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“Doctors are at the forefront of innovation in the NHS and the Government’s continued commitment to encourage innovation is welcome. We would seek further clarity from the Government on its intention on possible membership of the committee that the Secretary of State may establish to advise on the form and allocation of innovation prizes.”
The NHS Confederation, in its briefing for Second Reading in the other place, stated:
“There is little detail in the bill about how the prizes would operate.”
That is absolutely true. It continued:
“We would welcome further clarification to the following questions: What will be the size of innovation prizes? Will prizes be awarded to individuals or organisations? Who will make up the committee and how will they be appointed?”
Those are typical questions in the NHS—“There is another committee. Who is going to be on it? Is this a chance for me? Can we get a representative on it?” It is typical of the structure and culture of the NHS.
The Royal College of Nursing, in a Second Reading briefing for this place, stated:
“Nurses are often at the forefront of innovation to improve the quality of patient care. The RCN welcomes the commitment to establish innovation prizes if these are transparent, fair and genuinely raise the morale of NHS staff. However, the way in
which the schemes are implemented locally will be key in terms of assessing the practical impact the prizes will have on the NHS and those that work in it.”
I leave those thoughts with my hon. Friend the Minister, because it seems to me that we have an opportunity to bring innovation into the NHS by encouraging health professionals to do things that will get them the prize or whatever it is, including by spreading best practice in their workplace. I hope that the prizes are used sensibly and flexibly, so that we can further improve the NHS.
From what both Front Benchers said earlier, it seems that the part of the Bill that is likely to create debate during its passage is the provisions in part 3 on point-of-sale tobacco advertising and vending machines. I wish to say a few words about smoking and health inequalities. Members may know that in March, the Health Committee published a report on health inequalities. It addressed smoking, which is a major issue in health inequalities in this country and in other parts of the world.
The report showed clearly that the more deprived a person is, the more likely they are to smoke. Smoking is linked to almost every indicator of deprivation, including in income, education and housing tenure. There can be no question about that. Perhaps I ought to be saving part of my speech for another debate, because we have not yet had the opportunity to debate the Government’s response to the report. Other countries, particularly in northern Europe, classify deprivation and so on not by social class, as we do, but by education. There is no doubt that in countries not dissimilar to ours, there is more smoking among people whose education level is not high.
In turn, smoking drives health inequalities here in the UK. It accounts for half the gap in life expectancy between the richest and poorest in our society. There is clear evidence that quitting, or even better not starting, greatly reduces that gap. According to recent research by Dr. Laurence Gruer, the least affluent never-smokers have a much better survival rate than the most affluent smokers. Not smoking is a way of partly bridging the gap of health inequalities in this country.
In recent decades there have been great reductions in smoking rates, but they have been greatest among the most affluent. There is a danger that the poorest families could be left behind. I see that two members of the Select Committee are present for the debate, and one thing that we found was that although the health of the population is getting better, with life expectancy getting longer in every social class, the gap between the lower and higher social classes is widening. That is disturbing.
Just as smoking usually starts in childhood, so do the health inequalities that it brings. By protecting young people from tobacco marketing and reducing youth smoking rates, the Bill promises to reduce the health gap in future generations. That should not be considered lightly, because we are not talking about what is going to happen this year, next year or the year after. It is about what will happen in ill health and smoking maybe a generation down the line.
The measures in the Bill are proposed not in isolation but as part of a comprehensive strategy, most of which has gone through the House in recent years. It is especially important to have a proper plan for tobacco control, particularly if we believe that it is important to reduce health inequalities. When New York went smoke-free, it was not in isolation but as part of a five-point plan
including taxation, cessation support, public education and evaluation. Smoking among New Yorkers fell by almost 20 per cent. in four years, and the greatest improvements were among disadvantaged and high-prevalence groups.
I wish to progress the health case against point-of-sale display. In its report on health inequalities, the Health Committee supported that aspect of the Bill. The hon. Member for South Cambridgeshire rightly mentioned tobacco smuggling, but the relevant recommendation in the report stated:
“Smoking remains one of the biggest causes of health inequalities; we welcome both the Government’s ban on smoking in public places, and its intention to ban point of sale tobacco advertising, as evidence indicates that both of these measures may have a positive impact on health inequalities.”
That is very important, and the last time the House legislated on smoking, when we had the big debate about smoking in public places in 2006, it was the recommendation of the Health Committee that carried the legislation through. I congratulate hon. Members of all parties, including the hon. Member for South Cambridgeshire, the hon. Member for Romsey (Sandra Gidley) and the hon. Member for Wyre Forest (Dr. Taylor), who supported that recommendation at the time. Considering the matter in detail and having the Select Committee take evidence and make recommendations made a major contribution to turning the proposal into the popular legislation that it is now. Up and down the land, people say that the smoking ban is the best thing that happened—I hear that all the time. It happened because the House examined the evidence, considered the problems in our society and reached the right conclusions.
I may be in a different Lobby from the hon. Member for South Cambridgeshire on Report, but the evidence shows that the Select Committee also got it right on this occasion.
Mike Penning (Hemel Hempstead) (Con): I was a proud member of the Health Committee, but when we examined the evidence for the Government’s proposals, we rejected the Government’s attempts to cherry pick who would be protected by the legislation. We said, based on the evidence, that if we were to protect one, we needed to protect all. Such evidence is lacking for the provisions in the current Bill.
Mr. Barron: I agree with the hon. Gentleman’s first point. The first option—allowing smoking in public houses that did not serve food, but not in those that did—was not a public health measure. From a public health point of view, it was not the brightest proposed legislation. The amendment from the Health Committee probably changed minds about the free vote. None the less, the evidence was there.
The hon. Member for Hemel Hempstead (Mike Penning) suggests that there is no evidence to support the proposed ban on displaying tobacco products, but I shall make the case that there is evidence about the effect of such point-of-sale displays. Hon. Members can look through the many representations that we have received on the subject and they will see that the great majority that suggest that there is no evidence that the provisions will be effective come from those who make their living by
manufacturing or selling tobacco products. [Interruption.] The hon. Gentleman can read this tomorrow if that is better, but I want to answer his question. The manufacturers or those who sell tobacco products question the evidence in support of the provisions.
By contrast, those who insist that the evidence is good are, for the most part, health professionals, health charities and researchers. The hon. Gentleman will have seen the letter that we received from Action on Smoking and Health—an organisation with which I have been involved for a long time. Nearly two pages contain the names of organisations that support the Bill, including eight royal colleges, cancer charities and other major charities. However, some people do not support the proposals, and I want to consider people’s motives either for supporting part 4 or for not supporting it.
Many hon. Members will have received standard letters from shopkeepers, who are genuinely concerned about the measure. Those letters simply say that there is no evidence that the provisions will be effective. It hardly seems likely that that opinion is based on first-hand reading of the published research. Indeed, we know that the message has been given to shopkeepers by an organisation that calls itself the Tobacco Retailers Alliance, which is funded by the big tobacco manufacturers through the Tobacco Manufacturers Association.
I have battled against the Tobacco Manufacturers Association and tried to influence the House on tobacco legislation since the early 1990s, when I promoted a private Member’s Bill. The Tobacco Manufacturers Association paid Members of Parliament to stay overnight on a Thursday to talk the Bill out on a Friday. Indeed, it was talked out. Its purpose was to ban tobacco advertising and promotion. It was eventually introduced in law by the Government, who should be congratulated on that.
The Tobacco Manufacturers Association has tried, through many different organisations, to buy influence in the Chamber for decades. The recent letter that we received from the Tobacco Retailers Alliance has many aspects worthy of note. At the end, it states that
“the Tobacco Retailers Alliance is funded by the TMA.”
So let us not forget who says that the provisions will not work.
We were sent four pages of questions in red, with accompanying answers. I shall read out only the first two. The first question and answer is:
“Why are shopkeepers so worried about hiding tobacco out of sight?
Because it may put them out of business. A tobacco display ban would be a huge financial and operational burden on small shops.”
The second question and answer is:
“Would shops be forced to close because of this?
Yes—we think so.”
Throughout the House’s history as a legislator on tobacco, going back to the late 1950s, when the late Sir Richard Doll found the connection between smoking and ill health, the tobacco companies have funded dubious research to oppose anybody who claimed that there was a direct connection between tobacco and ill health. They have got somebody to come along to say that small shops may be put out of business or that smoking “may” harm health. For decades, they have tried to undermine concrete evidence of the link between tobacco and ill health.
We must never forget that the Tobacco Manufacturers Association has influenced individual Members in this country for decades. Its aim is to protect at all costs a substance that leads to 50 per cent. of the people who use it dying a premature death. We should go further in our actions against the promotion of tobacco.
Sandra Gidley (Romsey) (LD): The right hon. Gentleman is clearly passionate about the subject. I may disagree with his line of thought, but will he go further and support any Liberal Democrat amendments to prevent the sale on of tobacco products by an 18-year-old to someone younger, as happens with alcohol?
Mr. Barron: I am happy to listen to the case for any amendments to improve people’s health and stop the selling of a substance that creates ill health and is addictive. I think that a member of the Conservative Government in the early 1990s said that if tobacco had been discovered and brought to this country today, it would be banned. I think that most people agree. However, it was discovered long ago and has not been banned.
When we examine suggestions of lack of evidence, we must remember where they come from. We do not rely only on the experience of Iceland and Canadian provinces, which show—in the real world—how putting an end to promotional displays reduces youth smoking. We also have a wealth of scientific evidence to show how that works.
Earlier this year, researchers in New Zealand published a systematic review of the evidence. Seven out of eight studies found a significant link between exposure to point-of-sale display and smoking initiation. Another study—this time of adults—found that even pictures of cigarette packs provoked cravings among smokers, and a third of recent ex-smokers reported urges to smoke after seeing tobacco displays.
That is, in miniature, a version of the debates that we had back in the early ’90s and late ’90s about billboards and posters in this country. Billboards did not even have to have tobacco products on them—all they needed was a bit of purple cloth, and most people with an inquiring mind would know exactly what they were about. The name of the product did not have to be there; people knew what was going on. That is how tobacco—and, for that matter, other products—have been promoted for decades in this country. Indeed, tobacco is still promoted in that form in places that retail it.
An even more recent study, which was published just last month, shows that tobacco promotional displays in the US are concentrated in low-income minority ethnic neighbourhoods. Interviews with shopkeepers reveal that contacts with tobacco companies left shopkeepers with little or no control over such displays. The tobacco companies make the decisions about where displays go, and if shopkeepers do not comply, they are penalised under incentive programmes. A study of tobacco displays in England conducted last summer also found evidence of similarly coercive relationships. That study found half of all displays within one metre of sweets displays, while one in five displays obscured the health warnings. One retailer explained:
“Display is owned by the tobacco company. When move briefs around by a deadline, trader has either star points or money donated...Tobacco company takes photos to prove briefs changed by deadline.”
The health and medical communities are united—I read the list of supporters out earlier. The research clearly shows that tobacco displays increase awareness of tobacco brands and prompt purchase among young people, and that jurisdictions that have put an end to such displays have seen youth smoking fall. There can be no question about that. No matter how one wants to dress it up or who pays for the research to do that, the peer-reviewed evidence is there for all to see. However, if the opinion of the leading researchers and health campaigners and the royal colleges were not enough, Channel 4’s FactCheck service concludes on its website that
“the evidence points pretty firmly the government’s way. And to say, as the opposition parties do, that there’s no evidence the ban will have an effect on smoking among young people seems pretty misleading.”
I say this to Opposition Members: go on FactCheck’s website and have a look at what it has found. The people at FactCheck are not supported by the TMA or the Government; they are people who have done open, individual research with our constituents about what should and should not happen.
Let me say a few words about the economic counter-arguments. Hon. Members will remember the mailbags filled with letters from the hospitality trade, which was genuinely alarmed by the effect that smoke-free legislation would have on its business. The tobacco industry told those businesses that the impact of such legislation would be devastating and they believed that, but it was not true. In the years following the introduction of smoke-free legislation, the number of premises licensed to sell alcohol in England increased by 5 per cent. Hon. Members will remember the claims sent to them about 39 pubs closing every week. However, that evidence, wherever it came from, was hardly independent and it cannot be verified. Such research does not say how many pubs closed before the legislation or how many new premises have opened since. Also, it often attributes changes entirely to the regulations, ignoring the recession, the long-term trends in the pub trade and—this relates to the Health Committee’s current inquiry—the pricing and availability of alcohol.
The British Beer and Pub Association sent all hon. Members evidence of where pubs had been closing. However, about three months ago I did a study of the borough of Rotherham—I am one of three hon. Members who represent it. I looked at the previous 12 months—the period for which the British Beer and Pub Association had sent us evidence—and found that there were actually four more pubs than there had been 12 months previously. I therefore find the idea of 39 pubs a day closing because of smoke-free legislation—or, for that matter, anything else—difficult to believe. I know that people in Rotherham like a drink, as I do now and again, but I do not think that the closure of 39 pubs a day is a real measure of what was happening. We must therefore always be careful when people send us briefs about proposed legislation.
Also, when shopkeepers say that the changeover will cost them £5,000 or £2,000, they are again quoting the tobacco industry. On closer examination, we realise that some of those costs include not only the cost of installing CCTV, but the cost of closing the shop to do so. That is hardly a truthful analysis of the cost of the changeover. The real costs would be much lower, with both Action on Smoking and Health and the Department of Health
having been quoted a cost of around £200 by leading Canadian suppliers, who have some experience of such matters. Small shops will also have until 2013 to comply, whereas larger shops will have until, I think, 2011, so there will be a lot of experience around to help with any costs to the small tobacco retailers we have discussed. Vending machines are also covered in the Bill, although I am a little confused, because we are giving the Government powers to take action in respect of vending machines without knowing what action we would like taken. However, perhaps that is a good thing—that is fine; that is okay.
Mr. Stephen O'Brien: That is a cop-out.
Mr. Barron: Hon. Members who are concerned about the future of local tobacco retailers should be particularly supportive of the provisions restricting vending machines. Vending machines compete with local retailers in the convenience tobacco market, taking just over £1 billion a year. That is quite a large sum. Unlike retailers, vending machines do not verify the age of the customer and are consequently a regular source of cigarettes for 17 per cent. of regular teenage smokers. Vending machines are also not popular with regular smokers, typically charging 20 per cent. more for 20 per cent. fewer cigarettes—that is, for packs of 16 cigarettes. One survey showed that only one regular smoker in 20 had used a vending machine once in the previous six months.
The other thing is that vending machines are found, by and large, in alcohol outlets—that is, in pubs. Relapse into smoking is strongly associated with alcohol. Situating vending machines in bars could trigger relapse among smokers trying to quit. Many years ago, when I stopped smoking, back in the 1970s, the one problem was going out at the weekend with my friends for a drink in pubs with smoky atmospheres. I am pleased that we have got rid of those atmospheres; I would like us now to remove the temptation to buy what is available over the bar or in more accessible places.
An end to tobacco vending machines would also end sales to children, transfer valuable business to more responsible retailers and support smokers trying to quit. The age check can be done by a retailer, but it cannot be done by a machine. There were some people saying in the media a few weeks ago, “Well, we wouldn’t let them put pound coins in it—they’d be able to get tokens for the vending machines,” but what a token has to do with the age of whoever puts it in a machine is completely beyond me.
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