I call the Minister of Health, Social Services and Public Safety, Mr Simon Hamilton, to move the Bill.
Moved. — [Mr Hamilton (The Minister of Health, Social Services and Public Safety).]
Members will have a copy of the Marshalled List of amendments, which details the order for consideration. The amendments have been grouped for debate in the provisional grouping of amendments selected list. There are three groups of amendments, and we will debate the amendments in each group in turn. The first debate will be on amendment Nos 1, 2, 3 and 5, which deal with the prohibition of smoking in an enclosed vehicle. The second debate will be on amendment No 4, which deals with the consultation on a sugar-sweetened drinks levy. The third debate will be on amendment Nos 6, 7 and 8, which deal with a duty to promote information and awareness of human transplantation.
I remind Members who intend to speak that, during the debates on the three groups of amendments, they should address all the amendments in each group on which they wish to comment. Once the debate on each group has been completed, any further amendments in the group will be moved formally as we go through the Bill and the Question on each will be put without further debate. The Question on stand part will be taken at the appropriate points in the Bill. If that is clear, we shall proceed.
No amendments have been tabled to Clauses 1 to 4. I propose, by leave of the Assembly, to group those clauses for the Question on stand part.
Clauses 1 to 4 ordered to stand part of the Bill.
We now come to the first group of amendments for debate. With amendment No 1, it will be convenient to debate amendment Nos 2, 3 and 5, which deal with the prohibition of smoking in an enclosed vehicle. Amendment No 1 is mutually exclusive with amendment No 2, and amendment No 3 is consequential to amendment No 2. I call Ms Rosie McCorley to move amendment No 1 and address the other amendments in the group.
After clause 4 insert<BR/>
"Prohibition: use of nicotine products or tobacco in enclosed vehicles
4A.—(1) The Department may by regulations make provisions prohibiting the use of nicotine products or tobacco in an enclosed vehicle at a time when a person aged under 18 is in the vehicle.".
The following amendments stood on the Marshalled List:
No 2: After clause 4 insert
"Prohibition: use of nicotine products or tobacco in enclosed vehicles
4A.—(1) The Department may by regulations make provisions prohibiting the use of nicotine products or tobacco in an enclosed vehicle at a time when a person aged under 18 is in the vehicle.
(2) The Department must, beginning with the coming into operation of subsection (1), raise public awareness of the change in the law to be effected by that subsection.". — [Mr McKinney.]
No 3: After clause 4 insert
4B.—(1) Where a police constable has reason to believe that a person has committed an offence under section 4A(1) the police constable may give that person a fixed penalty notice in respect of the offence.
(2) A fixed penalty notice is a notice offering a person the opportunity to discharge any liability to conviction for the offence to which the notice relates by paying a penalty in accordance with this section.
(3) The form of a notice under this section shall be such as may be prescribed.
(4) The fixed penalty payable under this section shall be such amount as may be prescribed.". — [Mr McKinney.]
No 5: After clause 5 insert
5A.—(1) The Department must not later than 3 years after the commencement of this Act review and publish a report on the implementation of Part one.
(2) Regulations under this section shall set out the terms of the review.". — [Ms McCorley.]
Go raibh maith agat, a LeasCheann Comhairle. Ba mhaith liom leasú uimhir a haon a mholadh. Beidh Sinn Féin ag cur i gcoinne leasuithe uimhir a dó agus trí, agus beidh muid ag tacú le leasú uimhir a cúig. Sinn Féin will oppose amendment Nos 2 and 3 and support amendment No 5.
As you said, this relates to making provisions to prohibit the use of nicotine products or tobacco in an enclosed vehicle at a time when a person under the age of 18 is travelling in the vehicle. This also relates to major health issues, and the arguments about the dangers of smoking and its impacts have been well rehearsed over many years.
This amendment relates to second-hand tobacco smoke, and it is the impact on children that we are addressing. Second-hand tobacco smoke is the smoke from a burning cigarette, pipe or cigar as well as the smoke exhaled by a smoker. It is a complex mixture containing more than 4,000 chemicals, over 50 of which are known carcinogens.
Second-hand tobacco smoke is a major preventable contributor to acute and chronic adverse health outcomes, and those exposed to second-hand tobacco smoke for long periods of time are more likely to develop and die from heart disease, respiratory problems and lung cancer. There is no safe level of exposure to second-hand tobacco smoke. Exposure to second-hand smoke in the confined space of a vehicle is particularly dangerous since second-hand smoke levels from a single cigarette can exceed concentrations previously found in the smokiest bars and restaurants.
Protecting children from second-hand tobacco smoke is critical as they are more vulnerable to the adverse health effects of exposure. This is because children are smaller and have immature immune systems and higher respiratory rates. Second-hand tobacco smoke is linked to leukaemia and brain and other childhood cancers, as well as to sudden infant death syndrome, asthma, ear infections and respiratory diseases in children. Even short-term exposure to second-hand tobacco smoke can trigger an asthma attack in children, and effects on lung health may be long-term.
I thank the Member for giving way and I totally concur on the dangers of passive smoking and why it is not a good idea. I want to ask two questions about the amendment. It would seem to suggest, by the way it is drafted, that other products such as nicotine patches, nicotine gum or even e-cigarettes would be contained within the provisions. Is that something that the Members intended or did not intend in the drafting of their amendment? Second, does the Member have any concerns about passing an amendment that the police may not enforce, given that a similar provision has been passed in Great Britain but the police have said that they will not enforce it?
I thank the Member for his intervention. We are concerned about all nicotine products. Clearly patches are not offensive and would not affect other passengers, so it would be nicotine tobacco things. Clearly the intention relates to where there would be second-hand damage or impact on other people; that is what the intention is.
As regards enforcement, we hope there would be a dual responsibility so that both the police and local councils would take responsibility for this. Obviously that is something that would need to be worked out either in regulation, further legislation or guidance.
No, we have not had any conversations about that. I do not actually have anything more to offer on that, so I will just continue.
In addition to protecting children from exposure to second-hand tobacco smoke, smoking restrictions also influence social norms regarding the acceptability of smoking. Smoke-free policies help to challenge the perception that tobacco use is a normal adult behaviour. This, in turn, can have a positive effect on youth and help them to remain smoke-free. We hope that positive intentions would arise as regards attitudes towards smoking, as well as the protection of children and young people under the age of 18, as a result of this amendment being brought into effect.
In response to the Member, I have already mentioned amendment No 3, relating to enforcement, and so we see that there would be a dual responsibility as regards enforcement between local authorities and the police. In addition, the effect and impact of the legislation being brought in to being can, in its own right, affect behaviour.
We can talk about the impact of seat belts. There are very few people now who would get into a car and not put on a seat belt, but very few have had those regulations enforced on them. The enforcement procedure is probably not that obvious or strong.
The first part of amendment No 2 is the same as our amendment. We would see the second part brought into being in subsequent regulations to raise public awareness. We support amendment No 5, which is about reviewing this not later than three years after commencement. I am not too sure whether three years is the best amount of time, but on the face of it, we support that amendment.
Go raibh maith agat, a LeasCheann Comhairle. First, I want to make a few comments on behalf of the Committee and to welcome the Consideration Stage. It has been debated that the main purpose of the Bill is to make provision to allow the Department to make regulations banning the sale of nicotine-containing products to minors. It also amends existing provisions on primary dental services and other services such as pharmaceutical services, as well as charges for services provided to persons not ordinarily resident.
I take this opportunity to quickly provide a brief overview of the evidence taken by the Committee and the key issues that we identified during Committee Stage. The Bill was referred to the Committee for Health for scrutiny on 9 December. Following our request for evidence, we received 10 written submissions from a range of stakeholders and took oral evidence from the Department, the BMA and Cancer Focus. The written and oral evidence focused mainly on the clauses that deal with the regulation of the sale of nicotine products and tobacco. However, significant comments were also made about smoking in private vehicles carrying minors — a provision that was not included in the Bill.
Having considered the written and oral evidence that was received on the regulation of the sale of nicotine products and tobacco, the Committee identified an issue on the enforcement of the age of sale provisions for e-cigarettes. The Committee came to the view that the best way to address that was for the tobacco retailers' register to be extended to include e-cigarette retailers so that they also would be subject to regulation. Members certainly felt that that would future-proof the legislation should evidence emerge at a later date of difficulties in enforcing the age of sale provisions for e-cigarettes.
In response to the views expressed by the Committee, the Department proposed an amendment that would allow it to amend the relevant provisions of the Tobacco Retailers Act 2014 to apply them to nicotine product retailers as well as tobacco retailers. The Committee was content with the Department’s response and agreed to support an amendment at Consideration Stage.
During the Second Stage debate, the Minister indicated that he intended to table an amendment to ban smoking in cars carrying minors. During the Committee Stage, the Department proposed such an amendment for consideration by the Committee. Such an amendment would provide the Department with regulation-making powers to allow for the creation of offences on smoking in a smoke-free private vehicle, for failing to prevent smoking in a smoke-free private vehicle where under-18s are present and for fixed penalty notices to be applied to the offences. The Committee welcomed the new policy and, therefore, agreed to support the amendment at Consideration Stage.
The Committee was aware that Executive approval was required for the departmental amendments, as they represented a change in policy, but, on Monday 15 February, the Minister wrote to the Committee to advise that Executive agreement had not yet been received for the amendments and that he was seeking agreement through the urgent procedure to allow him to meet the deadline for tabling amendments to the Bill. However, as we stand today, the amendments were not tabled.
Turning to the amendments before us, the Committee did not form a view on any of them during Committee Stage, so there is no formal Committee position on them. Therefore, that concludes my comments as Committee Chair.
I would, however, like to make a few comments as a Sinn Féin MLA on the proposed amendments in group 1 in the name of Rosaleen McCorley, Daithí McKay and myself. Rosaleen articulated the position on amendment No 1 and our position on the rest of the amendments. In reply to some of the commentary earlier, particularly from Mr Ross, I should say that amendment No 1 prohibits the use of nicotine products or tobacco in enclosed vehicles, and it is our intention that the debate be as wide as possible. Indeed, that was why we offered our support to the extension of the Tobacco Retailers Act to include e-cigarettes and why we advocate that that is a genuine enhancement to the legislation.
My colleague outlined the impact —
I thank the Member for giving way. I understand and appreciate that research on e-cigarettes is still probably in its infancy, but, if the rationale for the amendment today is to protect children in a car from second-hand smoke, is there evidence that there is such a thing as second-hand inhalation from e-cigarettes or from vaping? My understanding is that there is not, and, if that is the case, what is the rationale for banning it? Is there not also a rationale that, if a parent is smoking on the way to pick up their child from school, and the smoke and carcinogens are in the fabric of the car, that does an equal amount of damage to the child once they get into the car than this amendment would actually do?
I thank the Member for his intervention. He is right in a sense. There is no robust evidence or any real indicators that e-cigarettes impact negatively or positively. The jury is still out on that. However, there is a wealth of evidence on the impact that second-hand — indeed, what is now being called third-hand — smoking has, particularly on children and young people. Again, I point out that the terminology on the use of nicotine products or tobacco is something that was done in full communication and conjunction with the Committee and the Bill Office, so I think that this is a step in that direction.
I want to reference enforcement because there has been some discussion about it. It is apparent from the work of Cancer Focus, in particular, and the other cancer charities when they worked with organisations in England in 2012 and found that 80% of people wanted a ban on smoking in cars carrying children. There is a view in charities that, with such a high level of support, legislation could be self-enforcing. That is why we have issues with Mr McKinney's amendment. Enforcement needs to encompass that dual process, and I encourage the Health Minister to outline how that could be taken forward at Further Consideration Stage or, indeed, through regulations.
In conclusion, I believe that we need a long-term, sustained, comprehensive tobacco control strategy. We need to look at all the influences, at what curtails the tobacco industry, at what helps people to stop smoking and at what protects children and others from second-hand smoke. I urge the House to support amendment No 1 in our names in group 1. Thank you very much.
Thank you, Mr Chair. I rise to speak on the prohibition on smoking in enclosed vehicles and on amendment Nos 1, 2, 3 and 4. I will be supporting amendment No 1, although I believe that it may need tidying up at a later stage. In written and oral evidence to the Committee, the BMA recommended the inclusion of a new provision that would prohibit smoking in private vehicles carrying children under the age of 18. It also recommended that further consideration should be given to extending the ban to include smoking in all private motor vehicles, regardless of the age of the driver and passenger, and I believe that the amendment helps to do that.
Smoking is the single greatest cause of preventable illness and premature deaths in Northern Ireland, killing approximately 2,300 people each year. Some 17,163 people were admitted to hospital in Northern Ireland due to smoking-related causes in 2012-13. The estimated hospital costs of treating smoking-related illnesses in Northern Ireland were in the region of £164 million a year, based on figures from 2011-12, so it is probably substantially more than that now. I welcome anything that helps to reduce deaths and costs in our hospitals.
I will not support amendment No 2; it duplicates amendment No 1 and is not really needed. Amendment No 3 deals with fixed penalties. It has a flaw, in my opinion, in that it should partly be the role of councils to issue fixed penalties, and there does not seem to have been any consultation with the PSNI and the councils on that. I believe that it should be a joint role and responsibility, and there should have been consultation to see how that would affect those services. Amendment No 5 calls for a review, which I do not quite understand the need for. If we stop everybody smoking in cars, what is the point of a review on stopping everybody smoking in cars? We are doing the job — making sure that we stop people smoking — and that will improve everybody's life.
I speak as the SDLP health spokesperson and as a member of the Health Committee. I welcome the opportunity to speak on the Consideration Stage of the Health (Miscellaneous Provisions) Bill. I will address the group 1 amendments.
The rationale that underpins the SDLP amendments is about protecting people's lives and health, especially the health and well-being of children, from the dangers of nicotine and tobacco products. In that context, it is important to remind ourselves that smoking remains the single greatest cause of preventable illness and premature death here. The Public Health Agency estimates that in Northern Ireland around 360,000 people aged 16 and over smoke. Sadly, one in two smokers die early because of their habit. Each year, approximately 2,300 people die from smoking-related illnesses. Those are startling statistics.
I commend the Assembly, which has taken great strides in changing societal attitudes and culture on smoking. A hugely successful ban on smoking in public places and public vehicles, for example, was introduced in 2007. As well as the ban, there were two important ingredients: promotion and penalty. It was a carrot-and-stick approach, but it was effective. You will probably remember, Mr Deputy Speaker, the controversy that surrounded the issue, but, in the end, it produced a good result. Nobody is now fined because we achieved a societal change, and people respect the change that we were trying to achieve, despite its having been controversial. Some of the questions raised now on this Bill are similar to those raised on that smoking ban, but we should try to achieve the ambition.
I thank the Member for giving way. He is right, of course, and, at the time, there was quite a debate. The distinction, however, is that that ban was about a public space; it was in the public sphere and involved public vehicles or council vehicles that could be shared with other people. This moves the debate into the private sphere — a private vehicle — and, some people would argue, ultimately impacts on a personal and parental decision. Nobody is saying that it is a good idea; in fact, it is stupid to smoke in a car carrying children. However, has the Member any concerns about starting to legislate for the private sphere? Can a distinction be made between a car and a small flat or a room in a house?
I think that, for several reasons, we should go some distance towards exactly what you outlined. First, the confined space — the car — means that fumes are more noxious; secondly, a child does not have a choice; and, thirdly, I make a distinction between a car and a domestic house. I appreciate your point about a small flat, but, for me, that is probably going too far. If you are saying that there could be a difficulty with the size of a flat, I guess that you could point out that, if a car is small, the toxicity of the fumes could be more potent.
The child is travelling in that car, whereas he or she could be outside the house when the parents are smoking inside, or the parents could be smoking outside when the child is inside. There are arguments there, and I urge Members to support the exact direction of travel.
We continued on that journey when we raised the age for purchasing tobacco to 18 in 2008. Once again, we had the promotion and the penalty — the carrot and stick. We passed the Tobacco Retailers Act last year. It aims to restrict the availability of cigarettes to children and targets adults buying for children. We supported Westminster regulations on plain cigarette packaging, which I hope will act as a further disincentive to young people taking up smoking. Once again, there was promotion and penalty. The ingredients for success on the journey to protect people from the dangers of smoking are there, and we should embrace them.
Those who oppose what we propose today have not included promotion and penalty in their amendment. I urge those who have declared that they want to back a certain amendment to think about the SDLP amendment, which includes the successful ingredients for limiting the harmful effects of smoking. These are all evidence of a progression that must be welcomed and is all the more important given the detrimental impact of smoking.
What we have not done so far is legislate on smoking in cars with children, which is an important piece of the anti-smoking jigsaw. I will quote some statistics from the Department of Health: 15% of adults smoke with their children present in the car, which, given the headline figure that I outlined earlier, means that roughly 50,000 to 55,000 people regularly smoke with one, two or more children in the car. You begin to see the impact that it can have. That is unacceptable. Passive smoke poses a serious health hazard. Studies have shown that there is no safe level of exposure, not least in an enclosed vehicle. Every time someone smokes a cigarette, they breathe in a lethal concoction of toxins and other harmful chemicals, and every time a person breathes in passive smoke, the danger increases, as the smoke contains over 4,000 chemicals, many highly toxic and more than 50 known to be carcinogenic. The evidence is stark.
Passive smoke also affects children more than others, causing a variety of adverse health effects, including an increased susceptibility to respiratory tract infections, such as pneumonia and bronchitis, the worsening of asthma, middle ear disease, decreased lung function and sudden infant death syndrome. The Minister will be conscious of the earlier debate on the need for early interventions in all of these issues, and one of the earliest interventions would be to stop people smoking, which would have a tremendous effect on limiting child ill health. We know that children are more vulnerable to passive smoke exposure in vehicle because their immune systems are not yet fully developed, they breathe more rapidly and they inhale more pollutants than adults. Scientific evidence shows that ventilation does not eliminate the risk to health of passive smoking in enclosed spaces.
It is against that backdrop that early intervention and prevention are key. That is why the anti-smoking narrative from 2007 to today has been so valuable. We must continue that narrative. The only way to provide children with effective protection from passive smoke in cars is to prevent them breathing it in in the first place. It is simple, and it is exactly what has happened in other jurisdictions: Scotland, Wales and the Republic are all legislating on the issue, and England introduced a ban that came into force in October last year. I refer to Mr Ross's earlier intervention from across the Chamber and would like to clear up what the police said. The police simply said that they would give a three-month grace period after the implementation of the English Act; they did not say that they would not act on the Act. They said that they would give it a three-month grace period, which is a different thing. The headlines around the implications of that were perhaps much more negative, but, in fact, they were saying that they would implement it but were giving it a three-month grace period. My amendments are not solely about fining people; they are about creating a behavioural and cultural shift for people to realise that their actions are impacting on their child's health and that such actions will not be tolerated. In marrying those two things together, the police are perhaps sensibly looking at it and saying, "Promotion and penalty; let's go for the societal shift here. People are aware now". It is about that awareness programme as well.
I would like to put on record my appreciation of the many organisations that have called for the introduction of the ban. There has been overwhelming support from the royal colleges, health experts and leading authorities in public health across the UK. During Committee Stage, the British Medical Association and Cancer Focus wrote to the Committee stressing the need to include a ban in the Bill, while Chest, Heart and Stroke has campaigned for its introduction for a number of years. We all celebrate the expertise and commitment of those organisations; indeed, they have presented to the Committee many times in the past. We take the bona fides of that evidence. In fact, they have conducted a public opinion poll in Northern Ireland that reveals that a staggering 92% of people agree with the ban. I am sure that the House would agree that such public support reinforces the need to support the SDLP amendments in the first group.
Turning to the specific amendments in this group, I commend Sinn Féin for tabling amendment No 1. However, as I have outlined, it is limited. The SDLP believes that accompanying such a change in the law must be an effort to raise public awareness of the issue. You may simply say, "It will come in regulations", but there is no guarantee. We need to say what we mean and mean what we say. We should introduce a ban, promote it and introduce the penalty. We have already recognised the importance of raising public awareness during recent debates on organ donation. In fact, later in this debate, Sinn Féin will ask for a promotion campaign on a different issue. On one hand, they ask for it on that but, on the other, they say, "Just support our amendment and reject the SDLP's amendment, which includes promotion".
I thank the Member for giving way. Does the Member agree that the Human Transplantation Bill was well discussed and debated in Committee and we heard lots of evidence that informed us? It is not as though we are at the same place here. As we know, that Bill was then dropped and we were left with the useful public awareness-raising aspect of it, which was supported by everybody who gave evidence. It seems only right that we ensure that that part of the Bill is kept and that we have something that helps to increase rates of organ donation.
To borrow a court phrase, there rests the case for the defence. You either want promotion or you do not want promotion. In the transplantation issue that is coming up, Sinn Féin will be looking for evidence promotion. That is exactly what we are looking for in this group of amendments.
The same principles apply in amendment No 2. There is a need to have a substantive element of public awareness, but it is not just about that. This is the importance of the promotion aspect of it. I am talking about the balance of those two things: penalty and promotion. It is about creating a societal shift. It is about celebrating what we did all those years ago to ban smoking in bars and applying it to something that we categorically know is causing all these problems. We know that children are inhaling these dangerous and noxious toxins. We know that that is stacking up huge health service bills for us in years to come. We know what we have to do, and we cannot ignore that. To choose an amendment that ignores those crucial elements and ingredients of success would be to miss an important opportunity.
At this late stage, I still appeal to parties to think again. If there is a bit of nuance required at the next stage, let us look at that, but let us not cast our amendments aside now for a one-sentence amendment that bans smoking in cars without those important proven-track-record ingredients that would make such a difference attached. We are talking about our children — your children, my children and others' children. We are all talking about parents, but what happens if somebody who smokes in a car is taking your child to another destination? You are not going to be too happy about that. We need to send out a very strong signal tonight that we recognise and endorse those essential ingredients. If there is a bit of a tweak needed, let us talk about that, but let us not send out a signal from the Chamber tonight that we have rejected two of the most crucial elements of what will work to limit aspects of smoking that will affect our children.
We have had a whole range of anti-smoking campaigns here. I referred earlier to the Public Health Agency's one-in-two campaign. The SDLP believes that aspects of that campaign can easily be extended to ensure that members of the public are aware of the changes. As I said, I believe that the Sinn Féin amendment is flawed. I hope that the House has understood the nature of the flaw.
Amendment No 3 prescribes powers for the police for administering fixed penalty notices. The Minister had signalled an intent to amend in that regard. He clearly recognised a lot of what I am talking about by way of penalties. However, there appear to have been some drafting difficulties or other issues. The Minister's focus was then on how local authorities are hampered by not having stop-and-search powers, meaning that they are unable to issue a fine when they see a breach of the provision taking place. Only the PSNI here has those explicit powers and can issue on-the-spot fines. That is why we believe that it is vital to include amendment No 3 in the Bill. As I said, taking another approach might lead to another conversation, but we will have rejected one of the vital ingredients and easy options that could make a difference in the debate.
It is paramount to review any piece of legislation that changes the law. Amendment No 5 would place an obligation on the Department of Health to review our amendments to ensure that they are operating as they were intended and to give an opportunity for any further amendment that may be necessary to ensure that the legislation is as robust and coherent as possible. Earlier, Mr Ross intervened on the matter, and I wish to reflect on that. There has not been any conclusive study compiled on the impact of e-cigarettes. We accept that, but, at the same time, and as a precaution — you could always step outside the car for five minutes and have your e-cigarette — the SDLP believes that they should be included in the Bill. E-cigarettes have proven to be a great success for many adults quitting smoking, and I support that. However, we cannot afford to give them the benefit of the doubt when it comes to children's health. We are proposing that further amendment so that we can —
I thank the Member for giving way. One thing that people often talk about in the House is evidence-based policymaking. The Member seems to be suggesting that we make the policy with a lack of evidence just to be overly precautious. Is that not a little bit strange? There is no evidence to suggest that passive smoking from vaping — it is not smoke but water vapour — is damaging to somebody in the proximity. If we are looking at having evidence-based policymaking, surely we will not be looking to ban somebody from using an e-cigarette in a car. It does not seem to make logical sense.
On the face of it, perhaps, but, at the same time, it is an inhalable tobacco product, and, by extension, you exhale.
The issue is the size of the car and the space within which you are using the device. So, it is a precautionary principle. Principle attached to precaution is acceptable, and it is understood in our society that we can be precautionary and can say that we are banning something. This is something that comes under the umbrella of nicotine products or tobacco.
We understand the negative effects of nicotine and tobacco products on people's health. That is why we are proposing the measure. It does not shut the door; it is saying, "Let's review this in three years' time". That is a reasonable and sensible approach.
So, I think that the House would agree that a change in the law is necessary. Northern Ireland may remain the only jurisdiction in these islands that does not have a ban on smoking in cars with children. If so, children here would suffer as a result. I urge support for the amendments.
I welcome the opportunity to speak on this group of amendments. No one who has been watching the Bill's progress will have been surprised to see amendments of this nature coming forward. However, I reiterate the point I made at Second Stage: the Department should have brought this issue forward. That would have allowed for a greater degree of consultation as well as an opportunity for key stakeholders, such as the PSNI, to fully engage in the process. Indeed, I find the Department's appeal for a Back-Bench MLA to take forward a ban on its behalf, through amendments, to be quite bizarre.
The facts are clear. In Northern Ireland, approximately one in four people smoke, and one in two smokers will ultimately die early because of it. Whilst many people realise that the habit is damaging and generally bad for your health, I am sure that most would be shocked to realise the true impact of it on the local population. The habit kills well over 2,000 people here every year. That is more than the number of deaths from obesity, alcohol, illegal drugs and road accidents put together. It is our leading cause of preventable death, and it is putting a huge amount of pressure on our health service.
It is interesting to note that funding from the Department, through the Public Health Agency, towards TV advertising was £206,000 in 2011-12, whereas, in 2015-16, it is £58,000. In addition, smoking is the largest cause of inequalities in death rates between the richest and poorest in our communities. I therefore fully support any efforts taken to assist people to give up the habit and to stop others from taking it up in the first place.
Smoking causes harm, not only for the individual but for those around them. When people decide to smoke, they take a conscious decision to do so. However, when people have to breathe in other people's smoke, they have little choice in the matter. Second-hand smoke is a toxic by-product that is medically proven to affect anyone who is exposed to it.
The ban on smoking indoors in public places split public opinion when it was first proposed. However, even the most ardent smoker would not think about lighting a cigarette in a restaurant or pub now. Who could possibly disagree that the ban has not only helped the health of our workers but also greatly improved those environments? People have been protected in public areas and in their workplaces since 2007.
On that issue, we also have the smoking ban in psychiatric hospitals, which is due to come into effect next month. That will, in itself, raise a number of questions over how it can be effectively managed by staff. However, there is very little legislation in place to protect children and young people from the effects of smoking.
Young people are particularly vulnerable to exposure to second-hand smoke, much more so than adults, which is why the amendments are so important. Medical practitioners will tell you that children's bodies are still developing and that exposure to harmful substances puts them at risk of severe respiratory diseases. Exposure to second-hand smoke is known to cause asthma, bronchitis, pneumonia, sudden infant death syndrome, middle ear infection and a raft of other health problems. In addition, children who are exposed to smoke from an early age are statistically much more likely to smoke later in life.
Most drivers already take an active decision not to smoke in cars if children are travelling with them, but one of the leading local charities believes that as many as 13,000 children may still be exposed to second-hand smoke in cars across Northern Ireland. Some parents smoke in cars under the assumption that winding down the car window will let the smoke out, but, as we have heard, in reality, that only pushes it back into the car. In such a confined space, smoke can reach up to 10 times the recognised unhealthy level, and it often lingers for hours.
People should, absolutely, be free to do what they wish, within the law, in their homes and cars. I appreciate that some people will be concerned when they hear about the Assembly taking decisions such as this, but, before people jump to a conclusion, I urge them to consider the issue and to accept that, when actions are harming the lives of children, the Assembly should have a duty to intervene and introduce safeguards that limit such actions and harm. Whilst I do not expect the PSNI to carry out roadblocks as a result of this legislation, it is my hope that criminalising smoking in cars with children will prevent people from doing it in the first place.
I, like others, welcome the Consideration Stage of the Bill. The Alliance Party is supportive of the intent behind all the amendments in this group, but, like others, I am extremely disappointed that there has not been Executive agreement to permit a formal amendment to come from the Department. Perhaps the Minister can give us a reason why his colleagues failed on this occasion. Had it happened, it would have been instrumental in guiding us around the most effective route of establishing the best way forward.
Our understanding of the dangers of smoking has evolved considerably over the past number of decades and, in health terms, it makes sense to inform people of the huge dangers involved in smoking. Thankfully, today we better understand the health implications of smoking directly for the smoker, and also the dangers to others arising from passive smoking. Tackling smoking rates is a core aspect of all public health messages. While addressing the impact of smoking is a major pressure on scarce resources in our health service, it is absolutely essential that government continues to lead on steering our young people not to start smoking in the first place. I applaud the Public Health Agency on its work to date and over the years. Please, please continue to get the message over to our young people.
There are ongoing wider economic and social consequences. It is in that context that it is now commonplace in this and other societies that we regulate where and when smoking in cars occurs. Smoking is effectively banned in most public spaces. That is not just about the interests of the smoker, as the smoker is free to smoke in the confines of their own private space when it does not impact on others, but about protecting others from being impacted by smoking, often when they have no ability to choose or consent to suffer these ill effects. In that regard, it is surely a loophole that, today, smoking can take place in vehicles in which those under the age of 18 are being carried. They often have no means of consenting to the damage to which they are being subjected.
With that said, I am happy to support these amendments on behalf of the Alliance Party.
It will probably not come as a surprise to many that I support banning smoking. I led a debate on this subject in the early months of this mandate. I accept Mr Ross's arguments round civil liberties, how this impinges or impacts on those and how we make sure that we send out a very strong public health message when it comes to smoking. That is one of the key messages that legislation or regulations flowing from this should send out. It should send out a very, very strong message to people that this is not acceptable, that it is dangerous and that, most of all, it is dangerous to the most precious thing that parents will have in their life — it is a health risk to their children.
The health risks for all the population who smoke have now been well-documented for many decades. We have driven down those numbers with different measures. Now when you go abroad and people are smoking in a bar or restaurant, it almost seems an alien concept. We have become so used to the ban. It was very much a welcome step a number of years ago. The same arguments were put up then, such as, "This could be very difficult to enforce." It has become probably one of the most complied-with laws that we have passed here.
On the very idea that we would allow or permit in any form people to smoke in cars, I agree with the Minister. I think that when the issue was also talked about at Second Stage and people declared that they would be likely to bring forward amendments, he used the phrase "stupid" — "stupid", "reckless" or maybe even one stronger than that. I agree with his comments about anyone who would smoke in the car with their children. It is absolutely mind-numbing that people would act in such an irresponsible, reckless manner. The Assembly, with, I hope, the support of the Minister, can send out a clear message that that is not an acceptable way to behave.
I referred to the Department of Health's statistics. Does the Member accept that, if the Department has found that 15% of smokers smoke in their cars with children present, which represents 15% of 360,000 people, there is a problem that needs to be solved with, as I say, a ban, promotion and penalty?
I am grateful to the Member. Certainly, 15% is way too high — way, way too high. There is a sizeable number of people who do that. I will also point out — I think the point was raised in an interchange between Mr Ross and Ms McLaughlin or another member of Sinn Féin — that the damaging impact of smoking can last in a car for up to an hour after a cigarette has been smoked. I realise that we are probably not going to solve that problem. Having that sneaky fag, if you like, on the way to lift the kids from school is still incredibly damaging.
Maybe this is where I will test some of the arguments on civil liberty and even enforcement. Does it then become easier to ban smoking outright in cars regardless of the age group because it becomes easier to police, or do we just ban smoking in cars with children under the age of 18? I am certainly open to being persuaded either way on that.
I certainly agree that it is probably an easier way of doing it, if that is what you want to achieve, but the argument surely is not so much about whether anybody thinks it is a good idea to smoke in a car with children, or, indeed, whether anybody thinks it is a good idea to smoke full stop — I do not think that anybody does think that. The question is whether it is appropriate for government to legislate in what is a private sphere. The car is a private space. It is a private sphere, much like the home. Nobody is saying that it is a good idea to smoke around children in the home either, but it is accepted that it is a private space and that we do not legislate on it. In my view, the same, by extension, can be said about a private vehicle. It is a car, a private sphere, and we should not legislate in that area. That is what the argument comes down to, rather than what would be the easier way to enforce it.
(Mr Speaker in the Chair)
I accept the argument that the Member makes about private space. However, even in a very modestly sized house, the volume of air in a smallish room is significantly larger than that in a car. That comes into it.
As for the argument as to whether the Government should ever interfere in regulating anything that goes on in a private space, we have done so over the past 30 or 40 years, particularly with cars. There is a reference in old files that the Northern Ireland Parliament almost introduced seat belt wearing 11 years before it was introduced across the United Kingdom. That would have saved thousands of lives, had it happened, but the Parliament collapsed before it could be progressed. Today, no one argues that seat belts are a huge infringement on civil liberties. They save lives. They, along with many other factors that we have introduced, make a huge difference to road safety and to the injuries sustained. For example, when children are brought home from hospital, no one seriously says, "Well, it is a private space, so you can bring your child home lying across the back seat of your car". You cannot leave hospital without an approved child seat. You might say that it is an infringement of civil liberties, but I say that it is a good thing because it saves lives. It is too important to be left up to the individual when individuals do not always make the right choices.
I thank the Member for giving way. On a similar track, the BMA gave evidence to the Health Committee and referred to a recent study that said that the concentration of toxins in a smoke-filled vehicle — in essence, a car — could be up to eleven times greater than in even a smoky bar. There was clearly an identified urgent need in relation to that statistic that was given to the Committee.
I am grateful to the Chair of the Health Committee for that intervention. There is a small volume, in cubic metres, of air in a car. Even with the windows open, smoke simply does not clear. That is where the risk comes from.
I come back to the point that the big debate on the amendments is about what will be most effective. I would have preferred the Executive to table their own amendments, as there was a clear will at Second Stage for that to happen, although I know that there were issues, maybe, with getting Executive clearance. However, I would have liked us to have been through that process by the time we hit Further Consideration Stage so that we could build on any amendments to make them as effective and as robust as possible.
For me, this is probably the big debate for the Minister in moving this stage: do we go for a total ban on smoking in cars, which would probably be easier to enforce, or do we leave the discretion that it is simply a ban in cars carrying children under the age of 18? That is an important distinction to make. One is easier to enforce, but it might go too far and be an infringement on civil liberties.
I thank the Member for giving way. He has touched on an issue that the Minister might reflect on later. If he is saying that there is the potential that the Executive might not let some of this go ahead, is it not easier to back an amendment now, because there might not be a guarantee that it will happen? For whatever reason, something might happen in the Executive that would not allow this to proceed.
I am grateful to the Member for that, and I intend to back the amendment. I will listen keenly to what the Minister has to say and will possibly be guided by his advice. At Second Stage, he gave a commitment, as much from the perspective that this sends out a strong message in a public health arena as from anything else. It sends out the message that the Assembly is serious about tackling smoking and the dangers to children. I am minded to listen intently to what the Minister has to say. I support the principle, and I hope that the amendments do enough to get us to where we want to go.
I will talk to you later about that, Mr Speaker.
I thank Members for their contributions to the debate, which has been quite good. To pick up on one of Mr McCallister's latter points, Members will no doubt recall that, during the Second Stage debate, I expressed my support for legislation banning smoking in cars when children are present. It was my intention to table an amendment on that issue, and a draft of my proposed amendment was shared with and subsequently supported by the Health Committee in its report on the Bill.
In summary, my amendment would have introduced a clause to provide my Department with regulation-making powers to allow for the creation of offences on smoking in private vehicles where under-18s are present. The offences would be very similar to those for work vehicles under the Smoking (Northern Ireland) Order 2006 and relate to smoking in a smoke-free vehicle and failing to prevent smoking in a smoke-free vehicle. <BR/>Unfortunately, I was unable to secure Executive agreement in time to allow my amendment to be tabled for Consideration Stage. I will pick up on a point made in the discussion back and forward between Mr McKinney and Mr McCallister: it was a timing issue as opposed to any outright objection at Executive level, and I expect that further amendments, as required, which I will mention later, will secure the support of the Executive and be able to be tabled at Further Consideration Stage.
Amendment No 1, which is in the names of Ms McCorley, Mr McKay and Ms McLaughlin, goes further than the amendment that I had intended to table, in that it also provides powers for banning the use of e-cigarettes in cars carrying children. I am, however, prepared to support this amendment. I listened to the debates at Second Stage and this evening, and, in my view, the case for banning smoking in cars when children are present is clear. Children are particularly vulnerable, as many Members said, to the effects of second-hand tobacco smoke. For Mr McCallister, I clarify that I described those who smoke in cars with children as "idiots". It was as strong as that — he suggested that I was much more sensitive in what I said — and that view is held, maybe not in quite such strong terms, across the Chamber and in wider society.
I do not believe that there is any evidence at present to justify banning the use of e-cigarettes in enclosed spaces for health protection reasons. The latest report published by Public Health England in August last year concluded that e-cigarettes:
"release negligible levels of nicotine into ambient air with no identified health risks to bystanders".
I understand that, in the past, there were incidents about the enforcement of smoke-free work vehicles, where, to avoid paying a fixed penalty, offenders claimed that they were using an e-cigarette and not a tobacco product. While it could be argued that a ban on both products will assist enforcement of the legislation, there has been a considerable shift in the popularity of e-cigarettes in the last two years from the early products that resembled cigarettes to the later generation devices that do not. This argument, therefore, may soon be no longer relevant. However, the inclusion in the Bill of a power to ban the use of e-cigarettes in cars when children are present will future-proof the legislation and allow my Department the flexibility, at a later stage, to make regulations, if sufficient evidence is available.
Whilst I am prepared to support amendment No 1 at this stage, I may seek to tighten it further via an amendment at Further Consideration Stage.
I turn now to other amendments in the group. The second part of amendment No 2, in the name of Mr McKinney, relates to raising public awareness, which is, I agree, an important part of any change in the law on the use of tobacco or nicotine products in vehicles carrying children. In advance of the commencement of any new legislation that could result in a member of the public committing an offence, it is standard practice to raise public awareness of that offence. I do not necessarily believe that that needs to be stipulated in primary legislation.
Amendment No 3 would place the enforcement duty in relation to smoke-free private vehicles in which children are present solely on police constables. Members may be aware that existing smoke-free legislation on places or work vehicles is carried out by authorised officers of district councils. Therefore, councils have years of experience in dealing with similar tobacco control legislation. However, as district council staff do not have stop and search powers equivalent to those available to the Police Service of Northern Ireland, issues have arisen with obtaining the driver information required to issue fixed penalty notices for offences relating to smoking in work vehicles. For those reasons, my Department would prefer a dual enforcement approach similar to that adopted in England and Wales, where a ban has been in place since 1 October 2015. In practice, that would mean that a fixed penalty notice could be issued by the Police Service of Northern Ireland or a district council. It is my intention that a dual enforcement approach would be set out in any regulations drafted in relation to smoking and the use of nicotine products in cars where children are present. Therefore, I oppose amendment No 3.
Amendment No 5 provides:
"The Department must not later than 3 years after the commencement of this Act review and publish a report on the implementation of Part one".
I am not against the principle behind the amendment, although I am not massively in favour of it either for reasons that are more practical than of principle. It is stating the obvious that it would take some months to draft regulations under Part 1 of the Health (Miscellaneous Provisions) Act and to consult on them. Therefore, even with the best will in the world, it is unlikely that any new measures to ban smoking in cars with children will be commenced until early 2017. For the impact of the legislation to be properly and comprehensively assessed, a commitment to carry out a review three years after the regulations have come into force, rather than three years after the commencement of the Act, would make more sense and be more effective. I will, therefore, consider building in a requirement for a review in the regulations emanating from the Act, if the amendment is rejected this evening. If it passes, I will give consideration to the possibility of an amendment to make it operative after the commencement of the regulations as opposed to the commencement of the Act.
In short, I support amendment No 1 but oppose amendment Nos 2, 3 and 5 in the group.
Go raibh maith agat, a Cheann Comhairle. I thank the Minister for his swift response to the debate, and I will try to be equally swift.
I welcome the fact that there is general support across the House for the introduction of the measure, whether that be through amendment No 1 or amendment No 2. My party colleague Rosie McCorley moved amendment No 1 and referred to the damage that second-hand smoke causes. It was not that long ago that many of us — maybe not all of us — were sitting in smoky bars and clubs and even in our smoky living rooms. The difference between then and now is like night and day, so extending the ban to cars and enclosed vehicles, especially those with children in them, makes perfect sense.
As always, Mr Ross made a number of combative interventions, which is good. It makes for good debate, and it has been a good debate. He made a point about amendment No 1 and the inclusion of "nicotine products or tobacco" being too wide. The only point that I will make is that that is the beauty of regulations. The Department may make regulations that take into account some of the concerns about it being too wide. That can be drilled down to specifics, according to the wishes of the Department. It is good that the Department is minded to take this forward, hopefully within a fixed period.
The Chair of the Committee outlined that the Committee had no formal view on the amendments. She also said that, according to research, 80% of people want a ban on smoking in cars with children. A very important point is that we need a long-term tobacco control strategy, because what we are dealing with today is just one instance. The point was made that smoking in a car was 11 times more damaging than smoking in a bar or restaurant to those who suffer as a result second-hand smoke. This is an important measure to put forward to deal with the problem of second-hand smoke, but we need to come back to it. When we come back to the Assembly after May, we need to look at a strategy, because this is one of the biggest killers in our society.
Alex Easton outlined his support for amendment No 1. He said that some of the amendments might need to be tidied up at a later stage. We are willing to consider that at Further Consideration Stage, as is always the case.
Fearghal McKinney outlined that 360,000 people in the North smoke and that one in two dies because of it. That figure was also quoted by Jo-Anne Dobson. That is absolutely shocking. It remains shocking that, in 2016, so many people still smoke and that it kills so many people in our society. That is not acceptable. As politicians, we need to take a zero-tolerance approach to smoking, and that is why I say that we need a strategy, objectives and goals to drill down and tackle those deaths.
Alastair Ross asked whether we should legislate for things that happen in a private sphere: I say absolutely, yes. That is not the case in all instances, but there are many laws in place to tackle crime within the home, and, when it comes to public health, especially children's health, we should intervene in extreme circumstances. I believe that, given the damage that is done in a very confined space through smoking in a small vehicle where there are children, we need to intervene and legislate.
Jo-Anne Dobson informed the House that smoking killed 2,000 people a year and that it is the biggest preventable killer. That means that it is the killer that we can do most about as legislators. She referred to the fact that indoor public areas had been protected since 2007. That has been a great success. Of course, opinion was divided at that time, but, looking back, nearly 10 years later, I am sure that a lot of people, especially young people, will ask what all the fuss was about. Of course we should have done it. It was common sense, and it has saved many lives.
Kieran McCarthy was disappointed by the lack of Executive agreement on this and would have preferred to see the Department bring amendments to the Floor today. John McCallister said that he found it strange going abroad now and seeing smoking in bars and restaurants in other countries. We should be very proud that the ban is in place here in the North and, indeed, in the South. We are saving people's lives and protecting people from second-hand smoke when people in many countries do not have that protection. Many bar workers and those who work in restaurants and even in offices do not have the protection that many of our citizens have.
The Minister outlined that he had been unable to secure Executive agreement on amendments. Nonetheless, I appreciate and think that Members appreciate his effort and that of his Department to lead on the issue.
He was clear that the case against smoking in cars with children is proven. In his view, there is no evidence as yet to state that e-cigarettes are doing damage. In my view, however, because e-cigarettes are a recently developed product, we have not had the opportunity for an adequate research base to be formed to assure ourselves that they do not damage children or anybody else. It is wise therefore to keep the issue under consideration for the proposed review, because in three years' time we may have learnt a lot more about e-cigarettes. There are concerns at the moment that we cannot just dismiss.
Amendment No 2 refers to a need to raise public awareness. Rosie McCorley said that it is something that has not been consulted on and thus needs more consideration. That is my view as well.
Amendment No 3 is specific about fixed penalties. Rosie McCorley said that the law itself changes behaviours. Many people do not want to break the law regardless of whether there is good enforcement. That also applies to speed limits to a degree. Alex Easton concurred that there should be joint responsibility between a council and the police. That was supported by the Minister.
We will also be supporting amendment No 5. We support a review within a set time. As I said, we need to be cautious about e-cigarettes. The jury is out, but research is at a fairly early stage, so it makes sense to keep our options open on that one. After three years, we can look at it again.
As was said, people do smoke when their children are in the car. That is a fact. It is happening today and is probably happening right now. Adults do smoke in cars when young children, babies, newborns and infants are present. As far as I am concerned, that is not acceptable.
The Health Survey NI stated that 23% of households here could be exposing children to second-hand smoke in cars, and 30% of schoolchildren surveyed reported that smoking was permitted in the family car. It is not something that is happening in a small number of cases. It is happening to a great degree, according to statistics.
Smoking around children needs to be stubbed out once and for all. I commend amendment No 1 to the House and ask for its support.
Amendment No 1 agreed to.
New clause ordered to stand part of the Bill.
Go raibh maith agat, a Cheann Comhairle. Ba mhaith liom leasú uimhir a ceathair a mholadh. I beg to move amendment No 4:
After clause 5 insert<BR/>
"Levy on sugar sweetened drinks
5A.—(1) The Department must consult on a levy on sugar sweetened drinks within a year of enactment of the Act.
(2) The consultation required by subsection (1) should include?—
(a) a definition of sugar sweetened drinks;
(b) which sugar sweetened drinks should be subject to a levy;
(c) factors to be considered in determining and administering a levy;
(d) the financial rate at which a levy may be set;
(e) the anticipated health and economic impacts of the levy; and
(f) the options for funding measures to address adverse health conditions associated with the consumption of sugary drinks derived from the levy revenue.
(3) The persons consulted under subsection (1) should include?—
(a) members of the public;
(b) such organisations as appear to the Department to be representative of persons substantially affected by the making of the proposed regulations; and
(c) such other persons as the Department considers appropriate.
(4) The Department must publish notice of its consultation in such manner as the Department thinks is most likely to bring the consultation to the attention of any persons listed in subsection (3).".
Amendment No 4 is about the consumption of sugar and the impact of sugary, sweetened drinks. The fact is that we are consuming too much sugar. We are told by the Scientific Advisory Committee on Nutrition that, according to experts in the UK, we should not be exceeding 5% in sugar of our total dietary intake, but evidence shows that, on average, all age groups consume between two and three times more than the 5% target.
The highest percentage of sugar intake is among young people. We know —
We know that it is bad for our health. There is a strong connection between sugar consumption and health problems, and that includes dental decay, obesity, diabetes and cardiovascular conditions. In the North, 24% of children under 16 and 61% of adults aged 16 and over are overweight or obese. The number of people diagnosed with diabetes has grown by 33% over the last five years, with 4% of the population in the North now diagnosed with diabetes. Sixty-one per cent of five-year-olds in the North show signs of dental decay, compared with the UK average of 43%. It also has detrimental impacts on our health service. For example, research carried out by Safefood in 2012 estimated that the direct health costs, including GP costs, inpatient and outpatient costs and prescriptions, of dealing with obesity in the North are £92 million a year.
Sugary soft drinks are of particular concern. We know that the sugary soft drinks imbibed by children aged 11 to 18 are their largest single source of sugar — 30%. The fact is that they have zero nutritional value and low satiety. Just one can of sugary drink can take you over your daily intake level.
One way of reducing the consumption of sugary drinks is to raise the price, which we already do with taxes on cigarettes and alcohol. Basic economic theory suggests that demand for a product will fall as price increases, and that is backed up in practice. Public Health England reviewed the evidence on the effect of tax increases introduced on unhealthy foods in OECD countries since 2010 and concluded that higher pricing does lead to lower consumption of unhealthy foods.
I thank the Member for giving way. She is looking at the evidence; does she share my concern that the evidence actually suggests that a sugar tax would be a tax on the poor? Much evidence has backed that up. What we want to do is not to have additional taxes on people who can ill afford it.
I thank the Member for that intervention, and I will come to that point later.
We also have to take into account the fact that Cancer Research UK has given us statistics which warn that obesity is escalating at such a rate that it will cause almost 700,000 extra cases of cancer within the next 20 years. We also have evidence from Professor Mike Rayner of Oxford University, who has been looking at the issue for the last 10 years. What he says is this:
"It has become clear what we should tax. Health-related food taxes should be levied on sugary drinks, because it is the safest thing you can possibly do. All the alternatives to sugary drinks are healthier, even diet drinks. If you are going to shift from a sugary drink, you will substitute a healthier alternative."
We have to acknowledge other facts: children consume three times more sugar than is recommended, and soft drinks are the biggest source, accounting for 29% of the sugar intake of 11- to 18-year-olds and 16% for younger children. In the last few weeks, the British Medical Journal published a study showing that a 10% sugary drinks tax in Mexico has led to a 12% reduction in sales after a year.
Another aspect — this has been referred to by the Member across the way — is that people on low incomes consume a higher level of sugary drinks and are more likely to suffer the adverse health consequences. That means that people on lower incomes stand to gain the most from reducing their sugar intake. It is true that there is no single solution to obesity. A sugary drinks levy is one part of a wider strategy that is needed to encourage healthy diet and exercise. Importantly, as well as helping to reduce sugar consumption, the levy will raise revenue that could be reinvested in other initiatives to improve health. So, there will be a double benefit of the levy itself and the health initiatives funded by it.
In the South of Ireland, the Department of Health commissioned a piece of research that was carried out by the Irish Heart Foundation and Ipsos MRBI. They consulted on public attitudes to steps to tackle the high rates of consumption of sugar-sweetened beverages. What they discovered was that almost 100% of people agreed that children drink far too many sugar-sweetened drinks, with 44% saying they would reduce their intake if prices increased and 60% saying they would increase water consumption if they drank fewer sugary drinks. The facts are out there about why it is extremely important to take action as soon as possible on the issue. So that we achieve the right outcomes, we are calling for detailed, comprehensive consultation that would take place within a year of enactment and that would become part of the basis of introducing a levy on sugar-sweetened drinks. I call on the Assembly to support amendment No 4.
While this is probably a well-intentioned amendment, I do not believe that consultation on the issue will achieve anything. The evidence is not clear that it would work. It is not even clear that the Assembly has the power to introduce a tax anyway; this is probably a Westminster issue. It would use up a lot of departmental resources that are focused on other things to produce a consultation within a year.
Such a tax would be regressive and would have the biggest impact on the poorest families, potentially exacerbating food poverty. Based on what little we know, we are not clear whether we can do this, and without being able to take advice on the impact, I would tend to err on the side of caution on the issue.
I call on the Minister to maybe look at it at some stage in the future when all the facts are known and clear. At this moment in time, I am not able to support it without the facts and without the Committee being able to discuss it properly.
I welcome the opportunity to contribute to the group 2 amendments and the amendment that asks for the Department of Health to consult on the possible benefits of introducing a levy on sugar-sweetened drinks.
Obesity is a 21st-century epidemic. A recent study by the Institute of Education in London found that a staggering one in four children born here at the start of the century were obese by the time they reached 11 years of age. It also showed that levels of childhood obesity here are the highest in the UK at 24%, while in Wales they are 23%, in England they are 20% and in Scotland they are 19%. Such levels are not acceptable when we consider the extent to which obesity presents health problems for our children and others and all the problems that those then present to the health service. Serious health conditions often emerge, and the SDLP believes that the Assembly should do all within its power to prevent them from occurring in the first place. That will in turn, as I say, provide savings for the Department of Health.
Part of the global effort to tackle childhood obesity and to raise health revenues surrounds the introduction of a levy on sugary drinks, which is colloquially known as the sugar tax. Here, it is fair to say that we are at a very early stage in the debate. The Health Minister has indicated, and we heard further reflection tonight, that he has no plans to consult on the issue.
A recent RaISe paper that was tabled to the Health Committee stated that there are no recent figures on consumption, so there is a lack of clear data available. A consultation as proposed in the amendment is perhaps a logical step to ask the Minister to take, as we need to make informed decisions on this important issue. I say this sort of humorously, but here we are legislating for consultation when we do not have sufficient consultation for legislation. With regard to the implementation of a tax on sugary drinks, the paper stated that there have been mixed levels of success within other jurisdictions in providing better health outcomes. In Mexico, where there is a 10% levy on sugary drinks, that resulted in a 6% decrease in consumption, but similar strategies elsewhere have had different results. For example, the Danish model saw people buying cheaper brands and travelling across borders to buy products, and, of course, there would be an implication for that here too.
The Finnish model shows that, despite a high level of taxation on sugary drinks since the 1940s, obesity amongst children is actually increasing, albeit at marginally lower levels than in the UK. There is a lot to be considered in this. We need a concerted approach to tackling obesity, and a sugar tax may be one of the elements that would provide an overall solution.
There has been some movement in the UK on the introduction of sugar taxes. The Health Committee considered the issue and recommended the introduction of a tax of between 10% and 20%, along with a crackdown on the advertising of sugary products aimed at children, but that did not find overall favour. As we consider today's amendment in relation to here, there is an issue concerning taxation and who would enforce it. If we take the same approach as the countries that I mentioned, it would require a change in VAT. Of course, that is outwith our control; it is a reserved matter. There are other issues that need to be considered, such as the impact that such a tax could have on the local economy and on local businesses, and they must be given thorough consideration.
The SDLP is open to the concept of having a consultation and is content enough with amendment No 4, but we believe that a more holistic approach is required to tackle all the issues around childhood and other obesity.
I support the amendment. We should first be clear about what the amendment means or, rather, what it does not mean. It does not mean that a sugar tax will be inevitable, and it does not mean that every item of confectionery will suddenly cost more. I am glad that those who tabled the amendment have decided to restrict it for the time being to sugar-sweetened beverages or SSBs. There is no doubt, however, that the regular or excessive consumption of sweetened soft drinks is directly linked to weight gain and obesity and a raft of other health conditions, such as diabetes and heart disease. A fairly recent study found that —
I thank the Member for giving way. This might seem like a very technical matter, but two Members have referred to diabetes being affected by sugar. Of course, there is type 1 diabetes and type 2 diabetes. It is important to put it on record that type 1 diabetes has nothing to do with the intake of sugar.
I thank the Member for clarifying that. I am very aware of that.
A fairly recent study found that 24% of children living in Northern Ireland were obese, and our obesity figures for children aged 11 years were higher than England, Scotland or Wales. It is in that young age group that the consumption of excessive SSBs can have the biggest impact. The average child obtains one tenth of their daily calorie intake from SSBs. Of course, that is only the average child: some will not consume them at all, and, at the other end of the scale, there will be children consuming wildly excessive amounts.
Soft drinks and other sweetened goods more generally are far more prominent now than they were 50 or 60 years ago. However, I believe that, in the last number of years, the tide has started to turn, with many parents actively trying not to put such items in lunch boxes or in kitchen cupboards. Nevertheless, through the sheer variety of items on display and the effectiveness of advertising, too much sugar is being consumed. It is time that we started looking at other measures to reduce the sugar intake of children, not only in Northern Ireland but across the British Isles. I am aware that a number of countries, including many states in the US, have introduced taxes, mainly on sugar-sweetened drinks.
I am very conscious of the fact that government should not usually interfere or introduce additional charges on something that many people consider to be entirely a matter of choice. However, like the banning of smoking in cars in which there are children, sometimes, if there is clear and solid evidence and a foundation for doing so, difficult options need to be explored. This is why I believe that, if a levy were to be introduced in Northern Ireland, its primary motivation should be to influence consumption levels rather than simply to raise revenue. I expect that any money raised would be invested directly in public health campaigns. It has been estimated that a 20% duty on SSBs would reduce the number of obese adults in the UK by 180,000 or 1·3% of all obese adults and would raise around £1 billion in taxation revenue.
Whilst we support the amendment, we would have much preferred to see it being brought forward as part of a wider UK package. It would, however, be right to have concerns about the capacity of a relatively small country like ours to adopt such a scheme on our own. How, for example, would it be administered without placing a major bureaucratic burden on whatever Department would ultimately be responsible? Also, major care would need to be taken to assess properly the differing impacts on families from different socio-economic backgrounds. Whilst I want average consumption reduced, I do not want the occasional can of Coke to be priced out of reach of young people or their families.
I support the amendment; it is only right that we have a consultation and start to open up a public conversation on the issue, but, in reality, I suspect that we are still some time away from being able to make an informed decision as to whether or not to introduce such a scheme.
Very briefly, our party can concur with the content of the amendment. Obesity, as was said, is a major public health issue. It can limit life opportunities and lifespan, it brings a range of economic and social consequences, and it is responsible for considerable expense in an overstretched health service. We can, of course, sympathise with constituents who have an obesity problem. The amendment is unusual in that it is mandating that a public consultation occur. I would have thought that that could take place at any stage without public consultation. That said, the Alliance Party has no objection to the amendment if it is the view of the Assembly that it wants a watertight guarantee that a consultation would occur. Nevertheless, a consultation does not in itself entail follow-up action, and I am interested in the Minister's thoughts regarding any action that his Department might take on the issue.
In this job, I have often had occasion, when discussing the need to reform, change and remodel our health and social care system, to talk about the many challenges that face it as well as the broader societal challenges that we face now and into the future. Among those sorts of challenges that I often refer to, there is one that I have described as the "ticking time bomb" of unhealthy lifestyles. In their contributions this evening, many Members talked about the ticking time bomb of obesity in our society. It is not just in Northern Ireland; it is in the Western World, and many countries and states in this part of the world are suffering and experiencing the same problems as us, with growing levels of obesity and, particularly worryingly, childhood obesity.
The Royal College of Paediatrics and Child Health recently estimated that nearly 20% — one in five — children in Northern Ireland are now overweight or obese before they start primary school. We often bandy figures and statistics about, and we have done so in the debate so far and will continue to do so, but a statistic that says that one in five children, before they start primary school —not when they end primary school or move from primary school to secondary school — is obese or overweight is evidence of a deeply worrying trend that is not getting any better.
A recent health survey of Northern Ireland showed that there has been a 5% rise in the rate of obesity in adults since 1997. As many Members said, poor diet is also linked to the prevalence of many conditions such as cancer, stroke, heart disease and type 2 diabetes. I accept that these are, in many respects, arguments for action, which is why my Department published 'Making Life Better 2012-2023', which is our 10-year public health strategic framework. The framework provides direction for policies and actions to improve the health and well-being of people in Northern Ireland, and it builds on the Investing for Health strategy, which ran from 2002 to 2012, and retains a focus on the broad range of social, economic and environmental factors that influence health and well-being.
It brings together actions at government level and provides direction for implementation at regional and local level. The Making Life Better framework seeks to reduce inequalities in health and create the conditions for individuals and communities to take control of their lives and move towards a vision of a Northern Ireland where all people are enabled and supported in achieving their full health and well-being potential.
I am not convinced that we should act to introduce a so-called sugar tax at this time, and I urge caution on the amendment for several reasons. First, it is still unclear whether the Assembly has the power to implement a sugar-sweetened drinks levy or tax independently in Northern Ireland. This is an important issue because a decision to proceed is likely to come under very significant challenge. Therefore, we need to be very sure of our legal position before we proceed. Otherwise, we could create expectations that this is an area that we can take action in, when that might not be the case. The Department is seeking further advice on the issue, but it remains crucial to the entire debate, and we simply may not have the powers to implement such a levy in Northern Ireland.
Secondly, it is unclear from the current evidence that such a tax would have the desired effect of improving health outcomes. To date, studies have simply shown changes in purchasing behaviours. At Second Stage, I referred to an article that appeared in 'The Times' a number of weeks ago, and I think that its points are worth repeating this evening. The report contained comments from Catherine Collins of the British Dietetic Association (BDA). On reading the report, I initially thought that, if any organisation was going to be in favour of a sugar tax, it was probably the BDA, but her comments were also cautionary. She warned against becoming "fixated" on a tax, saying that it was wrong to single out sugar when a bit of everything and not too much of anything remained the best advice. She went on to question whether it would make people lose weight, and her view was that it would not.
She said that there was no evidence that reducing sugar-sweetened beverages in adults reduced body weight. It might be logical that any reduction in the purchasing of sugary drinks might improve health, but food consumption and diet are very complex, and people may well substitute sugar with other unhealthy products, such as those that are high in fat or salt, which would beg another question: should we tax those products as well or tax them further? Some in the House may welcome that. Should we tax a lack of exercise, which is another contributory factor to the rise in our obesity levels? A sugar tax might simply displace rather than solve the problem, and we would need to undertake very complex economic modelling of its impact. This could take time to complete and would be a waste of resources if we do not have the power to implement such a tax.
Thirdly, such a tax could well be, as Mr Ross said, regressive and have the biggest impact on the poorest families, potentially exacerbating food poverty.
Fourthly, we have no understanding of what the impact might be on businesses, especially small businesses here in Northern Ireland.
Fifthly, we do not yet have any analysis of the level at which a sugar tax should be set. If it was a few pence, would that really dissuade people? I suspect that it would not. If it was higher, what effect would that have on less well-off families and, indeed, businesses? We have no analysis either of the cross-border implications that Mr McKinney rightly pointed out.
Finally, on the argument for caution moving forward, I do not believe that this issue has yet to receive the attention that other public health issues have had over the years: for example, smoking, which we have been debating this evening. I do not believe that the impact that sugary drinks or sugary products have on health, and particularly obesity, have been properly discussed and debated in public in the way that other issues have.
I thank the Minister for giving way. Does the Minister agree that the amendment tabled today does exactly what it says on the tin? He mentioned some of the issues to do with consultation and the definition of sugary, sweetened drinks. What sugary, sweetened drinks should we subject to a levy? What factors need to be considered? What rate should a financial levy be set at? What are the anticipated health and economic impacts? Does the Minister not agree that consultation is exactly what we are calling for?
I am not sure that that is what is being called for in a consultation, and I will come to that in my concluding remarks. The point that I am making is that I do not think that this issue has had the degree of attention in the media or public discourse that, say, the public health impact of smoking or even the consumption of alcohol has had. I defy anybody in the House to say the contrary. I think that we need to be careful of moving ahead of that public debate and discourse. We have not had TV adverts or warnings on packaging that we have seen, say, with smoking or other public health campaigns. I do not think that people know how much sugar there is in various products and I am not sure that it is as widely known as the impact that smoking has on our health.
An interesting point on this issue was made in a BBC 'Question Time' debate by the leader of the United Kingdom Independence Party, Mr Farage. Why is it so obvious that Mr Farage would drink something like ginger beer? It is so quintessentially British. He said:
“Whether my can of ginger beer that I like costs 65p or 75p, it makes no difference, but learning in the last year that it contains 12 teaspoons of sugar has shocked the life out of me and I’m not buying it any more. Education, not tax, is the answer.”
I agree with him on that argument. At least for now, I agree that we need to seek to educate and inform people much better about the impact of sugary drinks and products.
As I predicted in advance, the proposers of the amendment, Ms McLaughlin and others, may well suggest that these are all issues that could be examined as part of their proposed consultation. I am not convinced that we should ever legislate for consultations. Notwithstanding that point, consultation is, in my belief, better suited to a scenario where you have a much clearer view about the ultimate direction of travel in which you want to go. In this case, that would be when we had determined that a sugar tax is a good idea. We have dealt with all the various questions that Ms McLaughlin raised in her intervention. You determine that a sugar tax is a good idea and something that you want to introduce, and you then consult on the details and specifics of how any tax or levy might operate.
What is perhaps more appropriate at this point, in this set of circumstances where we are still at the very early stages of our thinking on this and understanding of the issue, is a study as opposed to a consultation. I have consistently said that I am open to debate and discussion on this issue. However, given the concerns that I have set out — there are probably others that I have not touched on or which have not been thought about yet — I do not think that this Bill is the most appropriate place to have this discussion. I believe that a study, maybe one conducted by the Public Health Agency in Northern Ireland, would, in the first instance, be a far better first step than committing to a consultation. If the proposers of the amendment agree not to move it today, I will discuss the possibility of beginning a study later this year with the PHA. I therefore think that the amendment should be rejected at this stage and that discussions on taxing sugar-sweetened drinks should be taken forward separately.
Go raibh maith agat, a Cheann Comhairle. Amendment No 4 does not introduce a levy on sugary drinks; it merely asks that a consultation be carried out. It is an opportunity, at this very early stage of the conversation and debate, for the Assembly to lead on an issue that will have a positive outcome in terms of improving levels of public health.
Only last week, I listened to a vox pop on the radio about the high level of sugar in some coffee drinks in some of our well-known coffee establishments in Belfast. A number of members of the public in Belfast were interviewed, and most of them were extremely shocked at the vast amounts of sugar in their drinks. This is not restricted to fizzy drinks in the fridge. Sugar in hot drinks is perhaps another area that can be looked at.
It is very surprising too, because the calories are listed on the menu in a lot of those establishments. The information may be there, but you are relying on those who go into the coffee shop reading it and taking it in while they are choosing what to purchase. I think that the message there is to mind your frappuccinos.
The proposer of the amendment, Rosie McCorley, referred to the fact that our diet is changing. There are greater levels of obesity and diabetes, at a cost of £92 million a year — £92 million that could be better spent elsewhere in our health service. Obesity also leads to increased rates of cancer.
It is interesting — and Mr McKinney referred to this — that there was a reduction in the sale of sugary drinks in Mexico after the sugar tax was introduced. So it works in some circumstances, and we need to take the time to look at the case studies as to where it failed and tailor our approach accordingly.
The argument was made that low-income households suffer most regarding health. This needs to override any other argument citing the low-income buyer.
Alex Easton was short and sweet. He said that it was, perhaps, a Westminster issue, and he was not sure that we could legislate. He said that it was regressive and that the poor would suffer. I disagree with that point. The same argument was made when we brought forward proposals for a carrier bag levy. At that time, we were told that, if the taxation measure was not already in place at Westminster — that is, that it was a novel tax — we could legislate for it. So this is certainly worth exploring further.
Fearghal McKinney referred to the fact that one in four is obese by the age of 11. He referred to the fact that the rate of child obesity is 24%, or one in four.
Jo-Anne Dobson referred to the fact that soft drinks are more prominent than they were 50 or 60 years ago. That is absolutely true. I know many young people who have a bottle of coke for breakfast, even though they are told not to do so. These products are available, and there is so much choice, between Red Bull, Diet Red Bull, Diet Coke, Coca Cola, Fanta, Sprite. There is so much more choice than there ever was. Then, there is the issue of where many shops place these products. Quite often, when you are standing in a queue to buy something healthy, you are surrounded by sweets, crisps and fizzy drinks. You can see quite clearly, from that example, how the choice of something that is not good for you is staring you in the face. This is also an area that is in need of further consideration. It is something that was introduced in some US states, but I agree with Mrs Dobson that we need to look at it carefully. She said that it was right that we had a conversation.
Kieran McCarthy stated that obesity is putting pressure on an overstretched health service, and he wants more than consultation; he wants to hear about action. I agree with him absolutely.
The Minister, in responding to the debate, referred to the ticking time bomb of our lifestyles and the fact that the strategic framework has been put in place. He also referred to the fact that there is no understanding of the impacts on business and on lower-income families and said that they should be considered. We would like them to be considered as part of any consultation or conversation.
Of course, you always hear the argument — and it applied to the carrier bag tax as well — that low-income households will suffer more from a levy. If there were no tax on cigarettes or alcohol, you would get the same argument. However, the fact of the matter is that these things do damage. They are very bad for our health. They kill people. Cancer caused by smoking kills people. Alcoholism kills people. Obesity and diabetes kill people as well. So, we need to take measures to prevent this spreading.
It is not the only thing that we need to do. We need to exercise more. As a society, we do not exercise enough. We spend too much time in our cars, whether there is smoke in them or not, and that is not good for us either. Equally, we need more investment in a walking strategy. I met Outdoor Recreation NI earlier this week. There is a walking strategy in Scotland. Why could we not have the same here? Of course, we need a greater cycling infrastructure to ensure that people make those choices in Belfast as well as in our rural areas.
To conclude, this is an idea whose time has come. It will be a good start.
Amendment No 4 agreed to.
Amendment No 5 made:
After clause 5 insert<BR/>
5A.—(1) The Department must not later than 3 years after the commencement of this Act review and publish a report on the implementation of Part one.
(2) Regulations under this section shall set out the terms of the review.". — [Mr McKinney.]
Clauses 6 to 11 ordered to stand part of the Bill.
We now come to the third group of amendments for debate. With amendment No 6, it will be convenient to debate amendment Nos 7 and 8. These amendments deal with a duty to promote information and awareness on human transplantation. Amendment Nos 7 and 8 are consequential to amendment No 6. I call Ms Maeve McLaughlin to move amendment No 6 and to address the other amendments in the group.
I beg to move amendment No 6:
After clause 11 insert<BR/>
HUMAN TRANSPLANTATION AND ORGAN DONATION
Duty to promote transplantation
11A.—(1) The Department of Health, Social Services and Public Safety (“the
(a) promote transplantation, and
(b) provide information and increase awareness about transplantation.
(2) The duty under subsection (1)(a) includes in particular a duty to promote a campaign informing the public at least once a year.". — [Ms Maeve McLaughlin.]
The following amendments stood on the Marshalled List:
No 7: After clause 11 insert
"Annual report on transplantation
11B.—(1) The Department must lay before the Assembly, in each financial year, a report about transplantation activities in that year.
(2) The report must include?—
(a) the steps taken by the Department to fulfil the duties set out in section 11A, and
(b) the number and nature of transplantation activities carried.
(3) At least once every five financial years, the report must include?—
(a) the opinion of the Department as to whether this Act has been effective in promoting transplantation activities, and
(b) any recommendations the Department considers appropriate for amending the law so as to promote transplantation activities.". — [Ms Maeve McLaughlin.]
No 8: In the long title, after "care" insert
", to raise awareness of human transplantation". — [Ms Maeve McLaughlin.]
Go raibh maith agat, a Cheann Comhairle. I will speak in support of amendment Nos 6, 7 and 8. There has been much public debate about the need to promote organ donation and transplantation over the last number of years and in recent times, centring around the former private Member's Bill. There has been much debate about the need to place a duty on the Department to promote organ donation and transplantation. We need to reflect on the facts and look at the information. For example, the British Heart Foundation highlights, very starkly, that the current system is failing to meet the demand for donor hearts and points to the fact that there are currently eight people in the North waiting on a life-saving heart. There is much expectation and indeed a very human cost to this particular debate.
It is good that the public conversation has developed and become very vocal. However, it has to be said that the private Member's Bill that came before us in recent times was complex and confusing. Expert evidence, medical and otherwise, highlighted that huge sections of the Bill were inadequate. Experts, from clinicians to charities, all heavily criticised the Bill. It needs to be said that, in the context of these amendments, they were particularly critical of the then clause 4 on the deemed-consent issue. Indeed, Joe Brolly, in his own formidable style, stated that the Bill was "gobbledygook".
The Bill was flawed, in our view. The majority of evidence heavily criticised it on the issue of deemed consent. That was a consistent approach from clinicians to charities, including Opt for Life, which stated, "deemed consent under no circumstances". I say that because it is important to lay out the context. There was simply no evidence anywhere in the consultation —
I thank the Member for giving way. I thought that it would be useful, in the context of the debate tonight, to quote from the Opt for Life proposed legislative change in Northern Ireland. The proposal clearly sets out a three-pronged strategy for organ donation: putting in place new legislation, putting the required infrastructure in place and creating good public awareness during and after the proposed legislation.
I thank the Member for her intervention. There was absolute unity across all the sectors on public awareness and education. However, it is a matter of formal record that, when Opt for Life and many others came before the Committee, they stated clearly that what we were ending up with was not the journey that they had set out on. We need to be mindful of that.
It is important to point out that there was absolutely no evidence to suggest that the notion of opting out impacts either positively or negatively on organ donation rates. There was simply no evidence that the Committee could find. Often, Spain is heralded as the success, but evidence has shown us that the rates stayed exactly the same for 10 years. The only time that the situation in Spain changed was when the infrastructure was addressed, in terms of issues like specialist nurses. However, there was — I am coming to the point of the amendments — unity on promoting organ donation. Amendment No 6 before us tonight, which was consulted on in the private Member's Bill, does exactly what it says on the tin: it places a duty on the Department of Health, Social Services and Public Safety to promote and raise public awareness of organ donation. There was overwhelming support for that duty on the Department to promote organ donation by way of a public awareness campaign.
I thank the Member for giving way. I find it amusing that she is making all the arguments that I made at Second Stage of the private Member's Bill. Members of Sinn Féin argued against me at the time, and I remember some Members promoting the virtues of deemed and presumed consent at the time. I am glad that they have now examined the evidence, as I asked them to do.
I have no difficulty with what the Members are trying to do with their amendment, but perhaps they will look at it again in terms of the difference between promoting transplantation and promoting organ donation. It is organ donation that we need to promote; transplantation, obviously, comes afterwards. Obviously, you need to get the organs donated in the first place before you can do that. Perhaps the Member will consider that.
I thank the Member for his intervention. That is certainly one of the virtues of the democratic process and the role of the House in scrutiny. I think that all of us went on a journey in relation to the issue, and I do not expect that we are out the other side of it yet. I take the Member's point about language. It is certainly something that the clinicians have raised. Part of what we propose today is the inclusion of both organ donation and transplantation. I am happy to look at how we can strengthen that or even provide clarity. We will be guided by the Minister and the Department's sense on that as well.
There is overwhelming support for the duty. It was highlighted by many in their evidence that the public awareness campaign will need to motivate every family. We have heard much about the work that the Public Health Agency and other sectors have done. Each family needs to start to discuss organ donation and understand what their responsibilities would be, should a member of the family be in the position to save a life.
Amendment No 6 is clear and concise. It places a statutory duty on the Department to promote transplantation. Amendment No 7 sets up a mechanism that requires annual reporting by the Department on transplantation activities. That, again, has been an important feature throughout the debate. It would include the number and nature of such activities. It would require the Department, once every five years, to indicate how effective it has been in promoting transplantation activities and any potential ways in which the law could be amended to increase transplantation. That is an important point as well, because we have heard much about the legislation that has been implemented in Wales. This provides us with a space to find the learning, positive and negative, that comes from that process.
A number of organisations referred to the reporting requirements and suggested that any report should highlight successes and challenges. They said that, if there was a change in the number of organs donated, steps should be taken rapidly to understand the root cause. Again, those are all important pointers for us as we move forward.
I also suggest that the amendments provide us with an opportunity to develop an all-Ireland network for the sharing of learning that happens in Dublin and Belfast. I know that, recently, the Minister alluded to exploring something on a Belfast-Dublin corridor for that issue.
I am pleased to be able to take forward the amendments. They are clear and concise, and they provide us with a clear statutory framework to address the very core issues that have been raised with us by stakeholders from clinicians to charities in evidence and in the wider public debate. I urge the House to support the amendments.
I will speak to the group 3 amendments, which are on the duty to promote information and awareness of human transplantation, and on amendment Nos 6, 7 and 8, which I support. I will wholeheartedly support all those amendments, although I will say that it was a wee bit cheeky for the party opposite to lift somebody else's Bill. However, I recognise that the contents of the amendments are far too important to be just let go. I agree that they must be taken forward, especially after the evidence brought to the Committee by clinicians and experts. While, like I said, it was a wee bit cheeky, it probably is the right thing to do. I agree with the Chair that the Committee and the experts, the Churches and charity groups that gave evidence agreed unanimously — this was the only thing that we could all agree on — that education and promoting public awareness was the way to do this. That is where all the evidence pointed us, and that is why I support that.
Amendment No 6 proposes placing a duty on the Department to promote organ transplantation in a campaign that informs the public at least once a year. That was echoed to the Committee by the experts and was seen as the best way to increase organ donation. The clinicians and medical experts all supported that. I trust the experts, because I believe they are the ones to advise us and that that is the way we have to go.
Amendment No 7 places a duty on the Department to report on an annual basis on organ transplantation, on how successful the strategy is and on awareness activities that take place to promote and highlight the issue in local communities. It also ensures that the Department will report its opinion every five years on whether the provisions have been effective in promoting the transplantation activities and on any recommendations the Department considers.
Amendment No 8 is the long title, and there is really not a lot to say on that.
I welcome the opportunity to contribute to tonight's debate on the group 3 amendments. We should remember that what we have here was never intended to be part of the Health (Miscellaneous Provisions) Bill. What we have is the skeleton of a Bill that was proposed by Jo-Anne Dobson and largely rejected by the two larger parties. The SDLP attempted to amend it, and that was largely rejected by the two larger parties. What we now have are measures that appear to be tagged on to the end of the Health (Miscellaneous Provisions) Bill. That was done without even giving Mrs Dobson the courtesy of telling her what was coming down the track.
Given the effort that was put into this, and in recognition of what Mr Ross says about how people have travelled in the debate, I think that she deserved that courtesy. I understand where you are coming from, Mr Easton, but I think that "cheeky" is an understatement. Earlier, somebody mentioned a journey. I think that Mrs Dobson has had her luggage taken by those who have jumped on the other carriage. I say that in the context of what has happened here. A lot of effort was put into this, and we still need to consider the issue much more fully than in the process that is being proposed tonight, but I will get to that later.
It is important to remind the Chamber that around 200 people here are waiting for an organ transplant and that, sadly, 17 died last year, long before being offered the opportunity for a transplant. A few weeks ago, I visited the renal unit at Belfast City Hospital and met clinicians who, frankly, are performing nothing short of miracles. They explained the detrimental impact that long-term dialysis has on patients and the importance of receiving a kidney as soon as possible. This is a startling thing, but, last year, seven people came to the centre and donated a kidney, not, as many might expect, for a spouse or other family member, but for a stranger. I think that all of us here tonight should applaud those people for that generosity.
One issue raised during the visit surrounded the potential to increase cross-border living donations. Clinicians stated that progress has stalled on a service agreement between both jurisdictions. I would like the Minister to reflect on that and to detail what work his Department is engaged in to make cross-border donation a reality. I think that that request for information speaks to the broader context of where the debate should be. There is a great potential to share resources, to collaborate on increasing donation rates on an all-island basis, and, ultimately, to save more lives, because it is my understanding that there are even more people in the Republic willing to donate anonymously. That is nothing short of marvellous, and it is preparation for even more miracles.
So, it is against that wider backdrop that it is important that the Chamber does everything that it can to promote organ donation to ensure that people on waiting lists have the best chance of receiving a life-changing organ. It is important, and the Chamber should acknowledge the amount of work that Jo-Anne Dobson has done in bringing forward her Human Transplantation Bill. It is with regret that she will not be moving forward with her Bill, due to a lack of consensus, but, as I said, I hope there will be a return to the issue in the new mandate.
The SDLP has always called for more debate on organ donation and has lobbied for an increase in the number of organ donors to improve the networks for sourcing and sharing donor organs and transplant services throughout these islands for those seriously ill people who are on long waiting lists and whose lives are dependent on the gift of organ donation. The SDLP believes that today's Bill does not resolve the outstanding issues surrounding organ donation; it also believes that the issues surrounding increasing donor rates need much wider consideration. I cannot emphasise that enough. However, due to the fact that we are coming to the end of a mandate, the SDLP will not object to the proposals made in group 3, which call for greater awareness raising and an annual review of organ donation.
I welcome the opportunity to speak on the third group of amendments. It will come as little surprise to Members that I am prepared to accept my own wording in relation to organ donation, as contained in amendment Nos 6 and 7, which are a direct lift from my private Member's Bill, the Human Transplantation Bill. However, for the record, Members will be aware that, having been presented with the opportunity through a private Member's Bill to change the law to a soft opt-out system, parties and Committee joined together to oppose the system that they had both previously supported.
Whilst I support the amendments in the Bill, public awareness is just one part of the soft opt-out system and will not allow us to avail ourselves of the changes brought into being to the organ donor register last July, namely the ability for those who have an issue with donation to opt out. I do not, however, wish the Health Department to kick the can down the road by stating that, if these amendments are passed today, we must wait for the legislative changes to kick in before we can ever look at adopting a soft opt-out system in the future. Given the public will for change, I challenge the Health Minister to ensure that organ donation is given prominent billing in the ongoing discussions regarding the next Programme for Government.
I also noted the concern that was expressed during the Second Stage debate on the Human Transplantation Bill about the cost of my proposal for a public awareness scheme. I wonder whether those same Members hold those concerns tonight.
I strongly support all measures that will increase the number of organ donations. There are few more selfless acts a person can do than to sign up to become a donor. We must remember that many transplantations take place after the loss of a loved one, yet, for the recipient, that organ represents the chance of a new life. It is a second chance to live a long and healthy life, which is why the issue should be treated with sensitivity. There are countless examples of people who were desperately ill and are now living perfectly healthy lives. Members will be aware that my son Mark is only one of those people.
The fundamental point is that increasing the rate of organ donation will allow us to save more lives, especially given the ageing population, when need will only increase in five, 10 or 15 years' time. As long as Northern Ireland continues to look on from the sidelines, especially as other regions of the UK introduce or consider the introduction of their own soft opt-out systems, lives will continue to be needlessly lost. It is a tragedy that, last year alone, 17 people passed away while waiting on an organ. In addition, many other people on the transplant list, such as those who require a kidney transplant, are being confined to a lifetime on dialysis, and they and their families are suffering as a result.
Whilst I accept that good work is being done and that the amendments may go some way to help, the brutal reality is that, despite many years of trying and public support for organ donation standing consistently at around 90%, the number of local people signing up to the organ donor register has not risen beyond around 35%.
I commend Mrs Dobson's work in introducing and progressing her private Member's Bill and the Committee's work in scrutinising and shaping it. It is probably slightly bittersweet for her. Whilst the wording of the amendments is similar to the Bill, they probably fall short of what Mrs Dobson would like to have pushed onto her agenda for organ donation. At least it lays down an important marker. We may have found agreement in the Chamber as to how we progress something and, as the Chair said, put some of the structure in place on how to improve organ donation and availability.
Much of the debate on organ donation is about how to continue to ensure that families have those important conversations long before they are confronted with a set of tragic circumstances and that families know about their loved ones' expectations and wishes and what they wanted. That is very important in dealing with the blockages and issues at times of organ donation that seem to be presented to the Department. People may be on the organ register, but their family objects to donation.
It is a set of circumstances that one would never want to be confronted with. Imagine the difficulties of such a traumatic event and having to make those decisions. However, that is the important point about these amendments, which are about promotion and putting some structure in place to make sure that we can maximise donation so that, from now, the number of lives that were not saved — 17 people — falls, year on year. We can ensure that people who wish to donate have their wishes respected in the end and are not overruled by their family. All of that has to be done through very sensitive conversations that must be had at a difficult time.
I support the amendments on organ donation. They do not go as far as I would have liked, but I will certainly support them.
Apology accepted, Mr Speaker. I assure Members that I will be brief. On behalf of the Alliance Party, I support the amendments. However, the amendments come in the context of the recent de facto demise of Jo-Anne Dobson's private Member's Bill. I must express my astonishment about the opposition at the Health Committee meeting where Jo-Anne Dobson's excellent work and efforts were annihilated by the two bigger parties. That was unfortunate, to say the least.
While we do not yet have the basis or consensus to move towards a workable form of soft opt-out option, we have, nevertheless, had a much wider-ranging debate around human transplantation. There is clearly a need to encourage a greater volume of transplant organs, and I therefore support these amendments. Anything that the Assembly can do to provide organs for desperately ill people must be welcomed. We commend those who have given their organs to save the life of someone else, be they a family member or a stranger. Organ donation must be encouraged, and we support all measures to increase the number of donations available to be provided throughout Northern Ireland.
I note that amendment No 6, which appears in the names of Rosaleen McCorley, Daithí McKay and Maeve McLaughlin, mirrors the amendment to clause 1 of the Human Transplantation Bill recommended by the Committee for Health, Social Services and Public Safety in its report on the Bill. Members will be aware that the Human Transplantation Bill, as has been mentioned during the debate, was withdrawn by the Bill's sponsor, Mrs Dobson, following the Committee's report. That report proposed significant amendment of the Human Transplantation Bill, given the almost unanimous views expressed by clinicians that the system of statutory soft opt-out from organ donation, as proposed by the Bill, would potentially undermine the significant achievements of our organ donor programme over the last 20 years. I believe that the Committee was brave in doing what it did and should be commended for listening to the clear and unequivocal evidence that came from clinicians who work in the fields of intensive care and transplant surgery. I believe that the private Member's Bill was designed with the best of intentions but, in its drafting, it had the potential to damage our organ donation system; a system that is among the best in the world for live donor rates.
The work undertaken by the team at Belfast City Hospital was mentioned by Mr McKinney. I concur with his remarks entirely, and I am glad that he had the opportunity to visit the unit. I met clinicians and visited the same unit in the summer of 2015.
I am happy to take that point now, but I will come to it in more detail later in my contribution. It became clear to me, as it became clear to others and, indeed, to the majority of the Committee that, when you have public evidence such as we had before the Committee during its deliberations and evidence sessions from clinicians saying that they were deeply concerned about the Bill as it was drafted and that any move to soft opt-out or deemed consent — whatever one might want to refer to it as — could damage our system, it was only right and proper not to move forward with any amendments and to take a different approach. Again, I commend the Committee and its members for taking the approach that they did.
I noticed in some evidence sessions that the Member said that she had possession of various amendments that would have altered the Bill and perhaps made it more workable. She was at perfect liberty, if she had those amendments, to bring them forward at Consideration Stage when she brought the Bill back to the House. Perhaps she can explain why she did not do that if she was in possession of those amendments.
We have a system that is amongst the best in the world. I concur with what Mr McKinney said. The team is quite extraordinary. As I may have said at Second Stage, it is refreshing when you meet a team of clinicians in any field and they say to you quite openly — it is not something that we are very good at in this part of the world or that we are known for — that they want to be the best in the world. They are amongst the best in the world, if, indeed, not the best in the world, at what they do. We should be rightly proud of what they do. It is a team that has equalled the UK record for the number of transplants by one unit in one day. We should put on record again our thanks for everything that they do and our support for all the endeavours that they make. The fact that they are amongst the best in the world is a reason why we should listen to them when they speak.
The work undertaken by that team has seen live organ donation rates in Northern Ireland rise and rise to a level that is absolutely definitely the best in Europe and is one of the best in the world. That is amazing. We tamper with a system that is working well at our peril.
I will pick up on another point that a couple of Members spoke about. Cross-border organ donation opportunities was a point that I mentioned in my North/South Ministerial Council sectoral format statement last week. I think that there are opportunities to open up a cross-border Belfast/Dublin corridor for organ donation. When you talk to our clinicians at Belfast City Hospital, they will tell you about how there are two teams doing very similar work in two jurisdictions but who have not really spoken to each other properly, formally or consistently over 20, 30 or more years. Clearly, there are opportunities for them to learn from each other, as, indeed, there are opportunities to learn from teams around the world. However, there are particular opportunities to develop a service on a cross-border basis, which would be to the benefit of people on both sides of the border.
It is notable that, in 2014, the Republic of Ireland reported a dip — it was more than a dip; it was a drop — of a quarter in their organ donation levels. They are experiencing a very different problem from us. We have seen an increase in our organ donations in recent years. We have a far superior live organ donor rate. I recall media reports earlier this year that their figure was much lower than ours in Northern Ireland. To answer the questions that have been raised, I understand that discussions have started between clinicians. It is something that I raised proactively at the recent North/South Ministerial Council meeting, and I am keen for officials to take forward and explore the opportunities that there might well be.
We do kidney transplantation here but we do not do other transplantation in Northern Ireland. Many people, including some I know very well, have had to travel to Great Britain to get their transplant. Many of them would say to you that they are very grateful for the service that they get, but, on many occasions, they have to travel and it is unsuccessful and then they have to return home. They have to make several journeys before they get a successful match and a transplant.
That travelling is nearly more stressful than the fact that they are waiting for a transplant. Therefore, anything that we can do on a cross-border basis is to be welcomed.
We tamper with a system that is amongst the best in the world at our absolute peril. That is the message of clinicians such as Tim Brown and Aisling Courtney. Aisling Courtney said to the media recently that the clinicians are:
"concerned it might make things worse and what we all want ... is to make things better."
Doing damage to our organ donation system was a genuine fear, and Dr John Trinder, a consultant in intensive care medicine who gave evidence to the Committee during its deliberations, described the Bill as being "unhelpful and potentially harmful."
A one-time cheerleader for the Bill, Mr Joe Brolly, whom the Chair of the Committee referred to earlier, said that the Bill was "total gobbledygook" and "very confusing". When leading clinicians and organ donation advocates were freely expressing their concerns about the possible negative impact of deemed consent, the Committee was right to listen and to act as it did.
Since coming into this job, I have been pressed by many inside and outside this House to make my decisions as Minister of Health on the basis of the available scientific and medical evidence. I have made it crystal clear that I will always be guided by the scientific evidence and that I will listen to our clinicians. In circumstances in which virtually every transplant surgeon, nephrologist and intensive care consultant expressed deep concern that the original private Member's Bill could damage our world-leading organ donation system, we were all wise to sit up and listen.
I listened to comments from some Members, including those of the previous Member to speak, who suggested that decisions were taken on the basis of party politics. To suggest that is completely and utterly inaccurate. I stress again that transplant surgeons, nephrologists, intensive care consultants, with one voice, urged caution and expressed their worry that the Bill would damage our system and possibly deter people from donating organs. When that sort of evidence comes forward, it affirms the views of many in the House, and I am glad that it convinced others to change their mind as well. Caution, as we were urged to take, was the right thing to do in the circumstances.
To return to the amendment, it proposes placing a duty on my Department to promote organ transplantation in a campaign informing the public at least once a year. Although my Department believes that our record on promoting the organ donor register speaks for itself in raising awareness, I have decided to support the amendment, especially given that it has emerged from an informed and comprehensive review of the matter by the Committee. Furthermore, the very same clinicians that I mentioned earlier have encouraged us all publicly to enhance our efforts to educate the public about organ donation and, in so doing, raise societal awareness of the subject to a new level. I therefore support amendment No 6.
Amendment No 7 broadly mirrors the amendment to clause 14 of the Human Transplantation Bill, which was also recommended by the Committee in its report. The amendment proposes placing a duty on my Department to report annually on organ transplantation and awareness activities. It also proposes that, every five years, the Department should report its opinion as to whether the proposed provisions have been effective in promoting transplantation activities and any recommendations that the Department considers appropriate for amending the law so as to promote transplantation activities.
The proposed five-year interval for examining the need for any new legislation is, in my view, a responsible and sensible proposition. It is responsible because it should provide the clinicians with the space to get on with their job without any further short-term distractions of legislative proposals for soft opt-out or deemed consent. It is sensible because it would provide the Assembly with sufficient time to assess and reflect on the impact of the soft opt-out system introduced in Wales last year.
Although I have decided to support the amendment, my Department will seek to bring forward a technical amendment at Further Consideration Stage on the operation of the annual reporting cycle to clarify that, if the proposed report is to cover activities in a year fully, it can be finalised only after the year has ended. That having been said, I support all the amendments in the group.
Go raibh maith agat, a Cheann Comhairle. First, it is important to clarify that I do not share the same position as Mr Alastair Ross in this debate.
It has been a good debate. I came onto the Health Committee relatively recently. This has been a good Committee Stage. We all came at this from the perspective that we needed to secure the best outcome for organ donation rates. Many of us have been on a journey. I still think that soft opt-out, and all options, should remain options and should be given full consideration in the new mandate. However, a mixture of views were presented to the Committee. There were views given on some of the proposals to the Committee that I did not expect, and I think that the right decision was to hold off on this. The system we have is one of the best in the world and, given that mounting evidence and those mounting presentations, we need to be very careful about what we do next. As we were coming into the new year, concluding our evidence, and only had a number of weeks to take a decision that could have massive ramifications, I felt that the proper decision was to ensure that we take more time to look at this. Many made the point that we should wait and see how Wales does. I think that the Department should consider soft opt-out, keep that under review, and see the experiences elsewhere, but, on the basis of the evidence given to the Committee and the many differing views that we held, I felt that this was not the time to move forward with soft opt-out and that it certainly was not right to do it in a rushed manner given that the clock was ticking down to the end of the mandate.
On the other hand, credit has to be given to the proposer of the private Member's Bill, Jo-Anne Dobson. As a proposer of private Member's legislation, I know that there is a lot of work, a lot of effort and lot of grief. We have all seen the energy and commitment that Mrs Dobson put into that. It has generated great debate over the past year, and I have no doubt that that debate has, in itself, contributed to more people signing up for organ donation. I think that all Members agree that Mrs Dobson has done a great public service in bringing the private Member's Bill forward. As Mr Easton said, we felt that we needed to hold on to aspects of that Bill and put them forward. It may look messy as part of a miscellaneous Bill, but, given the impact that those amendments could have on organ donation rates, we believe that it is the right thing to do to improve the world-class system that we have. I congratulate Mrs Dobson on the work she has done, and I have no doubt that this issue will come back to the Chamber in the new mandate. We will need to give it full consideration again then.
One of those who is urging people to consider organ donation is Lucia Quinney Mee, a student at Cross and Passion College in Ballycastle in north Antrim. She has had three liver transplants in her life and has campaigned vigorously to find ways to improve the organ donation system. She has set up a Facebook page called Live Loudly Donate Proudly, and I am sure that some Members are probably sitting on Facebook at the minute and could check that out, like it and share it. A lot of people out there are campaigning to improve the organ donation system, and they all deserve much credit for the immense work they have done on that in recent months. Public awareness is the big issue and is a huge factor in ensuring that we get more names on that list, and I have no doubt that the success stories of Lucia Quinney Mee, Joe Brolly, Shane Finnegan and others have helped contribute to the higher donation rate that we have.
Maeve McLaughlin opened the debate and said that there had been much debate about organ donation promotion. She referred to the different views of the original PMB but stated that there was now unity on promoting organ donation and that it was important that we moved forward on that. Alastair Ross made a useful intervention, saying that the amendments needed to be tweaked. That is what Further Consideration Stage is for, and we will be open to agreeing those amendments.
Alex Easton said that the amendments were cheeky and the contents too important to let go. Fearghal McKinney took a counter view, saying that this was a skeleton of a Bill and that "cheeky" was an understatement. However, he made a good point about the good work of our clinicians. They perform nothing short of miracles. I spoke to someone recently who was with a close friend as they were carrying out work, and they worked from night until morning with hardly any rest. The service was absolutely fantastic. He certainly respected the fact that they could act under such pressure, given that what they were doing was life-saving work.
Jo-Anne Dobson accepted the wording of the Human Transplantation Bill. We need to do more to improve organ donation rates. That needs to continue to be a priority for the Assembly in the new mandate. John McCallister welcomed the fact that consensus to some degree had been met. Kieran McCarthy was also a supporter of the private Member's Bill.
The Minister referred to the fact that our system and our transplant team are amongst the best in the world and at the moment compare quite favourably with the South, which has seen a dip in figures recently. He made the point that this was not about party politics, and I think it is important to say that again. The debate about organ donation is a matter of life or death. We all have different views and are quite passionate about it. From our perspective, in our contribution at Committee Stage we always had an open mind and a focus on an outcome that was the best for all the people we represent. Tinkering with a system that leads to a better outcome is brilliant, but making a decision that could undo some of the great work that has already been put in place to ensure that we have a high organ donation rate is something that you cannot undo at short notice.
It is important that we keep a watchful eye on the issue. It needs to be a focus for the Assembly and the Department in the new mandate. We believe quite passionately in this and that these amendments will lead to greater organ donation rates. Again, I thank the sponsor of the private Member's Bill. She has put a lot of effort into the issue, and it is only right that credit is given to her. I hope that the Assembly will now agree and unite in ensuring that we change the law in regard to organ donation.
Amendment No 6 agreed to.
Amendment No 7 made:
After clause 11 insert<BR/>
"Annual report on transplantation
11B.—(1) The Department must lay before the Assembly, in each financial year, a report about transplantation activities in that year.
(2) The report must include?—
(a) the steps taken by the Department to fulfil the duties set out in section 11A, and
(b) the number and nature of transplantation activities carried.
(3) At least once every five financial years, the report must include?—
(a) the opinion of the Department as to whether this Act has been effective in promoting transplantation activities, and
(b) any recommendations the Department considers appropriate for amending the law so as to promote transplantation activities.". — [Ms Maeve McLaughlin.]
New clause ordered to stand part of the Bill.
Clauses 12 to 16 ordered to stand part of the Bill.
Schedules 1 and 2 agreed to.
Amendment No 8 made:
In the long title, after "care" insert
", to raise awareness of human transplantation". — [Ms Maeve McLaughlin.]
Long title, as amended, agreed to.