Examination of Witnesses (Questions 540-559)
CAROLINE FLINT
MP, FIONA MACTAGGART
MP AND MR
NICK ADKIN
24 NOVEMBER 2005
Q540 Charlotte Atkins: Where
does the responsibility for cessation divide between the prison
health service and the primary care trust?
Fiona Mactaggart: The provision
of quitting services, like other healthcare provision, is provided
within a prison increasingly by primary health care trust provided
services, and so, in effect, it is offered through that mechanism;
but the prison service can make demands and it can provide other
back up to it in terms of some of the work that we do in prison
education, and so on, and the carrots work of working with people
who are drug-addicted, which is a chronic and very serious problem
in prisons and very often the nicotine addiction that prisoners
display is one of a series of addictions to drugs, alcohol and
other things that they are trying to deal with in prison.
Q541 Charlotte Atkins: It
has been said, and this is directed really towards Caroline, that
the targets that primary care trusts have discourage them from
involvement in prisons or, indeed, young offences institutions.
I believe that my own primary care trust has done some excellent
work in Werrington Young Offenders Institution in my constituency,
but what is your view about that? Do the targets discourage primary
care trusts from taking on the big role of smoking cessation within
prisons and young offenders' institutions?
Caroline Flint: I am not aware
of that in particular. I have three establishments in my own constituency,
and as far as I am aware the PCTs in Doncaster have done some
excellent work with prisons on health and smoking cessation as
well. In each of the establishments in Doncaster they have developed
their own policies to tackle some of these areas and some of the
issues that Fiona has been raising. I am happy to go away and
look at that, but I do not think there is any particular barrier
to PCTs that have prison establishments in their areas not looking
to provide some similar services in the same way as we work on
issues around drugs as well.
Fiona Mactaggart: Could I add
something to that, and then, I am afraid, Chairman, I have to
leave. In our experience, giving a primary care trust targets
in terms of general community smoking cessation or giving an education
provider targets in terms of the general committee low-level qualifications,
basic literacy qualifications—in prisons we actually get
better results than elsewhere, and, therefore, having a primary
care trust set of targets which they can partly deliver through
delivering with prisoners actually, in prisons, if you are talking
about a highly addicted adult male population, we tend to get
better results than that population does in the community, and
so having the targets which they can deliver through prisons is
one good way of them being able to make a difference to some of
the people who have the worst problems with nicotine and other
addictions.
Caroline Flint: I agree with that.
Charlotte Atkins: It is probably a very
good and valid reason for having very locally focused primary
care trusts as well.
Q542 Dr Naysmith: I have
one very quick question, if you do not mind. Does it worry you
at all that law suits might be brought under the European Convention
of Human Rights, either by prisoners who smoke if you do ban smoking
in prisons, or by prisoners who do not smoke if you do not ban
it, and have you taken any advice on this?
Fiona Mactaggart: I have not taken
advice on that specific point, but in the Home Office, if we spent
all our time being concerned about legal action under the European
Human Rights Convention, we would not have a chance to think about
other things. I think the existence of the Human Rights Convention
and the fact it is part of the UK law is a very important reminder
to all of us that we need to protect the rights of citizens; and,
of course, as your question highlights, one of the tricks in dealing
with that is balancing competing rights; and this is a struggle
which we will have to work through in our prisons, as elsewhere.
Q543 Chairman: I will
just leave you with this thought. I understand what you talked
about, the compounding problems inside prisons, and 80% of prisoners
smoke and everything else, but also one in two people who smoke
die as well prematurely, so it is an issue in any circumstances
that no matter where people are smoking that is the major factor.
In terms of smoking in ill-health, one in two people will die
prematurely because of it.
Fiona Mactaggart: Very many prisoners
die prematurely from other things as well.
Chairman: I accept that entirely. It
does seem, and indeed the head of the prison service said this
to us last week, the issue about potential litigation and shared
cells is probably going to come to the forefront because of this
current legislation that the Government is thinking about. We
will leave that thought with you. Thank you very much for coming.
I think, Minister, we are going to move on to the issue of what
we perceive to be government policy at the moment in relation
to exemptions in clubs and non-food pubs. Doug is going to ask
the first question.
Q544 Mike Penning: Good
morning, Caroline. Do you accept that workers in all licensed
premises are at risk from second-hand smoke?
Caroline Flint: I think clearly
there is a risk from second-hand smoke, that is why we have spent
a lot of time over the last few years raising the importance of
this issue, and research does show us that workplace deaths caused
by second-hand smoke gave an estimate of something like 617 deaths
a year in the United Kingdom, so we acknowledge that second-hand
smoke is a contributory factor to ill-health and death. But the
policy measures that we discussed in Choosing Health, which
was widely debated at the time and consulted upon, which led to
our proposals, were based on reducing the numbers of places in
which people had to be in a smoking atmosphere, and we had to
balance both, yes, the health issues, but also what the public
was saying about where they felt the priorities were and still
recognise that smoking of itself is not an illegal activity.
Q545 Dr Naysmith: You
are accepting quite clearly that it is a hazard, so why are you
only going to legislate to protect some of them and not all exposed
workers?
Caroline Flint: I think there
are lots of things that are hazards in life, and that is not to
downplay at all the issue around smoking-related hazards. I think
we had to look at a way forward which would address public health
issues, would give more choice for people to work and enjoy social
time in a smoke-free environment, give more choice to workers,
and there will be more choice for every worker covered by our
proposals, both in the hospitality sector but also with our proposals
to protect in the bar area which we are consulting on further
as well. So every worker in England will benefit to a certain
degree from our proposals, but balanced with that was what we
also had in terms of what the public thought. We have had to think
very strongly about issues around enforcement, and I know there
are lots of different views on that, but part of the reason why
the voluntary bans and restrictions have been so successful is
that they have gone with the grain of public opinion and therefore
they have been pretty much self-enforcing.
Q546 Dr Naysmith: Bar
staff are the ones who are most at risk, and they are the ones
you are proposing to exempt?
Caroline Flint: No, we are not
exempting all bar staff; we are exempting those licensed premises
that do not prepare and serve food. The fact is that under our
proposals 99% of workplaces would be covered—that is up,
I understand, from around 51%—and, therefore, we are moving
forward enormously; but even for those bar staff in the drink
only establishments, there will be protection for them as well.
Q547 Dr Naysmith: But
only for some of them?
Caroline Flint: No, there will
be protection for those bar workers as well, because we are consulting
on how we can make the area around the bar smoke-free.
Q548 Dr Naysmith: There
is no way to make it smoke-free?
Caroline Flint: We are consulting
on how we can reduce the impact of smoke, and I would agree with
you, that there are issues around a perfect solution to this but
there are ways forward in which we can reduce the impact, and
that is what we are trying to do.
Q549 Dr Naysmith: All
the evidence that we have heard in this Committee—and I
am sure you are aware of it—says that there is not any way
you can protect bar staff from the effects of second-hand smoke?
Caroline Flint: The purpose of
the proposals, which was based on Choosing Health, is people
wanted to have more restrictions. It is very interesting when
you look at the surveys of individuals' points of view on this.
88% supported restrictions in public places, 91% of restaurants.
That went down to 65% in pubs and to 31% for a complete ban in
all areas. We have had to try and weigh up that strength of public
feeling. Our proposals are going further than the public were
suggesting through our bans on those pubs that serve food, but
at the same time we are trying to create an environment where
people have more choice, and I think more choice is important
to this debate.
Q550 Dr Naysmith: What
you are saying is: it is because of popularity that this policy
is being introduced, because you think it would be unpopular?
Caroline Flint: No, I think there
are a number of issues. I think when you are dealing with issues
of public health where we are trying to effect change in people's
behaviour, just banning, or telling people to do things for their
own good, I think we all know, does not necessarily work. We know
95% of deaths from second-hand smoke are related to second-hand
smoke in the home. We know, I am afraid to say, whilst we continue
to press the argument about dangers to children and other adults
in the home and not smoking in the car with children in the car,
we found earlier this year, for example, a third of parents still
smoked in the car while their children were present. We are trying
to address these issues, but, importantly, and I think it is interesting
looking at what has happened in other countries . . .
Q551 Dr Naysmith: It is
very interesting to if you look at what is happening in other
countries?
Caroline Flint: Yes, it is, because
if you look across the European Union the only country so far
to go for a complete ban is Ireland. Every other country—Sweden,
Finland, even Norway that now has a complete ban all started off
with exemptions. In Sweden, for example, they allow specific smoking
rooms. Finland are planning to bring in legislation which will
do the same. Norway exempted bars, as did California and New York,
and only after a period of time did they move further. One of
the reasons for that is they wanted to bring the public with them,
and that was their choice, and we have looked at the situation
and that has been our choice on this occasion.
Q552 Dr Naysmith: We have
had a very interesting morning here. We have had the Chief Medical
Officer of Health telling us that he is in favour of a complete
ban, and even in answer to a supplementary question the officer
agreed with a member of the Committee that he thought bringing
in a partial ban would not necessarily make it more likely that
a full ban would come following on behind; it could make it even
more difficult. He also said that it is the only time he thinks
in seven years, I think he said, when his advice had been completely
ignored. We have heard something similar has happened in Northern
Ireland, where the medical advice was that a complete ban should
go ahead. How can you justify going against what is clearly the
evidence of the experts?
Caroline Flint: There clearly
is evidence about the health outcomes caused by second-hand smoke,
and I think it would be fair to say, and I think the Chief Medical
Officer would agree, that in the last eight years of this government
we have done more than any other government before. I do not want
to be put in too political a situation, but we have done more
than any other government before to work within the Department
of Heath but also other departments as well to tackle issues around
smoking, whether that is in terms of tobacco control, whether
that is in terms of advertising, whether that is in terms of providing
on the NHS services for people to give up smoking; and clearly
that is one of the reasons why the levels of smoking have gone
down in England. They have gone down elsewhere in the United Kingdom,
but they are at their lowest level ever in England and they are
lower than Scotland, Wales and Northern Ireland. I think that
would be acknowledged. We do listen to the advice of the chief
medical officers at of other organisations as well, but we also
have to make some choices about how we develop the work we are
doing, and in our opinion, based on a number of different factors,
we felt that it was important to move to a more completely smoke-free
environment but recognising that there were very clearly strongly
held views—and I think we have all become aware of very
strongly held views on this issue in this House and outside of
it—about how far we should go at this stage. I think that
was a choice that was made based on a number of different factors,
but there is no doubt that we are moving further in the direction
to get public support for smoke-free public places.
Q553 Dr Naysmith: Despite
the figures you quoted earlier on, there probably is support for
a complete ban already.
Caroline Flint: I am afraid it
would be nice to say there is, but even I think ASH, who produced
a survey produced by MORI, I think, earlier this year, found that
only 49% of the public were in favour of a complete ban. The ONS
survey of 2004 showed it standing at 31%. I would say the previous
year it was, I think, 11 points behind that; so there is a movement
in terms of public opinion, but I am afraid to say, on a complete
ban, when you tell the people a complete ban in all settings,
in social settings, pubs, there is not the majority. What you
see is it goes extremely higher when we talk about restrictions,
which is why 88% support restrictions in public places, 91% in
restaurants, and I have to say, even though it is a majority,
it goes down to 65% in pubs for restrictions. We are going further
in that respect than public opinion, because we recognise public
opinion is moving.
Q554 Dr Naysmith: The
movement is probably the most important aspect as well, as we
discussed earlier on. It does seem, despite your protestations,
that popularity is a very important influence in deciding what
you can do, whether you think the population will support it or
not.
Caroline Flint: I do not think
it is about a popularity contest; I think it is about recognising
that we are talking something that even of itself is not illegal.
Therefore, one of the issues here, one of the issues, I should
say, which we have to bear in mind is how we take the public with
us in terms of self-enforcement. As I said earlier, I think one
of the reasons why in all our lifetimes the voluntary bans have
been successful—on the tube, on the bus, in the cinema and
so forth—is because there has been a sense that that was
the right thing to do. It has meant that there has been limited
disorder as a result of that, and part of what we are trying to
do here is to have a light touch in terms of enforcement, and
I think part of you achieving that is going with some of the grain
on challenging, which I think we are challenging, but at the same
time recognising that difference. I would say that I have looked
at the consultations in Scotland and Northern Ireland, and, like
our own formal consultation this summer, clearly the overwhelming
responses to that were in favour of our proposals but would have
liked to go further. Interestingly, I have not seen public opinion
polls of individual attitudes in Northern Ireland and Scotland;
so I cannot comment on that and whether that reflects the same
public opinion polls we have done in England.
Q555 Dr Naysmith: You
quoted ASH a minute or two ago, and we heard evidence this morning
that support in England is now higher than it was in Ireland prior
to the introduction of a ban in Ireland. When they introduced
it in Ireland, a smaller section of the population were in favour
of it than now in England?
Caroline Flint: As I said, the
poll that I am aware of in terms of ASH was 49% in favour of a
full ban.
Q556 Chairman: Minister,
could I just ask you. Is it the Government's contention that unless
it is popular in terms of the public and opinion polls then this
would be a hindrance to actual enforcement?
Caroline Flint: No, it is about,
I think, weighing up a number of considerations around enforcement
and the will of the people to self-enforce in these areas. I think
that applies to a lot of issues that we deal with in public life
where we actually rely—if you think about things like dropping
litter, if you think about a whole host of areas—we rely
on public speeding in cars, we rely on the public to support the
legislation, support the laws and self-enforce it and then we
have safeguards to fall back on, quite rightly, in those different
areas where that is not the case, which is why within our proposals
we are making it an offence in certain areas for people to smoke
in places that are smoke-free and for businesses to not take action
or be seen to encourage smoking when they should not be.
Q557 Chairman: Do you
think there is a role for leadership in terms of issues around
smoking and health as opposed to waiting for the 51% to tick over?
Caroline Flint: I think there
absolutely is a role for leadership, which is why I am very proud
that over the last eight years we have both accepted, I think
in a way that was never accepted before, the issues around smoking
and the dangers, which is why, as I said earlier, both in tobacco
control, in terms of the warnings we have on cigarette packets,
we will shortly be consulting on a picture warning to see if that
will be more effective, or as effective; it is why we have invested
a huge amount of money in smoking cessation, and I should say,
particularly in our spearhead areas—and I know you are probably
going to talk to me about that later—which are the most
deprived communities in this country, we have been very much prioritising
smoking cessation availability. Of course, I would like to say
this as well in terms of other workplaces, because I know people
are concerned about the bars, but in terms of the other workplaces,
whilst we have seen an increase in either smoking restrictions
or smoke-free workplaces, that is still higher amongst those workplaces
where it is white-collar workers. Therefore our proposals, willing
of themselves, support all those workers in those places that
currently are not covered but according to the figures will be
particularly important for those who are in the lower paid jobs
and more manual working environments.
Q558 Mr Burstow: On that
point I wanted to start really. You made reference earlier on
to the 99% coverage that you believe the policy will achieve in
the workforce. Is it not really the case that that 99% at the
moment is just a rhetorical device in terms of presenting the
policy and that there is not actually any evidence, and there
could not be until the policy is implemented, to actually show
that 99% of the workforce is covered? Indeed, when we had the
Chief Medical Officer here before us earlier today, he said there
is no evidence and, indeed, no figures that support the assertion
that 99% of the workforce will be covered. Where is the evidence?
What is the evidence that supports that position?
Caroline Flint: That information
has been provided by officials at the Department of Health who
also advise the Chief Medical Officer. Nick might want to add
something to that, but it is based on an uplift from 51% to 99%.
Mr Adkin: I think I explained
when I first came to the committee two weeks ago, three weeks
ago: if you ask people now, "Is your workplace completely
smoke-free?", 51% of people say it is completely smoke-free.
On the basis of this policy, looking at where people work, which
sectors they work in, the figure will rise to over 99% of people.
Based on if you look at the proportion of people who will be working
in those exempted sectors, it will be 99%. That is where we came
up with the calculation. We are assuming complete enforcement
for that assumption.
Q559 Mr Burstow: So it
is 100% enforcement of those workplaces where the ban will apply
in full. Rather than pursuing this now, I think it would be useful
to have those statistics set out in a note, if it is possible?
Caroline Flint: I am happy to
provide that to the Committee.
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