban will be disputed in the courts by bar workers;
  • a partial ban will create unfair competition;
  • a partial ban will widen health inequalities;
  • public opinion now supports a comprehensive ban;
  • legislation should be clear and simple if it is to be easily enforceable. (Paragraph 116)

17.  A broad range of opinion has argued that a comprehensive ban would achieve the Government's stated aims in a much more satisfactory fashion than a complex partial ban, and that from the commercial perspective of the hospitality and gaming industries, a comprehensive ban is also the preferred option. We find it hard to understand how the strong evidence base, clear public support, and the results of the Department's own Regulatory Impact Assessment can be ignored. (Paragraph 117)

18.  Political support for a smoking ban in the Republic of Ireland is in stark contrast to the approach of the UK Government which has been muddled and vacillating. Policy towards the control of smoking in public places and workplaces has been a litany of good intentions undermined by faint-heartedness. The strong public health message embodied by Smoking Kills, the White Paper of 1998, has been hedged about with so many qualifications and exemptions that the legislation to protect non-smokers from the harmful effects of secondhand smoke has lost its clarity of purpose. Nor has the Government chosen to represent the ban on smoking primarily as an issue of worker protection, as was done in the Republic of Ireland, but instead as a more nebulous 'public health' measure. As a result of this failure of leadership, the Chief Medical Officer, who admitted that he considered resigning over the issue, described the Government's legislation as putting "Britain among the laggards of public health policy-making internationally rather than the global leaders". (Paragraph 128)

19.  We conclude that there are four key components to achieving widespread compliance:

  • an adequate level of public support;
  • clarity and simplicity in the regulations governing a ban;
  • a framework of penalties which adequately and appropriately target those who fail to comply with the law, in particular those who deliberately flout the law;
  • strong and committed political leadership. (Paragraph 129?)

20.  The last three of these are sorely lacking in the Government's proposals. Widespread compliance through a high degree of self-regulation will only be achieved by a comprehensive ban without exemptions for any licensed premises or membership clubs. (Paragraph 130)

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