Clause 1 - Smoke-free premises, places and vehicles
Health Bill
10:35 am
Andrew Lansley (Shadow Secretary of State for Health, Health; South Cambridgeshire, Conservative)
I was rather hoping that, in the course of her comments on the clause, the Minister might explain to us the underlying principles of the Bill. Nevertheless, let us get straight to it. The purpose of the clause is to bring into law the prohibition on smoking in certain premises. From that prohibition will flow the discussion about how it is to be defined and how exemptions are to be made.
I suppose that, at this stage, I want to explore two things. The first is the Government’s view on the structure of the prohibition. On what evidence have they based it? The second is the consultation process on the policy that led to the introduction of the legislation. Before we get into the detail, it would be sensible to understand where the Government are coming from.
The Committee will recall the discussion on Second Reading. I want to make it clear that our objective is to achieve a dramatic reduction in the incidence of smoking in public places, thereby contributing to a reduction in the prevalence of smoking. There were substantial reductions in the 1970s and 1980s, but the trend has slowed since then and there are serious problems, particularly the prevalence among younger people, which has barely reduced in the past four or five years. The Minister will know that one of the issues is the extent to which young people starting work are able to smoke in the workplace. The evidence clearly suggests that if we can reduce opportunities for smoking at work, we can reduce the overall prevalence of smoking among young people, with consequential major long-term health gains.
At the time of the publication of the White Paper, the Scientific Committee on Tobacco and Health set out clear summary evidence of the negative health impacts of smoking in relation to lung cancer and coronary heart disease. As I said on Second Reading, the most significant part of that in terms of changing the character of the debate on smoking—especially passive smoking—was the increasing evidence of the impact of relatively small amounts of environmental tobacco smoke on myocardial infarction, or a heart attack.
Occasionally I must wear these glasses, and not just because we shall later be discussing general ophthalmic services. I am not trying to curry favour with the optical professions. The Minister will be aware of the interesting paper published in the BritishMedical Journal on 24 April 2004, which relates to a six-month period in the town of Helena, Montana. That geographically isolated community had a local byelaw that prevented smoking in all public places. During the six months when that law was in force, the number of admissions to hospital for heart attacks fell significantly from an average of 40 admissions during the same six months of the preceding year to 24 admissions during the time the law was in effect. When the byelaw was subsequently challenged in a court and suspended, the rate of attendances at hospital for heart attacks rose again.
It is increasingly clear that relatively modest amounts of exposure to second-hand smoke can have significant impacts on health, especially where coronary heart disease is concerned. For some, second-hand smoke can have a substantial impact on their likelihood of having a heart attack. We must be aware of the benefits of what we are trying to achieve. This is not a matter of nuisance. I preface some of the arguments that my hon. Friend the Member for Westbury (Dr. Murrison) and I shall make later by stating that we are not talking about the nuisance effect of smoke; we are talking about the health effects of smoke. This is a Health Bill.
One of the central matters that has been in our minds is the strange circumstances of the Government’s publication last November of a White Paper that was supposed to be about health. Published evidence to which I have just referred illustrates the health impacts of second-hand smoke and shows the necessity of there being a means by which we can dramatically reduce the prevalence of smoking. However, the proposal that was put into the public health White Paper appeared to be geared more to questions related to the nuisance value of smoke to people eating meals in restaurants or pubs than it did to evidence relating to health.
Of course, we understand that a balance must be struck. It is an obvious, simple fact that if we were, somehow, able to ban smoking entirely, we would reduce the negative health impacts dramatically. About 23 per cent. of premature mortality among men is in some way related to smoking. However, we cannot bring in a complete ban because smoking is legal and has been for a long time. Many people are habituated to smoking, and we are striking a balance between their liberty to smoke and the impact that that has on others. Those are the balances that we shall have to strike in the course of this debate.
The Government do not seem to have struck a balance at all, either geared to public opinion or to health effects. Public opinion research that I have seen seems to point to the kind of conclusions that my colleagues and I have reached. The public’s view is that workplaces and restaurants should be smoke-free but that public houses are something of an exception. Even on that matter, public opinion has moved sharply to a point where they wish pubs, generally, to be smoke-free except for specific rooms or areas that are designated for smoking. The largest number—although not a majority; it is something less, at 47 per cent.—in the last survey that I saw suggested that that was where the greater number of the public pitch their tent. There is no major public view that a balance should be struck whereby pubs are either smoking with no food or non-smoking with food.
That is a strange conclusion that the Government reached last November and then put forward. It was reflected, as I am sure the Minister will remind her colleagues many times, in the Labour party manifesto. If that had been the end of the matter, the Government would have proposed legislation based on their manifesto and would not have done anything else about it, but they did not. They consulted.
On 20 June, the Government issued a consultation. It is reasonable to ask what the point of that consultation was. Was it to find out specific details regarding enforcement and implementation? No; it was, on the face of it, to establish whether the proper balance had been struck with the proposed policy. We know what was going on: the new Secretary of State and team at the Department of Health very much wanted to move away from the policy that they had been left with to one that made more sense in health terms. That is not surprising considering that they were receiving advice from the chief medical officer who, as he recently made clear in his evidence to the Select Committee on Health, was strongly of the opinion, in his annual reports from 2002 to 2004, that there should be a comprehensive ban on smoking in all enclosed public places and that anything else would be substantially less beneficial.
It is not surprising that Ministers might want to reflect that professional advice in policy, so they had a consultation—but was it real? What was it intended to allow? I understand that there were 57,000 responses, 90 per cent. of which opposed the partial ban that the Government propose. What kind of response to a consultation would it take for the Government to change their mind about a policy that they subjected to consultation? Does it take 100 per cent? Are the Government prepared to proceed with opposition of anything up to 99 per cent? That is odd. The Minister will have to explain why they have proposed legislation of a structure that is clearly opposed by expert bodies and regarded as nonsensical by the public.