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Baroness Cumberlege: My Lords, I had a distinguished father-in-law who used to say, "Moderation in all things, and not too much of that." I suspect that that is the view of the noble Lord, Lord Mason. However, perhaps I should be serious and remind your Lordships that 110,000 people in this country die prematurely every year as a result of smoking-related diseases. It is a real danger, and it is right that we should warn people on posters and on cigarette packets.
Lord Avebury: My Lords, does not the Minister agree that just because one person has been lucky enough to play Russian roulette and get away with it, others should not be encouraged to take equivalent risks? As the noble Lords, Lord Monson and Lord Mason, do not appear to understand the statistics in relation to the risk, is there not a case for expanding the warning on cigarette packets to give details of the morbidity and mortality arising from cigarette smoking so that people can make comparisons with the healthy existence of non-smokers?
Baroness Cumberlege: My Lords, the noble Lord is correct in what he says in the first part of his question. We have looked at the size of warnings on cigarette packets. At the moment the European directive specifies that the warning should cover at least 4 per cent. of each large surface of the packet; in fact, in the UK we demand 6 per cent.
Lord Gisborough: My Lords, as cigarettes kill around 100,000 people compared with BSE which has killed only 10 and all the cattle have had to be slaughtered, does not a ban on all smoking become even more necessary?
Baroness Cumberlege: My Lords, with regard to BSE, it has been proven through science that the risks of eating beef are infinitesimal. We should not perhaps enter upon that subject; a debate is tabled for quite soon.
Lord Wyatt of Weeford: My Lords, does the Minister recognise that the figures she gives are wholly bogus? They are not based on scientific fact. Will she also allow the Department of Health to state the truth? Active smokers actually live longer without senile
Baroness Hayman: My Lords, will the Minister point out to her noble friends who do not like scientific evidence or large numbers and seem to prefer to deal with case histories that they should take the opportunity to do a ward round with any chest physician in any district general hospital? They will meet some of the real people who have suffered the terrible effects in health terms of smoking. Will she also point out that although there may be tax revenue advantages from people smoking, there is huge expenditure in the National Health Service in dealing with the effects of smoking-related diseases?
Baroness Cumberlege: My Lords, yes. It is not only chest diseases. One only needs to visit people who have had limbs amputated through the effects of smoking to see how distressing the situation can be. Of course, the cost to the NHS is enormous.
Lord Molloy: My Lords, does the noble Baroness agree that there may be hundreds of cases where people have smoked all their lives and nothing much seems to have happened to them? However, the British Medical Association says that there is no doubt whatever that a serious link exists between lung cancer and people who inhale tobacco.
Baroness Cumberlege: My Lords, the British Medical Association has fought this case long and hard. There is no doubt whatever that smoking does damage one's health. Studies have been carried out with regard to Alzheimer's Disease which show that there may be marginal benefits. However, those are far outweighed by the risks to general health.
Lord Monson: My Lords, is the noble Baroness aware that for many years the Department of Health claimed that 50,000 people a year died through the effects of smoking tobacco? Overnight that was doubled to 100,000 and then, realising that that was a suspiciously round figure, it was pushed up to 110,000. In the light of those widely varying statistics, is the Minister surprised at the suspicion of my noble friend Lord Wyatt of Weeford when he hears those figures?
Baroness Jay of Paddington: My Lords, rather than concentrating on the good luck of one old lady, would it not be more helpful to think about the numbers of 15 year-old girls who unfortunately are taking up smoking? Do the Government have any proposals to try to reduce the numbers of girls aged 15 who smoke? The figure has gone up by 10 per cent. since 1988 when the new health promotion activities began.
Lord Winston: My Lords, it is a fact that a number of NHS patients are being treated in the private sector by NHS staff. Is the noble Baroness aware that, while the Government continue to deny that bed and nursing shortages lead to that situation, it must be cheaper, more efficient and a better use of resources to treat NHS patients on waiting lists in the NHS hospital where they were assessed?
Baroness Cumberlege: My Lords, the NHS has always used the private sector. We only have to look at the purchase of drugs that come through commercial firms, the use of builders and contractors--and in the 1980s the health authority that I used to chair used a private laundry to very good effect--to realise that there has always been a mixed economy in the NHS. It seems right that if we are to reduce the waiting times, as we have so successfully done, when it comes to the peaks it is clearly appropriate that the NHS should use all the facilities in this country and treat people, if that is what they want, in private hospitals.
Baroness Gardner of Parkes: My Lords, is my noble friend able to confirm the statement made to us this morning at a meeting of the North Thames health authority that there has been a dramatic and remarkably good improvement in the waiting list times? Does that apply in the same way in other parts of the country?
Baroness Cumberlege: My Lords, yes. Last year in the London regions we saw a reduction of 16,000 patients waiting over one year for treatment and, for the first time ever, nobody waited 18 months. Nationally, half of all admissions are emergencies; of the remaining 50 per cent., half are admitted within six weeks and nearly three-quarters within three months. We have seen the waiting time fall from an average of nine to four months.
Lord Monkswell: My Lords, given the Government's introduction of an internal market within the National Health Service--presumably to identify the costs of treatment and to promote treatment at the lowest
Baroness Cumberlege: My Lords, it is a matter for individual health authorities and trusts to decide the best way of meeting the needs of patients within their area or patients who are waiting to go to their hospitals for treatment. On occasions, this may mean that services are purchased through private hospitals. We see nothing wrong in that.
Baroness Nicol: My Lords, are the people on the waiting list those who have seen a specialist and are now waiting for treatment, or does the waiting list include those waiting to see a specialist? Is that information collated separately?
Baroness Cumberlege: My Lords, these are people who are waiting for their operation having seen a specialist; but we recognise the point the noble Baroness makes concerning the waiting time between when the GP sees the patient and referral. That will be included in future.
Baroness Jay of Paddington: My Lords, is the Minister aware that the Fitzhugh Directory of NHS Trusts, which, perhaps unlike the Department of Health, is trying to gauge the national position and is a reputable organisation, this week published figures showing that the vast majority of trust hospitals in the country are making a profit from their use of private patients within hospitals? Surely it would be better, if there is capacity to treat private patients within NHS hospitals, that the hospitals should first of all clear their waiting lists of health service patients rather than using their facilities for private patients.
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