Examination of Witnesses (Questions 20-39)
DR FIONA
ADSHEAD AND
MR NICK
ADKIN
20 OCTOBER 2005
Q20 Dr Taylor: So it does have an
effect?
Dr Adshead: Yes.
Q21 Dr Taylor: Is it not illogical
when one is thinking of protecting employees to go down the route
that the Government appears to be going at the moment, to exempt
certain premises so we are no longer protecting the employees
in those places?
Dr Adshead: Obviously the policy
we put forward covers more than 99% of work and public places.
Q22 Dr Taylor: Ninety-nine per cent?
Dr Adshead: Yes.
Q23 Dr Taylor: Really?
Dr Adshead: Yes, 99%.
Q24 Dr Taylor: Will not pub owners
change what they are doing so they can increase the 1% that is
not covered?
Dr Adshead: I think there is already
evidence that some pub chains have put forward that they want
to go smoke-free anyway, and I think there is quite a lot of evidence,
in terms of responsiveness to customer wishes, that businesses
have already gone smoke-free.
Q25 Dr Taylor: Would it not be easy
for everybody if you went down the big bang approach and introduced
the changes immediately—I do not mean immediately—at
the end of the consultation all at once rather than the staged
approach that you are planning?
Dr Adshead: One of the questions
that we included in the consultation were issues around timetabling,
and some of the responses that we got, in fact a large proportion,
did argue for introducing all the legislative approaches at once
and also argued for bringing forward the time scale, for example,
for pubs, but some representatives of licensed premises argued
the opposite, that the time scale should be increased for them.
Q26 Dr Taylor: You did say there
were four things that helped you to decide: heath evidence was
one part, public opinion was another, and enforceability was another.
What was the fourth?
Dr Adshead: It is about how effective
and practical it will be, but essentially, as Nick has already
reflected, this is based on health advice and evidence, public
opinion, really what was will work and be effective obviously
in the government in question, which obviously for us is England.
Q27 Chairman: You mentioned that
a figure of 99% would be protected. Is that in the leisure industry
or a lot wider?
Dr Adshead: That is based on our
definition of "enclosed work places".
Q28 Chairman: All work places, not
just the leisure industry?
Mr Adkin: Yes, if you look at
the data on where people work, 99% of people who work in enclosed
places, over 99, will be protected completely by this proposal.
Q29 Chairman: Because it will cover
all work places. What percentage is covered now?
Mr Adkin: If you ask people: "Is
your workplace completely smoke-free?", 51% of people currently
say their work place is completely smoke-free, so that will increase
that response to over 99%.
Q30 Dr Naysmith: Do you have any
estimate of what the proportion is or would be in the leisure
industry?
Mr Adkin: We have not got a proportion
that covers the sort of basket of all the leisure industry. What
we produced in the consultation document was an estimate for pubs,
where we estimated the proportion that would fall into the category
of not preparing and serving food, where we reckoned it was between
10 and 30%, and the responses from the consultation where they
have estimated that have both fitted within that range.
Q31 Mike Penning: Can I take you
back to the point you made earlier on to do with the declining
tobacco sales in Ireland after the ban. I think most of us saw
the reports that were shown there. Subsequently there have been
reports, which I wonder if you could comment on, where tobacco
sales have started to increase again in Ireland. Is this a trend
that we have seen around the world where the bans have taken place,
there is obviously an initial decline in tobacco sales and then
it starts to pick up again, or is Ireland different from the rest
of the world?
Dr Adshead: I am not aware of
that. Nick, are you?
Mr Adkin: I am not aware of that
data, no.
Q32 Charlotte Atkins: Dr Adshead,
you said you were there at the beginning of the White Paper "Choosing
Health" and therefore you were very much involved in that.
Obviously that paper talks about the health policy being "equality
proofed", and obviously that is the objective of the Government,
but do you not accept that going down the road of creating drink
only pubs where smoking can happen and also membership clubs that
that will increase inequalities? For instance, in my part of the
world, if you go to Stoke-on-Trent, the more deprived areas are
likely to have drink-only pubs, and they are going to become smoking
dens, if you like, whereas if you want to go to another pub that
sells food there will be no smoking there. The problem is going
to be created that more and more people from lower socio-economic
groups are going to end up going into the heavily smoke-laden,
drinking-only bars and that is bound to increase inequalities,
is it not?
Dr Adshead: You are absolutely
right. We are committed to tackling inequalities and, in fact,
because we want to make sure, as you say, that things are inequality
proofed one of the questions that we asked in our recent consultation
was exactly that, for people to comment on the potential to increase
inequalities. At the time when we formulated the policy the best
available evidence to us then from the Food Standards Agency and
from others was that ten to 30% of pubs would fall into the category
of being exempted. What has been very helpful, I think, as a result
of the consultation is that that British Medical Association and
others authors in the British Medical Journal and primary care
trusts themselves have done more detailed work and looked into
some of the issues around the potential for generating more inequalities.
The British Medical Association report pointed out that this may
well increase inequalities in health and that this pattern, but
not exclusively, would show more of a north/south divide. We have
looked at evidence from different PCTs who submitted evidence
to the inquiry. For example, in Gateshead and Wansbeck, they estimated
that 70% of their pubs would fall outside our definition of "prepare
and serve food"; so that has been a very important thing
for us to consult on to understand through evidence that people
have been able to generate for us since the policy was formulated,
and that is something that our politicians are reflecting on at
the moment as we formulise our policy statement.
Q33 Charlotte Atkins: From what you
are saying PCTs have been giving you evidence. Are the PCTs going
to be doing work in their own patches to try to encourage pub
landlords and owners to go down the route of banning the smoking?
Dr Adshead: There has been a lot
of work round the country obviously in trying to tackle inequalities,
in particularly in relationship to smoking and, particularly in
the north east of England, we have really excellent smoking services—they
are some of our highest performing services—and there they
have really put a lot of effort into reaching the most deprived
groups. In fact, one of the services we highlighted in the white
paper is one where people were given access to stopping smoking
services in fact in the pub itself. So a lot of PCTs have been
taking action inequalities in smoking already to help people to
give up in those most deprived groups that you have highlighted.
Q34 Charlotte Atkins: A former secretary
of state for heath gave as a reason for having some exemptions
the fact that he did not want to see smoking being pushed back
into the home, but that does not appear to meet with the evidence
from the Royal College of Physicians who seem to say that that
evidence does not stack up, that that is not likely to happen.
Does that not remove one of the reasons for going down the exemptions
route?
Dr Adshead: Certainly my understanding
of the evidence—Nick may want to add some more detail—is
that there is not any evidence that smoke-free public places legislation
increases smoking in the home, but I think it is very important,
as I have already mentioned, to take into account that 95% of
second-hand smoke exposure anyway occurs in the home; so that
when we are thinking about how effective we implement policy to
reduce smoking we need to be really mindful of targeting smoking
in the home by helping smokers to give up and particularly, as
I have already mentioned, emphasise the damaging effect that second-hand
smoke exposure can have on children.
Q35 Charlotte Atkins: The former
secretary of state was just plain wrong, was he, when he gave
that view to our Committee?
Dr Adshead: I think that certainly
since . . .
Q36 Charlotte Atkins: He is not in
the Department any more, and he is unlikely to come back—he
tends to move on to other departments—so you should be free
to be able to say that he was just totally wrong, and he was a
smoker himself at that time himself I think?
Dr Adshead: There is not any current
evidence that would support that view, but I am sure that he based
his advice to the Committee on the best available evidence to
him at that time.
Q37 Charlotte Atkins: Perhaps based
on his own personnel experience at that point. Nick would you
like to add anything?
Mr Adkin: I think it is a legitimate
concern, and I think it should be raised as a concern because
it has some intuitive feel about that if you stop people smoking
they will buy their drink in the supermarket and take it home.
We know there has been a shift in the pattern of buying drink
in Ireland, but that has predated what went on in the ban. The
evidence is that generally in England more and more people are
making their homes completely smoke-free as work places become
more smoke-free as well. So there is some evidence that, even
without legislation, the general drift towards the smoke-free
happens in work places and the home.
Q38 Dr Naysmith: One of the other
exemptions that are proposed in the consultation document is to
exclude prisons, residential homes and psychiatric institutions.
Is there any rationale behind that and, if there is, can you explain
to the Committee what it is?
Mr Adkin: As we have said in the
consultation document, there are more difficult human rights aspects
around where a place is also essentially somebody's residence
or dwelling. You then have to take a different course of action,
and this has been pretty universally the case in international
experience in legislating in this area, that there is a desire
to exempt these places because (1) there is a human rights aspect,
and (2) they are often more difficult to enforce and then you
take a more guidance-based approach to dealing with smoking in
those places, and then there may be some point in the future where
you could extend the legislation to those areas. That is broadly
how people have attacked it.
Q39 Dr Naysmith: If we are talking
about people's rights and we are talking about second-hand smoke,
not the ability to smoke somewhere an in institution, surely that
is a conflict of human rights, is it not: the right for someone
to occupy a space that does not include someone else's smoke?
Mr Adkin: Indeed. The general
legal view, and it is reflected I think in all international legislation
that I am aware of, is that because you allow people to smoke—if
they are not in these institutions—in their home there is
a human right read across to this being effectively somebody's
home and there should be some degree of allowance for that. For
instance in California I know they have moved to make their prisons
completely smoke-free on a progressive basis.
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