Caroline Flint: I, too, hope that we can make progress today. This is an interesting debate, which gives rise to a number of issues. The hon. Gentlemans question was one of the first questions that I asked when I became a Parliamentary Under-Secretary of State for Health and had to consider all the different activities that are necessary across the piece, because
My discussions on the subject have been quite interesting. Indeed, I have had several conversations with my hon. Friend the Member for Barnsley, East and Mexborough about the fact that when I first entered the Department and asked whether the age limit should be raised, the position of various organisations was unclear, although in more recent months some organisations seem to have shifted their position towards that championed by my hon. Friend.
I understand that the Choosing Health White Paper contained a question about age-related sales, and although several organisations such as ASH supported a total ban, they offered very little that supported raising the age to 18, probably because their focus was on a total ban and they believed that that was where the next steps needed to be taken in order to reduce the amount of smoking in public places.
I asked about raising the age limit when I met several different stakeholders to discuss the Bill and the Choosing Health White Paper, particularly in the consultation that we conducted in the summer. Again, health organisations generally did not send out the strong message that they would support such a step, although there were exceptions, such as Cancer Research UK and people who represent trading standards officers, who suggested that it was worth doing more research on the matter and considering other possibilities. I shall discuss the reasons for that later.
As I said, the matter was not clear-cut, which was partly why we did not consult on the evidence. There did not seem to be a view, whereas there was clearly a view among all parties that legislation to restrict and to ban smoking in public places should be the focus of the Governments next steps in this area.
It has been an interesting six months. I do not believe that there is necessarily a one-age scenario for young people, whether we are talking about smoking, alcohol, buying solvents, or buying knives, which has been the subject of some debate, too. We should consider these matters case by case.
A positive suggestion has been made in meetings and when talking informally to people who work in local authorities that raising the age to 18 could make enforcement easier. Organisations such as ASH, however, are concerned not to send out the message that smoking is okay once someone is 18. That is a valid point of view.
The hon. Member for Westbury asked about representations from the tobacco industry. I understand that it is not particularly critical of the possibility of raising the age limit, but others on the anti-smoking side have said that it would say that, because it would like to market smoking as an adult activity and raising the age limit could help it in some way. That is the alternative argument of some in the anti-smoking and health lobbies.
It is important to recognise that we must address several areas when tackling smoking-related issues. Before I say more on that, I am pleased to say that
The statistics also show that between 1988 and 1996 there was a steady increase from 8 to 13 per cent. in the prevalence of regular smoking, which is smoking at least one cigarette a week, among children aged 11 to 15. However, I am pleased to say that that rate has fallen since 1996.
Mr. Andrew Lansley (South Cambridgeshire) (Con): Does the Minister recognise that the figures from which she quotes also show that in the last four years for which data were collectedfrom 2000 to 2004the rate of smoking among girls under 15 has not changed?
Caroline Flint: The fact that that rate has not changed means that it has not gone up, which it was doing before 1996. I have saidI hope that the hon. Gentleman treats what I say in good faiththat I am not happy about the prevalence of smoking, but it must be acknowledged that a rate that was steadily going up has gone down. Some rates have plateaued, and we must further consider how to deal with that situation.
Dr. Murrison: There are certain implications behind what the Minister says. She implies various things, but will she be specific about why she thinks those trends occur? It might help if she were to make some international comparisons, particularly with our European neighbours, and discuss what has been happening in those countries.
Caroline Flint: I shall just finish what I was saying, because the divide between girls and boys is an important consideration. The relevant figure for girls is 10 per cent., which is down from 15 per cent. in 1996; the figure for boys is 7 per cent., which is down from 11 per cent. in 1996. There are a lot of related matters that we must address. I am afraid that with girls in particular there are often issues of eating and diet to consider. There is a notion that smoking helps to keep the weight off and that one will eat more if one stops smoking. We have to get beneath some of the issues that create those gender divides.
Of course, we need to make comparisons. I understand that the age at which people can purchase tobacco ranges from 14 to 21 years old across Europe, and internationally. That is one reason why it is important to consult on and research this area: so that any decision to raise the age is based on firm evidence.
I move to the issue of advertising aimed at young people who are over 16. We recently ran a campaign that was aimed particularly at 16 to 24-year-olds. Our research found that traditional health messages often do not work very well with that group. I think that that is part and parcel of young people thinking that they will live for ever, and that they need not worry about
A combination approach is required. My hon. Friend the Member for Barnsley, East and Mexborough related the experience in Guernsey and there were interesting aspects to that. However, in addition to introducing the age change Guernsey embarked on an expansive programme of enforcement and education and a package of joined-up measures to make that age increase effective. We want to include that in the consultation.
The hon. Member for Westbury talked about test purchasing. It is never particularly nice that young people are used in any such situation, whether it involves alcohol or solvents or other goods that young people are not permitted to buy. Often they are younger than 15. However, they are important in enabling local authorities and trading standards officers to check whether retailers follow the law. I think that it is done incredibly sensitively. I was very pleased when I attended a recent responsible retailers awards ceremony in Doncaster to meet a young person who had taken part in the test purchasing schemes. It would be nice not to have to do it, but, unfortunately, it is part and parcel of necessary work. Even if the age were raised, it would still be necessary to ask in future whether retailers were asking for proof of age.
Dr. Murrison: I think that there is consensus on that. My point was that if the age were to be raised to 18 presumably the test purchases would be made by children who were that little bit older, and therefore a little more mature and capable of coping with a situation that many might find quite challenging.
Caroline Flint: There is logic in that point, but as I have said, at present huge sensitivity is applied and family members are involved when young people assist. The fact that local authorities deal with the matter in that way should be acknowledged.
The hon. Member for Northavon asked about amendment No. 71. The long title of the Bill is generally meant to reflect the contents of the Bill, but I should want advice on the matter from parliamentary counsel, in conjunction with the House authorities.
My hon. Friend the Member for Falkirk spoke about the Department of Trade and Industry. Clearly, issues arise in this context relating to the DTI and the Home Office, as well as health. The new clauses concern an offence by those who sell cigarettes. They are not about criminalising a young person. Therefore discussion is needed, which is why consultation is important. That is recognised in Scotland too, and although powers have been given to the Scottish Minister, the decision whether to go ahead is subject to an expert reporting groups evidence. It is not decided that Scotland will go ahead with the relevant measure. Those responsible are minded to do so if the evidence stacks up. That is very important.
The hon. Member for Westbury mentioned cost. We need to consider the costs and where the money is to come from, both for signage and for the enforcement costs resulting from restrictions on smoking, which we discussed at length earlier in the week. I was interested to hear that the measures in Scotland were opposed by the Liberal Democrats. I shall be interested to see what happens in Westminster.
I turn to the substance of the new clauses. I realise why the right hon. Member for North-West Hampshire and my hon. Friend the Member for Barnsley, East and Mexborough tabled them. It is an important matter. I have already announced that we plan to hold a formal 12-week consultation; I hope that it will start in February 2006. It will follow the normal lines of Cabinet consultations. It will allow us to delve more deeply into all the issues raised by hon. Members and others; we can get all the evidence and hear all sides of the debate.
The new clauses have some drafting problems. New clause 7 would amend section 7 of the Children and Young Persons Act 1933, which deals with the age for the sale of tobacco. However, a corresponding amendment would need to be made to section 4 of the Children and Young Persons (Protection from Tobacco) Act 1991. The 1991 Act makes it an offence not to prominently display the statement,
at every premises at which tobacco is sold. It would not make sense to amend the 1933 Act without also amending the 1991 Act.
Amendment No. 71 is a consequential amendment to new clause 7. It simply amends the long title of the Bill. I am uncertain whether it would be necessary.
New clause 2 attempts to create a regulation-making power by amending the Children and Young Persons (Protection from Tobacco) Act 1991. That new clause, too, has deficiencies. The amendment would deal only with the requirement to display signs on the age of sale. A corresponding amendment is needed to section 7 of the 1933 Act.
Column Number: 256
As a result of those drafting problems, neither of the new clauses achieves the desired effect. The very fact that new clause 7 would change the age from 16 to 18 means that it would pre-empt the consultation. I am sure that my hon. Friend the Member for Barnsley, East and Mexborough accepts that. I do not suggest that we are looking beyond the age of 18, but a range of ages is to be found among the member states of the European Union.
Mr. Lansley: I suppose the question is this: if the Government propose to consult in detail in February and to conclude that consultation in May, the results of that consultation are likely to be available just as the Bill receives Royal Assent. Whether or not the new clauses are entirely effective, does the Minister accept that during its passage through Parliament we should put into the Bill a measure capable of implementing positively the outcome of the consultation? Should we not use the Bill for that purpose?
Caroline Flint: Perhaps the hon. Gentleman will allow me to continue. I shall finish what I was going to say, as it might be helpful to all concerned.
It is an important issue. I take on board the point made by my hon. Friend the Member for Falkirk: giving reserve powers to the Secretary of State in other circumstances would, I am sure, have the Opposition rising to their feet to object. That being said, I want to reflect further on the matter. I have to discuss it with others. I should like to return to the issue on Report to give an indication of what I intend to do, but I must have discussions first. This is an important matter and there is an argument for asking whether we should have such powers, but only if they are subject to the evidence and consultation. For that reason, I want to reflect and consult on the issue before returning to hon. Members.
Sir George Young (North-West Hampshire) (Con): The Minister is making a helpful contribution, and I welcome what she has said. However, is she saying that new clause 2 is defective or that we need another amendment to another bit of the Children and Young Persons (Protection from Tobacco) Act 1991 to give effect to what we want to do?
Caroline Flint: My understanding is that new clause 2 relates only to the Act that deals with signage, whereas new clause 7 refers to the Act that defines age. Both are important in terms of change. Having said that, we would have to take a proper look at the drafting of any provision if we were to move forward, and I have looked at the Scottish Parliaments wording to inform my thoughts on the issue. In particular, I would want to be assured that if we did go down the proposed pathas I said, I want to reflect seriously and have more discussions on thatthe powers would be clearly subject to the consultation. If that were the direction that we wanted to take, we would then seek to make any changes through affirmative resolution. I hope that that helps the right hon. Gentleman.
I acknowledge the work of my hon. Friend the Member for Barnsley, East and Mexborough, who has been championing this issue for a considerable time.
I also give credit to the right hon. Member for North-West Hampshire for making his views clear throughout the Committee[Interruption.] He is very clear, although I am not sure that the rest of his party is. He has made it clear that he would like comprehensive legislation on the statute book to ban smoking in public places. Although he probably thinks that the Bill does not go far enough, I hope that he acknowledges and recognises what a huge step forward it is in meeting his concerns in this area of public health.
Mr. Crispin Blunt (Reigate) (Con): I have listened carefully to the Ministers comments and I am generally pleased with the direction in which they are going. However, I am not clear whether she has given an undertaking to return to the issue on Report, having completed the consultations that she must have with colleagues. Will she be using this Bill to give herself the necessary powers if the Government come to the conclusion that they are minded to make the proposed change? Will she give the whole House the opportunity to discuss the issue on Report or will the Government wait until a later stage in the House of Lords to tackle it? Will she return to the issue on Report if she wishes to take those powers?
Caroline Flint: I am seeking to have discussions so that I can give a definitive answer on Report. That is what I am working towards and I hope that helps.
As I have said before, this is a good example of how tackling smoking-related issues requires endeavours on a lot of fronts. Our proposals in the Health Bill will historically change the way in which we work and live our lives in relation to being exposed to second-hand smoke. They are part and parcel of a Government who have made it their commitment from 1997 to tackle tobacco legislation, to ban advertising, to bring legislation forward to make it a serious offence to sell tobacco to those under the age of 16, and to bear down on those who do so. That has been backed by national funds for campaigns and support throughout the NHS for smoking cessation services. Of course, we have now reached a point where we can further discuss restricting and banning smoking in most public places and workplaces. That is not bad for the Labour Government over the past eight years and it stands in comparison with the 18 years between 1979 and 1997.
Sir George Young: I am grateful to the Minister. On her final paragraph, she was in Prime Ministers questions yesterday when this bit of the Bill was raised with the Prime Minister. She will have heard, as I did, the Prime Minister saying that he would listen to the debate. That was very interesting because up to now we have been told that the manifesto is the manifesto and what is in the Bill is in the Bill. The Prime Minister did not say in his response to the hon. Member for Selby (Mr. Grogan) that there was no question of considering changing the ban on smoking in pubs that do not sell food, but that he is now going to listen to the debate. I welcome the flexibility that the hon. Lady has just displayed. I understand that that would be a change in policy and she would have to go back to her colleagues to get clearance and, as she said, other Departments are involved. I entirely accept that.
I accept what the Minister has said about being minded to table Government amendments on Report that build on the new clauses that have been tabled. She has clearly done some work to identify the necessary consequential amendments that would have to be tabled, so the Government draftsmen will hopefully not be confronted with an impossible task in making the necessary changes to new clause 7 and new clause 2.
I was encouraged by the debate. I welcome the support from my hon. Friends and from the hon. Member for Northavon, who said that he could smile on new clause 2. The hon. Member for Falkirk said that in Scotland this power already existed. Against that background, I am sure that he would not want to deny the same power to Ministers in England. The Minister gave us some indication of the time scale of consultation that will begin in February and last 12 weeks. That was helpful.
Against the background of the spirit in which the Minister replied it would be churlish for me to press new clause 2 to a division. I am conscious that I am a bit of a cuckoo in the Barnsley nest and that the hon. Member for Barnsley, East and Mexborough may have his own views. However, I am sure that he will want to get hold of the journalist to whom he referred on Tuesday, Mr. Siggs. I am sure that he will want to say that following pressure from Back Benchers on both sides of the House the Government have recognised the force of our mutual case and he may wish to claim single-handed victory to his local newspaper. On the basis that I will do the same to the Andover Advertiser, we can probably come to a mutual conclusion. Subject to what the hon. Member for Barnsley, East and Mexborough says, I am minded to claim a moral victory and not to press the new clause to a vote.
Column Number: 259
Jeff Ennis: On the very point that the right hon. Member for North-West Hampshire raised, I phoned Mr. Siggs the other day to give him a progress report, and he said, I do not mind you using me as the butt of your jokes, Jeff, but I digress.
I have pressed the matter since day one because I believe that raising the age is a public health issue as well as a matter of effective enforcement. I think of cigarettes as an age-restricted product available for over-the-counter sales, just like the dangerous knives and air guns that we considered under the Violent Crime Reduction Bill. I have the support of the Trading Standards Institute. The hon. Member for Northavon mentioned driving at 17 and working at 16. Those are not age-restricted sales products, but we should consider tobacco in that category rather than in the wider context of the debate about 16 to 18-year-olds.
There is a lesson to be learned from our debate on the new clause. I have been vociferous about the issue since the White Paper was published. I read it and, as an ordinary Member, put a question to the Minister suggesting that we put the matter out to public consultation, because it is a public health issue. I was slapped down by the civil servants, who said that it was nothing to do with such things, there was no proof and they were not prepared to take the matter forward. The lesson to be learned is that Members of this House, whatever their political persuasion, can sometimes enhance the public consultation process. I hope that my hon. Friend the Minister will take that message back to the Secretary of State. Civil servants are not always right and hon. Members can add to the debate.
I totally agree with the point that the measure has been successful in Guernsey but only as part of a wider group of measures. That is why I am going to support the proposal to put the matter out to public consultation. It is important that we do not just implement the measure without introducing a raft of others to complement it. Having said that, I shall not press my new clause to the vote.
Sir George Young: I beg to ask leave to withdraw the motion.
Motion and clause, by leave, withdrawn.
Prevention and control of health care associated infections
Dr. Murrison: I beg to move amendment No. 104, in page 8, line 7, leave out may and insert shall.
After seven days we have finished what many would say is the most exciting part of the Billin terms of public controversy, it probably is. However, we now move to other parts that are equally important. Certainly the issue of the prevention of hospital-acquired infection exercises many of our constituents. I am sure that in the next few hours we will have a good and fruitful debate on this part of the Bill in general and the amendment in particular.
Column Number: 260
We have discussed the difference between may and shall at considerable length, and I can almost predict what the Minister will say in response to the amendment. However, it is worth restating, with the indulgence of the Committee, the importance of shall as opposed to may in common usage. In the past few years, the Government have produced a raft of announcements and initiatives that have as their aim the control of hospital-acquired infections. It is important to make the point early in the debate that MRSA is just one of those infectionsthere is a great deal of confusion in the public mind and, I am sorry to say, in the minds of parliamentarians as well. However, there has been little in the way of results.
It is odd that we should be having this debate today, because this very morning the Healthcare Commission released its findings, having been commissioned to produce a report on the position that we have reached on hospital-acquired infections. I looked it up this morning on the website; it was embargoed until one minute past midnight, but it is there now. It makes quite uncomfortable reading. As it is so timely I hope that hon. Members will indulge me in saying a little about it. It is germane to the changing of one little word which would dramatically alter the emphasis of what the Minister is aiming at.
We should probably view the clause as bright idea No. 24 in the panoply of announcements that the Government have made on the issue. We are a little cautious and are mindful that bits of paper, announcements and good intentions do not clean hospital wards. They do not tackle the doubling of MRSA rates since 1997 or take us much further forward. We are left, I suppose, with the code that the Government want to introduce. It is important for us to try to beef it up and to tease out from the Minister what she wants it to achievethe specifics.
The 23 previous announcements have been a catalogue of good intentions, but we and, more importantly, those on the front line have been left none the clearer about what people are supposed to be doing and how each announcement would materially affect the bottom line: reducing the toll from hospital-acquired infections, which currently runs at 5,000 deaths a year. That is more than the number of people who, tragically, die on our roads every year. A link seems to be missing. I fear from the wording before us that the code will be No. 24 on the list. We shall go no further forward unless the Minister is specific about what she is going to do. The proposed new section will permit the Secretary of State to introduce a code with, presumably, lots of good stuff in it, but we need to know what content the Minister wants and what she wants to achieve. We are none the clearer. It could be a code with all sorts of funny things in it that the Committee or the House might not think would move matters along.
The Minister will have noticed from our extensive list of amendments that we are attempting to beef up the code provisions, and you will have noticed, Lady Winterton, that our 10-point plan for improving the cleanliness of hospitals and reducing hospital-acquired infections has been, to an extent, transported
The word shall puts an onus on the Secretary of State. We tabled the amendment because it is all very well to say that the Secretary of State may issue a codewe may all do all sorts of thingsbut we want something actually to be done. The Committee would, in passing the amendment, tell the Minister in no uncertain terms that something will be done. It would not give permission for it to be done on a discretionary basis in the future, but would tell her, There is a real problem here. Please get on and do something, and bring out the code, and ordain that she act. The amendment would up the ante a bit.
I know that the word shall has a particular meaning in parliamentary draftsmanship, and the Minister will no doubt tell me that may is more appropriate because of the way in which these things are drafted, but we must also consider the matter in terms of common usage. People out there who consider our proceedings might be baffled about announcement No. 24 and why the Minister is saying only that she may bring forward a code rather than that she will do so. That is the crux of this simple amendment. I hope that the Minister will tell us why she cannot accept this small change. She showed that she is capable of listening and, to an extent, of backing downshe listened in the debate that we have just had to my right hon. Friend the Member for North-West Hampshire and the hon. Member for Barnsley, East and Mexborough, who has just left. That is good and how things should work in Committees. I hope that she will reflect on our amendments to clause 13 in that vein, starting with this one.
My case has, coincidentally, been strengthened today by the Healthcare Commissions report. The commission clearly feels that there is an ongoing, big problem despite the previous 23 announcements. I shall briefly inform the Committee about the content of the report, as I doubt many hon. Members will have had the chance to read it yet. I am a slightly tedious individual who gets in at 7 oclock in the morning and has nothing better to do, and this morning I looked at my computer and picked up on the report, so I happen to have read it.
The commission looked at 99 hospitals and banded them, according to how clean they were, in bands 1 to 4. Thirty-three hospitals did very well and were placed in band 1, which shows that there is nothing to stop hospitals from aspiring to the highest standard of cleanliness. Forty-four hospitals were placed in band 2, and 23 in bands 3 and 4, of which a large number were those concerned with mental health.
The Minister will probably point out that those hospitals are not surgical hospitalswhich care for people who are acutely unwell and are a particular case in point. We need to be clear that the risk to people is
The report goes on to say that only a third of the hospitals are achieving high standards of cleanliness, which is quite right from the figures, but which is worrying. Given the furore in recent years, we would expect hospitals mostly to achieve a high standard of cleanliness. I expect that when the public gets hold of the reportit will probably be covered in tomorrows paperspeople will be similarly horrified that most of the hospitals in this country are not coming up to what the Healthcare Commission regards as a high standard of cleanliness.
The head of operations at the commission, Simon Gillespie, said that
He went on to say:
I shall come later to some of those sophisticated ways to prevent infection. We know that it is not simply a matter of cleaning the floors, but if a ward looks dirty, patients will be worried.
We all have constituents who tell us that they are not happy with the cleanliness of wards. It is usually the relatives, friends or visitors of patients who are acutely ill who write or contact us to say that they are horrified by what goes on. They sit by the patients bedside, often for long periods, and are therefore able to observe what goes on. Indeed, they are often the best witnesses. In my experience, one will often sit by a hospital bedside for a long time, observing what goes on. One becomes a bit of an expert on the goings-on in a particular ward; one gets to know the individuals and, very often, the cleaners. It is a salutary experience and one becomes something of an expert witness.
The letters that I receive from such people have quite an impact on me. It is worrying when they come up withadmittedly anecdotalreports about poor standards of cleanliness in hospitals. That usually results in my writing to the Secretary of State for Health to ask what is going on. She usually helpfully forwards my letter to the relevant trust chief executive.
The things described in the Healthcare Commission report really happen, so it is extremely timely. It just so happened that the report appeared only hours ago,
|©Parliamentary copyright 2005||Prepared 16 December 2005|