Examination of Witnesses (Questions 560-579)
CAROLINE FLINT
MP, FIONA MACTAGGART
MP AND MR
NICK ADKIN
24 NOVEMBER 2005
Q560 Mr Burstow: I think
otherwise we just end up disputing a number and not making a great
deal of progress. I wanted to come on to the issue of the consultation
that was held over the summer, because in the documentation you
have kindly provided us, in respect of question five in that consultation,
which was this issue of the distinction between pubs serving food
and those not serving food, you had 41,833 responses, and the
majority of those responses to that question—it says in
here over 90%—are against an exemption of pubs not serving
food. It goes on to say that is because the primary issue here
is health and safety at work for the workforce. What I guess I
want to get a clear idea of is, given that the Chief Medical Officer
in his annual report last year placed a lot of hope and faith
in your consultation exercise providing a basis upon which the
policy could be strengthened—and the decision the Cabinet
have made is that it is not going to be strengthened, it is not
going to change from the manifesto position—what was the
point of the consultation?
Caroline Flint: A number of aspects.
First of all, the consultation was actually consulting on the
details of the proposals in Choosing Health which were
then formally part of, if you like, our manifesto in the general
election of this year, which was pretty clear about the way forward
in terms of policy in this area. The consultation was primarily
about: "These are the proposals. We have had the consultation
in Choosing Health. Here are the nuts and bolts. What are
your thoughts?" That was the main point of the consultation,
which is why we had all the questions about food, about exemptions
and so forth. I would say actually some things have changed in
terms of where we were before. First of all, we brought forward
by 18 months to the summer 2007 the enforcement for licensed premises.
We have said that we will monitor from day one and review after
three years, and in that sense the policy, I think, has been improved
and firmed up. Of course, we are also looking at the number of
specific issues people have raised in relation to specific questions,
and we are still consulting on the issue of the area around bar
in terms of how far practically we can reduce the smoke in that
environment.
Q561 Mr Burstow: But,
if this about having a very clear and explicit policy in the manifesto
which the Government has now taken through to legislation, why
on earth ask the questions that would pose a potential challenge
to that policy? If you have a policy and you are going to implement
it regardless of what the public think, why ask the public for
their view in the first place?
Caroline Flint: Because we were
asking the public their view on specific questions, but, as you
can see from the consultation, and I have no problem with that,
many of the people who responded wanted to say, "Yes, we
know this is your policy. These are our views on this." And
I would hasten to say that whilst I appreciate a number of those
who responded want a total ban, there was also an acknowledgement
by those people that they felt that the policies that we had were
a step forward, and therefore the consultation has had some results
and some of those results have ended up, I think, strengthening
the policy we had before the consultation.
Q562 Charlotte Atkins: When
the Secretary of State came in front of us she made it very clear
that she thought it was only a matter of time before we had a
complete ban. Given what is happening in Scotland, Northern Ireland,
possibly Wales as well, is it not right that we should have introduced
the complete ban now? Would it not be wrong to say to pubs, "No,
a partial ban. Introduce expensive ventilation", even though
ventilation, in our view, would not take away the health risks?
You were talking about the smoke-free area around the bar. To
introduce expensive measures, when in fact in three years time,
when the monitoring has been done, we go for a complete ban, is
that not unfair to everyone concerned?
Caroline Flint: In answer to the
first part of your question, I do not think it necessarily follows
that because Scotland or Northern Ireland go one way, England
should follow, and I think that works the other way round: if
England goes one way, Scotland or Northern Ireland should follow.
There are some very interesting issues in terms of approaches
in attitude to health that are different between ourselves and
Scotland, for example. We could have many debates about that and
also the way health is carried out in Wales. I do not think it
necessarily does follow. On the second point around the issue
of is it worth pubs investing, there is the same choice for pubs
that there was before, to be honest. There are some chains, I
understand, that are intending to go smoke-free, and they were
intending to do that regardless of whatever policy the government
of the day was going to introduce. Really there is a choice here
for some of those pubs that are going to be exempted under our
proposals as to what they want to do and they have to make some
decisions based on where they see change happening, just as in
the same way this morning I have been at the Bakers' Conference
talking about issues around food and manufacturers and retailers
in that area. They have to make some choices about the way things
are changing and that is for them to decide. Having said that,
we are concerned to find a way forward about how best we can reduce
smoke in the bar area, and that is something we are still considering
and taking soundings on.
Q563 Charlotte Atkins: Certainly
pub chains like Wetherspoon's are going down the route of a complete
smoking ban recognising that they may take a hit in terms of sales
to start off with. What I am concerned about is the health inequalities
issue. There will be pubs in places like near my constituency,
Stoke-on-Trent, that effectively will be smoky drinking dens,
whereas maybe in my part of North Staffordshire we will have pubs
that are smoke-free serving food. The problems are—I think
the Secretary of State recognised this in her evidence and I know
you have read the evidence—that this would widen health
inequalities because smokers will tend to go to the drinking pubs
and they would not be able to eat food at those pubs and, in fact,
that would contribute towards the binge drinking culture that
we are trying to eradicate.
Caroline Flint: There is no point
in saying that there is not a difference because there is obviously
a difference because there is an exemption. What I would say is
that even for those customers in a drink only establishment, they
will see a difference because there will be regulations that tackle
the issue around the bar area and, therefore, for those people
who are currently smoking in those establishments where there
may just be, if anything, the metre rule around the bar, which
some of the associations have encouraged, they will see a difference.
The other aspect to it is this: in terms of health inequalities,
I think a major reason why we have some issues not only in this
area but in other areas to face in terms of health inequalities
is to do with poverty and affluence. In those areas it is very
important to see that the work we do in terms of education, regenerating
communities, is also one of the ways in which people start thinking
about their futures and aspirations and lifestyles. We know that
because we can see very clearly that those who are better off
are taking on information quicker in relation to healthy living
and acting upon it more than those who are less well off and so
forth. Alongside that, I should say, are our spearhead areas which
cover 88 PCTs and some 70 or so local authorities. Issues around
smoking have been made a priority, along with some other important
health issues, in order to look at a different way of providing
services that meet the needs of the most disadvantaged in our
communities. One thing is for sure, we have found that certainly
preaching and just sending information is not of itself enough
for people to say, "I am going to give up". Linked to
that, of course, is the fact, as I said before, in terms of workplace
coverage, in a greater way my understanding is, looking at those
figures, those workplaces that have higher numbers of lower income
manual workers in them are going to have a greater effect and
impact from this legislation than those in the more white collar
well-paid working environments. It is not just about where people
drink, it is about where people work as well. If you think of
all the people we have working in our health service and public
service institutions from within our own communities, that is
a substantial number of people who are going to find that their
working lives are going to change very dramatically.
Q564 Charlotte Atkins: Can
I just take you up on this issue about no smoking within a metre
of the bar. Dr Adshead, when she gave evidence to us a couple
of weeks ago, said: "The recommendation that there should
be a prohibition upon smoking within a metre of the bar is not
based on evidence of protecting health", the health of the
workers, "it is essentially trying to reduce the amount of
noxious exposure, the irritant effect of smoke within that distance.
It is not a recommendation that was put forward on health evidence
grounds". Given that we are primarily trying to protect workers
here, how can that recommendation be a sound approach when it
is really health we are talking about here and not just about
irritation? We know, for instance, that ventilation does not remove
the cancer producing effects of the second-hand smoke that workers
are exposed to.
Caroline Flint: I agree with Dr
Adshead on that. We are not claiming in that respect that is going
to eradicate the issues around second-hand smoke. We were looking
at issues around reducing, as I think she described it, the noxious
fumes and the irritant factor. Having said that, we are further
consulting on what other possibilities there might be other than
just what is talked about as the metre rule around the bar, which
was one of the questions we had in our consultation over the summer,
because there are some feelings that perhaps we could improve
upon that. We are talking about issues around designated areas
or a separate area as well.
Q565 Dr Naysmith: Can
you tell us who you are consulting with?
Caroline Flint: We have gone back
and consulted with industry and others on this issue and their
thoughts. I have to say one of the difficulties in all of this
is lots of people have different points of view about what should
happen, so I am afraid even within industry there is not one solution
to this particular issue. Some aspects of industry would rather
like us not to do anything at all. We are trying to work our way
through this to think about what might be the better way forward;
not necessarily the perfect way forward but the better way forward.
Q566 Charlotte Atkins: But,
in contrast, we had evidence when we visited Dublin of the real
health improvements of bar workers since the complete ban was
introduced. Surely that must be the way forward if you are looking
at not only the health effects for workers within bars but also
the overall health effects for the population at large?
Caroline Flint: As I said, we
are working to improve the choice of people to both socialise
and work in a smoke-free environment. Whilst I accept, because
it is there obviously, that there is a small section—a very
small section—where smoking will be allowed, and that does
have implications for bar staff, for the first time we will be
offering to all those people who work in the hospitality industry
in one shape or another a far greater choice than they have ever
had before about where they should go. That is something that
without these proposals would not be available. As I said, the
purpose of our legislation is primarily to widen the choice and
opportunities for people to work and socialise in a smoke-free
environment. To that end, linked to the other issues I have raised
about what we took into account, we are making serious progress
here. Ireland has made its own decision and that is their choice;
as is the case in Scotland and other countries as well. I would
say that in terms of the work we have done in this country, in
England, on smoking cessation in other areas, we are held up by
the World Health Organisation as one of the countries to watch
and take advice from.
Q567 Charlotte Atkins: Certainly
I accept that but you are not arguing, are you, that bar workers,
hospitality workers, make a choice about whether they put their
health at risk by working in particular environments?
Caroline Flint: I am saying that
there is greater choice than there was before. Without our proposals
it would be just voluntary still. It does mean that there is greater
choice. I accept there are individual choices to be made, but
there are greater choices than there would be without this legislation
for people both choosing to use pubs and for those working in
them. That is something that is achieved as a result of these
proposals.
Q568 Charlotte Atkins: But
the choice effectively will not be a choice made by the workers,
it will be a choice made by the owner of the pub, the pub chain.
It is not easy for people to be able to make that choice to go
and work in a different establishment, especially if you are a
relatively poorly paid worker who perhaps has caring responsibilities
at home and cannot readily move from one town to another town.
Caroline Flint: I accept the point
that people face different difficulties in terms of their choice
of work based on all sorts of factors. I am just saying that through
these proposals will be the potential of more choice than ever
before for those people working in the hospitality industry. That
goes across the piece from, if you like, bars to coffee shops,
to restaurants, to hotels, to other leisure environments, where
a lot of the same sort of workers we are talking about do work.
Q569 Mr Burstow: To finish
this thread off, if I may. We had some figures presented to us
earlier on from the Local Government Association on work they
have done around the country which showed that in Easington 81%
of pubs in the most deprived areas of that council area do not
sell food in their pubs. This notion of choice about whether to
choose to work in an unhealthy or a healthy environment in a community
where the predominant way in which the licensed trade is operating
suggests that there really will not be any choice for workers
in that sort of area. Is this a policy which says to someone who
wants to work in a smoke-free environment they have to get on
their bike and find a pub somewhere far, far away from where they
live in order to avoid the harmful effects of second-hand smoke?
Caroline Flint: No. As I said
before, I am saying that without our proposals there would not
be any choice whatsoever because you would have smoking or not
down to the publican or the licensee. We are bringing forward
legislation that will dramatically change the landscape in which
people work and play. Yes, I appreciate the work the Local Government
Association and others have done in looking into their own areas.
I know a lot of local authorities are engaged with PCTs on strategies
that they can carry out to look at their premises, I have to say,
as well as others in terms of encouraging a more smoke-free environment.
We have done our own work in relation to this and, certainly,
in terms of some of the information we have got back we reckon
there is a range of between 10% cent up to 30% which will be affected.
I appreciate that might be more in some areas but I would also
say in terms of places like Easington and elsewhere, if I think
of some of the unlicensed places in Doncaster, for example, where
people work, local cafes and what have you, they will be smoke-free.
Therefore, there are other sectors of the local economy too which
are going to be affected by our proposals and make them smoke-free
where clearly there are a number of people whose lives will be
changed.
Q570 Mr Burstow: If you
are bar worker in one of the premises that continues to have smoking
because of the exemptions you are not really going to be in a
position to benefit from the protection that you are extending
and surely, as a result of that, those bar workers will be entitled
to avail themselves of the legal protections under the Health
and Safety at Work Act, because you have acknowledged that the
health consequences of second-hand smoke are clear, proven and
harmful.
Caroline Flint: This is not legislation
under employment law or health and safety legislation. In fact,
I understand the last time this was looked at the proposal was
a code of practice, which was clearly just a code of practice,
some years ago, that did not move forward and, therefore, in fact,
we are moving a way forward from where we were talking about codes
a few years ago. In terms of those employees, what I can say is
they will still be better off from our proposals. Without going
into the discussion again around the bar area, we will be looking
to reduce the smoke in that area and we are consulting on that.
The Secretary of State has made clear that we will be monitoring
from day one and, therefore, will be working with our spearhead
communities and others to look at how these proposals work in
practice but also how they sit alongside the other activities
we are doing within communities to improve health outcomes particularly
as a result of health inequalities.
Q571 Mr Burstow: Can I
just come on to something else which is about the evidence base
that underpins a lot of where we are now. At an evidence session
we had last year as a Committee with the former Secretary of State,
John Reid, he talked to us about the effects of a comprehensive
ban driving more people to go back home and smoke rather than
smoke in places that formerly would have allowed smoking. Is that
still something the Department supports as a view? Is that still
something which the Department thinks will be a likely outcome
if there was a comprehensive ban?
Caroline Flint: I read that evidence
to have a look at exactly what the former Secretary of State for
Health said. From my reading of it, and you have probably got
it in front of you, he was referring to off-sales. There is no
doubt about it, in terms of a general pattern of drinking behaviour,
off-sales have gone up in terms of people's purchase of alcohol,
probably due to the fact of retail outlets and what have you.
Not only in Ireland, but in England and elsewhere, the drinking
patterns have changed in terms of people buying drink, taking
it and drinking at home. You can probably correlate that to when
cinema attendance went down because people were watching videos
at home. My interpretation of what John Reid said was that he
was referring to issues around off-sales. On the second point
in terms of is there a displacement, in terms of the evidence
we have got, in particular there have been two reports in the
last six months, one was the Royal College of Physicians' report
in July of this year and there was a second report, which Nick
can remind me of, which had done some work looking at this issue
about whether there was displacement to the home, which did not
show that there was evidence that smoking restrictions did displace
into the home. Having said that, we do know that smoking in the
home is still a big issue, which is one of the reasons why we
ran our campaign in relation to the children inhaling smoke, but
also our recent campaign talking about other adults in the family.
There are still some serious issues there. The other point to
bear in mind, and the RCOP report—I read their evidence
as well—was a self-reported report and, I do not know, sometimes
people are not always willing to admit what they do when they
are being challenged about it, particularly smoking in front of
their own children. I think it was a self-reported analysis. I
do not dispute it though and I am happy to say, as far as I am
aware, there is no current evidence that would suggest there is
a move to more smoking in the home as a result of restrictions
or bans.
Q572 Mr Burstow: We have
certainly seen some evidence from our trip to the Republic which
showed very clearly that there was, if anything, a beneficial
effect of a comprehensive ban in terms of smoking at home.
Caroline Flint: I should say that
there was a slight increase in Ireland last year, as I understand
it—I do not know whether it is statistically significant—in
terms of smoking prevalence. It went down and there has been a
slight increase up.
Q573 Mr Burstow: Our understanding
from the research and the evidence so far has been that the prevalence
rates in the Republic went down. It went down by 6%, it was quite
significant.
Caroline Flint: You are right,
the overall prevalence of cigarette smoking in Ireland is 23.6%
as at August of this year. That represents a decline of 1.52 percentage
points since August 2003, however the most recent figures show
a small rise and I am happy to provide the Committee with the
evidence.
Q574 Mr Burstow: They
must be hot off the press because we were there only about two
weeks ago. I just want to make certain we are absolutely clear
about what John Reid did and did not say to us. I am interested
in the construction you have put on what the former Secretary
of State had to say. He also went on to assert that 15% of people
in Ireland now did carry out, took stuff home. Is that figure
a figure that you still stand by?
Caroline Flint: I have got proportion
of beer sales consumed at home. These are based on some figures
this summer at the Luxembourg Smoke-Free Europe Conference based
on Brewers of Europe data, I understand, so I cannot speak for
the wine drinkers here. In terms of Ireland, in 2003 it was 23%
of beer sales consumed at home. I do not have any data for post
the March 2004 ban in Ireland. It is not just Ireland, but in
the UK it is 39% of beer sales that are consumed at home. There
has been a steady increase over the years and I think that is
about patterns of drinking and socialising that have changed with
videos and all that sort of change.
Q575 Mr Burstow: You have
not got a figure for the actual change since that ban came in?
Caroline Flint: I do not have
data for post-March 2004. To be fair, it has been an issue that
has been raised with me amongst people who have been concerned
about the bans. It is a legitimate question to ask, whether or
not it would have an impact on the home. It does remind us how
important it is that whatever proposals we have for public places,
there is still a great deal of work to be done in terms of reaching
those families for whom smoking is something that they do at home.
We know, for example, amongst some of our younger women that they
feel smoking may lead to a low weight baby and, therefore, reduce
the pain in childbirth. That is something that has been put to
me. That is a really important issue we have to address. As I
say, in and of itself a ban would not change that young woman's
view on that matter, we have got to find another approach.
Q576 Mr Burstow: That
is a very important point. Does it really help, therefore, to
get that message across in a very clear way that is readily understood
by everyone to have a policy which says one cannot smoke in these
environments but it is okay in certain other environments within
a pub to smoke? Does that really send a clear, consistent message
that people can then act upon? Certainly in our experience in
Dublin, the message that was given to us time and time again was
that as a result of the comprehensive ban it was changing habits
and behaviour in the home as well in a beneficial way.
Caroline Flint: I am pleased to
hear that and I am pleased to acknowledge it. I can reassure you
that the policies this Government have undertaken over the last
eight years is changing habits as well in this area.
Q577 Mr Burstow: But we
are interested in this policy now and how this moves things forward.
Caroline Flint: This policy now
will move things forward by, we believe, reducing prevalence by
another 1.7%, I think that is correct. Therefore, there is no
doubt that this policy will continue to contribute to the reduction
in people who smoke.
Q578 Mr Burstow: What
would the prevalence reduction be if it was a comprehensive ban?
Mr Adkin: A comprehensive ban
would reduce smoking rates by 1.7 percentage points. Our policy
will reduce smoking rates by up to 1.7 percentage points. We are
not absolutely clear, because of the policy, how much of that
overall reduction—
Q579 Mr Burstow: Are you
saying your policy will have exactly the same effect potentially
as a comprehensive ban?
Mr Adkin: We think a comprehensive
ban is 1.7 percentage points. We think this policy is up to 1.7
percentage points. It is a range.
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