Examination of Witnesses (Questions 1-19)
RT HON
PATRICIA HEWITT
MP AND SIR
NIGEL CRISP
27 OCTOBER 2005
Q1 Chairman: Good morning, Secretary
of State. Would you for the record introduce yourself and your
companion?
Ms Hewitt: Thank you very much,
Chairman. Patricia Hewitt, Secretary of State for Health, Sir
Nigel Crisp, who is the Chief Executive for the NHS and Permanent
Secretary for the Department of Health.
Q2 Chairman: Could I ask you, first of
all—it will be no great surprise to you—about the
issue of the last 24 hours or more. Last week the Government made
a statement, or, should I say, the Parliamentary Secretary of
State for Northern Ireland made a statement—the Hon Member
for St Helens South—that his intention was to introduce
comprehensive measures to protect all workers and the public from
the dangers of passive smoking and second-hand smoke in workplaces
and in all enclosed public places in Northern Ireland, including
all pubs and all bars. Are we to accept that workers and the public
in St Helens South are going to have less protection against secondary
smoke than workers and the public in Belfast South?
Ms Hewitt: Chairman, the consequence
of devolution is that we will have different decisions on some
subjects in different parts of our country, although each of those
decisions follows very extensive public consultation. The Bill
that we are introducing today—the Health Improvement Bill—will
mean that smoking is banned in every office, every factory, every
shop, every restaurant, every bit of public transport, virtually
every enclosed work space and public space in England. It will
mean that 99% of the workforce will be able to enjoy a completely
smoke-free environment, that 12 million more people will be protected
from second-hand smoke, it will certainly help smokers who want
to give up to do so and because of that it will reduce over time
by thousands the number of people who die from smoking-related
diseases. Of course, we are equally concerned about workers in
the food only pubs and the membership clubs who are going to be
exempted from this ban, and that is why we said, not only, of
course, in our manifesto but we have made it clear today, that
there will be no smoking allowed, even in those pubs and clubs
that choose to continue to allowing smoking, within the bar area.
We will now have a further round of consultations on that and,
in particular, we will consult on the possibility of creating
separate smoking rooms or areas in order to give as much protection
to those bar staff as we can.
Q3 Chairman: Can you tell the Committee
what is the outcome of the summer consultation in relation to
these proposals? Have they been assimilated? I have got in front
of me the statement that was made last week about the consultation
in Northern Ireland, which as I understand it at the moment does
not have any devolved powers—they are suspended—but
that is probably another debate, but there was massive support
during their consultation earlier this year for a comprehensive
ban, which it looks like we are going to legislate in our parliament
for them to have. What is the outcome of your similar consultation?
Ms Hewitt: We had, Chairman, an
enormous public consultation last year before the White Paper
and of course for the Labour Party before the manifesto was drawn
up, and what that public consultation showed very clearly was
that the vast majority of people want a complete ban in the vast
majority of enclosed work spaces and public places, they want
to be able to go out for a meal without being disturbed by other
people's smoke, but there was strong support for the view that
the significant minority of people who do choose to smoke, despite
the health risks, and who want to be able to have a cigarette
along with a drink when they go to a pub should be able to do
so in pubs that do not serve food, that memberships clubs should
be able to make their own decision on this, but, nonetheless,
we would do our best to protect the workforce. The summer consultation
was, of course, on the details of the regulations that would be
needed to give effect to those exceptions, and what came back
there was very strong support for the principle of legislation—a
very large number of people wanting us to go that 1% further so
that it would be 100% of the workforce rather than 99% in a completely
smoke-free environment—and there were also concerns about
the particular proposal to have a one-meter exclusion zone—you
know, the line on the floor or the wall—around the bar,
and that is why we have looked again at all of this. There were
very different views on this, as I think everyone knows, and we
did what any organisation would do under the circumstances: we
discussed it between ourselves and we agreed that, since any way
forward has both advantages and disadvantages, we would continue
on the lines that we set out so clearly in the manifesto only
five months ago but with this further consultation on how we give
the bar staff in the exempt pubs and membership clubs as much
protection as we can quite possibly through the creation of separate
smoking areas or rooms.
Q4 Chairman: The Northern Ireland
consultation had 91% of respondents expressing support for comprehensive
controls. Do we have a percentage for the respondents to this
particular consultation on the smoke-free elements of the Health
Improvements Protection Bill?
Ms Hewitt: I have not got the
exact figures with me—of course we will publish the usual
summary of the consultation responses—but it was around
90% who supported legislation in this area. There were, of course,
people who do not believe we should be legislating at all, but
I think the great majority of those who support legislation would
like us to go that extra step further and also ban smoking in
the drink only pubs. However, I would stress here that the legislation
will come into effect in the summer 2007. That is considerably
earlier than we originally proposed, because for licensed premises
we originally suggested the end of 2008. Most people responding
to the consultation said, "Do it faster"; and we will.
We will monitor the impact from day one, we will have a full review
at the end of three years, and this is a very significant step
for public health and a very, very significant step towards the
complete ban that I know you and many others would like to see.
Q5 Chairman: Obviously other members
of the Committee will want to ask you questions on this, but given
this issue about private members clubs and the exemptions that
we hear about in the media, how is this going to impact on the
issue of heath inequalities in England?
Ms Hewitt: There is a real concern
about health inequalities. If you look back over, say, the last
20 years, of course it used to be the case that almost the same
proportion of people in the middle classes and people in working-class
communities were smoking. What has happened since then has been
a very sharp decline in smoking rates amongst middle-class people
and a rise, in a few cases, amongst more working-class communities;
so the gap has widened. What we are doing in this Bill will actually
help reduce inequalities, because the vast majority of people
in the north and everywhere else will be protected from second-hand
smoke in their workplaces. We have got superb stop-smoking programmes
in the NHS which have helped over a million people to stop smoking
since 1998 and we are going to continue developing that, but I
agree that one of the problems with the policy we set out in the
manifesto and the distinction between the food and the non food
pubs is that there are more non food pubs in the poorer communities
of our country. That is a disadvantage, and we looked at that,
but because every approach has disadvantages, we decided, after
proper reflection and discussion, to come back to the proposal
that we made in the manifesto which, of course, all of us in government
in our party were elected on just five months ago.
Chairman: I will not mention top-up fees!
Charlotte.
Q6 Charlotte Atkins: Will it not
be the case that many pubs will decide not to serve food, and
so what you will get is smoky drinking dens in less affluent areas
encouraging binge drinking, because people will not be able to
eat with their drink, and smoke-free food-serving pubs in the
more affluent areas?
Ms Hewitt: I think there is a
risk that some pubs that are currently serving food will decide
to stop serving food in order that their customers can go on smoking
if they choose to, and that is a real disadvantage, and I readily
admit that. The alternative would have been not to draw this distinction
between pubs and restaurants serving food and those who do not,
but when we looked at our manifesto, when we looked at this very
difficult balance that we are trying to strike between protecting
employees from second-hand smoke and respecting the rights of
a minority of adults to do something that is perfectly legal,
then we decided that the right balance was the one that we had
struck in the manifesto; but there are disadvantages whichever
way you go on this one. I have to say that the disagreements that
we have had inside government—and that is perfectly normal—are
mirrored by disagreements amongst the public, and I think certainly
many of my constituents in a working-class community do feel very
strongly that, just as they are free to make that choice to smoke
in their own home, they should be free to have a cigarette with
a drink. It is a very difficult issue and, of course, there is
a strong case to be made for a complete ban, but this is a very
significant step towards that complete ban, and I think the disagreement
on 1% of the policy should not blind any of us or the health professionals
and the anti-smoking lobby to the enormous step forward that we
are making in this Bill.
Q7 Charlotte Atkins: How will you
monitor the effects so that when the review happens in three years'
time we can have proper evidence as to what has been happening
in England?
Ms Hewitt: We will put in place
before the summer 2007 more detailed mechanisms for that monitoring,
but, of course, one of the things that we are already doing is
measuring, through surveys, the number of people who are smoking,
the number of people exposed to second-hand smoke in different
places, but we will, through consumers' own reports, through contact
with the industry, and such like, and, indeed, through reports
from members of Parliament, be able to see exactly what is happening
in those food only pubs and in the membership clubs and that will
feed into the final review at the end of three years.
Q8 Mr Burstow: Secretary of State,
you were saying, I think, this morning on the "Today"
programme that there is total agreement around 99% of the policy—and
you have reiterated that point—but when it came to the Public
Health White Paper last year one of the things that it pointed
out was that between 10 and 30% of pubs were, and would be likely
to remain, smoking pubs. How does that equate with a policy that
is 99% achieved when an intended 30% of pubs will continue to
be smoking pubs?
Ms Hewitt: What we are looking
at here is the totality of workplaces, and, as I was saying earlier,
every office, every factory, every shop, every cinema, virtually
every workplace in our country is going to be smoke-free by the
summer of 2007, and that is why we are completely confident that
99% of the workforce will be enjoying a completely smoke-free
environment. Currently it is about 50%. So there will be 12 million
more workers in a smoke-free environment in the summer of 2007
compared with where we are today. That is why this is such a big
step forward.
Q9 Mr Burstow: Would you accept that
there are 10 to 30% of pubs that will remain smoking pubs under
this legislation?
Ms Hewitt: This is going to be
a matter for publicans themselves to decide. Nobody is compelling
drink only pubs also to allow smoking. That is a choice that publicans
will make, just as members of genuine membership clubs will make.
My sense is that public opinion on this, public attitudes towards
smoking, are moving very rapidly. I remember not so long ago when
people on every bus, almost everywhere you went there were people
smoking, and that is coming down very rapidly, although it is
going to be a lot faster with this legislation. My very strong
belief is that by the end of three years we will have seen a further
reduction even amongst the drink only pubs, and that is why I
continue to believe, as I said to the BMA in June, that it is
only a matter of time before we do have a complete ban.
Q10 Mr Burstow: If public attitudes
are moving so rapidly, surely the Government can be ahead of that
public shift in attitudes and actually give a lead by having a
clear and comprehensive ban in all public houses and not just
those that are serving food. Why is there still this distinction?
Is there an evidence base that underpins the policy, or is it
just that a manifesto commitment was made as a result of the previous
Secretary of State's very strong opinion on this and we are now
stuck with the previous Secretary of State's position?
Ms Hewitt: We are giving a very
clear lead on this. This is an enormous step forward in public
health and it will move within a very short space of time. It
will go from about 50% of employees in a smoke-free environment
to 99%. That is a huge step forward. But the manifesto commitment
was based on a very, very extensive public consultation that you
will be aware of which was reflected in the position we put forward
in the Choosing Health White Paper, and that is what we are legislating
for in this Bill.
Q11 Mr Burstow: One more thing on
this issue about the 10 to 30%. Charlotte has already asked you
a question about how we are going to measure this over the next
three years. What baselines will be set? Will there be data collected
so we know absolutely at the outset of this policy how many pubs
are still allowing smoking? We can then measure over the three
year period whether or not, as you say, a number of those choose
to become smoke-free?
Ms Hewitt: Of course we will do
that.
Q12 Mr Burstow: So there will be
specific statistics at the beginning of this process?
Ms Hewitt: We will monitor this
so that we can see the impact both of the near total ban that
we are imposing and the exceptions.
Q13 Dr Stoate: You have said that
this is a huge step forward, but to most people outside it is
a confusing mess which is going to be extremely difficult to police.
That is the reality which I am picking up from all sorts of corners
at the moment. If we have a Public Heath Improvement Bill—and
in your own words you have said that the non-food bars are likely
to be in the less affluent places—how can we justify better
public health protection in more affluent places and less public
health protection in less affluent places? In terms of bar staff,
that surely must be a very difficult thing to justify.
Ms Hewitt: This is an enormous
step forward because, as I was saying earlier, it is going to
mean that virtually every workplace and every public place that
we go to every day will be smoke-free. That is going to make it
much easier for smokers who want to give up to do so, often supported
by our stop-smoking programmes, it is going to reduce dramatically
the number of people who are exposed to second-hand smoke, but
we also need to recognise that of course the great majority of
deaths from second-hand smoke are the result of smoking that takes
place in people's own homes; and I have not heard anybody suggesting
that it is an appropriate role for government to ban people from
smoking in their own homes. What is important is that we create
and reinforce a public culture in which smoking is no longer the
norm and we help people to give up smoking, if they want to do
so, through the stop-smoking programmes but also through this
Bill. This will save over time thousands of lives.
Q14 Dr Stoate: I could not disagree
at all, in fact; that is absolutely true. Why then have any exemptions
at all? If we know this Bill is a public heath measure and the
Government's role is to protect the public's heath, why bother
with exemptions of any sort?
Ms Hewitt: For exactly the reasons
that I have outlined and that we set out in the Public Heath White
Paper following that public health consultation, because we are
trying to strike a balance here between protecting all employees,
including the bar staff in the non-food pubs and the membership
clubs, and respecting the rights of a minority, but significant
minority, of adults who say, "Look, I can smoke in my own
home and if I am going to my working men's club down the road
or to a pub which is not serving food and I am not upsetting people
who are having a meal, I also want to be able to have a cigarette
with my drink." It is a difficult balance to strike. There
is not a perfect way forward on this, but this, I believe, is
the right way forward in the light of the manifesto commitment
that we all gave.
Q15 Dr Stoate: The problem is that
the logic of it is the same as saying: we will only fit seat-belts
for 99% of cars and people who live in less affluent areas can
have fewer seatbelts in their cars. If we are talking about an
issue which saves lives, then it must be right to protect everyone's
life to the same extent, and I do not believe that this compromise
achieves that?
Ms Hewitt: I completely understand,
I have considerable sympathy with your view point, but these were
issues that we discussed in great detail following the public
consultation, and, as I say, we were trying to balance that argument
with another powerful and important argument about the rights
of the minority to act in a way that they choose and which it
is perfectly legal for them to choose. Nobody is proposing that
we make smoking anywhere completely illegal. We had that difficult
balance to strike, but I do want to stress that I have brought
forward the implementation date for this law quite significantly
so that we get the benefits of it earlier, and we will monitor
it from day one and we will have that full review completed at
the end of three years so that we can then make a further judgment
on the best way forward, and that is why this is such a significant
step forward.
Q16 Anne Milton: Decreasing inequalities
in health has been a central plank of government policy, is that
correct, over the last few years? Yet the partial ban will increase
inequalities in health. In fact, we heard last week, and I do
not know whether it is in order to quote, from Professor Dame
Carol Black, "I would like to emphasise again that this partial
ban would simply disadvantage the poor in this country and it
would make the gap between good health for the poor and for the
rich even larger." This is going to increase inequalities
in health.
Ms Hewitt: We have set a reduction
in health inequalities as one of our major goals, and that is
something that has to be achieved through a whole variety of measures.
I do not want to get party-political, but I have so say it is
more difficult to do that after 20 years of a government that
had no interest whatsoever, indeed would barely admit that health
inequalities existed never mind do anything about it. These are
very deep-seated and we need to look at the much broader picture,
not only this Bill, which is going to protect virtually every
worker in the disadvantaged areas that I represent and in other
parts of the country from second-hand smoking, but the other things
that we are doing, for instance, through the neighbourhood regeneration
programmes, thorough the development of health trainers, through
the smoking cessation programmes, all of which will help us to
reduce health inequalities.
Q17 Anne Milton: I also do not want
to get party-political, because I do not think it is terribly
useful and I am not going to. What worries me is what you are
going to do, not what has happened in the past. Do you disagree
that this will increase inequalities in health?
Ms Hewitt: I believe from the
evidence we have had that we will see more non food pubs in poorer
areas than in more affluent areas. That, as I said earlier, is
one of the real disadvantages of drawing this distinction between
food and non food pubs; but if we had not drawn that distinction,
and we certainly looked at that option, we would have had other
disadvantages. We might have had places serving food also deciding
to have a smoking room, and there were arguments against that.
There is not a perfect way forward on this that balances the different
considerations and different rights and responsibilities. I believe
that this is not only a sensible way forward but it takes us a
very long way forward and we will then monitor and review it,
as I have said.
Q18 Anne Milton: I want a "yes"
or a "no". Do you think it will increase or decrease
inequalities in health?
Ms Hewitt: If you look at heath
inequalities as a whole, I do not think you can make that judgment,
because the vast majority of people in poor areas are going to
be protected from second-hand smoke in their workplace along with
everybody else.
Q19 Anne Milton: So you do not necessarily
agree with Carol Black?
Ms Hewitt: Not necessarily. I
think she was talking specifically about the pubs issue, but when
you look at health inequalities you have to look at the wider
picture. If I look, for instance, at the most disadvantaged community
that I represent and similar communities around the country. What
I see is a reduction in the number of people smoking and, because
of the investment that we are making in regeneration, in helping
people to get back to work, in new sports and leisure facilities,
in support for better health and more sporting activity, we are
actually seeing a really significant improvement in the choices
people make about smoking and about exercise and the other things
that fundamentally determine our health.
Anne Milton: Can I finish off by saying
that I think we have to stick to smoking. We are talking about
a partial ban against a total ban and not about other public health
measures that you might be undertaking.
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