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As regards the quote that the noble Lord read out, I do not think that we can duck out of the fact that smoking, as the Government's Chief Medical Officer has said, is a great danger to health. That is an inescapable fact and it would be an irresponsible government who were not taking forward a range of programmes to make the public aware of these dangers and to deal with issues around tobacco advertising. I do not think that the Government feel in any way repentant about that particular issue. We are aware of some of the issues surrounding a ban, but we think that increasing public awareness of the dangers of second-hand smoke exposure is a significant way forward.
Viscount Simon: My Lords, is my noble friend aware that the chemicals to which people are exposed through second-hand smoke include arsenic, DDT, formaldehydewhich they say is used as a preservative for dead bodieshydrogen cyanidewhich is referred to as a gas chamber poisonPolonium 210, which is a radioactive compound, and toluene, which is an industrial solvent? If these facts were more widely known, would people not give up of their own accord?
Lord Warner: My Lords, I bow to my noble friend's knowledge in this area. He is of course right that cigarettes carry very dangerous compounds and we know that smoking kills over 120,000 people in the UK each year. The good news is that there has been a rise in the number of people quitting since 1999, and about 270,000 people have quit.
Baroness Noakes: My Lords, I take the Minister back to the reply he gave when the noble Lord, Lord Clement-Jones, asked when the Government were going to give their official position on the ACOP. I remind the Minister that the Health and Safety Executive finished consultation in 1999 and we have still not had the Government's official position on the implementation or acceptance of the ACOP. When will he tell us?
Baroness Finlay of Llandaff: Will the Minister inform us whether the contractors working in government departments and on the Parliamentary Estate are being advised that smoking is not acceptable, given the dangers to themselves, quite apart from the dangers of passive smoking to other people working in government areas?
Lord Warner: My Lords, we move seamlessly from smoking to the Working Time Directive. The directive already applies to all NHS staff except doctors in training, to whom it will be extended from August 2004. The Department of Health is actively working with the NHS and the medical profession to implement this change in ways which will benefit both patients and staff. Solutions will vary from NHS trust to NHS trust, but will include using staff differently by, for example, creating night teams to staff hospitals out of hours.
Lord Skelmersdale: My Lords, I am grateful for that Answer. If I were of a suspicious frame of mind, I would wonder whether I had left my prepared supplementary lying around in the Library. The Minister's honourable friend, Mr Hutton, stated in a press release today:
Lord Warner: My Lords, I have not seen the noble Lord's prepared supplementary, but I reassure him that we have not been sitting idly by. He may not be aware that some time ago we set up a Working Time Directive expert group, which had on it people from the Royal Colleges, the JCCs, the NHS Confederation and other key stakeholders, who have been working together on the issue. There are 19 Working Time
Lord Clement-Jones: My Lords, the Minister talks about actions being taken, pilots, discussions and so on and so forth. Is it not the fact that the NHS is not yet ready for the introduction of the Working Time Directive in the particular area identified? Why does he not accept the suggestion of the Royal College of Physicians that the introduction of the Working Time Directive be delayed?
Lord Warner: My Lords, we are not convinced that the Working Time Directive does need to be delayed. I can certainly write to the noble Lord. I shall not bore noble Lords with all the details, but I can refer to the 19 pilot sites, where some very interesting work is going on about the way in which pressure can be taken off senior house officers, for example. We can reorganise the work so that out-of-hours services are producing benefits for patients as well as coping with the Working Time Directive.
Baroness Gardner of Parkes: My Lords, can the Minister tell us how he can reconcile his remarks that he is quite confident that everything will be all right in 2004 with the press reports which indicate that many accident and emergency wards might have to close because there will simply not be enough junior trainee doctors to handle the work?
Lord Warner: My Lords, I wish the noble Baroness a happy birthday. As part of her birthday gift, I assure her that we do not accept that services will close as a result of implementing the Working Time Directive. I draw the House's attention to the fact that we have implemented the Working Time Directive for other NHS stafffor a much larger group of people. That came into force in 1998.
Lord Warner: My Lords, what I can say is that we know that the Government have committed themselves to increasing NHS funding by on average 7.4 per cent in real terms in England over the next five years. That includes provision for the impact of the Working Time Directive. We have also set aside £46 million over the next three years to help trusts to implement the directive. More than £5 million has already been dispersed so far this year to the 19 Working Time Directive pilot sites that are trialing new and better ways in which to work.
Baroness Finlay of Llandaff: My Lords, will the Minister inform us what action the Government are taking to manage the tension between the local delivery of services and the need for a critical mass of specialists to manage very sick patients on a 24x7 basis?
Lord Warner: My Lords, the Government have already put in place a large increase of well over 1,000 extra specialist registrars. They will be concentrating the allocation of those posts in the trusts that might have the greatest difficulty in tackling the problems around the Working Time Directive.
Lord Berkeley: My Lords, my noble friend will be aware that the Working Time Directive also applies to railway workers. My noble friend Lord Sainsbury recently told the industry, through this House, that it had known about that since 1999 and should have been fully prepared. Presumably my noble friend the Minister has taken that advice himself, and will be fully prepared for the extra year that the medical workers have been given, beyond those on the railways, so that everything will be in order by next August.
Lord Warner: My Lords, you will be astonished to know that I am not briefed on the question of railway workers. That subject is a little wide of the Question.
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