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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