Health (Miscellaneous Provisions) Bill: Final Stage

Executive Committee Business – in the Northern Ireland Assembly at 6:15 pm on 15th March 2016.

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Photo of Simon Hamilton Simon Hamilton DUP 6:15 pm, 15th March 2016

I beg to move

That the Health (Miscellaneous Provisions) Bill [NIA 72/11-16] do now pass.

I am pleased to move the Final Stage of this Bill in the Assembly today. When I reflect on its passage, I think it is fair to say that its scope and purpose have changed quite markedly since I introduced it in the Assembly on 30 November last year. Initially, the Bill focused on two main areas. Part 1 contained provisions dealing with nicotine products that will enable the Department to make regulations prohibiting the sale of nicotine products to under-18s; to create an offence for proxy purchasing — in other words, an adult purchasing a nicotine product on behalf of a minor; to develop regulations in relation to banning the sale of e-cigarettes from vending machines, and to raise the level of fines for sales of tobacco from vending machines to a level five fine, thus ensuring fines for all underage tobacco or e-cigarette sales offences are consistent.

Part 2 of the Bill sought to amend anomalies in the Health (Miscellaneous Provisions) Act (Northern Ireland) 2008. The amendments were mainly technical in nature and sought to correct references to the various categories of people and bodies responsible for providing dental, ophthalmic and pharmaceutical services. It also amended provisions concerning charges for services provided to persons not ordinarily resident in Northern Ireland.

I move now to the provisions that seek to prohibit the sale of nicotine products, including e-cigarettes, to those under 18. The sale and use of those products has grown considerably in popularity since the ban on smoking in public places was introduced in 2007. Limited research is available on the long-term health consequences of e-cigarettes, and, while they may have a role to play in harm reduction for existing smokers, I do not wish to see non-smokers, particularly children and young people, becoming addicted to nicotine through these products.

A survey that was carried out in 2015 showed that around 13% of 11- to 18-year-olds in the UK reported that they had used an e-cigarette. That represents an increase of almost 3% from the previous year. Whilst e-cigarette manufacturers do not recommend their sale to under-18s, and some retailers impose their own age restrictions, the lack of regulatory oversight has increased the likelihood of e-cigarettes being purchased by children and young people I believe, therefore, that it is important that we protect our children, as Governments in England and Wales have chosen to do, by making e-cigarettes age-restricted products.

As the Bill progressed through its Committee scrutiny, amendments were proposed that sought to introduce a number of new provisions in the Bill and which acted as a stimulus for substantial debate. I will briefly touch on those issues. At the Bill's Consideration Stage, back in February, the Assembly agreed an amendment tabled by Sinn Féin Members to ban the use of tobacco or nicotine products in enclosed vehicles when children are present. Around 80% of second-hand smoke is invisible and odourless. That can inadvertently make people think that it is safe to smoke around others. However, evidence suggests that there are no safe levels of exposure to second-hand smoke. Research also shows that smoking in vehicles can place passengers at a greater risk of second-hand smoke exposure due to the confined internal environment. Children are more susceptible to the harmful effects of second-hand smoke than adults. That is partly because their immune system and lungs are less developed, and they breathe more rapidly and their smaller bodies can absorb more toxins.

At Further Consideration Stage, I tabled an amendment that sought to introduce a new clause. I also proposed some technical amendments, which, I believed, would strengthen the Bill and demonstrate my clear determination to tackle smoking and the dangers it poses for children. I am pleased to say that the Assembly was persuaded by the arguments setting out the merits of my new clause and my other amendments. As a result, I am convinced that we now have much tighter legislation, which will result in the more effective implementation of regulations aimed at protecting the future health of our children.

At Consideration Stage, the Assembly also agreed an amendment tabled by Sinn Féin Members that required the Department to consult about a levy on sugar-sweetened drinks. It aimed to prescribe key issues that my Department should consult on, as well as which stakeholders should be consulted. I opposed the amendment and cited a number of reasons for my opposition. For example, I believe that we need to do more to educate people about sugar before moving to legislate. There is also a lack of evidence that shows the impact on health outcomes and not just on purchasing behaviour. My concern is that a levy on sugar-sweetened drinks might simply cause people to switch to other unhealthy foods, with the result that the problem is displaced but not solved. Finally, there are arguments that such a tax is regressive and that the tax does not, by itself, combat obesity but could potentially exacerbate food poverty.

On my last point, I note that, in Mexico, a 10% tax on sugar-sweetened was implemented on 1 January 2014. More than 30% of the Mexican population is obese, and the tax was introduced to combat the growing obesity problem, not to raise revenue. In 2015, Mexico's National Institute of Public Health and the University of North Carolina carried out research, which showed that they have not seen any changes in obesity as a result of the changes in purchasing behaviour. However, the largest impact was on lower-income households, which cut their purchases of sugar-sweetened drinks by an average of 9%. That appears to highlight the potentially regressive nature of the tax and is one of the reasons why I have expressed my concerns and continue to hold those concerns.

My position is that we need to seek to educate and inform people much better about sugar-sweetened drinks. That is why, at Further Consideration Stage, I tabled an amendment that sought to remove the duty to consult on a levy on sugar-sweetened drinks and to replace it with a duty to carry out a study on a sugar-sweetened drinks levy. I also tabled an amendment seeking to extend the period within which the study must be carried out to two years after enactment. That was to reflect the complexity of the issues and to give the Department more time to commission appropriate studies and advice and to consider them fully before reporting on a study. I am pleased to say that the Assembly was persuaded again by my arguments and accepted both amendments. As a result, I am convinced that we now have a more realistic time frame in which to undertake a study, which should, in turn, provide us with more comprehensive information about how we should best move forward on the issue of a sugar-sweetened drinks levy.

At Consideration Stage, the Assembly also agreed amendments that require the Department to promote and provide information on transplantation and to provide an annual report on transplantation. It has been said many times during our debates that, in Northern Ireland, we have a tried-and-tested voluntary registration system. I also believe that our record in Northern Ireland on promoting the organ donor register speaks for itself with regard to raising awareness. I again take the opportunity, as many did during debates on the Bill, to pay tribute to the transplantation team at Belfast City Hospital and to remember that the work that it has undertaken has seen live organ donation rates in Northern Ireland rise to a level that is now the very best in Europe and also stands amongst the best in the world.

I am also aware that we have consistently been urged by clinicians, medical experts and interest groups to increase our efforts to educate the public about organ donation and enhance the existing level of awareness on that important matter. As I fully understand the motivation behind the amendments that were tabled at Consideration Stage and that now appear as clauses 15 and 16, I decided to propose a number of technical amendments at Further Consideration Stage in an attempt to ensure that the language used in the clauses is clearer and more easily understood. One of the key challenges in increasing the rate of organ donation is to convert the relatively high number of potential donors on the register to actual donations with family approval above the current average of 60%.

I am, therefore, establishing a clinical advisory group to develop a communications policy with a wide ambit to implement a programme targeted at achieving that increase. I will make available the resource to deliver this programme. That will be in addition to the promotional activities encouraging people to join the register. I will place a copy of the terms of reference for the clinical advisory group in the Assembly Library before recess. My Department will brief the Health Committee on the communications policy that is produced by the group later this year, subject to the approval of whoever is Health Minister at that time. Again, I am pleased to say that the Assembly accepted the rationale behind my amendments and was prepared to accept them.

I am grateful to all those who engaged with my Department on the Health (Miscellaneous Provisions) Bill and offered their insights and suggested amendments at the various stages of the Bill's journey through the Assembly. I express my gratitude to members of the Health Committee for their thorough scrutiny of the Bill and for the time that they took to examine the clauses and take evidence from witnesses. I am also grateful for their helpful contributions and support during the debates in the House. I am convinced that the provisions in the Health (Miscellaneous Provisions) Bill will help to make a positive and lasting difference to the health of people throughout Northern Ireland across a broad range of areas. Therefore, I encourage all Members to support the Bill.

Photo of Maeve McLaughlin Maeve McLaughlin Sinn Féin 6:30 pm, 15th March 2016

Go raibh maith agat, a LeasCheann Comhairle. On behalf of the Committee for Health, Social Services and Public Safety, I welcome the Final Stage of the Bill. As the Minister outlined, the Bill has been significantly altered, and I believe that it has been altered for the better with regard to its nature and operation.

The Bill started off with two main purposes: first, to allow the Department to make regulations on banning the sale of nicotine-containing products to minors; and, secondly, to amend existing provisions in areas such as dental services, pharmaceutical services and charges for services provided to persons not ordinarily resident. However, as the Minister outlined, the Bill widened somewhat as a result of its passage through the Assembly, with the inclusion of the provision on smoking in cars carrying minors, the promotion and reporting of organ transplantation and organ donation, and the study by the Department on a levy on sugar-sweetened drinks.

The evidence received by the Committee on the Bill as introduced was positive. There was firm support for banning the sale of nicotine-containing products to persons under 18 years of age. That support was carried through to the creation of an offence for proxy purchasing for nicotine-containing products. Very little comment was made on the clauses that amend provisions in areas such as dental and pharmaceutical services and charges for services provided to persons not ordinarily resident. However, stakeholders were content with the provisions as made.

There was significant comment on what was not included in the Bill: the banning of smoking in cars carrying minors. During Committee Stage, the Department provided the text of an amendment that would give it regulation-making powers to allow for the creation of offences for smoking in a smoke-free private vehicle and failing to prevent smoking in a smoke-free private vehicle where under-18s were present and also for fixed penalty notices to be applied to that offence. The Committee welcomed the new policy and agreed to support the amendment, which was subsequently tabled by the Minister at Further Consideration Stage and supported by the House.

The Committee considered the provisions on transplantation and organ donation as part of its scrutiny of the Human Transplantation Bill. The majority of the Committee supported the duty to promote and report on transplantation and organ donation. I am pleased that the Bill has reached Final Stage today and look forward to its implementation.

I will make a number of comments now as an individual MLA. I welcome the inclusion of my party's three amendments, albeit that, to some extent, they amended themselves, particularly the ban on smoking in cars carrying under-18s. That, quite simply, is the right thing to do. The right approach to public health involves the early intervention and prevention that we hear and speak so much about. This is simply to protect children from the effects of second-hand smoke or from even taking up smoking. The stark fact remains that 2,300 people die every year in the North from tobacco-related illnesses. I welcome support for that amendment and hope that it goes some way to playing its part in the delivery of a robust tobacco strategy across the North and across the island.

Moving to the amendment on the sugar tax levy, I thank Members for their support. It needs to be stressed that this is not a panacea for all our ills, but it is, in our view, the right public health approach. There is a direct link between sugar consumption and ill health, whether that be diabetes, obesity, dental decay or, in many cases, cardiovascular disease. Our amendment, which has been further amended by the Minister, provides an evidence base of the impact and details how a levy on sugar sweetened drinks would be administered, and I welcome the fact that it has progressed to Final Stage.

I welcome the amendment on organ donation and human transplantation, and I acknowledge the work that Jo-Anne Dobson did to take her Bill to a certain point in the legislative process. I do not think that I need to rehearse the very stringent and robust evidence that we heard or the learning that we all underwent from her Bill. However, we have something going forward in law that is what the clinicians and charities asked us to do. It does what it says on the tin. We now have a responsibility to the Department of Health to promote and report on organ donation. That should not be the end of the road for transplantation or organ donation, but, as we stand here today, it is the appropriate legislation.

Finally, as these are my last comments as Chair of the Health Committee, I want to pay particular tribute to the staff and Clerk of the Committee. All in the House will acknowledge that the portfolio is a wide and varied one, and I pay particular tribute to the staff who have done that work very diligently. I also pay tribute to the departmental officials who often had to bear my wrath and that of the Committee and did so in a very professional manner.

I also want to join in the love-in that has broken out in the Chamber today and thank the other Committee members. I pay tribute to the current Health Minister for his cooperation on a number of key issues, and, in particular, I pay tribute to Kieran McCarthy. During my baptism of fire in this brief in the last number of years, I thank him for his input and his valuable role. Suffice it to say, Kieran, that "Any other business" will never be the same again without you.

Photo of Kieran McCarthy Kieran McCarthy Alliance

Exactly. I was going to remind the Member that she will probably remember me best for "Any other business". It was usually at the end of a busy agenda that I had planned in my head to raise something that had cropped up during the week. You were always very generous in allowing me to raise any other business. Thankfully, action was taken to remedy the problems as far as possible. I thank you for that. Thanks, Mr Speaker.

Photo of Maeve McLaughlin Maeve McLaughlin Sinn Féin

I thank the Member for his kind comments. Most certainly, Kieran, that is what you will be remembered for. I am not sure that I would go as far as to say that it was only things that had just occurred to you in the course of the meeting, but well played, nonetheless. You did your best with it, and, again, I wish you and your extended family every success for the future.

I thank Committee members for their cooperation on the legislation and, indeed, on the heavy legislative lift that the Committee has had in the last number of weeks and months. I will leave it at that. I welcome the fact that we have taken this to the Final Stage.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

I am pleased that the Bill has reached this stage. The Assembly has a relatively good record in adopting policies designed to assist people to give up smoking and to stop others taking up the habit in the first place. We need to remember just how damaging it is to a person's health. Every time a smoker has a cigarette, they inhale over 4,000 chemicals. For as long as it remains the greatest cause of preventable death and disease in Northern Ireland, the Assembly must continue to take a hands-on attitude to tackling smoking. Crucially, that includes preventing young people becoming addicted in the first place, and, therefore, I am pleased that today's Bill prohibits the sale of nicotine products to under-18s and from vending machines. Whilst e-cigarettes are leading to people coming off the traditional tobacco cigarette, insufficient research exists on their long-term health effects. The Assembly may need to revisit that in the next mandate.

The ban on smoking in cars carrying young people is another positive aspect of the Bill. Smoking causes harm not only to the individual but to those around them, particularly children, whose lungs are still developing. The toxic cocktail of chemicals that quickly builds up in cars should hopefully now occur even less.

I am hopeful that the human transplantation and organ donation aspect of the Bill will ensure that the passionate volunteers and charities who have promoted organ donation across Northern Ireland for many decades will no longer do so alone. I again urge that their involvement be central to any public awareness campaign to ensure that their considerable expertise and knowledge is utilised to the full.

Organ donation and transplantation affects so many families across Northern Ireland. Those of us in that organ donation family remain firmly committed to ensuring the promotion of and increase in life-saving transplants. The House is more than aware of the considerable public support for change that has been consistently identified. I again say that I do not wish this can to be kicked down the road, and, like my esteemed colleague Mr McCarthy, I, too, will be watching. I hope that the future Health Minister, whoever he or she may be, will ensure a consistent focus on increasing life-saving transplants and, indeed, will listen to the organ donation family, those who are closest to one of the most emotional issues that we can debate in the Chamber.

It gives me great pleasure to welcome the Bill and its passage today. The important outworkings for us all will come when the ink is dry.

Photo of Kieran McCarthy Kieran McCarthy Alliance

Right, Mr Deputy Speaker, this is it. This is the last. What is contained in this is the last opportunity, so listen carefully. I cannot believe, after 18 years in this Assembly, that this is it, but I will go for it anyway. This has been the busiest day of my life in the Assembly. I have been up and down like a yo-yo. You will be glad to see the back of me.

I welcome the Final Stage of the Bill. The Bill has evolved significantly over past weeks in several beneficial ways. We would, perhaps, have benefited more from structured consideration of the amendments that emerged through the Committee. Nonetheless, we have a positive result. In particular, I welcome the move towards banning smoking in vehicles with children. Like every Member who has spoken, I want to see the end of that, so that we put our children at no risk whatever.

I feel a lot of sympathy for my colleague Jo-Anne Dobson, who, despite valiant efforts on the organ donation issue, was not successful in getting her Bill through. However, I am sure that there will be another day. I had the pleasure of meeting her son Mark this afternoon in the Hall. He is a walking example of what organ donation can do. I hope, Jo-Anne, that, in the future, you will have more success.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

I thank the Member for his continued support and loyalty. I, for one, will miss him greatly. When I joined the Health Committee, Kieran, you were an inspiration and a support, and you remained steadfast and committed throughout. I also had the honour of working with you on the Agriculture Committee and on mental capacity. I will never look at Kircubbin again without thinking of you and all those references you made.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

Even today. You have been a true friend to me, and I thank you for that.

Photo of Kieran McCarthy Kieran McCarthy Alliance

Thank you, Jo-Anne, for your compliments. Even today, Kircubbin was on the agenda at the ARD Committee.

Much work lies ahead in implementing the legislation and delivering on its components. I look forward to seeing that work completed from outside and the wider public health and societal benefits that it will bring.

As this is my very last contribution to the Northern Ireland Assembly in the Chamber, I want to thank our Chair of the Health Committee, Maeve McLaughlin, who chaired our Committee very well, kept us on the right road and was liberal in her attitude towards what one could say. Thank you very much, Maeve, for your help along the way. Indeed, I thank every other MLA on the Committee for their help and cooperation, particularly in Committee deliberations. That includes our Committee staff, our Assembly Research and Information Service and everyone who contributed to making our Health Committee positive and getting us to where we are this evening.

I want to thank Maeve's predecessor as Chair of the Health Committee, Sue Ramsey, who, Members will remember, was very competent in the job and who, through ill health, was not able to carry on. I thank you both very much for your work on that Committee.

I thank Simon Hamilton as Minister for responding positively to my petition not so long ago on the needs of youngsters and adults with autism. Simon Hamilton came up with £2 million to put to that much-needed cause. Unfortunately, too many parents have kids nowadays with autism, but they were grateful for that assistance from Mr Hamilton.

Finally, I offer a genuine invitation to any Member when they visit the revamped Exploris aquarium in Portaferry.

[Laughter.]

Cash was provided by our Executive and, indeed, Mark Durkan. As you enter my village of Kircubbin to get to Portaferry —

Photo of Roy Beggs Roy Beggs UUP

The Deputy Speaker has been very generous today.

Photo of Kieran McCarthy Kieran McCarthy Alliance

— do stop and pay me a visit, but do not all come at once, for God's sake.

[Laughter.]

I want you to stop and bring me up to date with what is happening in this place. Everyone is very welcome, and perhaps they can have a cup of tea or a cup of coffee overlooking Strangford lough. You may remember that, this morning, I waved the bus pass. I am going to use that bus pass, along with my wife, hopefully. Beware, everybody, because I am going to visit Castlederg, Kilrea — wherever you come from and wherever you come from.

[Laughter.]

I want to see maybe a cup of tea or coffee or something.

Go raibh maith agat and slán go fóill. Ta tae yez aw an sae lang the noo. Thank you, everybody, very much, and a sincere goodbye.

[Applause.]

Photo of Simon Hamilton Simon Hamilton DUP

I do not think I am going to top that, Deputy Speaker. I think many of us will now be a little concerned about being stalked by Mr McCarthy as he uses his Executive-granted free bus pass to travel around Northern Ireland. He will be very welcome in Comber at any time, as he knows.

I thank the Members who contributed for their very positive and encouraging remarks about this legislation. I think it is very clear from today's debate, as has been clear from all the debates as the Bill passed through the House in its various stages, that this is a piece of legislation that has captured the interest of Members and has generated some very useful and informed debate on a diverse range of important health topics. I am also pleased that the Bill largely enjoyed cross-party support as it progressed through its various stages.

In summary, the Bill will help to protect people's lives and health, especially the health and well-being of children, from the dangers of nicotine and tobacco products. It will afford us the opportunity to carry out a proper study on a levy on sugar-sweetened drinks, which could then allow us to move towards work on specific proposals thereafter. Finally, it will help to raise the public awareness of organ donation, with the intention that increased promotion will result in the outcomes required for an increase in donor rates. In this, my last contribution in the House on what the Chair, I think euphemistically, described as a wide and varied brief that is Health, I ask Members to support the Bill.

Question put and agreed to. Resolved:

That the Health (Miscellaneous Provisions) Bill [NIA 72/11-16] do now pass.

Photo of Roy Beggs Roy Beggs UUP

I ask Members to take their ease for a few moments.

(Mr Speaker in the Chair)