Select Committee on Health Written Evidence


Memorandum by the Royal College of Physicians of Edinburgh (SP32)

SUMMARY

  The Royal College of Physicians of Edinburgh welcomes the proposals to ban smoking in most public places but, given the strength of scientific evidence on the dangers of second-hand smoke, the College cannot support the wider exemptions and slower timetable proposed for licensed premises. The College is particularly concerned about the exclusion of some licensed premises serving restricted food items, proposals to permit smoking at the bar and the longer lead time for licensed premises. In addition, it should be clear that any exempted premises should have designated smoking areas only, looking forward to a future when no-one will be exposed to the dangers of passive smoke in a public building or at their place of work. The scientific evidence is now irrefutable that second-hand smoke damages health, and a total ban in public places will support the denormalising of this life threatening habit.

BACKGROUND

  This evidence is offered by the Royal College of Physicians of Edinburgh. The College has over 10,000 Fellows and Members across the world and, indeed, has more Fellows and Members in England than in any other country. Our main objectives are to improve the standards of medical practice and health, largely through standard-setting and education of doctors through out their careers. A previous President of the College, Sir John Crofton, was instrumental in the foundation of ASH Scotland and the College continues to be a partner in the Scottish Coalition on Tobacco (SCOT), which has been actively involved in the successful legislation in Scotland which will ban smoking in public places from March 2006. The College is also a strong supporter of colleagues in the Royal College of Physicians of London and their work on the dangers of smoking and passive smoking.

DEFINITION OF SMOKING

  The definition used within the Scottish Bill has been amended to smoking rather than smoking tobacco, given the enforcement problems that could arise from distinguishing claims of smoking herbal cigarettes from tobacco-based products. The College recommends that the definition is changed in the proposed Bill for England to focus on smoking any substance.

DEFINITION OF ENCLOSED PUBLIC PLACE

  The definition of "enclosed" as used in the Scottish Bill is more rigorous at 50% enclosure rather than the 70% proposed for England. This provides for semi-enclosed structures eg station platforms in large urban stations, and would capture most open fronted bars, entrances and restaurants where walls can be removed onto adjacent pavement terraces. The 70% level could result in a higher number of disputes over semi-enclosed premises and would obstruct enforcement.

SPECIFIC INCLUSIONS THROUGH REGULATION

  The College considers it helpful to provide for future amendments by regulation, including the power to include other premises within the definition of an enclosed space. The example cited within the proposed Bill of sports stadia is particularly relevant, given the combined risk to health from second-hand smoke and fire where large numbers of people gather. The opportunity to encourage a smoke-free environment should not be missed, given the number of families and young people who use such stadia, and the College would encourage the inclusion of stadia within the scope of the Bill or regulations.

  The issue about smoking in doorways will be critical to enforcement with employers and retailers seeking to maintain a smoke-free environment at their entrances and avoid a "smoking ghetto" on the pavements and car parks. This will also be of particular help to hospitals and other health premises and assist managers to enforce a total ban on all NHS property (including car parks). The College encourages the inclusion of doorways within the definition or regulations to support enforcement.

LICENSED PREMISES

  The College cannot agree to the restricted exclusion of licensed premises where food is being served or for private clubs. There is no logic within such proposals if other retailers are bound by the ban, and it is discriminatory to continue to expose workers in the pub and club trades to second-hand smoke, particularly as workers in the hospitality trade have the highest exposure to second-hand smoke of any occupation (1). They are thus at the highest risk to the hazards with a 50% increased risk of lung cancer (2). The exposure of hospitality workers to dangerous components of second-hand smoke falls dramatically following banning smoking (3). In San Francisco, the respiratory health of bar workers improved significantly following banning smoking in bars, whether or not these workers stop smoking themselves (4).

  The proposed ban on smoking at the bar is insufficient to protect staff, will complicate enforcement and do much to damage the denormalising of smoking which the majority now support, including the over 70% of smokers who have indicated a wish to stop smoking (5). Ventilation systems do not effectively remove the pollutants in second-hand smoke (6), thus, smoking anywhere in the premises will result in hazard permeating to those in the bar, including staff. Furthermore, staff will need to enter the smoking rooms to serve and/or clear and will thus be exposed to risk. Enforcement will be particularly difficult even for responsible bar owners.

  The College accepts that any premises serving non-exempted food at any time will be covered by the ban at all times, and that this will limit those premises that fall outside the Bill. However, this is unsatisfactory and will be difficult to enforce. Taking the power to amend the definition of exempted foods will add to the confusion as lists change. Exempting any premises that serve food adds to the complication of enforcement by giving responsibilities to Food Standards Officers in addition to Environmental Health and Trading Standards Officers.

  There is no justification for a longer lead time for the restrictions proposed for licensed premises, which are themselves inadequate with exemptions of some bars where food is not being served.

RESIDENTIAL PREMISES

  The College understands the need for exemptions where the premises are in effect the individual's home, and that this will include private houses and certain residential homes. However, those working in these environments need to be protected against the hazards of tobacco smoke. Thus, it is critical that communal residential premises are not wholly exempted from the Bill, and that there are designated smoking areas only within these premises as appropriate to the level of need among residents.

  There was considerable debate in Scotland over the issue for psychiatric hospitals and units, particularly with the reduction in residential care and the integration of psychiatric units within general hospital buildings and community health centres. Other supportive measures to encourage smoking cessation among psychiatric patients should be provided and promoted to ensure that all non-residential facilities can also be made smoke-free. The College is not in favour of exempting all psychiatric patients from a ban that will capture all other groups of in-patients.

  However, it may be necessary on humanitarian grounds to provide, for a limited time, very restricted smoking facilities within in-patient environments. Examples include facilities for elderly patients whose discharge may be significantly delayed.

MEMBERSHIP CLUBS

  The College is strongly opposed to the inclusion of private clubs within the exemption list because of the risk to staff employed in such premises, the lost opportunity to contribute to denormalising of smoking, and the potential to avoid the ban by licensed premises not currently offering admission by membership.

  The College believes that the risk of increasing the numbers of private clubs that permit smoking will also increase health inequalities if the proposed Bill is not amended. It is critical that all public buildings become non-smoking to support smoking cessation activities by community health workers and those individuals who have expressed a wish to stop but struggle to achieve it. The Department of Health must support the implementation of this important public health measure with training for all healthcare workers in smoking cessation and easier access to smoking cessation services for all current smokers.

OTHER EXEMPTIONS

  The definition of a place where a self-employed person is working should not include a taxi or private hire coach. The College also has concerns about permitting smoking in a vehicle if, although only occupied by one person at a time, that vehicle may be shared between staff.

TIMETABLE

  The College believes that the main aims of this legislation are to protect staff from second-hand smoke and to encourage smoking cessation for improved public health. The timetable should reflect the earliest possible introduction date, and the College sees no justification for allowing licensed premises an additional 12 months. Setting a "go live" date that encourages early adoption seems reasonable.

September 2005

1.  Wortley P M, Caraballo R S, Pedersen L L, Pechacek T F; Exposure to Secondhand Smoke in the Workplace: Serum Cotinine by Occupation; J Occup Environ Med 2002, 44, 503-9.

2.  Siegel M; Involuntary Smoking in the Restaurant Workplace: a review of employee's exposure and health effects; JAMA 1993 274 90-3.

3.  Repace J; Respirable Particles and Carcinogens in the Air of Delaware Hospitality Venues before and after a smoking ban; J Occup Environ Med 2004 46 887-905.

4.  Eisner M D, Smith A K, Planc P D Bartenders' Respiratory Health after Establishment of Smoke-free Bars and Taverns; JAMA 1998 280 1909-14.

5.  Smoking-related Behaviours and Attitudes 2002. Office of National Statistics 2003.

6.  Action on Smoking and Health: A Killer on the Loose. An Action on Smoking and Health Special Investigation into the Threats of Passive Smoking to the UK Workforce; ASH 2003.


 
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Prepared 19 October 2005