Examination of Witnesses (Questions 120-133)
PROFESSOR DAME
CAROL BLACK,
DR RICHARD
EDWARDS, DR
ALLAN HACKSHAW
AND DR
RICHARD ASHCROFT
20 OCTOBER 2005
Q120 Anne Milton: Presumably that is
self-reported. If you introduce a ban, everybody feels guilty
to do so, and they then start lying when you ask them what they
do.
Dr Edwards: It is self-reported,
but if you look at the non self-reported measure like the cotinine
levels in children, which is a metabolite of nicotine and is a
good indicator, that has approximately halved over the last 20
years or so in the United Kingdom for that is in this report.
The exposure of children, who are very largely exposed in the
home—that is the main exposure—has been reducing.
That is borne out internationally as well.
Q121 Chairman: Who gathered the evidence
in Ireland?
Dr Edwards: One of the main papers
was written by Shane Allright, who I think is employed at Trinity
College, Dublin. I think it was an independently commissioned
research. I would have to check on that.
Q122 Chairman: We will have a look
at it.
Dr Edwards: Two papers have been
published this week on the Irish experience.
Chairman: Those we have not seen.
Q123 Dr Taylor: I think you said,
Carol, that most smokers want to give up and there is evidence
of that. Is the evidence in your report? Where is that evidence?
Professor Dame Carol Black: I
do not think it is in there. There is literature.
Dr Edwards: It is in Smoking-Related
Behaviour and Attitudes survey and maybe, in the Health
Service for England, I am not sure. However, there is nationally
available data, which has been available year on year, showing
that most smokers want to give up.
Q124 Dr Taylor: Presumably that does
not apply to the teenagers whoa re taking it up still pretty heavily.
Dr Edwards: A large proportion
of them express the wish to give up as well.
Dr Hackshaw: That estimate is
not across the board. It will vary according to age group, I imagine.
Dr Taylor: Yes. It would be nice to see
that, because it is the teenagers who many of us are particularly
bothered about.
Mike Penning: Especially amongst teenage
girls, who seem to smoke for other reasons, not least their weight.
I am experiencing this at home at the moment.
Q125 Dr Naysmith: Professor Black,
the Government in its consultation paper raises the possibility
of exemptions for certain long-stay institutions such as residential
homes, prisons and psychiatric institutions. I think the ground
they argue for is that it is an ingrained part of the culture
of these institutions and that a ban on smoking in situations
like that could have a very drastic and perhaps adverse effect
on the lives of the people in these institutions. That was not
quite the argument that was put this morning from the representatives
of the Department; nevertheless, you reject the Government's arguments
on this. Why is that?
Q126 Charlotte Atkins: Yes. We would
like a comprehensive ban. We would like to be pragmatic perhaps
about individual cases, but we think we would be better to have
a comprehensive ban. We would take entirely the point that was
raised in the earlier discussion, that in a prison you may have
a very heavy smoker in a room with a non-smoker. We would prefer
most definitely in the situation of a prison—and perhaps
it might be difficult to do—that you would have, if necessary,
a smoking area—and I can appreciate that the logistics of
that are not easy—but that we should have a comprehensive
ban and then we should address with the relevant services how
we might have to accommodate perhaps individual cases.
Q127 Dr Naysmith: What do your colleagues
in the psychiatric profession think? Have you had discussions
with them?
Professor Dame Carol Black: We
have not had discussions. We do know that in psychiatric institutions
we do have a problem with a higher rate of smoking in the staff,
both the nursing staff and, I believe, the medical staff. That
is obviously something that is of considerable worry to us. We
would still say that it should be comprehensive and then we would
hope to deal—
Q128 Dr Naysmith: What sort of mechanism
could we use in rest homes and psychiatric institutions?
Professor Dame Carol Black: One
would have to think somehow of providing a smoking area that is
distinct or separate from the home or the institution. I do not
think any of these things are easy, but, if you start from the
premise that you will have exemptions, it becomes incredibly difficult
I think to do it that way.
Q129 Chairman: Obviously there are
some psychiatric institutions where people are in there by force
of law, as indeed prisoners are in there by force of law as well.
What are the practicalities of having a shelter or a place to
go to smoke under those circumstances?
Professor Dame Carol Black: I
see the difficulties but I think it is up to those institutions.
They have to deal with lots of problems, they would have to come
to some arrangement for this. I do not think any of these things
are easy, but I would have thought we ought to be able to provide
some area that is separate from the main buildings. I agree that
with staffing and all the problems it is not easy, but I think
it would be much better to go for a comprehensive ban.
Q130 Chairman: Is there a case for
more smoking-cessation programmes in institutions like prisons
and other long-term institutions?
Professor Dame Carol Black: We
would like maximum effort put into these types of institutions.
I would echo what Fiona said, that in this country we have done
very well with the programmes that we have, and for a time you
might have to concentrate particular effort in these institutions
to try to help them get over what might be a somewhat bumpy period.
Dr Edwards: I think it should
be possible to provide secure outside areas, so smoking can still
occur outside in the usual way. But, as Carol said, whenever you
introduce a policy like this you must do it with providing smoking-cessation
support. That is absolutely crucial. As was heard in the Department's
evidence, there are examples of smoke-free prisons in the UK,
and certainly in California, and there are examples of smoke-free
residential mental health care institutions. One of the institutions
in Norfolk has gone smoke-free, and I am sure there are others
as well. There are some practical problems, but the principle
must be to protect the staff and non-smoking other residents from
an unacceptable health hazard.
Q131 Chairman: In the prison I mentioned
earlier, the smoking shelter for staff and prisoners is within
the boundary walls, as it were, or fences of the institutions.
It may be the case that it would be difficult for a complete ban
to take place at some institutions. Clearly that is something
that would need to be addressed. It might be physically impossible
under some circumstances to have that.
Q132 Chairman: If there are no further
questions, could I thank you all for coming along to give evidence
to the Committee this morning. We will look forward to the further
evidence that is going to be submitted.
Professor Dame Carol Black: Could
I say, if this were to come in, you would almost complete the
report that was first published by the Royal College of Physicians
50 years ago.
Q133 Chairman: Only 50 years!
Professor Dame Carol Black: Our
recommendations—and we have moved through them over 50 years—could
be complete.
Chairman: There was a dispute about the
science a little bit more then than there perhaps is today.
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