Examination of Witnesses (Questions 1-19)
DR FIONA
ADSHEAD AND
MR NICK
ADKIN
20 OCTOBER 2005
Q1 Chairman: Good morning. Could I welcome
you to what is the first public session of the newly formed Health
Committee and, for the purposes of this particular inquiry, may
I say to anybody in the room who has an interest, we have published
a memorandum today of the written evidence that was submitted
to this Committee and it is available. I wonder if I could first
of all begin by clarifying exactly what the Department of Heath's
policy is in relation to smoking in public places and work places.
Is it as it appears in the consultation document or has it changed
in the last few days or weeks?
Dr Adshead: What we are able to
comment on, obviously, is government policy as it stands at the
moment and Choosing Health and its subsequent consultations, as
you have just reflected, laid out a comprehensive package around
progressively promoting smoke-free public places and work places.
As you know, the key elements of the package are that by the end
of 2006 all government departments in the National Health Service
will be smoke-free, with some key limited exemptions which we
consulted on, for example, including residence homes and mental
hospitals. By the end of 2007 all other work places and public
places will be smoke-free except for licensed premises, where
we specifically recommended by the end of 2008 arrangements for
licensed premises will come into place which made the distinction
between all premises going smoke-free where food is prepared and
served. Obviously, what we are aiming to do here is complement
this with a much broader range of tobacco control, because at
the end of the day what we are trying to do is to get people to
give up smoking, because ultimately that is what will make England
smoke-free.
Q2 Chairman: Are we to assume that
the intention is still to exempt pubs where food is not served
and membership clubs as well?
Dr Adshead: The consultation obviously
asked people what was practicable and also what was going to be
effective, and one of the key areas we consulted on was that distinction
between food being prepared and served as a way of distinguishing
licensed premises, because what we wanted to reflect was public
opinion around being in a smoking environment whilst eating food.
What we found during the Choosing Health consultation was that
there was a very strong preference for there not being smoking
environments when people are eating food and therefore we chose
to make the distinction around pubs, in particular, on those grounds.
Q3 Chairman: There has been some
speculation in the press recently about pubs that have smoking
rooms. I understand this is to mean that there is a room in a
pub where you can close the door; nobody actually works in it
but people can go and sit in it and have a drink and smoke at
the same time. Is that something that we should take seriously
as being what the Department is looking at at this stage?
Dr Adshead: Current government
policy does not include smoking rooms, but we consulted, as you
are aware, on a range of different measures, and something that
pub industry and its associated partners came back with was that,
rather than having the distinction between food and not food,
that smoking rooms or rooms where smoking could occur was one
possible model that was put forward. We are aware, for example,
in Italy there are models on that; so there is an international
precedent for that, but it is not current government policy as
it stands and was consulted on at present.
Q4 Chairman: Was that a universal
view of the industry that that should or could take place?
Dr Adshead: I think a universal
view would suggest that everybody who actually put a response
in from the industry included that. I am not aware that is the
case. Nick, do you have any opinion on that?
Mr Adkin: No. On the responses,
I think you have seen a large number of them, the pub industry,
lead by the BBPA, have a proposal which is about floor space with
an intention to voluntarily go to 90% of floor space being smoke-free
by 2009, I believe. That was their voluntary proposal which they
say has been signed up to by 50% of the pub industry, but there
were a range of different views. The British Hospital Association,
for instance, was for a complete ban.
Q5 Chairman: There was not a universal
view that smoking rooms are the answer to the problem?
Dr Adshead: No.
Q6 Dr Naysmith: There is no evidence,
I think, and I do not think we have seen any evidence, that a
policy of banning smoking at the bar has any effect on employee
exposure at all. Is that something that you can say sensibly or
do you have evidence that we have not seen?
Dr Adshead: The recommendation
that there should be a prohibition on smoking within a metre of
the bar was not based on evidence of protecting health; it was
essentially about trying to reduce the amount of noxious exposure,
the irritant effect of smoke, within that distance. Obviously,
as you may be aware, again some licensed premises promote this
as an example of good practice, but it is not a recommendation
that was put forward on heath evidence grounds.
Q7 Dr Naysmith: Why was it put forward?
I think David has some questions he wants to ask.
Dr Adshead: It was put forward
essentially because it was felt that, if you were a bar worker,
having smoke directly blown in your face within that distance
was unpleasant, but it was not a recommendation that was based
on heath evidence.
Q8 Mr Amess: Chairman, I might have
been asleep at the start, but did you begin by introducing yourselves
and explaining to everyone what it is you both do and who you
are?
Dr Adshead: No, we did not. We
would be more than happy to do that. I am sorry, as I was not
asked to, I did not.
Q9 Mr Amess: It is no criticism of
anyone, but I have not got my bit of paper here.
Dr Adshead: Absolutely. I can
explain who I am and I am sure Nick will be able to do the same.
I am Dr Fiona Adshead, I am Deputy Chief Medical officer in the
Department of Heath and I have a broad range of responsibilities
over health improvement in other areas, and one of them includes
tobacco policy.
Mr Adkin: I am Nick Adkin, I am
the Tobacco Programme Manager in the Department so have responsibility
for tobacco policy except for tax, duty and smuggling.
Q10 Mr Amess: Have you been with
the department long?
Dr Adshead: I have been with the
department for 18months. In fact I joined in mid February 2004,
just as we were beginning to develop the consultation process
for Choosing Health, so I have seen Choosing Health through as
a policy.
Mr Adkin: I joined the then DHSS
about 17 years ago.
Q11 Mr Amess: Goodness. So you really
do know where the bodies are buried! Your book would be worth
reading. This proposed policy: I have listened to what you have
said and I am still a bit puzzled who is driving this. Where is
the evidence that it will work?
Dr Adshead: One of key elements
of the proposed legislation we put forward is that we have committed
in Choosing Health to consult on it. What we know from international
experience is that legislation works if is obviously effective
in terms of having its desired impact, but also if it is practicable,
if it is workable. We know from smoke-free public places legislation
from other countries that it is really important that it is well
considered and thought through, so that is exactly why we went
through the consultation.
Q12 Mr Amess: Can you tell me specifically
about the international experience that you are relying on?
Dr Adshead: I think one thing
that. . . . There is a whole range, as you are probably aware.
There is evidence from New York, from California, more recently
from Ireland, obviously the Scottish experience in recent months.
I think what many of them demonstrate is that often, certainly
in California and New York, a phased approach in the more difficult
areas where public opinion is less behind smoke-free public places—and
that often tends to be pubs and bars—tends to be more successful
certainly in those areas.
Q13 Mr Amess: We always seem to be
drawing on America as an example, but, of course, the structures
of government are entirely different, so enforceability is quite
a big issue, but it is interesting to hear why you are drawing
on that proposed policy. The other thing I wanted to ask you is
there is obviously a different policy in different parts of the
United Kingdom. Is this because there is a difference of interpretation
of scientific evidence? Can you help the Committee? Tell us why
there is this difference in policy?
Dr Adshead: Obviously each of
the devolved administrations, as you reflect, have been actually
consulting on their own smoke-free public places policy, and I
think in England we recognise that the policy that we need to
put forward needs to reflect both English needs, circumstances,
issues around public opinion, but we need, if you like, to come
up with an English solution. Obviously we have been aware of what
has been going on in the other devolved administrations, and in
Ireland, as I have already said, and are taking that into consideration
in terms of not only the way we put forward our own consultation,
reflecting, for example, some of the definitions around what would
constitute an enclosed public space, but also in terms of keeping
an eye on that as policy develops.
Q14 Mr Amess: So the scientific evidence
and the forecast of the United Kingdom is exactly the same, we
are interpreting it differently. Is that it?
Dr Adshead: Scientific evidence
is obviously often international, so the basis for it comes from,
for us, the Scientific Committee on the Health Effects of Alcohol
(SCOTH), it also comes from some of the WHO work, from their advisory
research council and cancer, and what those all make clear is
that second-class smoking as is a significant public health hazard.
Most of us, and I cannot speak for other administrations, but
certainly I would imagine that we are all basing it on the same
evidence base, but I think what is important is that health evidence
is only one part of a decision-making process: so that obviously
public opinion in each country, circumstances, workability, practicality
and other issues all need to be taken into account, and that is
precisely why we put so much emphasis on doing a thorough consultation
and listening to as many stakeholders. I think it is worth saying
that about 57,000 people responded to our consultation, which
I think gives us a firm basis for understanding what would both
be practical and effective.
Q15 Mr Amess: Finally, Mr Adkin,
with your 17years of experience, do you agree with everything
your colleague has just told the Committee?
Mr Adkin: Yes, I do.
Q16 Mr Amess: We will let you sort
it out afterwards.
Mr Adkin: In the international
context, I think every government in the world accepts the evidence
base, but it is a judgment for each government how they approach
it. In California the evidence base was clear and they went for
an approach which left out bars until later in the process, New
York the same. It is a combination of the medical evidence, which
I think is clear, despite what some of the antis say, and then
a judgment on how best to implement it in your particular jurisdiction.
Mr Amess: Thank you very much indeed.
Q17 Dr Taylor: Can we try and get
behind the aims of the legislation. There are so many aims and
I would like you to be absolutely open. Obviously it is to protect
employees in the workplace; it is to protect members of the public
using those work places; it is to protect kids. Is it also intended
to encourage existing smokers to give up?
Dr Adshead: I think the main reason
for legislating, as you have reflected, is to protect people from
the harmful effects of others' second-hand smoke.
Q18 Dr Taylor: The employees and
members of the public in those places?
Dr Adshead: Yes, indeed, but,
of course, some of the major benefits, in fact, are in reducing
deaths from smoking itself, because providing a smoke-free environment
does support and encourage people to give up smoking. We know
that in England there are about 86,000 deaths a year from smoking,
and so for us the key issue is reduced smoking. I think it is
also fair to say from the research evidence that 95% of exposure
to second-hand smoke occurs in the home, which is why in the Department
we have placed so much emphasis on raising awareness around the
harmful effects to children and why we have had things like our
children smoking campaign and, more recently, we have extended
the scope to point out to adults through the "I smoke you
smoke" campaign that, in fact, smoking itself is harmful
to individuals but, very importantly, it can harm other people's
health as well.
Q19 Dr Taylor: So a key issue is
to encourage existing smokers to reduce or to give up. Is there
evidence from the places that have already done this that this
works?
Dr Adshead: There is evidence
that that is the case, yes. Overall from international experience,
if you start against not a comprehensive tobacco control policy,
you would find a 4% drop overall in the number of people who smoke,
the prevalence of smokers. In this country, as we have reflected
in our partial regulatory impact assessment which we also consulted
on, we estimate that the impact will be about 1.7%, and, for example,
from Ireland, they estimate that an extra 7,000 smokers have given
up since the introduction of their ban.
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