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My opening remarks refer to subjects that are not mentioned in this Bill. During the passage of the last Health Bill, I tried hard, and with a degree of support throughout the House, to secure an amendment to put the full price of prescribed drugs on the medication itself. I intend to introduce a similar amendment to this Bill. Patients would be encouraged to finish their full course, thus saving repeat prescriptions. I have always felt strongly that all prescription drugs ought to have their full value clearly printed on them, so that patients know exactly what they are getting for their prescription charge. One must not forget that many prescribed drugs are outstanding value for money. Sadly, I must declare an interest as a diabetic. As such, I am exempt from prescription charges, but I greatly welcome the relief that has recently been awarded to those with such long-term illnesses as cancer.

I turn now to health insurance, which is, I accept, a controversial subject. In order to further reduce waiting lists and the heavy load on the National Health Service, I have long advocated that insurance health premiums ought to be allowed against income tax. Private health insurance is a very large proportion of annual expenditure for those who opt for it, particularly if a wife and children are also involved.

I am also particularly concerned about car parking charges at National Health Service hospitals, especially for lower-paid members of staff. In many cases it is almost unviable for them to go to work at all. Many patients attending accident and emergency departments have no idea how long they will be hospitalised and are often dismayed to find that they have been fined on returning to their vehicle. This must be terribly morally wrong. I intend to table an amendment that I hope the Government will feel is reasonable and, indeed, sensible. One has only to look at hospital car parks at weekends to realise how easy it is to park, compared to a weekday. Sadly, this must show how top-heavy the management of the National Health Service has become.

I declare an interest as an ardent member of the Lords and Commons Pipe and Cigar Smokers’ Club. During the passage of the Health Bill in 2006, I tabled an amendment that would have prohibited the sale of all tobacco products. My views on smoking are well documented in Hansard. I believe strongly that Her

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Majesty’s Government are being incredibly hypocritical towards those who smoke. If we are not meant to smoke, we should not be able to buy tobacco in the first place. Her Majesty’s Government must make up their mind as to whether tobacco is a legal product. If it is legal, the sellers must surely be allowed to promote what they have to sell.

Many noble Lords have mentioned smuggling. The figures that I have researched most carefully show that the amount lost to the Treasury as a result of smuggled tobacco is £3.8 billion. I repeat that figure: £3.8 billion. In these times of economic downturn, I cannot understand why every effort is not being made to correct this situation. Perhaps the Minister can explain what action is being taken, or what measures the Government are prepared to take, to recover this huge—I emphasise that—amount of lost revenue. Here, for once, I agree with the noble Lord, Lord Faulkner of Worcester.

I now turn specifically to the tobacco provisions of Clauses 18 to 22. They do not, as other noble Lords have mentioned, have a rightful place in this Bill. The purpose of the Bill, so wisely and eloquently expressed by the Minister, is principally to legislate for aspects of the next-stage review of the National Health Service. The tobacco provisions are about the environment and conditions for the sale of tobacco products at retail level, from supermarkets to small shops. The provisions in this Bill that ban tobacco product displays are purely consumer protection measures, just as is the Tobacco Advertising and Promotion Act 2002, which these provisions amend. They should be elsewhere and should not have been injected inappropriately into this Bill. The noble Lord, Lord Stoddart of Swindon, made these points with his usual vigour.

These proposals make no legal sense. Under the Bill, it will be an offence to display a product that it remains entirely legal to sell. As other noble Lords have said, this simply cannot make sense. One must not forget that it undermines the rights of commercial freedom under Article 10 of the European Convention on Human Rights and, indeed, is contrary to the principles of free movement of goods already enshrined in Article 28 of European Community treaty. The Department of Health claims that the purpose of the display ban is to reduce smoking among young people, and I fully support this commendable objective. However, the evidence that the department cites in support of a ban is weak, inconclusive and unconvincing. I am sure that the evidence can be well and closely scrutinised in Committee.

I am at least as concerned about how the Department of Health, in its report on the consultation undertaken on its proposals, has played down and diminished the effect that its proposals are likely to have on small-scale retailers. Those retailers are typically small businesses serving a local community. They are invariably family businesses. They are certainly not familiar with responding to government consultations, particularly when those consultations are not produced in their mother tongue, as was the case in this instance. It must not be forgotten that 76 per cent of these small businesses are owned by people from Commonwealth countries. The Bill will saddle them with a whole new raft of regulations on display, on how to deal with and serve their smoker

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customers, on signage and on how they must indicate prices to their customers. For them, the one-off and continuing costs of complying with the regulations will be unreasonable and completely unjustified burdens, as the noble Lord, Lord Naseby, said.

In the case of the smoke-free provisions of the Health Bill in 2006, the Department of Health predicted that there would be increased trading and profitability. The real impact, evident well before the current economic depression, was precisely the opposite, with businesses actually closing down. The last smoking ban has already claimed the jobs of 44,000 people in the pub industry. It is feared that, if these proposals become law, a further 59,000 jobs will be in jeopardy. I have no faith in the department’s predictions of the outcome of its display ban. I would rather put my faith in those small retailers; after all, they are at the coal-face of the retail industry. I have talked to many of them in recent days. They know why children smoke, even if the Department of Health does not; it has nothing whatever to do with displays of tobacco products in their shops. They are in the front line of denying access to tobacco products by the underaged. They should not now be burdened with regulations serving absolutely no necessary purpose. The noble Baroness, Lady Golding, made that point with her usual great clarity.

Many communities in both urban and rural areas have already lost their local pub and their post office. Surely it is madness now, particularly in this economic climate, to strangle the small community shop with red tape. The Government claim that they support small businesses, while they are spending billons of pounds bailing out failed financial institutions and supporting major industries. I believe most strongly that they need to demonstrate their support for small businesses by removing this display ban completely from the Bill. I look forward to the Bill’s further stages.

7.52 pm

Baroness Goudie: My Lords, I speak on this occasion in support of the Bill. I am particularly delighted that my noble friend the Minister, an acknowledged expert in his field, is here today to bring such important health and social care measures before this House. The renewal of the National Health Service under this Government continues. I pay tribute to all those who work so tirelessly in the NHS. It is right that the NHS should now seek formally to engage with its patients, staff and the general public to secure the service for generations to come. I also support proper supervision of the pharmaceutical market and cannot fail to support any efforts made to improve adult social care, which for many of us is a subject close to our hearts, as each of us have been touched by caring for relatives. However, I must strike a note of caution and question why Part 3 on tobacco is before us at all.

I am a fervent supporter of this Government and believe that we have the leadership that will see us through difficult economic times. I know that we all look forward to an early economic recovery, but I question why we are debating issues today that will not, for sound economic reasons, become effective until 2011 or 2013. I am not a smoker, I hold no brief

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for the industry and I am not concerned that a legitimate business should be legitimately regulated. However, I am seriously concerned about the economic, social and, indeed, human impact of smuggling and trafficking. That is what causes me to take an interest in Part 3 of the Bill.

Noble Lords will be aware of my interest in the most appalling aspect of smuggling—people trafficking. Organised crime uses whatever means it can to fund these vile crimes. Criminals use illicit trade to fund this activity. Tobacco smuggling is, sadly, an important aspect of this trade. If we are to focus on tobacco, it is time to legislate to eliminate the illicit trade. Part 3 of this Bill will adversely affect UK manufacturing businesses. It will endanger the small shops that are the centre of each of our communities and it will fuel the illicit trade, yet it seems that there is no convincing evidence that it will improve public health or stop young people gaining access to tobacco products. Youth access controls have to be carried out by precisely the retailers whom this Bill seeks to punish. That is aside from the increasing number of young people who buy their tobacco from illegal sources, sometimes unwittingly buying a counterfeit product. I am not convinced that the Government have the evidence base to act or that they have considered all the options. I note that there were three options in the original consultation paper on tobacco control, yet there are only two in the published impact assessment. Why has the second option of restrictions rather than a ban been discontinued?

We are too quick to ban things before considering how restrictions might achieve the desired effect without the unintended consequences. If there is evidence that advertising and promotion of tobacco products at the point of sale are so attractive to youth that they are a public health menace, we have a duty to act now, but even then we should always look to the easiest legislative route. I fear from everything that I have read about this issue and from all that I have heard today that the case for the ban of the display of tobacco products has not been made. I fear that the consequences of this proposal will be the loss of small shops and an increase in the already large illicit market for tobacco products, with no proven health benefits.

We have a duty to analyse the evidence and on that basis to reach sound conclusions. I do not believe that the evidence is there and I feel that we are sending the wrong message to the country by adding even more burdens on small shop keepers. Why do we seek to allow the Secretary of State to ban something now, when the Government have already acknowledged that this should not become fully effective until 2013? In the interests of good government and given the lack of evidence and clearly difficult economic consequences, I believe that we should remove Part 3 from the Bill. I suspect that the Government have existing powers under the Tobacco Advertising and Promotion Act 2002 to ban display. If they can demonstrate that this constitutes advertising in shops, there is no need to introduce yet more powers in this Bill.

I have been contacted, as I suspect have many noble Lords, by many different interest groups on this Bill, some seeking to suggest amendments and even to go further by amending the Bill to ban branding altogether.

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I warn noble Lords that that would be a further step on to dangerous ground. British brands are an exceptionally important part of our economy and any move to destroy them in any field must be resisted. This House should defend British intellectual property, not consider ways in which to undermine or destroy it. We need to regulate legitimate businesses in a fair and appropriate manner. Evidence must guide the formation of policy. We cannot ignore the already burgeoning illicit market and we must not do anything that causes it to grow. Indeed, we should redouble our efforts to seize illicit products and prosecute those who perpetrate this trade. We should not be considering ways to punish those who, every day, have to make decisions about the age of their customers and effectively police existing laws. We should be considering means by which to help them, to enforce the law and to do all that we can to reduce youth smoking. The measures in the Bill do not seem to me to do that.

7.59 pm

Lord Selsdon: My Lords, it is extraordinarily difficult for me to know where to begin, so I think I will begin with the noble Lord, Lord Darzi. He is a mister. If he were not a noble Lord and you were to write to him, would you put an “Esq” on the back, because he is “of Denham”? I will begin with Denham. I must declare an interest because if you do not these days you may get into trouble—people will think that you have none. My first interest in this goes back to my great-grandfather who had a house at Denham. He was the first person with a dairy herd to isolate tuberculosis and to keep badgers out in defence of his property, which upset many people. I have always been interested in tuberculosis, and in bugs and viruses. I found that I had the weakest of all things—a weak stomach. Whenever the food was bad, I was sick, but I have never spent a day in bed in my life. The Saudis once suggested that I should be appointed royal taster.

I thought that we were here to debate making people better, keeping them well and letting them live longer. We seem to have somehow lost our way. I now return to one of the noble Lords on my own Bench, my noble friend Lord McColl. He is a doctor and a great man and does a lot of good around the world. In my days in the Middle East I often wondered why people lived so long. Ayatollah Khomeini’s father was meant to have died at 123. I was told that Gaddafi’s father had died at 106. I asked the noble Lord, Lord McColl, “You were sometimes in Africa. Were you ever in Libya?”. He was not really interested in talking to me because he was talking on a much higher level, but he said yes. I said, “Would it be possible that Gaddafi’s father could have lived to 106?”. He said, “Yes, I think I last operated on him when he was 103, but I'm not sure whether it was lunar or solar”.

That for me was almost as great an event as when the noble Lord, Lord Darzi, saved the life of the noble Lord, Lord Brennan, and the most reverend Primate the Archbishop of York was praying on the other side. I can say this because the noble Lord said that it was public property. He turned afterwards to the most reverend Primate and said, “I won”.

Those were great events, but the speech of the noble Baroness, Lady Campbell of Surbiton, was also great

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because it made me think. The problem facing us is bureaucracy. We have potentially the most powerful health unit in the world. It accounts for somewhere around 12 per cent of GDP. It was 8 per cent of GDP but GDP has fallen so quickly. The one thing that we have in this country which employs a lot of people is the health service. I must declare an interest. My uncle, my brother-in-law, my sister’s husband and a nephew all worked in it and I have a great respect for it, but not for the bureaucracy. In this country, we have things that we have forgotten about. We need to be able to research, diagnose and then treat. We need to know what it is we are seeking to diagnose and treat.

In all the time that I have been involved in building hospitals, my favourite appointment was when I was director for many years of the oldest healthcare company in the world—Terme di Porretta near Bologna. We built healthcare centres in places as old as Roman times—for example, in Zarka Majin, in Jordan, where Herod beheaded John the Baptist. We studied where the pharaohs were and we believed in the mind and the body. It was almost “physician heal thyself” in that the body will heal itself.

In this country, we have some of the best research in the world. Unbeknown to many of you, we are almost the most successful pharmaceutical country in the world. We export somewhere around £12 billion a year and have a turnover of £20 billion. We employ 72,000 people and the production per person in the pharmaceutical or healthcare sector is higher than in any other sector of the industry in the world. Also, the R&D in pharmaceuticals is greater by far than even defence. Here we are, one of the leaders in Europe and a net exporter when, at the moment, we have a deficit in visible exports this year of maybe £100 billion. The health service is employing 1.2 million people. It employs more people than any other health service in the world. That does not matter, but the people who are already there need to be reorganised to be more productive.

We should also recognise that with our historic links, the English language and the ability to speak Latin in English—I did not know that many great physicians can—we are at a point where this could be the most important commercial business of this country for the next 25 years. Rather like the noble Lord, Lord Stoddart of Swindon, I do not believe that we should say that it is free at the point of delivery. We are all clients. We are customers. We have our rights and people would like to serve us. The potential does not seem to have sunk in.

From time to time, on the basis that I was interested in tuberculosis, I became interested in MRSA and all the hospital-borne diseases. I tried to work out where the bugs came from. I call them bugs although you are not allowed to do that. Suddenly, I was on a human embryo and stem cell committee. I was the only one who did not know what I was talking about or what other people were saying. A certain noble Lord would whisper to me, “Why didn't you ask the Chief Medical Officer about the primitive streak?”. So I asked about the primitive streak and he could not tell me about it.

Then I suddenly realised that the Home Office was involved and what we were talking about was effectively DNA—the original cell. I got involved and I declared

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an interest. I spoke to the Minister at some point, who then wrote me a letter and asked me whether I would be kind enough to go and see him. I took all the papers that I had written myself and he could have papered his office with them, but I know that he would have given them to someone and they would have ditched them. I then said that I would come and see him again because here within Europe we have really great potential.

We have the R&D here. We have the people who have been trained. I have never really understood why a vet trained for five years and a doctor for only four years, but a surgeon trains for ever. I have talked about some of the latest things in diagnosis and the latest equipment. Unfortunately, historically, all the diagnostic equipment was British. That has all gone out of the window. Much of the surgical stuff has gone. One of my earliest clients was Thackeray, which made hip joints. Now we find that the continent of Europe has BMW service stations where you can do elective surgery—nine operations per surgeon per day of 40 minutes each. There are right-handed and left-handed people on the right sides of the bed and everything is there—bone banks and blood banks.

I am president of the Anglo-Swiss Society. We tried to close it down but we could not quite. Switzerland was where we all went. I was looking at how we might be able to use adult stem cells for regeneration. The people in Switzerland are pretty good at that and we were looking to set up an adult stem cell bank using the latest cryotechnology for research into treatments. I said, “Do you have any MRSA or C. difficile?”. In Holland they have the least, at 6 per cent; in the United Kingdom we have 23 per cent. You cannot take a Dutchman into Germany and send him back again unless he is treated. This is a bug. I said, “Do you have any incidence?”. They said, “Yes, I think so. We'll let you know”. The next day in Davos they said, “Two”. I said, “Two per cent?”, and they said, “No, two”. I asked them why and they said, “It doesn't survive here”. I suddenly thought that when people went to higher altitude stations when they had tuberculosis, they would not be cured, but maybe the bugs would not mutate. Therefore, in that cold, dry atmosphere you would have clean hospitals. I do not know whether that is true.

Down below the Swiss hospitals, there are bunkers. You have to be ready to be invaded. There is a nuclear bomb shelter that is absolutely clean and clear. What we are going to try to do with the British side—it is accepted as the best in research—is to see if we can start to go back to using people's body parts to heal themselves, which has worked extremely well. There are many instances of this and I will not go into allogeneic or all the types of stem cells. I have to learn them by heart. But here is one technical area that is really very exciting.

There is also money to be made. We have the biggest balance of payments surplus in drugs of anyone in Europe and we are right in the forefront of it, but somehow the bureaucracy of our great organisation does not realise that the noble Lord, Lord Darzi, on his own with three people could probably do the same amount as 500 people. I talked to him also about some

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of the latest technology, including the da Vinci machines for elective surgery, whereby remotely you look to combine drugs and elective surgery without the need for hospitalisation. I am getting a bit carried away.

Noble Lords: Oh!

Lord Selsdon: My Lords, I do need a bit of help, because this is what people do now. I say, “Isn’t there anything wrong with you?”. They say, “No, there must be something”, and then they tell me that they have biliary cirrhosis. The current condition on which I could do with a bit of help is ankylosing spondylitis. I would appreciate it if anyone could help me, because one of our colleagues here would like some advice. What I find is that you can talk about health. It is a healthy thing to talk about. We really do have some good people; they hide their lights under bushels from time to time.

Finally, I come to my major project of the year, and I will take only 30 seconds. There is a well known rock band called Moonlight. Its hit heavy metal record is effectively called “Opium”. Project Moonlight, which I started, relates to the two countries that can use morphine legally in the form of codeine, France and the United Kingdom. I have talked to the drug companies. Morphine, in general, comes from poppy straw from India, Pakistan and Tasmania. I ask the Minister if we can get the drug companies together, to which they have agreed in principle, because you have to stop India and Pakistan producing morphine; I have suggested that Tasmania should produce wine instead, as it always used to. You then say, “Look, if we are the two countries that can use codeine legally, could this country not place a substantial order in Afghanistan for our health service?”. That would work, as long as we did not pay all the money at once. I will write to the Minister on Project Moonlight after the Recess.

I am sorry to have occupied noble Lords for a while, but I thought that I would think diagonally or laterally or, as some people would say, go off at a bloody tangent.

8.12 pm

Lord Monson: My Lords, the noble Lord, Lord Selsdon, is a very difficult act to follow, as always. I am sure that there are many admirable provisions in Parts 1 and 2 of this Bill, which, I fear, I have not studied, but the same cannot be said of much of Part 3 and, specifically, Clause 19. It is upon this clause that I wish to concentrate. I am less concerned about Clause 20, which concerns tobacco vending machines.

It is extraordinary how freedoms have been curtailed in this country recently. Could the servicemen returning to this country in 1945, after spending up to five years fighting to liberate continental Europe and much of Asia from tyranny, have possibly imagined that they, supposing that they are still around, their children and their grandchildren would have to stand outside in the sleet and rain like outcasts, simply to enjoy a cigarette or small cigar, all because of a stubborn refusal by zealots to compromise and agree on a middle way, as has been achieved in a number of European countries?



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