Previous Section Index Home Page

8 Jun 2009 : Column 546

Will the Secretary of State at least tell the House now, on Second Reading, that he will not exclude the possibility of leaving the Bill as it is in this respect, so that Ministers can make the necessary regulations in the future? If he does not do that, he may close off the possibility of a change in the primary legislation.

Andy Burnham: I thank the shadow Secretary of State for his congratulations, and look forward to crossing swords with him once again. I have enjoyed many exchanges with him in television studios and across the Floor of the House, and I am sure that I shall do so again.

I did indeed read Lord Warner’s words in preparation for today’s debate, and they obviously carry considerable weight, given the position that he held in the Department and his role in the Bill’s passage. I am also aware of the particular position of mental health trusts, not just in terms of their relationship with bodies working for the Department for Work and Pensions or, as the hon. Gentleman said, with the new deal, but in terms of their relationship with local authorities and other parts of the public sector.

The hon. Gentleman is right to identify issues that need to be examined. That is why we set up the review. As his intervention demonstrated, this is a complex issue, and, especially given my recent arrival, I do not think that it would be wise for me to make a snap judgment today on whether to accept an amendment from the Lords. However, I give the hon. Gentleman a commitment to work through the issue, and I suspect that, with his engagement and that of the Foundation Trust Network, we shall be able to reach the right place.

Rob Marris (Wolverhampton, South-West) (Lab): May I express a counter-balancing view? I am not at all sure that my right hon. Friend will be able to “reach the right place”. I think that the fact that NHS institutions—foundation trusts—carry out private procedures is a distraction from their core business. I am saddened that they continue to do that, and extremely saddened that they now want to bust the cap—a bit like universities with top-up fees—and get away with charging more for private services. I urge my right hon. Friend to go in the other direction and ban the whole thing.

Andy Burnham: That intervention illustrates why I am not going to jump in feet first and say something that I might regret. It also illustrates that there are strong views on both sides of the debate. However, I think my hon. Friend would agree that we would not want the operation of the cap to stand in the way of improvement of NHS services if it could be demonstrated that that could be achieved, particularly where NHS trusts—especially mental health trusts—might wish to work in closer partnership with other parts of the public sector. Those are the issues that we shall have to tease out in the review. As I have said, it will be a thorough review, so that NHS and other key stakeholders can be properly consulted and we can ensure that any new proposals are workable and have broad support from managers, staff and patients.

The Bill also amends powers in relation to public appointments. The Secretary of State currently has powers to suspend chairs and non-executive directors of primary care and other NHS trusts. The Bill extends
8 Jun 2009 : Column 547
those powers to cover chairs and non-executive directors of strategic health authorities, relevant arm’s length bodies, and other bodies concerned with health. As with other responsibilities relating to public appointments that rest solely with the Secretary of State, this power will be delegated to the Appointments Commission.

The third part of the Bill reforms the process by which primary care trusts commission pharmaceutical services—I feel right away that the hon. Member for Romsey (Sandra Gidley) and I will be picking up a debate we had some time ago about how best to drive improvement in the pharmacy sector, and I respect the huge experience she has in the subject. It grants PCTs additional powers to deal with poor performers, including the right to issue remedial notices and to withhold payments from contractors who do not meet minimum standards. The Bill will also permit primary care trusts to provide pharmaceutical services themselves in an emergency such as a flu pandemic or where there is no suitable alternative.

The Bill also makes changes to the social care complaints system, enabling people who pay for their own care to refer any complaints to the local government ombudsman, just as those who receive free care from their local authority are currently able to do. I think the House will accept that that closes the long-standing loophole whereby self-funders have not been allowed to make complaints in the same way.

The Bill also gives a firmer legal footing to the transfer of anonymised data on doctors’ and dentists’ pay from Her Majesty’s Revenue and Customs to UK health departments. These data have been shared between HMRC and UK health departments for more than 20 years and form a vital part of the evidence that goes to the Doctors and Dentists Review Body on pay.

Let me turn to the final aspect of the Bill. It is becoming increasingly clear that the big challenges to the health of the nation are rooted in our lifestyles, and that if we want to build a sustainable NHS, we must now put as much focus on preventing illness as on treating it.

Mrs. Madeleine Moon (Bridgend) (Lab): I am aware that this part of the Bill addresses tobacco control and protection for children in relation to tobacco, but is it not time that we looked at protecting children in other respects as well, because they are particularly at risk from both tattooists and piercers? Currently, there are no minimum age limits for children having piercing of their genitals, navels, nipples, mouth, nose, eyebrows and ears. There are also no minimum training qualifications and no skills qualifications for those who carry out such piercing. Should we not also be looking at the risks to children from such tattoos or piercing, which include the danger of infection, bleeding, complications and the need for plastic surgery? Should we not be updating the NHS to take account of such new risks to our young people?

Andy Burnham: I thank my hon. Friend for that contribution. I am always on the side of the argument that says we must give maximum protection to young people. I think I am correct in saying that there is currently a minimum age for having a tattoo, and I can assure my hon. Friend that I have no plans to change
8 Jun 2009 : Column 548
that. However, I know that she and other Members have raised the issue of piercing before, and I undertake to meet her to discuss her concerns more fully.

Mark Pritchard (The Wrekin) (Con): I congratulate the Secretary of State on his promotion. We all want people to live longer and to lead healthy lifestyles, but does he not share my concern that there might be an unintended consequence of particularly the health promotion aspect of the Bill in relation to tobacco advertising and the display of products, in that local convenience stores and small shops may well close? Of course the right balance must be struck and I agree that we need health promotion, but we must also bear it in mind that most small shop owners are responsible and undertake their duties in a lawful way, and that in order to survive they need to sell products and to provide products to the wider community.

Andy Burnham: I understand the hon. Gentleman’s point, and I can confirm that it would never be my intention to make it harder for small retailers to survive; I do not think anybody would want that. Nevertheless, we have to act to counter the fact that many young people still take up smoking, and if we in this House can take measures to reduce that, we have a responsibility to consider them. It is my judgment that this can be done without causing the effect on small businesses that the hon. Gentleman described, provided that we can find the right point of balance so that we do not put an unfair burden on small shops. I hope the hon. Gentleman will work with us to find that point, because we still have some way to go before we reduce smoking rates among young people to a level that we would find acceptable.

Mr. David Clelland (Tyne Bridge) (Lab): I, too, congratulate my right hon. Friend on his appointment; I am sure that he will make an excellent Secretary of State, and I hope that he also proves to be a tolerant one. Is he aware that in Canada, Iceland and Thailand, which are the only countries to have introduced a comprehensive retail display ban, there is no evidence to suggest that it has had any effect on youth smoking rates or consumption? Indeed, the Prime Minister of New Zealand has ruled out such a ban, stating:

On what basis is my right hon. Friend taking this measure forward?

Andy Burnham: I am grateful for my hon. Friend’s kind words of congratulation. I stand to be corrected, but what I read of the evidence over the weekend suggests to me that in both Iceland and Canada measures to restrict point of sale materials did have an effect on smoking prevalence among young people. In Iceland, the fall in smoking prevalence among 15 to 16-year-olds between 1999 and 2007 was most rapid in the period immediately following the display ban introduced in 2001—smoking prevalence for that age group fell by more than 40 per cent. during that period. I would argue that it is not correct to say that there is no evidence to demonstrate the effectiveness of this proposal, but I agree that it should be introduced in a way that does not make it even harder for small shops to trade. We all have concerns about the high streets in our constituencies, the community facilities and the community shops and services. It is not our intention to make those
8 Jun 2009 : Column 549
commercial pressures even greater; nevertheless there are steps we could take to reduce smoking among young people. Where there is evidence to suggest that things that we could do could have an effect, we are duty-bound to consider them.

Peter Bottomley (Worthing, West) (Con): In addition to that, will the Secretary of State try, whenever he can, to make the point to those who smoke that they should try never to be the first person to light up in any group and that they should try not to smoke in front of someone younger than them?

Andy Burnham: The hon. Gentleman makes an excellent point.

Simon Hughes (North Southwark and Bermondsey) (LD): I join others in welcoming the Secretary of State to his new job—it is a very important one. The debate about how one prevents young people from becoming addicted to a harmful substance, be it tobacco, alcohol or another harmful drug, is difficult. While respecting the rights of adults to make choices about those products, will he give an undertaking that, first, everything he proposes will be evidence based and, secondly, that he will always seek all-party agreement, via the Select Committee and through other means, to ensure that we proceed with maximum consensus on such difficult issues? As we all know, young people can find ways around regulations as easily as anybody.

Andy Burnham: I am happy to give the hon. Gentleman that consideration, but what I ask in return is that if we give the evidence a thorough test in Committee and find that proof exists for certain action, the House does not then find other excuses not to take such action. Like me, I do not think that he is comfortable about the prevalence of smoking among young people in our constituencies. I think that there is more we can do to cut the number of young people smoking, and if that can be done, the effects on their standard of health will be huge. We must take this important issue incredibly seriously.

David Taylor (North-West Leicestershire) (Lab/Co-op): I congratulate my right hon. Friend on his new appointment. We must recognise how powerful and influential the tobacco lobby is. At every stage it challenges causation, manufactures uncertainty and hides behind third-party organisations—Save Our Shop is funded by the Tobacco Manufacturers Association. As the very last resort, it will drag its feet against the inevitable—what Philip Morris calls throwing grit into the gears of regulatory reform.

Andy Burnham: My hon. Friend makes an important point, which stresses the need—perhaps this goes back to what the hon. Member for North Southwark and Bermondsey (Simon Hughes) said—for us to examine the evidence and put aside some of the vested interests. I will argue strongly that if we can take steps to reduce the level of smoking among young people, we should always do so.

Smoking remains the leading cause of preventable death in this country. Although the number of people who smoke in England is at an all-time low, there are still too many young people taking up smoking.

8 Jun 2009 : Column 550

Philip Davies (Shipley) (Con): I, too, congratulate the Secretary of State on his promotion. Will he think again about the ban on tobacco display, which is a triumph for the nanny state? The most recent evidence that the Department of Health itself commissioned on this subject showed that brand awareness was not a factor in influencing young people to smoke compared with other social, economic and family background factors. He said that he does not want to damage small businesses, and that is reassuring, but his Department says that it will cost at least £1,000 a store to implement this proposal. It is gesture politics of the worst kind: will he think about it again?

Andy Burnham: I will think about it, but I would just point out that during the life of this Government we have taken measures to restrict the promotion of tobacco and control exposure to it. At every point in that journey, the voices from the Opposition Benches have cried, “Nanny state!” Almost every time that a sensible measure has been proposed to tackle smoking, especially under-age smoking, we have heard those voices. If we had listened to them, we would not have reduced the proportion of people who smoke from 28 per cent. in 1997 to 21 per cent. in 2007. On this issue, the calls from the Opposition do not have credibility. Without those measures, we would not have had that progress— [ Interruption. ] The noise is rising from the Opposition, but we will stand firm on this issue.

The total number of deaths caused by smoking in this country is more than the number of deaths from diabetes, road traffic accidents, suicide and drug and alcohol related causes combined. Some 8.5 million adults still smoke, and some two thirds took up the habit when they were under the age of 18. Some 200,000 11 to 15-year-olds smoke, which is a major cause of health inequality. Children from disadvantaged backgrounds are much more likely to become smokers.

Since the tobacco advertising ban, the main conduit for marketing cigarettes to children is through retail displays in shops. There was a full and impassioned debate on this issue in the other place, where the full range of views was set out and discussed. Their lordships have thoroughly scrutinised evidence on the benefits and costs of our proposals, and their conclusion—by an overwhelming majority—is that we should act now in accordance with the measures set out in the Bill.

Mr. Lansley: Will the Secretary of State confirm that the reduction in the prevalence of smoking was greater in the 1980s, under the Conservative Government, than it has been at any other time in the last 50 years, because of the impact of the increase in the price of cigarettes? The increase in prices in Iceland had the same impact.

We believe that evidence exists to support the proposition that we should ban tobacco vending machines in the public areas of licensed premises. Why are the Government resisting that suggestion?

Andy Burnham: On the hon. Gentleman’s first point, I do not wish to make a party political point— [ Interruption. ] I normally do, but not on this occasion. I remember the time of “The Health of the Nation” in the early 1990s, and progress was made in reducing smoking, but there was a real acceleration in 1997, with the introduction of smoking cessation courses and nicotine
8 Jun 2009 : Column 551
patches being made available to people. When tackling an issue of this magnitude, it gets harder and harder the lower we seek to go. The cut that I mentioned in the number of people smoking is a real and appreciable difference that will bring real health benefits to the people concerned and the national health service for years to come.

On the hon. Gentleman’s second point, I shall discuss vending machines shortly. If I pick up the drift of his question, he wants us to go even further than is proposed in the Bill. I hope that he will discuss with his colleagues the possible effect of that on small businesses, but let us have the debate.

People ask about the evidence. A study published in 2008 by Cancer Research UK reviewed two decades’ worth of research on the influence that point-of-sale displays have on smoking among young people. The collective conclusion of these studies is that point-of-sale displays not only encourage children who already smoke to make impulse purchases of cigarettes, but encourage children who have never smoked to take up the habit.

Research by leading academics at Stanford university’s school of medicine, published in 2004, showed that removing point-of-sale displays and advertising could reduce the likelihood of smoking among children and young people by as much as 50 per cent., even when other factors, such as parental smoking, are taken into account. Point-of-sale displays in the US are much more prominent than they are in the UK, but even if this legislation had only a 10th of the impact that it is estimated to have had in the US, it would still mean that 3,000 fewer children would become smokers each year— [ Interruption. ] I hear the muttering from the hon. Member for Shipley (Philip Davies). If he is talking of the nanny state and saying that it is not worth doing, then shame on him.

Mr. John Redwood (Wokingham) (Con): Will the Secretary of State give us his forecast of how many people might not become smokers if the point-of-sale measure goes through? What other measures is his Department considering in order to have even more success in reducing smoking?

Andy Burnham: The Department is considering a broader review of tobacco control policy later this year. We will be able to provide the right hon. Gentleman with a fuller answer then. I agree with the shadow Secretary of State that vending machines are an important part of the debate—we need to have that debate—but it is also important to act proportionately and to ensure that we consider the legitimate needs of small businesses when making any changes.

To give retailers time to prepare, the point-of-sale provisions will not come into force until October 2011 for larger businesses and 2013 for smaller shops. I hope that that responds to the concerns raised by the hon. Member for The Wrekin (Mark Pritchard). That will allow smaller retailers time to adjust, refit their shops when their old displays are due to be replaced anyway and limit as far as possible additional costs.

The Bill will also create powers to control the sale of cigarettes to children and young people through vending machines. Cigarette machines represent 1 per cent. of the overall cigarette market, but 17 per cent. of 11 to
8 Jun 2009 : Column 552
15-year-olds describe them as their usual source of tobacco. Initially, we will introduce stricter controls to ensure that only adults can purchase cigarettes through vending machines, but if those restrictions fail to stop underage sales we will consider banning vending machines outright.

In conclusion, the NHS is both transformed and transforming as an institution. This journey of reform has seen our priorities evolve over time. There have been three phases of reform. In the wake of the 2000 NHS plan, when the focus was on building capacity and driving up core standards, we needed the discipline and focus that centrally agreed targets confer. Following that, the focus rightly switched from numbers to process, as we took steps to introduce greater diversity and flexibility into the system, pushing power down to local organisations and enabling the NHS to look outwards to the communities it serves rather than upwards to Whitehall. Now, with Ara Darzi’s “Next Stage Review” and this Bill, we are opening up a third era of reform for the NHS, one that is focused on people—patients and staff—and that empowers clinicians and staff as the driving force of reform. It will all be backed by an NHS constitution, securing the values and principles of our national health service for future generations. I commend the Bill to the House.

Next Section Index Home Page