Examination of Witnesses (Questions 40-60)
DR FIONA
ADSHEAD AND
MR NICK
ADKIN
20 OCTOBER 2005
Q40 Dr Naysmith: So why are we not
doing it?
Mr Adkin: I think what we want
to do is say there should be an exemption and then, with the prison
service and with prison health, work out a route forward for dealing
with smoking in prisons.
Q41 Dr Naysmith: Is there anything
to reduce smoking: a program to progressively provide protection
for these sometimes quite vulnerable people, not just in prisons,
but in residential homes and psychiatric institutions?
Mr Adkin: There is certainly a
big initiative for helping people to quit in these places. Which
is right?
Q42 Dr Naysmith: That is not same
thing?
Mr Adkin: It is not the same as
providing protection from second-hand smoke. There is an intention
to do that as much as you can, but there is this central core
at the heart of it about the human rights question which at the
moment is balanced in favour of the rights of a smoker because
it is their home essentially.
Q43 Dr Naysmith: I understand that,
but it is also a public place as well for other residents?
Mr Adkin: Yes.
Q44 Dr Naysmith: Is there a time
limit suggested? Are you working towards a time limit?
Mr Adkin: No, there is no time
limit suggested.
Q45 Dr Naysmith: Would it be a good
idea to do that: set a time limit and work towards it?
Mr Adkin: I think that is being
considered in the responses to the consultation.
Q46 Dr Naysmith: One more final question
related to something that came up earlier. We were talking about
the different countries in the UK having possibly different policies.
Does that not seem pretty daft, that we could have a different
policy in Scotland, in England, marginally different in Wales
and Ireland in a relatively small country or group of islands?
Would it not be more sensible for us all to work together to have
same policy?
Dr Adshead: I think, more generally,
one of the strengths of having devolved administrations is that
they can look at the needs of their own population and reflect
what is right for them, and I think there are other precedents
in policy terms of having distinctive policies. I am not an expert
on other areas across a broader policy field. I do not think this
would be the only time that there is a distinct and different
policy. Obviously it is very important, I think, as we have already
reflected, that we all work from the same common evidence base
and, as far as practical, we learn from each other's experiences
to make things workable and effective.
Q47 Charlotte Atkins: Going back
to the issue of prisons, I am concerned about the situation where
you have may be two people in the cell and one is a smoker and
one a non-smoker. What is the Department's policy on that? Are
you talking to the Home Office about the issue of people being
banged up together and one being a heavy smoker and one being
perhaps a non-smoker, and are there any policies in place or any
protocols in place to try to alleviate that situation?
Dr Adshead: I think you have identified
one of the key issues, and, as Nick has already reflected, we
need to balance the competing rights of individuals. Certainly
as part of the consultation processes some prisons have written
to us expressing exactly those kinds of issues about how they
could be protected in communal places, and, yes, we are talking
to the Home Office and, yes, in the Department we take prison
health seriously, so that we are considering all those issues,
and that was why we included that in our consultation so that
we could get a really broad range of perspectives and balance
up the best way forward for now.
Q48 Charlotte Atkins: Are you anywhere
near finding a resolution to this given that it is likely to be
case that prisons and psychiatric institutions would be exempted?
Dr Adshead: When the bill is introduced
into Parliament, obviously that will be the beginning of our more
formal policy-making, but at the moment our policy is to discuss
and understand what the issues are around prison health and then
to formulate next steps, which will be publicly announced when
ministers have made their decision.
Q49 Chairman: Could I ask you a supplementary
to that. Obviously the concept of non-enforcement in a prison
is difficult for most people to grasp, but I saw on regional television
a couple of months ago now that one of the young offenders institutes
in Yorkshire has just got a national clean air award because it
is a non-smoking prison. Has the Department looked at that as
opposed to talking to the Home Office about it, or both?
Mr Adkin: The prison health service
is jointly the Department of Heath and the Home Office. They have
the lead in this area. They are looking at it at the moment. They
are looking at the experience in places where they have gone completely
smoke-free as well as the issues that have been raised about smokers
or non smokers in cells; so that is being looked at at the moment.
Dr Adshead: Choosing Health highlighted
the need to think about improving the health of prisoners, because,
as you are aware, they often come from some of the most deprived
communities and often have quite significant health issues.
Q50 Chairman: It seems that if a
young offenders' institute could do it, then may be we would see
legislation that had a time scale on exemptions, or potentially
a time scale on exemptions, but we are not that far down the road
yet?
Dr Adshead: As we said, obviously
all of this is under discussion, but we are aware of some excellent
programmes promoting health within prisons.
Q51 Dr Stoate: Can I ask a very quick
supplementary to clarify an issue to Nick? You said something
about human rights legislation which cuts across this. Is it not
therefore your opinion, or the opinion of your legal advisers,
that the human rights of a smoker outweigh the human rights of
a non-smoker? Yes or no.
Mr Adkin: I do not think it is
as clear-cut as that, because there are issues. For instance,
when a worker goes into a person's home, who has the greater human
right there? Is it the person whose home it is to smoke? If they
have someone coming in, say, to fit them for a wedding dress,
which is an example that has been brought up in the consultation,
whose rights predominate? Is it the smoker's or the non-smoking
worker, for instance, who may come in and be exposed?
Q52 Dr Stoate: To pick up Charlotte's
point, say you have two people living in a cell, both of whom
have equal residence status, one is a smoker and one is a passionate
non-smoker who has asthma which is exacerbated by smoke. Who has
the greatest human right, the smoker or the non smoker, because
it cannot be both?
Mr Adkin: I do not have a legal
answer to that specific example. I think what we are looking at
is exactly how we take forward smoking in prisons.
Q53 Dr Stoate: I am not just talking
about prisons. Prisons is a good example, but I am talking about
in general terms, assuming all other things are equal, a non-smoker
verses a smoker, who has the greatest human right? You are the
one who mentioned initially that human rights legislation gives
the smoker the right to smoke in their own home. What about the
non-smoker's right not to have smoke in their own home, all other
things being equal?
Mr Adkin: I cannot give you a
legal answer that will cover all circumstances. I am sorry.
Q54 Anne Milton: Can ask you why
second-hand smoke is being dealt with as a priority given the
danger to public health posed by other environmental pollutants
around, such as exhaust fumes, and also, is it fair or indeed
appropriate to pursue what is effectively a punitive policy against
the tobacco industry when the effects on public health of other
products made by other industries, such as fast food and alcohol,
and there has been a lot about that recently, are subject to much
less stringent scrutiny and restrictions?
Dr Adshead: To take the first
part of your question, which was about comparing tobacco against
other pollutants, one thing we do know is that if you are looking
particularly at indoor pollutants, tobacco smoke is probably the
one that has the biggest impact on health, and it is very important,
because it is entirely avoidable, that we focus on that and that
is why we put so much emphasis on that. I cannot answer compared
to a whole range of other pollutants in its own environment. I
am afraid my policy area does not cover that. I think in terms
of how we look more broadly across public health, although this
particular select committee is focusing on smoking in public places,
Choosing Health itself was a very comprehensive policy that looked
at all the major health issues that are facing people in England
today. It picked up on key issues around sexual health, around
alcohol, around diet, exercise and obesity; it looked at how we
need to take a much more comprehensive approach not just to focus
on individual risk factors but to think about how people live
their lives, the realities about how people live their lives,
and the influence on how, as the policy name suggests, that healthy
choices are the easier choices, and that that means doing exactly
what you suggest. It means looking across the broad environmental
and cultural influences on people's heath. Some of the work we
are taking forward, of which I will not go into the detail as
I do not think it is appropriate for this particular committee,
is, exactly as you suggest, to work with the food industry, and
we have in place a series of processes at the moment to look at
issues like food provision to children and other issues around
clearer labelling and other policy work; so it would not be fair
to say that the Government does not have a balanced programme
on public health, it does indeed, and I think tobacco is a very
good example of how we have taken a comprehensive policy approach
across an area and we are developing and addressing other public
heath areas in a similar way.
Q55 Anne Milton: It is just that
the tobacco is top of the list. So when you want people to smoke
less and you bring in legislation to persuade people to smoke
less, we could suggest that everybody is weighed before they go
into McDonalds or wherever. The obesity issue is equally as big
an issue.
Dr Adshead: We have in the Department
six priority areas. We have public service agreements . . . As
a department we are also with other Government departments on
some of these key health indicators, and obesity is one of them
that we share with two other departments and we have a programme
of cross government action on this. I think that if a list exists
in that format, we have six priorities and we are as a department
working equally hard on all of them, but I would want to emphasise
that smoking is one of the key avoidable forms of premature mortality
and also morbidity and has a major impact on people's quality
of life in this country.
Q56 Anne Milton: I apologise for
going on: the effect of this legislation on reducing the number
of people who smoke, if you could give that a figure, how effective
out of 10?
Dr Adshead: Against what?
Q57 Anne Milton: Reducing the number
of people that smoke?
Dr Adshead: As I mentioned, what
we know from international evidence is that 4% overall where there
are no other tobacco control policies in place will give up smoking.
Because we have got a comprehensive tobacco control policy in
this country in Choosing Health, if we increase that, we estimate
the prevalence, the number of people or the proportion of people
in the country who smoke would drop by 1.7% overall. That is our
estimate from smoke-free public places legislation.
Q58 Chairman: Can I just ask you,
Dr Adshead, the most recent consultation over the summer, we understand,
has come back with more of a call for a comprehensive ban than
what the Government's proposals were. Could you tell us what is
going to be done as a result of that and what we are likely to
find when the Government is going to be maybe responsible?
Dr Adshead: Obviously our commitment
as a result of the consultation was to consider all the responses
and then address any changes that we needed to make in the policy.
Our ministers are currently considering that, and in the Queen's
Speech we made a commitment to introduce a bill within this session
of Parliament.
Q59 Chairman: You have got no further
timetable than that at this stage.
Dr Adshead: I am afraid not.
Q60 Chairman: Could I thank both
of you for coming along and giving evidence this morning.
Dr Adshead: It is our pleasure.
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