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Session 2005 - 06
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Standing Committee Debates
Health Bill

Health Bill




 
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Standing Committee E

The Committee consisted of the following Members:

Chairmen:

†Mr. Eric Illsley, Mr. Martin Caton, †Ann Winterton

†Blunt, Mr. Crispin (Reigate) (Con)
†Butler, Ms Dawn (Brent, South) (Lab)
†Dorries, Mrs. Nadine (Mid-Bedfordshire) (Con)
†Engel, Natascha (North-East Derbyshire) (Lab)
†Ennis, Jeff (Barnsley, East and Mexborough) (Lab)
†Flint, Caroline (Parliamentary Under-Secretary of State for Health)
†Hodgson, Mrs. Sharon (Gateshead, East and Washington, West) (Lab)
Joyce, Mr. Eric (Falkirk) (Lab)
†Kennedy, Jane (Minister of State, Department of Health)
†Kidney, Mr. David (Stafford) (Lab)
†Lansley, Mr. Andrew (South Cambridgeshire) (Con)
†Merron, Gillian (Lord Commissioner of Her Majesty’s Treasury)
†Murrison, Dr. Andrew (Westbury) (Con)
†Reed, Mr. Jamie (Copeland) (Lab)
†Webb, Steve (Northavon) (LD)
†Williams, Stephen (Bristol, West) (LD)
†Young, Sir George (North-West Hampshire) (Con)
John Benger, Gordon Clarke, Committee Clerks

† attended the Committee


 
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Tuesday 6 December 2005
(Morning)

[Mr. Eric Illsley in the Chair]

Health Bill

10.35 am

The Parliamentary Under-Secretary of State for Health (Caroline Flint): I beg to move,

    That—

    (1)   during proceedings on the Health Bill the Standing Committee shall (in addition to its first meeting at 10.35 a.m. on Tuesday 6th December) meet—

      (a)   at 3.55 p.m. on Tuesday 6th December;

      (b)   at 9.00 a.m. and 1.00 p.m. on Thursday 8th December;

      (c)   at 10.35 a.m. and 3.55 p.m. on Tuesday 13th December;

      (d)   at 9.00 a.m. and 1.00 p.m. on Thursday 15th December;

      (e)   at 9.00 a.m. and 2.00 p.m. on Tuesday 20th December;

      (f)   at 10.35 a.m. and 3.55 p.m. on Tuesday 10th January;

    (2)   the proceedings shall be taken in the following order: Clauses 1 to 8; Schedule 1; Clauses 9 and 10; Schedule 2; Clauses 11 and 12; new Clauses and new Schedules relating to Part 1; Clauses 13 to 15; new Clauses and new Schedules relating to Part 2; Clauses 16 to 30; new Clauses and new Schedules relating to Part 3; Clauses 31 to 52; new Clauses and new Schedules relating to Part 4 (except new Clauses and new Schedules relating to the accounts of health service bodies and the auditing of such accounts); Clause 54; Schedule 4; Clause 55; Schedule 5; Clauses 56 and 57; Schedule 6; Clauses 58 to 66; Schedule 7; Clauses 67 and 68; new Clauses and new Schedules relating to Part 5; Clauses 69 to 71; new Clauses and new Schedules relating to Part 6; Clause 53; Schedule 3; new Clauses and new Schedules relating to the accounts of health service bodies and the auditing of such accounts; Clauses 72 to 76; Schedules 8 and 9; Clauses 77 to 80; remaining new Clauses and new Schedules; remaining proceedings on the Bill;

    (3)   the proceedings shall (so far as not previously concluded) be brought to a conclusion at 7.00 p.m. on Tuesday 10th January.

I am pleased to move the programme motion because, as a result of discussions through the usual channels before it met, the Programming Sub-Committee did not need to vote on it. That indicates that all parties were pleased with it.

You will be aware, Mr. Illsley, that we plan to continue, if necessary, until 20 December. The Lord Commissioner of Her Majesty’s Treasury, my hon. Friend the Member for Lincoln (Gillian Merron), has placed no knives on our debates; we want to ensure that everyone has ample time to discuss the important parts of the Bill. Without further ado, I commend the motion.

Mr. Andrew Lansley (South Cambridgeshire) (Con): I welcome you to the Chair, Mr. Illsley. It will be a pleasure to serve under you and your fellow Chairman. I do not recall having had the pleasure of serving under your chairmanship before, but I look forward to doing so.

I am grateful to the Minister for moving the programme motion. It seems tight but achievable so long as we constrain ourselves to the subject in hand rather than speaking of extraneous matters. The Minister did not point out that we have nine
 
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substantive subjects to discuss, although one or two loom somewhat larger than the others. However, we must ensure that we have time to discuss other matters that are less controversial but none the less significant.

I am comforted by the fact that the same will not be done with this Bill as happened with the Health and Social Care (Community Health and Standards) Act 2003. I had the privilege of serving on the Committee that considered that legislation, and I remember that the general medical services contract was added on Report rather than being discussed in Committee. For example, we shall have the opportunity to discuss the general ophthalmic services contract in Committee. I hope that it will be given at least the one and a half hours that was allocated to discussing the general medical services contract. Subsequent events have demonstrated the value of discussing such matters in Committee before implementation exposes all the problems.

I know that the eyes of the nation are upon us today—little else is happening. People will be looking to us to proceed swiftly to discuss Part 1, which is a matter of great interest. I am happy to say that we accept the programme motion; we want to get on with the business at hand.

Steve Webb (Northavon) (LD): Thank you, Mr. Illsley, and good morning. This is the first time that I have served under your chairmanship, and I look forward to serving under you and your colleague.

We welcome the flexibility that the programme motion gives us. It will allow us time to discuss Part 1, which has attracted a great deal of attention. However, many members of the Committee will have received representations—for example, about the proposed changes to optometry services. If it seems as though important issues will be squeezed out, the Sub-Committee has the opportunity to revisit the motion. However, to begin with, the flexibility that it gives us is welcome.

One of my worries is that one issue can dominate debates in Committee and that other important changes receive little scrutiny as a result. If we do not scrutinise them in Committee, the danger is that those one or two headline issues will dominate time on Report. That would be regrettable, as further important issues are dealt with later in the Bill. I give you my assurance, Mr. Illsley, that we will not seek to protract proceedings. We will make our points as succinctly as possible and then sit down.

Dr. Andrew Murrison (Westbury) (Con): It is a pleasure to serve under your chairmanship, Mr. Illsley. I was a member of the Programming Sub-Committee, and I should like to correct the Minister’s assertion that we were “pleased” with the programme. We were in so far as we do not have the knife; that is welcome given that most of the public controversy rests with the initial clauses of the Bill. However, it would be more accurate to say that we were content with the total time available. We must get to the important later clauses, particularly those relating to ophthalmic services and
 
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pharmacy. It would be regrettable if the emphasis on smoking, controversial though that is, were to detract from our consideration of those matters.

Question put and agreed to.

The Chairman: I must now outline one or two arrangements. I remind the Committee that there is a money resolution in connection with the Bill. Copies are available in the Room. I should also like to remind hon. Members that adequate notice must be given of amendments and that, as a general rule, my fellow Chairman and I do not intend to call starred amendments, including any that may be reached during an afternoon sitting of the Committee.

May I also point out at this juncture that starred amendments Nos. 75 and 76 have been printed in error in the name of the Minister rather than in those of the hon. Members for Northavon (Steve Webb) and for Bristol, West (Stephen Williams)? Hon. Members are free to remove their jackets as they wish when I am chairing the Committee. It might be necessary to seek permission from my fellow Chairman.

Clause 1

Smoke-free premises, places and vehicles

Question proposed, That the clause stand part of the Bill.

Mr. Lansley: I was rather hoping that, in the course of her comments on the clause, the Minister might explain to us the underlying principles of the Bill. Nevertheless, let us get straight to it. The purpose of the clause is to bring into law the prohibition on smoking in certain premises. From that prohibition will flow the discussion about how it is to be defined and how exemptions are to be made.

I suppose that, at this stage, I want to explore two things. The first is the Government’s view on the structure of the prohibition. On what evidence have they based it? The second is the consultation process on the policy that led to the introduction of the legislation. Before we get into the detail, it would be sensible to understand where the Government are coming from.

The Committee will recall the discussion on Second Reading. I want to make it clear that our objective is to achieve a dramatic reduction in the incidence of smoking in public places, thereby contributing to a reduction in the prevalence of smoking. There were substantial reductions in the 1970s and 1980s, but the trend has slowed since then and there are serious problems, particularly the prevalence among younger people, which has barely reduced in the past four or five years. The Minister will know that one of the issues is the extent to which young people starting work are able to smoke in the workplace. The evidence clearly suggests that if we can reduce opportunities for smoking at work, we can reduce the overall prevalence of smoking among young people, with consequential major long-term health gains.

At the time of the publication of the White Paper, the Scientific Committee on Tobacco and Health set out clear summary evidence of the negative health
 
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impacts of smoking in relation to lung cancer and coronary heart disease. As I said on Second Reading, the most significant part of that in terms of changing the character of the debate on smoking—especially passive smoking—was the increasing evidence of the impact of relatively small amounts of environmental tobacco smoke on myocardial infarction, or a heart attack.

10.45 am

Occasionally I must wear these glasses, and not just because we shall later be discussing general ophthalmic services. I am not trying to curry favour with the optical professions. The Minister will be aware of the interesting paper published in the British Medical Journal on 24 April 2004, which relates to a six-month period in the town of Helena, Montana. That geographically isolated community had a local byelaw that prevented smoking in all public places. During the six months when that law was in force, the number of admissions to hospital for heart attacks fell significantly from an average of 40 admissions during the same six months of the preceding year to 24 admissions during the time the law was in effect. When the byelaw was subsequently challenged in a court and suspended, the rate of attendances at hospital for heart attacks rose again.

It is increasingly clear that relatively modest amounts of exposure to second-hand smoke can have significant impacts on health, especially where coronary heart disease is concerned. For some, second-hand smoke can have a substantial impact on their likelihood of having a heart attack. We must be aware of the benefits of what we are trying to achieve. This is not a matter of nuisance. I preface some of the arguments that my hon. Friend the Member for Westbury (Dr. Murrison) and I shall make later by stating that we are not talking about the nuisance effect of smoke; we are talking about the health effects of smoke. This is a Health Bill.

One of the central matters that has been in our minds is the strange circumstances of the Government’s publication last November of a White Paper that was supposed to be about health. Published evidence to which I have just referred illustrates the health impacts of second-hand smoke and shows the necessity of there being a means by which we can dramatically reduce the prevalence of smoking. However, the proposal that was put into the public health White Paper appeared to be geared more to questions related to the nuisance value of smoke to people eating meals in restaurants or pubs than it did to evidence relating to health.

Of course, we understand that a balance must be struck. It is an obvious, simple fact that if we were, somehow, able to ban smoking entirely, we would reduce the negative health impacts dramatically. About 23 per cent. of premature mortality among men is in some way related to smoking. However, we cannot bring in a complete ban because smoking is legal and has been for a long time. Many people are habituated to smoking, and we are striking a balance
 
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between their liberty to smoke and the impact that that has on others. Those are the balances that we shall have to strike in the course of this debate.

The Government do not seem to have struck a balance at all, either geared to public opinion or to health effects. Public opinion research that I have seen seems to point to the kind of conclusions that my colleagues and I have reached. The public’s view is that workplaces and restaurants should be smoke-free but that public houses are something of an exception. Even on that matter, public opinion has moved sharply to a point where they wish pubs, generally, to be smoke-free except for specific rooms or areas that are designated for smoking. The largest number—although not a majority; it is something less, at 47 per cent.—in the last survey that I saw suggested that that was where the greater number of the public pitch their tent. There is no major public view that a balance should be struck whereby pubs are either smoking with no food or non-smoking with food.

That is a strange conclusion that the Government reached last November and then put forward. It was reflected, as I am sure the Minister will remind her colleagues many times, in the Labour party manifesto. If that had been the end of the matter, the Government would have proposed legislation based on their manifesto and would not have done anything else about it, but they did not. They consulted.

On 20 June, the Government issued a consultation. It is reasonable to ask what the point of that consultation was. Was it to find out specific details regarding enforcement and implementation? No; it was, on the face of it, to establish whether the proper balance had been struck with the proposed policy. We know what was going on: the new Secretary of State and team at the Department of Health very much wanted to move away from the policy that they had been left with to one that made more sense in health terms. That is not surprising considering that they were receiving advice from the chief medical officer who, as he recently made clear in his evidence to the Select Committee on Health, was strongly of the opinion, in his annual reports from 2002 to 2004, that there should be a comprehensive ban on smoking in all enclosed public places and that anything else would be substantially less beneficial.

It is not surprising that Ministers might want to reflect that professional advice in policy, so they had a consultation—but was it real? What was it intended to allow? I understand that there were 57,000 responses, 90 per cent. of which opposed the partial ban that the Government propose. What kind of response to a consultation would it take for the Government to change their mind about a policy that they subjected to consultation? Does it take 100 per cent? Are the Government prepared to proceed with opposition of anything up to 99 per cent? That is odd. The Minister will have to explain why they have proposed legislation of a structure that is clearly opposed by expert bodies and regarded as nonsensical by the public.


 
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Dr. Murrison: Does my hon. Friend agree that if the Government run consultations that are seen to be a sham, it destroys all future consultations because the public and organisations will see that all the input that they give in good faith simply will not be taken seriously? The figure of 90 per cent. is overwhelming; it is extraordinary that the Government are not listening on that. I am sure that my hon. Friend will agree that the cost of such exercises is an issue for concern if the Government simply ignore them.

Mr. Lansley: I am grateful to my hon. Friend. That is exactly right. You would think it out of order, Mr. Illsley, if we were to talk about other consultations which, frankly, seem to be bogus, but that seems to be a continuing feature. The medical profession and people across the NHS are heartily tired of the extent to which they are engaging in bogus consultations on matters on which the relevant decisions seem to have been taken in advance.

Steve Webb: I am interested to see the importance that the hon. Gentleman attaches to the consultation that the Government have just undertaken. Why is he choosing selectively from the results of that consultation? Did it not also show that the public rejected an exclusion for private clubs, which he supports?

Mr. Lansley: I was not trying to represent the whole of those consultation responses, to which we will return when we discuss other issues. Clearly, we have to strike a balance. I am not saying that the results of the consultation must be the only basis on which we make our judgments; I am asking on what basis the Government entered into the consultation. It is obviously intended to inform what we do, and I shall have to make my judgments, as the hon. Member for Northavon will have to make his, and as the Minister will have to do for the Government. I want to know why the Government proceeded with the consultation, given the broad opposition to the structure of the partial ban that they propose. If the consultation was real, what have the Government done to reflect the responses in their policy?

I shall now discuss the structure of the benefits associated with the legislation as set out in the regulatory impact assessment. The Minister will recall that the RIA considered what benefits are likely to accrue from the partial ban that is being proposed. I am sure she will say that the ban will cover 99 per cent. of workplaces, the implication being that 99 per cent. of the benefit will be derived because 99 per cent. of workplaces are covered. What she does not take into account is the simple fact that more than one in two workplaces is already smoke-free, and that a higher proportion of the rest have designated smoking-only areas, the number of which is declining dramatically. Members of the Committee will know that more employers are coming to the conclusion every day that they should move to a work-free—[Laughter.]—a smoke-free workplace for health and safety reasons and because of their responsibilities towards their employees.


 
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Many of the benefits that would be derived from workplaces becoming smoke-free are already being gained, so the question is what additional benefits are to be gained by introducing a smoking ban. The RIA highlights that fact, drawing the broad conclusion that a comprehensive ban would have the benefit of reducing the number of deaths by about 2,300, by my reckoning, as a result of the reduction in second-hand smoke. The partial ban would lead to a benefit that is only just over half that figure, not a figure that is only 1 per cent. away from the benefit of a full ban. Ministers must therefore tell us why they believe that we should engage in this major, complicated regulatory exercise. The costs of enforcing a partial smoking ban are higher than the costs of enforcing a comprehensive smoking ban, yet the Government propose to derive only half the benefit.

Dr. Murrison: Does my hon. Friend agree that the RIA is quite controversial, particularly since Professor Konrad Jamrozik’s paper, which was published in the British Medical Journal earlier this year, suggested that passive smoking at work accounted for a total of 617 deaths a year—a fairly precise figure—and at home, interestingly, for 10,700 deaths a year?

Mr. Lansley: I am grateful to my hon. Friend for mentioning that because the evidence set out by the Scientific Committee on Tobacco and Health related to various studies, many of which compellingly describe the impact of second-hand smoke on health and the likely mortality resulting from it. However, the studies overwhelmingly involved people with partners, spouses or family members who smoke or people who are persistently exposed to second-hand smoke at work.

There are extrapolations. I made a point earlier about the impact of modest exposure to second-hand smoke on coronary heart disease. It is significant, because initial evidence suggests that there is no linear relationship between exposure to second-hand smoke and the impact on mortality and morbidity, particularly where coronary heart disease is concerned. It is a non-linear relationship, and therefore modest exposure to second-hand smoke is one of the issues that we have to address. That is why I have no doubt that our objective should be to try to reduce sharply the incidence of smoking in all enclosed public places. The debate is simply about how we get there and the mechanisms involved.

11 am

The point that I want to establish at the outset is why the Government have gone down such a path. Why have we ended up in a position where the origin of the policy appears to have more to do with satisfying competing arguments inside Government than the health needs of the country? We seem to have had second thoughts—perhaps even third or fourth thoughts—set out among Ministers in the course of this year, on which they appear to have been frustrated and unable to act. The chief medical officer made it perfectly clear to the Health Committee that he did not agree with the Government’s policy, and said:


 
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    “I think it is rare for the Government to ignore the advice of its Chief Medical Officer or to fail to act on it. This is the first situation I have encountered in the seven years I have been in post when this has happened.”

The Minister has to explain why we are in this position at all.

The regulatory impact assessment, if we are to believe it, shows that the Government’s proposals will achieve barely half the potential benefits of a ban, with all or more of the enforcement costs and more of the ensuing complications and difficulties for the public. There is also limited evidence of the certainty of those benefits. Although I am taking the mid-point of the Government’s estimates, it is entirely possible that, as the Government’s regulatory impact assessment contemplates, the benefits for customers exposed to second-hand smoke may be negligible as a consequence of the changes. We need to be clear about what we are setting out to do.

So with clause 1, the purpose of which is to introduce the overall prohibition, although we might come on to one or two detailed points our main purpose is to examine what the Government are setting out to do. How did they come to this policy and how do they justify the fact that they will not deliver the benefits of a reduction in smoking, which are really needed?

Steve Webb: It seems appropriate to use clause 1, which introduces part 1 of the Bill, to make a short number of observations about the general strategy for the smoking ban that the clause will enable to be brought into force. It is helpful to say at the start that a number of the amendments that we will discuss later will try to make the best of a bad job. Our preference would have been the total ban that was in our manifesto and remains our policy to this day. It is worth stressing that, because later this morning and beyond some of the things that we suggest may not be consistent with a total ban. We will be trying to make a partial ban more effective.

I want to place on the record at the start my clear commitment and that of my hon. Friend the Member for Bristol, West to a total ban in line with our manifesto. The reasons for that have been eloquently expressed by the hon. Member for South Cambridgeshire (Mr. Lansley), who rightly pointed out that the maximum benefit from the Bill, in terms of the Government’s cost-benefit analysis, would come from a total ban. I find it puzzling, therefore, that he supports a different partial ban, which produces fewer benefits.

Dr. Murrison: At this early stage, will the total ban in the hon. Gentleman’s treatise cover cannabis? I understand that his party’s policy is to liberalise the use of cannabis, and he did not quite clear that up on Second Reading.

Steve Webb: The hon. Gentleman seems rather obsessed with the subject of cannabis; perhaps we should discuss that. Interestingly, clause 1(2)(a) states that

    “‘smoking’ refers to smoking tobacco or anything which contains tobacco, or smoking any other substance”


 
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so that is within the scope of the Bill. Our support for the Bill incorporates anything else that might be smoked in enclosed public places as well.

We are concerned—there is some common ground with the Conservative spokesman in this respect—about the welfare and health and safety of people who work in enclosed public places. It is as simple as that. As far as we are concerned—a number of my colleagues have made this point to me quite forcefully, and I agree with them—this is not about whether we approve or disapprove of what people do, for example, in their own homes; it is about places where that action has a consequence for other people. Arguably, part 1 of the Bill might usefully have been a health and safety measure brought in by another Department, because that is very much the way in which we approach it.

People sometimes say that the issue does not matter because those who work in smoky environments could choose to work somewhere else. In fact, that is arguable. If a town has one bar and it is a smoky bar, the people who work there may not be able to find other employment, but even if they could, from a health and safety point of view why should they have to? If asbestos was found in the roof here, we would not say, “It’s not a problem. Let’s go and use Committee Room 13.” We would say that it was bad for the health of the people who work here and sort out the health and safety problem. That is the approach that Liberal Democrat Members take. My liberty to smoke is not an unlimited liberty; it is limited by the impact of my exercise of that liberty on other people. We believe that that applies whether or not food is being served and whether or not the premises in question are a private members’ club. Such exemptions make no sense if we view the issue as one of health and safety.

There is an advantage to the way in which clause 1(2)(a) is drawn. As I said, it states that “smoking” relates not merely to tobacco but to other substances. Clearly, it will be a great deal easier if the enforcement authorities do not have to inspect the contents of the cigarette to try to work out exactly what it is. If smoke is coming from the substance, that is sufficient to provide for a ban.

No doubt we shall discuss the place of public opinion in all this; indeed, we have had some selective readings of public opinion already. Where health and safety is concerned, we should be leading public opinion, not following it. I believe that there is momentum in public opinion in the direction of a total ban and that there is evidence from other countries that when bans are introduced, they become popular very quickly and few people ever want to turn the clock back. The Government should have the courage of their convictions and lead public opinion in the interests of the health and safety of workers, not follow public opinion and be afraid of the focus groups.

I have described the framework within which we approach the Bill, and the lens through which we shall assess any amendments tabled. We hope that, by the
 
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end of our process of scrutiny, we will have a Bill that generates more benefits for people who involuntarily are subjected to passive smoking and its consequences.

 
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