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I must declare an interest as a fellow of the Royal Pharmaceutical Society, but I believe that if we are to advance the pharmacy agenda and ensure that the public are offered a greater range of pharmaceutical services, needs assessments are essential. That is not about preventing dispensing doctors from doing anything; it is more about giving the public more access to, for instance, smoking-cessation services. I hope that, in the long term, it will mean that when an application is made to open a new pharmacy, the primary care trust will have some control over what happens and will be able to insist that some extra services are provided. I hope that it will mean that we can move away from the supply side, and that people can expect a greater range of services from their pharmacies. I hope that the hon. Member for South Cambridgeshire will eventually see the proposal in a more positive light, because that is how I think it is intended.
Mr. Lansley: My memory does not serve me well enough to recall how I was involved, but I think that the discussion of the impact of the control of entry regulations took place during our debates on the Bill that became the Health and Social Care (Community Health and Standards) Act 2003. If the hon. Lady consults the record, she will find that I questioned the then Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), on the subject. I said that while I did not oppose the liberalisation of control of entry, it must take place alongside proper measures providing for the Department to pay if it wished to have access to community pharmacy. If it was not willing to pay, there would have to be some compensating mechanism through control of entry.
The problem is that in the circumstances that the hon. Lady is describing, someone might wish to set up additional pharmacy premises to offer an additional service to the public. Why are we trying to prevent that from happening? The issue is not a pharmaceutical needs assessment preventing people from providing additional dispensing or pharmacy services; it is how to procure those services in places where there is a lack of community pharmacy. It is in that regard that the contract has not really done the job yet.
Sandra Gidley: I think I am grateful to the hon. Gentleman for his comments, although they seem to be slightly at odds with what he said earlier. I am certainly grateful for his clarification of the way in which he sees the whole picture. His initial throw-away comment was that the pharmaceutical needs assessment seemed to be a backhand way of getting at dispensing doctors. That seemed to be his prime concern. It is a shame that he did not take the opportunity to say something a bit more positive then, but he has done so now, and I thank him for his intervention.
We shall have a greater opportunity to debate many of these matters in Committee. There are concerns about innovation, but they have already been mentioned. We shall probably want to return to the subject of asylum seekers. I appreciate the concessions made in the House of Lords, but I do not think that we have yet arrived at an optimum solution.
There is much to be recommended in the Bill, and also much to be improved. The Liberal Democrats do not plan to vote against it, and we look forward to working with all parties to try to improve it.
Mr. Deputy Speaker: Order. I think that we are going to have to pick up the pace a little if all seven Members still wishing to take part in the debate are to have the time so to do.
7.30 pm
Mrs. Maria Miller (Basingstoke) (Con): Before moving on to the main points I wish to make, I would like to talk about two issues that have taken up a lot of time in our debate. The first is the ban on in-store display material for cigarettes. Before I became a Member of Parliament, I worked in marketing and advertising for 17 years—indeed, at one point I worked with a cigarette brand—and I urge the Government to consider very carefully whether the proposals they are making today will have the outcomes they desire. I wholeheartedly agree that we need to manage very carefully the way in which cigarettes are marketed and sold to anybody, and particularly young people, but the Government are confusing the two issues of access to cigarettes and the attractiveness of cigarettes.
Simply stopping access to cigarettes, as the measure seeks, by hiding them under the counter in shops does not tackle the key issue, which is that youngsters find the idea of smoking cigarettes attractive; it is seen as part of their social life and as making them cool members of their community. Supermarkets have not been successful in marketing own-label cigarettes because they do not have the required brand cachet. Simply hiding cigarettes under the counter does not solve the problem that the Minister is trying to address, which is to stop so many young people in our community smoking. I wholeheartedly support him in that objective, but I am not sure he is using the right tools to achieve it, and I think he needs to do far more work with cigarette manufacturers to understand properly the key motivations and drivers that make people smoke. I do not think that can be achieved simply by getting rid of display material.
The second issue is to do with a point the Secretary of State made about the National Institute for Health and Clinical Excellence and the availability of recommended treatments. I am sure I do not need to remind the Minister that the Government have already intervened to change what NICE has said should be the desired amount of access to in vitro fertilisation treatment. NICE has firmly said women between the ages of 23 and 39 should have access to three cycles of IVF treatment. That is certainly not available in my constituency, my primary care trust area or my strategic health authority area. It is unavailable not because of any lack of desire to make this very important service accessible to my constituents, but because of a lack of money and funding. We need to prioritise funding. The Government have said today that it will be mandatory for all PCTs to make all NICE guidelines available to all our constituents, but the Government also need to address how that will be paid for, because it is unclear to me how they will square that circle in my area, and other Members may have the same problem.
The three main points I wish to make today are to do with three omissions from the Bill. One of them has already been touched on and Members in the other place have tried to rectify the problem, but the other two have not yet been covered. The Bill is wide-ranging, so it is surprising that it does not address any of them.
The Secretary of State brushed aside the deliberations of Members in the other place when he said he was not minded to allow the new clause 34 that they had inserted into the Bill to remain. The measure allows for exemptions to private patient caps for NHS foundation trusts to be made in regulations. That is particularly important in my constituency. Basingstoke and North Hampshire NHS Foundation Trust, which serves my constituents but is located in the constituency of my right hon. Friend the Member for North-West Hampshire (Sir George Young), provides excellent care, particularly in cancer treatment. It has an international reputation, which is extraordinary for what is a district hospital. It has that reputation because of the quality and calibre of its surgeons and cancer specialists and the ground-breaking work they do in rare abdominal cancer, liver cancer and colon cancer.
The hospital has the capacity to treat far more patients than it does at present, but because of the restrictions in place it is prohibited from doing so. It is therefore prohibited from expanding its work in a way that would benefit the people suffering from these chronic diseases—I am sure many Members’ will have constituents and family members who have suffered from some of them. Such development could boost the income of what is a very successful hospital. That income would be used to improve its ability to serve our local community and to improve the local NHS services that are already in place. I felt that the amendment in the other place gave the Government the opportunity to introduce regulations that would help my hospital and my community to get a better service. I was therefore disappointed that the Secretary of State was so quick to dismiss as merely a quick fix a measure that had been well thought-through and well debated in the other place.
Basingstoke residents already know the importance of having an internationally renowned hospital in our community, and the benefits of that. We have the Pelican cancer research centre and the ARK, a state-of-the-art teaching facility, and all because of the expertise in the community. We should be nurturing that expertise, not limiting it as the Government and some of the Secretary of State’s party colleagues, such as the hon. Member for Wolverhampton, South-West (Rob Marris), seem to suggest. I urge the Government to think again. I do not think they should consult too widely as that may well lead to the idea being kicked into the long grass, as currently happens to so many ideas in this place. Consultation is not necessarily the right way forward. The Government should talk to the hospitals that are being restricted and hampered. I know the management of my local hospital would be more than happy to talk to the Government on this matter.
I shall now move on to the other two measures that I am surprised were not included in the Bill. I echo the sentiments of my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) that the Secretary of State should perhaps take on the role of public health Minister himself. The Government’s policy needs to put more emphasis on public health. It is disappointing that the amendment to include more detail in the constitution was not passed in the other place. Among other things, it gave more clarity of the central role public health should take in the NHS. Public health remains a Cinderella service in the NHS. The Minister needs to think very carefully about that, particularly the role of health visitors.
It is interesting that the Government have not taken the opportunity presented by the Bill to start to deliver on their pledge to implement Lord Laming’s recommendations after the recent and tragic death of baby P. The recommendations included highlighting the key role health visitors play in child protection and their function as a universal service, seeing all children in their home environment and with the potential to develop strong relationships with families. The Government missed the opportunity to put these recommendations in place and to put them into action.
The Government must live up to their promise to implement Lord Laming’s report in full. Many of the ideas contained in the report do not require legislation, but the Government know that taking health visitors off the statute book in 2001 had a significantly deleterious effect on the number of health visitors coming into the profession. There has been a 13 per cent. drop in the number of health visitors since the dedicated health visitor register was closed in 2004 and the Bill could have provided an opportunity for the Government to demonstrate the valuable role that health visitors can play. They could even have considered placing the role of health visitor back on a statutory footing. I know the profession is interested in talking to the Government about that. Unless the Committee picks this issue up in more detail, it will be another missed opportunity in the Bill.
I say that because the move towards using a mix of lower-skilled staff to replace qualified health visitors is not consistent with the Government’s undertaking to implement Lord Laming’s report in full; it is precisely the highly qualified and highly skilled nature of health visiting that he focused on in his report. The service is stretched to breaking point in too many parts of the country, leaving more than two out of three health visitors saying that they no longer have the resources to respond to the needs of even the most vulnerable children. I urge the Minister to consider in his response how he could weave this idea and, in particular, the implementation in full of recommendation 32 of Lord Laming’s report into the Bill, even at this late stage.
The third and final issue that I wish to raise relates to children’s trusts. Clause 2 contains a detailed analysis of the duty to have regard to the NHS constitution, yet the group of organisations that are to have such a duty does not include any mention of children’s trusts or Sure Start centres. To someone like me, who looks at these issues in some detail, it feels as though the Department of Health has put its head in the sand. The Apprenticeships, Skills, Children and Learning Bill establishes children’s trusts as statutory bodies that have an important, if not vital, role to play in the commissioning of services, including NHS services, for children in local communities. I find it interesting that the Department of Health does not appear to be talking to its colleagues in the Department for Children, Schools and Families in order to understand how this Bill and the NHS constitution will interact and link with children’s trusts, which its DCSF colleagues feel have such a pivotal role to play. Perhaps this is an oversight or something that the new ministerial group has not yet thought about, but I urge it to do so. If it does not, when the Bill is read by the people running our health services in our communities, such as the group of people I met in my constituency on Friday, who are doing all they can to weave together children’s services and make a better and more sustainable offer in
Basingstoke, those people will be forgiven for thinking that the Department of Health still does not understand the importance of integrated working in the way it structures legislation.
As I said, I noticed that Sure Start children’s centres are also not an integral part of the Bill, despite their being a flagship policy of this Government—again the Department of Health does not seem to be getting a grip on that. Ministers are doubtless aware that the national evaluation of Sure Start undertook a study in 2007 on the effectiveness of Sure Start local programmes and demonstrated clearly that health-led Sure Start children’s centres are the most effective way of using the significant amount of public money involved. I realise that there are many new faces on the Treasury Bench and perhaps they need a little more time to get to grips with this part of their brief, but I urge them to look carefully at how they can work more effectively with their colleagues in the DCSF, because such working simply is not happening and that is not right for taxpayers’ money, for our constituents or for the people who work in the NHS and our children’s centres, and those who work in our children’s trust boards in future.
7.43 pm
David Taylor (North-West Leicestershire) (Lab/Co-op): Underpinning this debate is the principle that smoking is an addiction of childhood—it is not an adult choice. Today, 1,000 under-16s will have started to smoke for the first time by trying a cigarette, and 80 per cent. of smokers start to smoke before they are 19. The tobacco industry needs to recruit more than 100,000 new smokers each year to replace those who die or who cease smoking. Smoking plays a huge role in perpetuating health inequalities and accounts for half the difference in life expectancy between social classes 1 and 5.
The Bill introduces two important measures that will protect children from smoking and help smokers who are trying to quit. It includes measures to restrict or prohibit cigarette vending machines and to put an end to the tobacco industry’s power wall promotional displays. Regrettably, it does not include a third measure: the requirement to sell tobacco products in plain packaging. Those measures are proposed not in isolation but as part of a comprehensive strategy; it is a proper plan to reduce the terrible burden of tobacco-related death and disease.
Campaigners on both sides of the argument have long been vocal, as we have heard in today’s debate. In one corner are those who would promote public health and in the other are those who would protect private profit. These are not equivalents. If the measures in the Bill would not work, health professionals would have nothing to gain from promoting them, but it is precisely because they will work that the tobacco industry is fighting so hard to defeat them.
I have mentioned vending machines, and the case against them is unanswerable; I was pleased to hear that Her Majesty’s Opposition will be pressing for the measures in the Bill to be toughened. Hon. Members who are still to speak, including the Minister, will doubtless make more detailed arguments, but, in short, mine is as follows: tobacco vending machines provide young smokers with about one in six, or 17 per cent., of the cigarettes they consume, whereas the figure for the entire population
is about 1 per cent.; these young smokers use the machines as a ready supply of cigarettes because there is no real risk of their being asked for proof of age; those who profit by these illegal sales are almost never prosecuted—we must never forget that; and the machines are unpopular with regular smokers and are sited mostly where alcohol is sold and the resolve of smokers who are trying to quit will be at its weakest. I welcomed the Secretary of State in an intervention. I think he will be a superb Secretary of State, because he has the experience, track record and vision to make a success of the job. I urge him to draft, on behalf of the Government, the strongest regulations possible to introduce an immediate and total ban on tobacco vending machines.
I turn to the central feature of point-of-sale displays. Those who make and sell cigarettes hotly contest the evidence that point-of-sale displays increase youth smoking. However, very few smokers start smoking as adults and if we were to succeed in stopping under-age smoking, the industry would be bankrupt in a generation—that is self-evident. The Bill is against the tobacco industry’s interests, as we have seen in the furore and the campaign that it has mobilised, yet again, against any tobacco control measures. The more the industry tells the Government that they are off track, the more certain we and they can be that we are bang on target.
Saskatchewan was the first Canadian province to end point-of-sale display. At the time, its youth smoking rates were rising sharply, but when it put an end to tobacco displays those rates began to fall. The tobacco lobby had the ban suspended for a time, during which the youth smoking rate flatlined, but once the regulations were reintroduced the rates began to fall again—to me, that is proof positive that there is a strong link between the two. Overall, a rising trend had been reversed and the subsequent fall, despite the temporary suspension of regulations, was faster than the Canadian average.
Hon. Members listening to this debate should pay close attention if they receive briefings on this matter from the tobacco industry, as I am sure many have done. In the past, the industry sought to undermine the evidence—part of its modus operandi is always to muddy the evidence, challenge the science and breed uncertainty where something significant is going on—by referring to irrelevant adult smoking rates, by quoting an average decrease that starts years before the legislation came into effect and by comparing Saskatchewan not with the average Canadian province but only with those where youth smoking was falling fastest.
I move the discussion on 1,000 or 2,000 miles, to Iceland, which provides further evidence both of the effect of point-of-sale displays and the lengths to which the tobacco lobby will go to disguise it. In a long-term study that included almost all year 10 students in Iceland—those aged 15 to 16—smoking rates were seen to have fallen by a third, from about 20 per cent. two years before the ban to less than 14 per cent. two years later.
Sandra Gidley: That figure is correct, but it is slightly complicated by the changes in taxation of tobacco products over that length of time. Can he elaborate on how that fits into the picture? I find it very difficult to tease out the details. For example, there was an increase in smoking rates after the taxation went down.
David Taylor: The hon. Lady is right to suggest that many factors influence smoking prevalence. Trying to control those factors, including for levels of taxation, and to identify and isolate what is happening at point of sale is difficult. The Tobacco Retailers Alliance certainly found doing that inconvenient and instead chose to use a small sub-sample of what was in essence a survey of adults. It continued to misrepresent the evidence until the Public Health Institute of Iceland, which was responsible for both studies, told it to stop doing so. I am pleased that the institute was moved to do that.
The health and medical communities are united in saying that tobacco displays increase awareness of tobacco brands and prompt purchase by young people. Jurisdictions that end such displays have seen the prevalence of youth smoking decline, and that is what this part of the Bill is about. If the opinion of leading researchers, health campaigners and royal colleges were not enough, Channel 4’s Fact-Check service concludes:
“The evidence points pretty firmly the government’s way. And to say, as the opposition parties do”—
by that it probably means opposition in the tobacco industry, rather than Opposition parties—
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