Health Bill

– in the House of Lords at 3:32 pm on 4th July 2006.

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Photo of Lord Grocott Lord Grocott Chief Whip (House of Lords), HM Household, Captain of the Honourable Corps of Gentlemen-at-Arms (HM Household) (Chief Whip, House of Lords) 3:32 pm, 4th July 2006

My Lords, I have it in command from Her Majesty the Queen to acquaint the House that Her Majesty, having been informed of the purport of the Health Bill has consented to place her Interests, so far as they are affected by the Bill, at the disposal of Parliament for the purposes of the Bill.

Bill read a third time.

Clause 5 [Vehicles]:

Photo of Lord Monson Lord Monson Crossbench

moved Amendment No. 1:

Page 4, line 12, at end insert-

"( ) Subject to prescribed conditions, regulations under subsection (1) shall provide that where a vehicle is being used by no more than one person at a time, even if it is a place of work, it is not smoke-free."

Photo of Lord Monson Lord Monson Crossbench

My Lords, this is a slightly amended version of an amendment moved on Report by the noble Earl, Lord Howe. Partly because of the lateness of the hour—it was after 9.30 pm—and partly because the Minister had pointed out a small, but significant drafting defect, the noble Earl decided not to press his amendment at that stage, while reserving the right to return to it at a later stage. In the end, he decided not to do so, which is why some of us have picked up the baton after altering one small, but significant, word in the drafting.

Perhaps I can explain. The Minister had argued that the original amendment was superfluous, since powers already existed in the Bill to enable the Government to relax slightly the very severe restrictions set out in Clause 5 if they chose ultimately to do so, at the time of the regulations being framed. This amendment therefore ensures that the restrictions in question will indeed be slightly relaxed so that it will no longer be illegal for people to smoke in vehicles used for business, provided that they are only occupied by one person at a time. Of course, companies, unincorporated businesses and partnerships would still have the freedom to impose their own restrictions if they so chose. The restrictions that remain in Clause 5 would still be very severe compared with the status quo or with the laws that prevail in continental Europe.

The Government seem to be arguing that second-hand smoke is not only disagreeable—few would quarrel with that—but also that it is one of the most deadly poisons known to man and that it remains poisonous hours after the last smoker has left the scene. That is ridiculous and it is certainly not borne out by the everyday experience of well over 99 per cent of the population. As the noble Earl, Lord Howe, said on 19 June:

"To say that there is a potentially lethal health risk from someone getting into the cab [of a lorry or tractor] after the previous driver has been smoking there seems ... ridiculous. If there is any residual smoke present, it will disappear rapidly ... there should be a common-sense cut-off point in these matters".—[Hansard, 19/06/06; cols. 603-04.]

Despite that, the Government argue that, although employees in prisons, residential care homes and hotels will have no protection, all other employees must be protected from the slightest exposure at all costs. But, even on this basis, the law will be defective. An employed salesman, for example, who flies from London to Newcastle for a day, picking up a hire car from the airport, could well find that car reeking of the smoke from the previous occupant. The same could apply if he had to spend the night in a hotel room. Moreover, the clause does not confine its tentacles to employees. As I have pointed out at earlier stages, it will hit a partnership consisting of two people who may well be a husband and wife team, both of whom smoke and neither of whom has the slightest desire to be protected from each other. To quote the noble Earl, Lord Howe, once again, the Government are ignoring "reality and common sense". I beg to move.

Photo of Lord Naseby Lord Naseby Conservative

My Lords, I support the noble Lord, Lord Monson. The implementation of Clause 5 reflects all that is wrong with the Bill because nowhere is the Government's response proportionate to the risk. It does not matter whether you look at the global situation or the fact that 25 per cent of the adults of this nation smoke and still want to smoke—no provision is made for them. The noble Lord mentioned passive smoking, but not once have the Government conceded an iota that the alleged death sentence from passive smoking is highly speculative and highly unlikely to happen.

In this case, the Minister rightly says that this is a mobile place of work and that, in this circumstance, drivers must snuff out their cigarettes. But the question that Parliament has to ask itself is: who is going to enforce this situation? Will it be the police? We know that the police are not the least bit interested in enforcing this position—understandably, as we read daily in the press how stretched they are. Will it be the local authorities? I have spoken to my local authority and it is not in the least bit keen to take on this new burden.

The conclusion—the Minister has not yet said this but it is the only logical conclusion—is that we are going to have a whole host of mobile community protection units, presumably on motorcycles and mopeds, checking on whether those who are smoking in their cabs are sole drivers. It is totally unworkable, and that is the problem with so much of the Bill. The central thrust of the Bill is fine; it is the unworkability of certain sections that, frankly, makes a mockery of what this is all about. We all know what happens with seat belts in taxis—no one fixes their seat belt in a taxi. People are also busily using their mobile phones while driving up and down the country, and now we are going to add another restriction. It is a farce. The issue of long-distance drivers, who have a place behind them in the cab where they sleep, is still unresolved. Is that a place of work or is it a home? I do not know. The Minister does not know. Nobody knows.

Instead of slavishly following Scotland's left-wing, do-good and frankly pretty useless Government, why can we not just for once take a close look at what they do all over the continent, find out which is the best procedure for this situation, and implement that? That seems a sensible way forward. That is why I very much support the amendment moved by the noble Lord, Lord Monson. I hope that the Minister will respond positively, and that he will not do what happened after Report. In the newspaper the next morning I read that we will have "no smoking" signs in every bus shelter in the United Kingdom, 98 per cent of which are open to the air. But perhaps the Minister was misreported. I very much support the noble Lord.

Photo of Lord Russell-Johnston Lord Russell-Johnston Liberal Democrat

My Lords, I take the opportunity afforded by this amendment—which I support because I think it is sensible—to make one short, final intervention in this debate, which has gone on for a long time. A number of colleagues—notably the noble Lord, Lord Stoddart, across the Floor on the Labour Benches, to which we know he always shows great loyalty; the noble Lord, Lord Naseby, who has just spoken from the Conservative Benches; and myself from the Liberal Back Benches, my Front Bench having given the Government unequivocal support—have consistently opposed the part of the Bill dealing with smoking, which I regard as draconian and repressive legislation quite unnecessarily and unjustifiably restricting freedom of choice.

None of us—including the noble Lords, Lord Naseby and Lord Monson—has denied that smokers, despite the pleasure that they derive from the habit, of which there has been little mention in the debate, face a risk of cancer. That is a fact that we accept. None of us has denied the right of non-smokers to enjoy smoke-free conditions in their workplace, in public places and on public transport—although bus shelters, as the noble Lord, Lord Naseby, said, may be slightly different. But I think that all of us continue to believe that the extent of damage to health from so-called passive smoking, difficult as it is to quantify and evaluate, is, in the terms of the Scottish legal verdict, non-proven. Nevertheless, our amendments have accepted that which we doubted, in the interests of seeking a fair and balanced solution. Separation, we have argued, provided both protection and choice. This has been rejected with uncompromising zealotry—though the Minister is not really a typical zealot; it's a bit out of character. But it is the same logic: the same logic that led to alcohol prohibition in the United States and that led to the burning of shops which sold alcohol in Beirut. It is an intolerant logic and it is wrong.

I know that the majority are against me and that those on my own Front Bench consider me politically incorrect and misguided. I do not care. I care about freedom.

Photo of Lord Palmer Lord Palmer Crossbench

My Lords, I have put my name to this amendment tabled by my noble friend Lord Monson. I could not agree more with him. It is the degree of inconsistency of the Government's smoking policy—in that one is allowed to smoke in old people's homes and in prisons but not elsewhere—that seems so extraordinary. I hope that the Minister will accept this very small amendment.

Photo of Earl Howe Earl Howe Shadow Minister, Health 3:45 pm, 4th July 2006

My Lords, having tabled a similar amendment at previous stages of the Bill, and having argued at some length in favour of it, I am more than happy to give this amendment my support for the reasons so eloquently expressed by other noble Lords.

The root premise of the Bill is that prolonged and substantial exposure to environmental tobacco smoke carries with it unacceptable risks to health. To say that the cab of a lorry in which a single driver has previously been smoking presents an unacceptable health risk to anyone subsequently getting into it seems absurd. No arguments have been advanced by the Government to persuade me that we should take that proposition seriously. Indeed, it seems to me that in this matter the Minister has relied much more on assertion and arbitrary demarcation lines than on sound science.

We have said before, and it is worth saying again, that this is not a Bill to protect the public from any quantity of environmental tobacco smoke, no matter how tiny. It is a Bill that attempts to address what one might call the larger picture. We are at risk of taking the Bill to unworkable extremes if we insist that a farm worker on his own in the cab of a tractor, or a company executive driving alone in a pool car, may not have a cigarette. The Government have made it clear that work vehicles that are only ever used by one person will not have to be smoke-free. How it will be possible in all cases for enforcement officers to distinguish that situation from the kind that I have just mentioned is not at all clear. I, for one, would argue that for the law to seek to make that distinction is pointless.

Photo of Baroness Barker Baroness Barker Spokesperson in the Lords, Health

My Lords, I want to make just three points to make the Liberal Democrat Front-Bench position clear. I do not regard my noble friend Lord Russell-Johnston, of whom I am very fond, as politically incorrect; he is just incorrect on this matter. As we have said in previous debates, residual smoke stays for a very long time. The level of danger which that poses to an individual who goes into a confined space, of which a car is one, may vary, partly on the condition of the person, such as whether he has an asthmatic condition which triggers it. Nevertheless, the smoke is present for some considerable time.

My second point concerns the accusation—I think it was an accusation—that the Scottish Executive, of whom the Liberal Democrats are part, are do-gooders. I think that doing good in this case is right, as it does good for the many people who wish to have clean air.

My final point, which is the one that sways me, is that people at work often have to put up with other people's behaviour, such as other people's smoke. They often feel that they are not in a position to challenge it, but they do not want it because it is unpleasant, irritating or damaging to their health.

For those three reasons, it is right for us to come down on the side of caution in this matter and to support a measure that will make life healthier and more pleasant for a great many people.

Photo of Lord Walton of Detchant Lord Walton of Detchant Crossbench

My Lords, at first sight this amendment looks acceptable, but it is acceptable only in a superficial way. Although I can understand fully the arguments that have been posed by the noble Lord, Lord Monson, and supported by the noble Lords, Lord Naseby and Lord Russell-Johnston, let us think, for example, of a hospital car transport service, where in between transporting patients to and from hospital the driver decides to have a smoke when he or she is alone. The car is then filled with smoke before the patient gets on board to be taken to or from the hospital.

Let us look at a taxi driver or a driver of a private hire vehicle who, between taking individuals from one place to another in the course of his or her work, fills that car with smoke. Let us think of a school bus driver who, having taken a group of children to school, fills the bus with smoke while driving back to the depot and picking up another group of schoolchildren to take them to school. It is possible to argue that the level of pollution remaining in those vehicles could well be below that likely to be hazardous to the individual, as the noble Earl, Lord Howe argued, but we cannot be certain that that is the case. I entirely agree with the view that if a vehicle is only ever used by one individual at work or at other times, it is perfectly acceptable for that individual to be able to smoke in that vehicle, but when it is also used to transport others, this amendment falls, and I would not support it.

Photo of Lord Monson Lord Monson Crossbench

My Lords, would the noble Lord not agree that there is nothing in my amendment to prevent health or local education authorities making it a condition of employment that drivers of ambulances and school buses do not smoke when they are in their vehicles?

Photo of Lord Stoddart of Swindon Lord Stoddart of Swindon Independent Labour

My Lords, as the noble Lord is not going to reply to that, I shall say a few words on this amendment from the Spiritual Benches rather than the Labour Benches, and from the point of view of an independent Labour Member of this House rather than that of a Labour Member.

This is such a mild amendment that I would have thought that the Government would try to retrieve some of their reputation for authoritarianism by agreeing to it. The noble Lord, Lord Monson, outlined the circumstances when it might be used: when a car which might be used during the course of work is then used out of work by the driver and perhaps his daughter, and because it is a place of work his daughter, son or wife would not be allowed to smoke in it. That is carrying things to the height of absurdity. It is a lunatic proposition.

I believe that the whole Bill is lunatic in concept, but this amendment brings it into complete and utter disrepute. I cannot understand why the Government will not accept reasonable amendments. I do not smoke, and the reason I am opposing the Bill is because of its intolerance and its removal of personal freedoms that people have enjoyed for hundreds of years. That is why I and many others have been opposing the Bill—not because we are smokers or have an interest, but because we believe that smoking is legal and that people should not be harassed as they are being.

The Bill is supposed to be about protecting people from second-hand smoke. There is no real clinical evidence that second-hand smoke hurts anybody, but even assuming that it does in some way, the propositions that have been put forward throughout the Bill are to protect non-smokers' health—and indeed, their inconvenience—and at the same time to protect the right of people to assemble in public places, if they wish, provided there is separation. I know that the amendment is not totally about separation, but I want to emphasise the fact that the opponents of the Bill have been trying to be fair to both sides of the argument. However, the Government and the anti-smoking lobby will not listen to what is reasonable under all circumstances in what is supposed to be a democratic country.

I should have thought that, this afternoon, the Government would at least say to the noble Lord, Lord Monson, "We are prepared to make this tiny concession to you at the end of the Bill", but judging by the look of the Minister, he has absolutely no intention to do so. He will stand by his extremist view that he has echoed throughout the passage of the Bill, the view that because the House of Commons and the Government have supported the measures—despite the fact that it was not a manifesto commitment—this House must accept it as it came from the House of Commons.

Frankly, I think—I believe—that this has been a wholly disreputable exercise in this House. Those people whose bigotry over a long period has demonised smokers and made them pariahs have based the Bill on junk science and are now allowing a most irrational measure to go through this House. I am thoroughly ashamed of this House and the House of Commons for what they are doing in the Bill.

Photo of Lord Faulkner of Worcester Lord Faulkner of Worcester Labour

My Lords, it was certainly not my intention to intervene, but having been, I assume, one of the people to whom the noble Lord, Lord Stoddart, refers as bigoted and a zealot on these matters, I think that I should come to the Government's defence and say that I very much hope that my noble friend has no intention of accepting the amendment.

References were made to the science on second-hand smoke. The danger is that we will repeat earlier debates on the Bill—indeed, Second Reading debates—but I commend to the House the very latest report from the United States Surgeon General, published last week, in which he states that the science is clear: tobacco-smoke pollution is a serious health hazard. He identified a series of illnesses, especially those caused to children, as a result of second-hand smoke. Exposure of adults to second-hand smoke has immediate adverse effect to the cardiovascular system and causes coronary heart disease and lung cancer. The scientific evidence indicates that there is no safe level of exposure to second-hand smoke. Eliminating smoking in indoor spaces fully protects people from exposure to second-hand smoke. Separating sections, air-cleaning systems and ventilating buildings cannot eliminate the risk of exposure to second-hand smoke. The Surgeon General stated:

"The debate is over. The science is clear. Secondhand smoke is not a mere annoyance but a serious health hazard".

Photo of Lord Faulkner of Worcester Lord Faulkner of Worcester Labour

My Lords, I am sorry but I shall continue, if the noble Lord does not mind.

This attempt to imagine that we should exclude work vehicles, such as refuse vehicles where a gang of people may be at work and where people are coming and going all day long, because it is somehow safe if a couple of people smoke and it will not do any harm to the others is just absurd. The science does not support that point of view.

The Bill is about freedom—the freedom of people to enjoy clean air when they work. The sooner that we defeat the amendment and pass the rest of the Bill, the better.

Photo of Lord Geddes Lord Geddes Conservative

My Lords, I apologise for not being here at the beginning of the debate on the amendment, but I am so incensed by the comments of the noble Lord, Lord Faulkner, that, with the leave of the House, I must speak. He quoted a long spiel, which I am sure that he read accurately, but the significant point that he cited, which I heard very clearly, referred to indoor spaces. Is the noble Lord referring to a vehicle as an indoor space?

Photo of Lord Warner Lord Warner Minister of State (Reform), Department of Health, Minister of State (Department of Health) (NHS Reform) 4:00 pm, 4th July 2006

My Lords, as someone who was described by one journalist as part of the anti-smoking Taliban, I suppose I should be quite pleased to be described by the noble Lord, Lord Russell-Johnston, as a zealot behaving untypically. That is a kind of promotion really.

We have accepted all reasonable amendments, if I may say so to the noble Lord, Lord Stoddart, but we do not regard this amendment as one of those that we should accept. We have examined the Government's intentions in this House in respect to smoke-free vehicles in much detail during both the Committee and Report stages of the Bill. Again I make it absolutely clear that the Government have no intention to include private vehicles—including rental vehicles for private use—under smoke-free legislation. The Government will propose in regulations that the only vehicles to be required to be smoke-free will be those used for the transportation of members of the public or for work purposes by more than one person. This means, as I said on Report, that smoking will be permitted in vehicles that are for the sole use of the driver and are not used for work purposes by anyone else, either as a driver or passenger. We have been absolutely clear and consistent on that throughout the passage of the Bill.

The Government have listened very carefully to the arguments that have been brought forward about smoke-free vehicles and remain entirely convinced that vehicles used for work purposes by more than one person, regardless of whether they are in the vehicle at the same time, should be required to be smoke-free at all times. I thought the noble Baroness, Lady Barker, put the point extremely well. The reasons for this are logical and simple: we wish to create consistency in the level of protection from second-hand smoke that this legislation would provide between people working in vehicles and those working in non-mobile workplaces.

Through this amendment, people could still be exposed to second-hand smoke. Some suggest that windows could be wound down to let in fresh air. Perhaps they could be—but how can an employee be assured that the person before him who had smoked in a work vehicle would let in fresh air? Indeed, what would happen when the smoking employee handed a vehicle over to a non-smoking employee at the end of a shift? Are the noble Lords who propose the amendment suggesting that there should be some time lag before the vehicle can be used again, to let the smoke clear? That would also require windows to be left open, which could present problems with security. What would be the cost to industry?

The noble Lords who tabled the amendment are suggesting that people who use a vehicle for work should be given less protection from the risks of second-hand smoke. I fail to see a single defensible reason why a person who uses a work vehicle should be at risk of exposure to hazardous second-hand smoke when an equivalent worker in a non-mobile workplace is protected from these proven health risks. I emphasise again that they are proven health risks.

I shall provide two examples to demonstrate my point. Let us look at a security guard who works alone on shift in a security cabin. At the end of his shift, another security guard takes over. If in this example the cabin was not required to be smoke-free at all times, smoking by the first security guard in the cabin would result in the second security guard being exposed to the health risks of second-hand smoke. For this reason, we have made it clear that the workplace needs to be smoke-free at all times.

Let us now look at a driver working alone on shift in a delivery van, which is his workplace. At the end of his shift, another driver takes over. If in this example the van was not required to be smoke-free at all times, smoking by the first driver could result in the second driver being exposed to second-hand smoke, as there can be no guarantee that second-hand smoke would have cleared entirely from the cabin. For this reason, we have made it clear that the mobile workplace needs to be smoke-free at all times. The situation between the delivery van driver and the security guard is exactly the same: one is in a mobile workplace; one is not.

We have examined exhaustively the scientific and medical evidence for this legislation. I recognise again, despite giving all the sources to a number of noble Lords, that we have failed to convince them. I shall not go through all the evidence again. People can read the sources in the reports of the Committee and Report stages.

My noble friend Lord Faulkner has drawn attention to the most recently published report—over 700 pages—by the United States Surgeon General. He examined in great detail the evidence and made a number of conclusions. He made it absolutely clear in those conclusions that second-hand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer. That report confirms and adds to the extensive body of evidence of the health risks associated with second-hand smoke.

We also know that second-hand smoke, even in small quantities, is the second most common asthma trigger in the workplace. Asthma UK found that:

"20 per cent of people with asthma feel excluded from parts of their workplace because other people smoke there. This inhibits their daily life as well as opportunities for promotion and development".

Suppose someone with asthma had to use a work vehicle in which someone had previously smoked and where second-hand smoke was still present. Given that there are over 5 million people living in the UK with asthma, and given that we know that second-hand smoke can linger often for extended periods in enclosed spaces, there could be a real health risk.

Photo of Lord Stoddart of Swindon Lord Stoddart of Swindon Independent Labour

My Lords, does the Minister agree that the incidence of asthma has increased and that at the same time the incidence of tobacco smoking has decreased? Explain that.

Photo of Lord Warner Lord Warner Minister of State (Reform), Department of Health, Minister of State (Department of Health) (NHS Reform)

My Lords, I do not have to explain it. I have already explained that second-hand smoke is a trigger for asthma. That is all we need to know in the context of this Bill. Second-hand smoke contains over 4,000 chemicals in the form of particles and gases. The WHO and the United States Environmental Protection Agency have both classified tobacco smoke as a known human carcinogen. We must remember that 85 per cent of second-hand smoke consists of invisible, odourless gases.

It is essential to retain the Bill as it is to protect people in their workplaces. I can reassure the noble Lord, Lord Naseby, about Scotland. In Scotland all vehicles that are for use for work purposes by one or more persons must be smoke-free at all times. We have not modelled this legislation on Scotland. We propose offering leeway for smoking in vehicles that are for the sole use of the driver and are not used for work purposes by anyone else as a driver or passenger. That is different in content from the Scottish position.

The Government's intention on smoke-free vehicles has been made absolutely clear. It is right to give workers who share a vehicle that same protection from second-hand smoke exposure as people who share other kinds of workplaces. I explain to the noble Lord, Lord Naseby, who raised the subject of lorry drivers with a bed in the back—as I believe he put it—that if the lorry is used by just one person, smoking would be allowed. However, if it is a workplace for more than one person, it would have to be smoke-free. We are absolutely consistent on that.

One can see that the Government's intention on smoke-free vehicles is entirely consistent with our approach towards smoke-free public places and workplaces. The amendment, as I believe I have made clear, would be totally unacceptable to the Government and could leave workers in vehicles at risk from the hazardous effects of second-hand smoke in the workplace, which is wrong in principle and wrong in practice when having regard to people's health. The Government do not accept the amendment.

Photo of Lord Monson Lord Monson Crossbench

My Lords, I am most grateful to all noble Lords who have spoken in favour of the amendment from almost all quarters of the House. I am particularly grateful to the noble Lord, Lord Naseby, for reminding us that this part of the Bill will largely be unenforceable and, accordingly, will bring the law into contempt, which is surely not desirable. I am grateful too to the noble Lord, Lord Stoddart of Swindon, for reminding us of the value of fairness, surely a particular British virtue. But the Minister stands totally firm and unyielding, sadly but not surprisingly. I point out to him and to the noble Lord, Lord Faulkner of Worcester, that if second-hand smoke in motor vehicles were as lethal as they claim it to be, I and my siblings would have been dead long before we reached our teens.

Alas, the sensible Dr Reid is no longer in the driving seat on this matter. The present incumbent seems to prefer a doctrinaire and unyielding position to flexibility and common sense. It is true that even if this amendment is agreed to, the Bill will remain much more severe and draconian than anything proposed in the Labour election manifesto. Still, even a minor move in the direction of genuine liberalism, as represented by the noble Lord, Lord Russell-Johnston, his colleague, the noble Lord, Lord Steel of Aikwood, and by many noble Lords on other Benches in this House, is better than total illiberalism. Accordingly, I wish to test the opinion of the House.

On Question, Whether the said amendment (No. 1) shall be agreed to?

Their Lordships divided: Contents, 93; Not-Contents, 198.

Division number 1 Private Parking: Ports and Trading Estates — Health Bill

Aye: 91 Members of the House of Lords

No: 196 Members of the House of Lords

Ayes: A-Z by last name

Tellers

Nos: A-Z by last name

Tellers

Resolved in the negative, and amendment disagreed to accordingly.

Photo of Lord Palmer Lord Palmer Crossbench 4:24 pm, 4th July 2006

moved Amendment No. 2:

After Clause 73, insert the following new clause—

"PRESCRIPTIONS: LABELLING SHOWING ACTUAL COST

(1) The National Health Service (Charges for Drugs and Appliances) Regulations 2000 (S.I. 2000/620) are amended as follows.

(2) After regulation 11 insert—

"11A PRESCRIPTIONS: LABELLING SHOWING ACTUAL COST

(1) The packaging of any drugs or appliances supplied in accordance with regulations 3 to 6A shall carry a label showing the full cost to the National Health Service of those drugs or appliances.

(2) Paragraph (1) applies irrespective of whether-

(a) there is an exemption from charging under regulation 7 or 7A, or (b) a valid exemption certificate under regulation 8 is in force.""

Photo of Lord Palmer Lord Palmer Crossbench

My Lords, I have read with great care and interest what the Minister said last week. I should also like to place on record my thanks to him for his very full follow-up letter. He will, I am sure, be delighted to see that I have slightly changed the wording of my amendment for this afternoon's proceedings.

I remind the House that the purpose of this very simple amendment is twofold: to encourage patients to finish their prescribed drugs and to realise what outstanding value for money they are getting. I have consulted widely on this subject—it appears to have met with support from the medical profession and, indeed, from all the pharmacists with whom I have spoken. I do so hope that, with the revised wording, the Minister will now be able to accept the amendment. I beg to move.

Photo of Baroness Finlay of Llandaff Baroness Finlay of Llandaff Crossbench

My Lords, I commend the noble Lord, Lord Palmer, on tabling the amendment, which has a great deal of merit in it. He is right that many patients obtain repeat prescriptions without thinking about whether they need them and accumulate boxes of different drugs, some of which are expensive. The trouble is that some of the most responsible and sickest patients will look at the price of their drugs, feel horrified and feel honour bound to the rest of the population to stop them. Therefore, there is a tension between this action coming out of the blue and remaining with the status quo. As far as I know, there has never been a large-scale study of the merits or otherwise of pricing up the drugs for patients. There are merits too in terms of giving information to patients.

I hope that the noble Lord, Lord Palmer, will accept that the amendment is probably a little before its time and that when a definitive study has been carried out—many people have the hunch that he will be proved right—it may then be a good measure in terms of informing the public about the drugs that they are taking and openness of information.

Photo of Earl Howe Earl Howe Shadow Minister, Health

My Lords, on Report I was happy to support the noble Lord, Lord Palmer, in the case that he made for transparency of pricing on medicines. Having listened to him again I still think that the idea has merit. Indeed, I was encouraged that the Minister himself acknowledged that there is benefit in patients having access to as much information as possible. However, the noble Baroness, Lady Finlay, has made an extremely important point. We are to a large extent treading into the unknown and it would be nice to have more information than we do on some of the key issues rightly raised by the Minister in his letter to the noble Lord, notably the reaction of patients to seeing prices on the medicines that they were taking. Some patients indeed would react by adhering to the medicines all the more rigorously. On the other hand, other patients might not do so: they might be deterred from seeking medical help in the first place. We would not wish to see that second result.

While the noble Lord's idea has more than a germ of merit to it, it is perhaps premature to consider it seriously in the context of the Bill. Nevertheless, I hope that the Minister will consider the idea seriously as he takes the Bill away.

Photo of Lord Walton of Detchant Lord Walton of Detchant Crossbench

My Lords, at first sight I too found this an attractive amendment. One of the problems that we have encountered over many years in the National Health Service is that patients have had little information or understanding of the cost of many of the procedures to which they are subjected, not least in relation to the cost of drugs that they receive. At the same time I share some of the anxieties expressed by my noble friend Lady Finlay about the amendment. It seems to me that the Minister might consider the possibility that at the right moment a limited pilot study of the effects of something similar might be well worth carrying out in order to inform the public and to inform government policy at some time in the future.

Photo of Baroness Barker Baroness Barker Spokesperson in the Lords, Health 4:30 pm, 4th July 2006

My Lords, I indicated during our earlier discussions that we, too, have a great deal of sympathy with the noble Lord, Lord Palmer. I believe that he has the basis of an extremely good idea here. I support it not because it is likely to dissuade patients from taking medicines that they are prescribed but because it might enable them to have a far more informed discussion with the different people in different parts of the NHS who are involved in prescribing medicines and taking medicines away and who frequently give patients conflicting instructions that do not seem to make sense. Anything that informs patients is positive. Some patient groups are incredibly well informed about medication, while others are not. But if this enables that to happen and sometimes presents a challenge to clinicians, it is not a bad thing.

The noble Lord, Lord Walton, suggested the setting up of a pilot study. Would that require primary legislation or could a pilot study go ahead without it?

Photo of Lord Warner Lord Warner Minister of State (Reform), Department of Health, Minister of State (Department of Health) (NHS Reform)

My Lords, as I indicated on Report, I had a good deal of sympathy with the thinking behind this amendment—and I still have that sympathy. I must acknowledge that the noble Lord, Lord Palmer, has made some effort to improve the amendment and has taken on board my comment that it would be easier to indicate the cost of medicines to the NHS than the full retail cost. As I said on Report, I agree that patients should be as well informed as possible about NHS services that they receive. However, as a number of noble Lords have said, my greatest concern is that this measure could lead to some patients, especially older people, stopping taking or failing to reorder vital medication that they know to be expensive because they do not wish to be a burden on the NHS. We simply do not know. We do not have the evidence about how people would react and it is not appropriate to put a change of this kind in primary legislation before we have that evidence.

I shall not repeat all the points that I made in my letter and to some extent on Report about some of the practical issues. There are practical issues involved in implementing a system of this kind. It is not quite as simple as one might think. There are issues about prescriptions coming from different sources and how you deal with those; there are issues about appliances, prescriptions from walk-in centres and resulting from patient group directions, and so on. We know that there would have to be a consistent system of computer upgrades to cope with a system of this kind, the cost of which would certainly run into tens of millions of pounds. We are not saying that that makes it a showstopper or that it makes it impossible, but we need to consider the practicalities before going forward.

We also have some doubts as to whether amending the NHS charges regulations is the correct vehicle for a change of this kind. This is not the most obvious place to make a change of this kind. However, to give some comfort to the noble Lord, Lord Palmer, and to other noble Lords who have indicated a degree of qualified support for the amendment, I can say that my colleague, Andy Burnham, the Minister of State for delivering quality, who is actually responsible for this policy area in the Department of Health, is considering, outside the Health Bill, further work to see whether indicating the cost will discourage patients from taking vital medicines and, if it does not, will look to see whether it would be justifiable to introduce a similar but more limited flexible arrangement to that which would be established by the amendment.

The noble Lord has certainly gained Health Ministers' attention with the amendment. We want to take the issue forward with a proper study and I congratulate him on pursuing with some tenacity his views on the issue, with which, as I said earlier, we have some sympathy. In that context, I hope he will be willing not to proceed with his amendment.

Photo of Lord Palmer Lord Palmer Crossbench

My Lords, I thank the Minister for that reply and I thank my noble friend Lady Finlay for her comments. I have often been called premature in my life.

I am heartened by what the Minister said about his colleague in another place looking into this whole subject. It has concerned me for at least 20 years, particularly the terrible wastage of the amount of drugs that must simply get thrown away. On the premise that the Minister will give me his unqualified support and ensure that something will be done about looking into this issue, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Schedule 3 [New Schedule 12B to 1977 Act]:

Photo of Lord Warner Lord Warner Minister of State (Reform), Department of Health, Minister of State (Department of Health) (NHS Reform)

moved Amendment No. 3:

Page 71, line 36, leave out from "to" to end of line 37 and insert "any Strategic Health Authority whose area includes any part of the Trust's area."

Photo of Lord Warner Lord Warner Minister of State (Reform), Department of Health, Minister of State (Department of Health) (NHS Reform)

My Lords, Amendments Nos. 3 to 11 are minor drafting and technical amendments. I beg to move.

On Question, amendment agreed to.

Schedule 8 [Minor and consequential amendments]:

Photo of Lord Warner Lord Warner Minister of State (Reform), Department of Health, Minister of State (Department of Health) (NHS Reform)

moved Amendments Nos. 4 to 6:

Page 85, line 30, leave out paragraph (a) and insert-

"(a) for "a Health Authority" substitute "a Local Health Board", and"

Page 86, line 4, at end insert-

"Pharmacists (Fitness to Practise) Act 1997 (c. 19)

In the Schedule to the Pharmacists (Fitness to Practise)Act 1997 (fitness to practise of registered pharmaceutical chemists) omit paragraph 5."

Page 87, line 33, leave out "second paragraph (fa)" and insert "paragraph (fa) inserted by paragraph 74(2)(a) of Schedule 11 to the 2003 Act"

On Question, amendments agreed to.

Schedule 9 [Repeals and revocations]:

Photo of Lord Warner Lord Warner Minister of State (Reform), Department of Health, Minister of State (Department of Health) (NHS Reform)

moved Amendments Nos. 7 to 11:

Page 89, line 11, column 2, at beginning insert-

"In section 15, subsections (3) and (4)."

Page 90, line 19, at end insert-

"National Health Service Appointments Commission (Establishment and Constitution) Order 2001 (S.I. 2001/793) The whole Order."

Page 90, line 43, column 2, leave out "In Schedule 2, paragraph 1." and insert "The whole Order."

Page 91, line 5, column 2, leave out "Article 2(2) andSchedule 2." and insert "The whole Order."

Page 91, line 13, at end insert-

"Special Health Authorities (Audit) Order 2006.I. 2006/960) The whole Order."

On Question, amendments agreed to.

Photo of Lord Warner Lord Warner Minister of State (Reform), Department of Health, Minister of State (Department of Health) (NHS Reform)

My Lords, I beg to move that this Bill do now pass. I thank all those who have taken part in our debates over the past four months, particularly noble Lords on the Front Benches. My noble friend Lord Faulkner and the noble Lord, Lord Walton, have given us a great deal of informed support and help with this Bill. Their contributions have always been constructive, informed and helpful. I thank my noble friend Lady Royall for her help, particularly during Grand Committee.

It has been a privilege to have been involved in this important and historic Bill, and to have brought it through the House. Its impact on protecting the health of the public will be significant.

Moved, That the Bill do now pass.—(Lord Warner.)

Photo of Lord Faulkner of Worcester Lord Faulkner of Worcester Labour

My Lords, I thank my noble friend Lord Warner for his kind comments and congratulate him on the skill, patience and good humour with which he has taken the Bill through the House. I think he would agree that his task would have been rather more difficult if the Bill had come to this place in exactly the same form in which it entered the House of Commons, with the exemptions it then contained. Now, though, we have a Bill which in my view, and, I think, in the view of the great majority of noble Lords, will do more for the public health of our country than almost any other measure since the introduction of the Clean Air Acts. I am delighted to support it.

Because we are passing a Bill that contains comprehensive smoke-free provisions, I am able to tell the House that the private Bill I introduced on behalf of the city of Liverpool to make it smoke-free will no longer be needed, and the formal steps to withdraw the Liverpool City Council (Prohibition of Smoking in Places of Work) Bill will be taken by the promoters' parliamentary agents. I understand that formal Member approval is required first, and that that will be obtained later this month.

The noble Baroness, Lady Howarth of Breckland, will make a similar statement in respect of the London local authorities Bill which she introduced. She and I and the promoters believe that these two Bills played some part in winning the debate for smoke-free provision, and we are grateful to all noble Lords who supported us at Second Reading on 20 July last year.

I should also mention the third local authority private Bill on smoking, the Merseyside Local Authorities (Prohibition of Smoking in Places of Work) Bill, which was introduced into this House on 23 January. The promoters of that Bill also propose to withdraw it on the basis that the Government's Health Bill achieves virtually all they hoped for from theirs. That Bill would have been the responsibility of the late Lord Chan, whose untimely and sudden death earlier this year was widely mourned in this House and across Merseyside.

Lord Chan's greatest legacy lay in developing child health in the developing world, and the work he started is being continued by the countless students he trained. He will be most remembered on Merseyside for his commitment to tackling health inequalities and helping those who suffered from deprivation. He saw the provision of smoke-free workplaces as an essential element in that. Lord Chan would have been as delighted as I am to see this Bill pass today.

Photo of Baroness Howarth of Breckland Baroness Howarth of Breckland Crossbench

My Lords, I am happy to follow the noble Lord, Lord Faulkner of Worcester, in his celebration of a full ban on smoking in the Government's Bill. I also celebrate the role played by the Liverpool and Merseyside private Bills, and particularly the role of my friend, the late Lord Chan, whom I miss greatly in this House.

I remind the House of the role of the London Local Authorities (Prohibition of Smoking in Places of Work) Bill, which was promoted by the vast majority of local authorities in London through the Association of London Government. The Bill, which was considered at the same time as the Liverpool Bill on Second Reading a year ago, gave this House an extensive opportunity to discuss the merits of a full ban on smoking in places of work.

Credit should be given to the London boroughs, as well as to the Liverpool and other Merseyside local authorities, for their work in pushing forward the debate in favour of a full ban. We must remember, as the noble Lord, Lord Faulkner, has mentioned, that at the time of the debate on the London and Liverpool Bills the Government had not yet brought forward legislation and were suggesting a partial ban. I was personally delighted that the Government listened and changed their mind for the better—that is what modern democracy is truly about.

Now that we will have a Health Bill providing for a full ban, I have been advised by the Association of London Government, speaking on behalf of the London boroughs, that it will take steps to instruct the withdrawal of the London local authorities Bill from Parliament. I thank this House and the Government for ensuring that legislation exists to protect all workers from the harmful effects of second-hand smoke. In particular, I thank the Minister for his extraordinary patience through this long Bill.

On Question, Bill passed, and returned to the Commons with amendments.