Clause 1 - Smoke-free premises, places and vehicles

Health Bill – in a Public Bill Committee at 10:35 am on 6th December 2005.

Alert me about debates like this

Question proposed, That the clause stand part of the Bill.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I was rather hoping that, in the course of her comments on the clause, the Minister might explain to us the underlying principles of the Bill. Nevertheless, let us get straight to it. The purpose of the clause is to bring into law the prohibition on smoking in certain premises. From that prohibition will flow the discussion about how it is to be defined and how exemptions are to be made.

I suppose that, at this stage, I want to explore two things. The first is the Government’s view on the structure of the prohibition. On what evidence have they based it? The second is the consultation process on the policy that led to the introduction of the legislation. Before we get into the detail, it would be sensible to understand where the Government are coming from.

The Committee will recall the discussion on Second Reading. I want to make it clear that our objective is to achieve a dramatic reduction in the incidence of smoking in public places, thereby contributing to a reduction in the prevalence of smoking. There were substantial reductions in the 1970s and 1980s, but the trend has slowed since then and there are serious problems, particularly the prevalence among younger people, which has barely reduced in the past four or five years. The Minister will know that one of the issues is the extent to which young people starting work are able to smoke in the workplace. The evidence clearly suggests that if we can reduce opportunities for smoking at work, we can reduce the overall prevalence of smoking among young people, with consequential major long-term health gains.

At the time of the publication of the White Paper, the Scientific Committee on Tobacco and Health set out clear summary evidence of the negative health   impacts of smoking in relation to lung cancer and coronary heart disease. As I said on Second Reading, the most significant part of that in terms of changing the character of the debate on smoking—especially passive smoking—was the increasing evidence of the impact of relatively small amounts of environmental tobacco smoke on myocardial infarction, or a heart attack.

Occasionally I must wear these glasses, and not just because we shall later be discussing general ophthalmic services. I am not trying to curry favour with the optical professions. The Minister will be aware of the interesting paper published in the BritishMedical Journal on 24 April 2004, which relates to a six-month period in the town of Helena, Montana. That geographically isolated community had a local byelaw that prevented smoking in all public places. During the six months when that law was in force, the number of admissions to hospital for heart attacks fell significantly from an average of 40 admissions during the same six months of the preceding year to 24 admissions during the time the law was in effect. When the byelaw was subsequently challenged in a court and suspended, the rate of attendances at hospital for heart attacks rose again.

It is increasingly clear that relatively modest amounts of exposure to second-hand smoke can have significant impacts on health, especially where coronary heart disease is concerned. For some, second-hand smoke can have a substantial impact on their likelihood of having a heart attack. We must be aware of the benefits of what we are trying to achieve. This is not a matter of nuisance. I preface some of the arguments that my hon. Friend the Member for Westbury (Dr. Murrison) and I shall make later by stating that we are not talking about the nuisance effect of smoke; we are talking about the health effects of smoke. This is a Health Bill.

One of the central matters that has been in our minds is the strange circumstances of the Government’s publication last November of a White Paper that was supposed to be about health. Published evidence to which I have just referred illustrates the health impacts of second-hand smoke and shows the necessity of there being a means by which we can dramatically reduce the prevalence of smoking. However, the proposal that was put into the public health White Paper appeared to be geared more to questions related to the nuisance value of smoke to people eating meals in restaurants or pubs than it did to evidence relating to health.

Of course, we understand that a balance must be struck. It is an obvious, simple fact that if we were, somehow, able to ban smoking entirely, we would reduce the negative health impacts dramatically. About 23 per cent. of premature mortality among men is in some way related to smoking. However, we cannot bring in a complete ban because smoking is legal and has been for a long time. Many people are habituated to smoking, and we are striking a balance   between their liberty to smoke and the impact that that has on others. Those are the balances that we shall have to strike in the course of this debate.

The Government do not seem to have struck a balance at all, either geared to public opinion or to health effects. Public opinion research that I have seen seems to point to the kind of conclusions that my colleagues and I have reached. The public’s view is that workplaces and restaurants should be smoke-free but that public houses are something of an exception. Even on that matter, public opinion has moved sharply to a point where they wish pubs, generally, to be smoke-free except for specific rooms or areas that are designated for smoking. The largest number—although not a majority; it is something less, at 47 per cent.—in the last survey that I saw suggested that that was where the greater number of the public pitch their tent. There is no major public view that a balance should be struck whereby pubs are either smoking with no food or non-smoking with food.

That is a strange conclusion that the Government reached last November and then put forward. It was reflected, as I am sure the Minister will remind her colleagues many times, in the Labour party manifesto. If that had been the end of the matter, the Government would have proposed legislation based on their manifesto and would not have done anything else about it, but they did not. They consulted.

On 20 June, the Government issued a consultation. It is reasonable to ask what the point of that consultation was. Was it to find out specific details regarding enforcement and implementation? No; it was, on the face of it, to establish whether the proper balance had been struck with the proposed policy. We know what was going on: the new Secretary of State and team at the Department of Health very much wanted to move away from the policy that they had been left with to one that made more sense in health terms. That is not surprising considering that they were receiving advice from the chief medical officer who, as he recently made clear in his evidence to the Select Committee on Health, was strongly of the opinion, in his annual reports from 2002 to 2004, that there should be a comprehensive ban on smoking in all enclosed public places and that anything else would be substantially less beneficial.

It is not surprising that Ministers might want to reflect that professional advice in policy, so they had a consultation—but was it real? What was it intended to allow? I understand that there were 57,000 responses, 90 per cent. of which opposed the partial ban that the Government propose. What kind of response to a consultation would it take for the Government to change their mind about a policy that they subjected to consultation? Does it take 100 per cent? Are the Government prepared to proceed with opposition of anything up to 99 per cent? That is odd. The Minister will have to explain why they have proposed legislation of a structure that is clearly opposed by expert bodies and regarded as nonsensical by the public.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health) 10:45 am, 6th December 2005

Does my hon. Friend agree that if the Government run consultations that are seen to be a sham, it destroys all future consultations because the public and organisations will see that all the input that they give in good faith simply will not be taken seriously? The figure of 90 per cent. is overwhelming; it is extraordinary that the Government are not listening on that. I am sure that my hon. Friend will agree that the cost of such exercises is an issue for concern if the Government simply ignore them.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am grateful to my hon. Friend. That is exactly right. You would think it out of order, Mr. Illsley, if we were to talk about other consultations which, frankly, seem to be bogus, but that seems to be a continuing feature. The medical profession and people across the NHS are heartily tired of the extent to which they are engaging in bogus consultations on matters on which the relevant decisions seem to have been taken in advance.

Photo of Steve Webb Steve Webb Shadow Secretary of State for Health

I am interested to see the importance that the hon. Gentleman attaches to the consultation that the Government have just undertaken. Why is he choosing selectively from the results of that consultation? Did it not also show that the public rejected an exclusion for private clubs, which he supports?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I was not trying to represent the whole of those consultation responses, to which we will return when we discuss other issues. Clearly, we have to strike a balance. I am not saying that the results of the consultation must be the only basis on which we make our judgments; I am asking on what basis the Government entered into the consultation. It is obviously intended to inform what we do, and I shall have to make my judgments, as the hon. Member for Northavon will have to make his, and as the Minister will have to do for the Government. I want to know why the Government proceeded with the consultation, given the broad opposition to the structure of the partial ban that they propose. If the consultation was real, what have the Government done to reflect the responses in their policy?

I shall now discuss the structure of the benefits associated with the legislation as set out in the regulatory impact assessment. The Minister will recall that the RIA considered what benefits are likely to accrue from the partial ban that is being proposed. I am sure she will say that the ban will cover 99 per cent. of workplaces, the implication being that 99 per cent. of the benefit will be derived because 99 per cent. of workplaces are covered. What she does not take into account is the simple fact that more than one in two workplaces is already smoke-free, and that a higher proportion of the rest have designated smoking-only areas, the number of which is declining dramatically. Members of the Committee will know that more employers are coming to the conclusion every day that they should move to a work-free—[Laughter.]—a smoke-free workplace for health and safety reasons and because of their responsibilities towards their employees.

Many of the benefits that would be derived from workplaces becoming smoke-free are already being gained, so the question is what additional benefits are to be gained by introducing a smoking ban. The RIA highlights that fact, drawing the broad conclusion that a comprehensive ban would have the benefit of reducing the number of deaths by about 2,300, by my reckoning, as a result of the reduction in second-hand smoke. The partial ban would lead to a benefit that is only just over half that figure, not a figure that is only 1 per cent. away from the benefit of a full ban. Ministers must therefore tell us why they believe that we should engage in this major, complicated regulatory exercise. The costs of enforcing a partial smoking ban are higher than the costs of enforcing a comprehensive smoking ban, yet the Government propose to derive only half the benefit.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

Does my hon. Friend agree that the RIA is quite controversial, particularly since Professor Konrad Jamrozik’s paper, which was published in the British Medical Journal earlier this year, suggested that passive smoking at work accounted for a total of 617 deaths a year—a fairly precise figure—and at home, interestingly, for 10,700 deaths a year?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am grateful to my hon. Friend for mentioning that because the evidence set out by the Scientific Committee on Tobacco and Health related to various studies, many of which compellingly describe the impact of second-hand smoke on health and the likely mortality resulting from it. However, the studies overwhelmingly involved people with partners, spouses or family members who smoke or people who are persistently exposed to second-hand smoke at work.

There are extrapolations. I made a point earlier about the impact of modest exposure to second-hand smoke on coronary heart disease. It is significant, because initial evidence suggests that there is no linear relationship between exposure to second-hand smoke and the impact on mortality and morbidity, particularly where coronary heart disease is concerned. It is a non-linear relationship, and therefore modest exposure to second-hand smoke is one of the issues that we have to address. That is why I have no doubt that our objective should be to try to reduce sharply the incidence of smoking in all enclosed public places. The debate is simply about how we get there and the mechanisms involved.

The point that I want to establish at the outset is why the Government have gone down such a path. Why have we ended up in a position where the origin of the policy appears to have more to do with satisfying competing arguments inside Government than the health needs of the country? We seem to have had second thoughts—perhaps even third or fourth thoughts—set out among Ministers in the course of this year, on which they appear to have been frustrated and unable to act. The chief medical officer made it perfectly clear to the Health Committee that he did not agree with the Government’s policy, and said:

“I think it is rare for the Government to ignore the advice of its Chief Medical Officer or to fail to act on it. This is the first situation I have encountered in the seven years I have been in post when this has happened.”

The Minister has to explain why we are in this position at all.

The regulatory impact assessment, if we are to believe it, shows that the Government’s proposals will achieve barely half the potential benefits of a ban, with all or more of the enforcement costs and more of the ensuing complications and difficulties for the public. There is also limited evidence of the certainty of those benefits. Although I am taking the mid-point of the Government’s estimates, it is entirely possible that, as the Government’s regulatory impact assessment contemplates, the benefits for customers exposed to second-hand smoke may be negligible as a consequence of the changes. We need to be clear about what we are setting out to do.

So with clause 1, the purpose of which is to introduce the overall prohibition, although we might come on to one or two detailed points our main purpose is to examine what the Government are setting out to do. How did they come to this policy and how do they justify the fact that they will not deliver the benefits of a reduction in smoking, which are really needed?

Photo of Steve Webb Steve Webb Shadow Secretary of State for Health 11:00 am, 6th December 2005

It seems appropriate to use clause 1, which introduces part 1 of the Bill, to make a short number of observations about the general strategy for the smoking ban that the clause will enable to be brought into force. It is helpful to say at the start that a number of the amendments that we will discuss later will try to make the best of a bad job. Our preference would have been the total ban that was in our manifesto and remains our policy to this day. It is worth stressing that, because later this morning and beyond some of the things that we suggest may not be consistent with a total ban. We will be trying to make a partial ban more effective.

I want to place on the record at the start my clear commitment and that of my hon. Friend the Member for Bristol, West to a total ban in line with our manifesto. The reasons for that have been eloquently expressed by the hon. Member for South Cambridgeshire (Mr. Lansley), who rightly pointed out that the maximum benefit from the Bill, in terms of the Government’s cost-benefit analysis, would come from a total ban. I find it puzzling, therefore, that he supports a different partial ban, which produces fewer benefits.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

At this early stage, will the total ban in the hon. Gentleman’s treatise cover cannabis? I understand that his party’s policy is to liberalise the use of cannabis, and he did not quite clear that up on Second Reading.

Photo of Steve Webb Steve Webb Shadow Secretary of State for Health

The hon. Gentleman seems rather obsessed with the subject of cannabis; perhaps we should discuss that. Interestingly, clause 1(2)(a) states that

“‘smoking’ refers to smoking tobacco or anything which contains tobacco, or smoking any other substance” so that is within the scope of the Bill. Our support for the Bill incorporates anything else that might be smoked in enclosed public places as well.

We are concerned—there is some common ground with the Conservative spokesman in this respect—about the welfare and health and safety of people who work in enclosed public places. It is as simple as that. As far as we are concerned—a number of my colleagues have made this point to me quite forcefully, and I agree with them—this is not about whether we approve or disapprove of what people do, for example, in their own homes; it is about places where that action has a consequence for other people. Arguably, part 1 of the Bill might usefully have been a health and safety measure brought in by another Department, because that is very much the way in which we approach it.

People sometimes say that the issue does not matter because those who work in smoky environments could choose to work somewhere else. In fact, that is arguable. If a town has one bar and it is a smoky bar, the people who work there may not be able to find other employment, but even if they could, from a health and safety point of view why should they have to? If asbestos was found in the roof here, we would not say, “It’s not a problem. Let’s go and use Committee Room 13.” We would say that it was bad for the health of the people who work here and sort out the health and safety problem. That is the approach that Liberal Democrat Members take. My liberty to smoke is not an unlimited liberty; it is limited by the impact of my exercise of that liberty on other people. We believe that that applies whether or not food is being served and whether or not the premises in question are a private members’ club. Such exemptions make no sense if we view the issue as one of health and safety.

There is an advantage to the way in which clause 1(2)(a) is drawn. As I said, it states that “smoking” relates not merely to tobacco but to other substances. Clearly, it will be a great deal easier if the enforcement authorities do not have to inspect the contents of the cigarette to try to work out exactly what it is. If smoke is coming from the substance, that is sufficient to provide for a ban.

No doubt we shall discuss the place of public opinion in all this; indeed, we have had some selective readings of public opinion already. Where health and safety is concerned, we should be leading public opinion, not following it. I believe that there is momentum in public opinion in the direction of a total ban and that there is evidence from other countries that when bans are introduced, they become popular very quickly and few people ever want to turn the clock back. The Government should have the courage of their convictions and lead public opinion in the interests of the health and safety of workers, not follow public opinion and be afraid of the focus groups.

I have described the framework within which we approach the Bill, and the lens through which we shall assess any amendments tabled. We hope that, by the   end of our process of scrutiny, we will have a Bill that generates more benefits for people who involuntarily are subjected to passive smoking and its consequences.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

Having heard the two previous speakers, I am grateful for this opportunity to outline further what we said on this matter on Second Reading. The contribution from the hon. Member for South Cambridgeshire was interesting, because, listening to it, one might have assumed that he supported a total ban. However, based on what we heard on Second Reading and in his contribution today, it is clear that that is not the case, and when we consider the amendments, we shall see that it clearly is not the case. It is interesting that the hon. Gentleman uses an argument used by those who support a total ban, but then steps back from the brink. It is not clear whether Conservative Members support any legislation to impact on smoking in public places.

Let me recap on why the Government have reached this position. First, 1.2 million people have stopped smoking since 1998. That is a good example of how we are building on the progress that has been made over decades in public awareness of the dangers of smoking both to those who smoke and to those exposed to second-hand smoke. The Government should get some credit for building on those reductions through our anti-smoking campaigns, particularly on exposure to second-hand smoke, aimed not just at smokers but at families with children.

Photo of Steve Webb Steve Webb Shadow Secretary of State for Health

The Minister has fairly characterised the further reduction of just over 1 million smokers as being part of a long-term trend, while mentioning what the Government have done. However, what would have been the counterfactual, supposing that there had been a do-nothing Government? Given a long-term trend of so many hundreds of thousands every few years, what would have happened over an eight-year period? How many fewer smokers would we have expected anyway, and how many can we ascribe to Government intervention? How much would have happened if the Government had stood by and watched? Some information now, or at some point, would indicate the effectiveness of the Government’s policy.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

I am happy to write to the hon. Gentleman on that issue. Smoking cessation sessions are available through the NHS, and I can provide details on the number of people who have quit as a result of being involved in them. Nicotine replacement patches are available at those sessions. Alongside that, Government support for getting the message across in relevant ways to different sections contributes to the underlying trend. Importantly, Mr. Illsley, we have to do further work with some of the harder-to-reach individuals and communities. We are not making as much impact with them as we want.

I cited, on Second Reading, an interesting article that I read about some young women who were worried about giving birth to a heavy baby. They thought that that would add to the pain of childbirth and that smoking would create a low birthweight baby and, therefore, less pain. The fact that some young   women think that demonstrates that we have to listen to and understand people’s reasons for not giving up. We should then try to engage differently with them; for example, with that group of young women by reassuring them about pain relief in childbirth. Equally, in our recent adverts aimed at young people we chose to give a social message rather than a health message. It was about how people feel about others, perhaps when looking for a new partner in life, and has been successful among young people.

In 1996, smoking was in fact increasing to 13 per cent. among 11-15 year olds. I feel that we have contributed to reducing that to 9 per cent. by 2004. That is one example; I am happy to write further on where Government intervention and the good work by primary care trusts and others has affected the trend.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

On that point, the Minister will no doubt know that the figures from which she quotes also show that in 1999, 9 per cent. of youngsters aged 11-15, were recorded as being smokers. It was back to 9 per cent. in 2004. If the 1996 figure was 13 per cent., up from 10 per cent. in 1992, the fact that it was down to 9 per cent. in 2004 does not necessarily indicate an established downward trend.

On the Minister’s point about the effectiveness of smoking cessation services, it would certainly help the Committee if we could see the emerging results of the examination by the National Institute for Health and Clinical Excellence of those services. I think that NICE is due to give guidance on that in the new year; it should have completed work on its initial guidance for consultation this month. Will the Minister ask NICE to give us access to its emerging conclusions before we conclude our proceedings?

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

I will not give a firm commitment on that at this stage. I will seek advice on where NICE is regarding that information. I can provide figures that are already in the public domain on the number of people who have quit four weeks into the available programmes. I shall write to hon. Members of the Committee on that issue.

On the point made by the hon. Member for Northavon, I understand that before 1996 the reduction had hit a plateau. We have tried to influence that by education and by national and local campaigns—both are important—by providing additional services through the NHS and, of course, by tobacco control. I know that measures on the sale of tobacco to young people are important for my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis).

Where we are today is based on where we felt that a step change was necessary. The “Choosing Health” White Paper is recognised as having been substantial. Not just smoking but the whole area of public health came under scrutiny in order to identify what more we could all achieve by focusing on preventing rather than treating illness. I shall not go into the consequences of smoking. The hon. Member for South Cambridgeshire acknowledged, and we can all agree, that smoking is a killer. It is a major contributor to cancer, chronic heart   disease and other illnesses and we know that passive smoking can also kill—the hon. Member for Westbury mentioned a report in that regard.

For a long time, all political parties have publicly acknowledged the dangers of smoking. That is one of our reasons for supporting the messages on cigarette packets that advise people about the dangers. In that context, the question that was asked in the “Choosing Health” White Paper was, “How can we take the issue forward?” A great deal of progress has been made by organisations that have encouraged voluntary bans. Going by the ages of Committee members, many of us will remember when it was permissible to smoke on buses and tube trains, and even at the cinema and in theatres. That was part of the atmosphere in which we were brought up, but things have changed substantially over many years.

I acknowledge the point made by the hon. Member for South Cambridgeshire. By saying that we will achieve 99 per cent. coverage under these proposals, I do not for a minute take away from the fact that a number of workplaces are already smoke-free or provide smoking areas. However, our figures are based on 51 per cent. coverage, and the proposals will take us a long way towards our goal. That is not to diminish the actions that have already been taken—and continue to be taken—in workplaces and other public places. I was pleased to present certificates to some organisations in Doncaster, both public and private, that had decided to become smoke-free.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health 11:15 am, 6th December 2005

The 51 per cent. to which the Minister refers is the proportion of workplaces in which no smoking is permitted. That figure is likely to be for 2002-03. What evidence has there been since then on the number of workplaces that are entirely smoke-free?

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

It is based on the 51 per cent. of people who report their workplaces as being completely smoke-free. It does not account for places in which there is a smoking room.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

That is the figure on which we base our information. I shall see whether there is any more up-to-date evidence. I do not want to get into an argument; I am being open and acknowledging that progress has been made on a voluntary basis. When we published “Choosing Health”, and asked the public and organisations what they felt about smoking, they expressed the view that we should go further, and that the time was right to legislate.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

Well, the hon. Gentleman raised a number of points about the bases for our decisions. I will try to explain them even more thoroughly than we did on Second Reading. I will be happy to take interventions, if I can just finish my point.

When we asked people for their opinions in “Choosing Health” there was an overwhelming response from both smokers and non-smokers on the places where there should be restrictions. Some of that is also backed up by the smoking-related behaviour and attitudes survey that was conducted by the Office for National Statistics in 2004, which found that 88 per cent. of people supported restrictions on smoking at work, 91 per cent. supported them in restaurants, 93 per cent. in indoor sport and leisure centres, and 65 per cent. in pubs.

However, when people were asked whether they supported a complete ban, in relation to pubs the issue became much clearer. They said that where food was served in restaurants or pubs, there should be a complete ban on smoking, but only 31 per cent. supported a ban in establishments where there was just drinking. However, I should say that that was an increase of 11 per cent. on the previous poll. That shows that although there is not a majority in favour of a total ban, the public’s attitude is moving. What we are trying to do in this legislation is reflect public opinion, building on the compliance that there has been with voluntary bans because they have been in tune with what the public feel.

The Bill introduces a total ban, but with some exemptions. As my right hon. Friend the Secretary of State has said, there will be a review within three years and monitoring and evaluation from day one. That is the reason for introducing regulations; instead of having to come back with primary legislation, we can come back and change the regulations at a later date. This is based on good evidence.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am grateful to the Minister for giving way, as it is tedious for her to take interventions that refer back to points made long ago.

The Minister says that this is based on good evidence. Does she not agree that it is in fact based on an association in the public mind between smoking and drinking, as distinct from between eating meals and smoking, which they are opposed to, principally on grounds of the nuisance and irritation caused by people smoking around others who are eating? I want the Minister to focus on this point. She refers to evidence, but where is there any health justification for distinguishing between places where food is served and places where it is not? Surely the health evidence is distinct and very different from the nuisance reasons?

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

I intended to come to that issue. A combination of factors led us to arrive at our proposals, which we put in our manifesto. One factor, which I am sure that the hon. Gentleman is keen to acknowledge, is what we know about dangers to health from smoking. However, smoking is not an illegal activity so, if we are to legislate, how do we get the balance right? How will our proposals be applied? How will they be enforced? Are they in tune with public opinion? Are they a driver for change? Our policy reflects the different levels of evidence in respect of all aspects of the matter.

As for the question of smoking in food and non-food establishments, I do not believe that I or my right hon. Friend the Secretary of State or her predecessor have ever said that there was a health-related distinction. We have said that we have health evidence, but we also have evidence about what the public feel is right in respect of reducing exposure to second-hand smoke. People were very clear about where they felt there should be a total ban, and where they felt there should not be a ban. The hon. Gentleman raised this issue on Second Reading. This is a health Bill and it will reduce smoking in public places and workplaces. However, the fact of the matter is that it is also a balanced Bill that reflects where public opinion is at present. Arguments have never been put forward about a health divide in respect of food. What is clear, as the hon. Gentleman stated, is that people have a preference, and that is reflected in the Bill.

The Bill takes us on a journey. For the first time, we are legislating and not leaving it smoking bans to voluntary effort. We are legislating in a real and substantial way on the huge number of areas where not smoking is voluntary, and on a number of places where smoking happens. The Bill will make that an event of the past.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

I want to make a little progress in dealing with the points raised by hon. Members.

Some points were made about the regulatory impact assessment. Again, we have been very upfront. The RIA is primarily about costs, and it is obvious that a total ban would be cheaper. I said so to the Select Committee, and it has been said on the Floor of the House. We have to balance the options and how they fit in with our work on policy development, and we have to balance that against the costs. As a result, we have gone for a measure that takes us a significant step forward, but it allows a few exemptions.

This morning, we have talked primarily about bars, but let us not forget the other exemptions. Some are in line with those in Ireland and Scotland for establishments such as hospices, prisons and so forth; and even some hotels have designated rooms for smokers. We recognise that a total ban would not be appropriate.

In the Bill, we have something that is clear. It is a lot clearer than the policy of the Conservative party. I am bemused; I wonder what Opposition Members would do if they were sitting on this side of the Room, although I hope that that will not be for a long time yet. They seem to want to have their cake and eat it. I am happy to take an intervention before going on to the specifics of clause 1.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

The Minister is gracious in giving way. I am trying to find some sort of evidence base for what she wants to achieve. We have heard about the distinction between food and non-food areas, and the lack of evidence about the health benefits. She might like to comment on the 1 m-from-the-bar rule on which she seems so keen. It seems to have been plucked out of the air, and there is no real evidence for the health benefit; rather, it is a nuisance. I hope that the   Minister can understand our concern about the distinction between nuisance and health—this is a health Bill.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

It is a health Bill, and I believe strongly that the measures in the Bill, particularly those in part 1 on smoke-free places, will contribute to a number of people giving up smoking and, I hope, stopping. Just as important, it signals a shift in the culture of the society in which we live; it will be predominantly smoke-free rather than allowing smoking with some smoke-free areas.

As I said before, we feel that there will be significant health benefits. However, it is also about public understanding and an acceptance of how people want to live their lives, which is why we are providing choice. I see no incompatibility between looking at health evidence on the dangers of smoking and then, through legislation, seeking to prevent smoking in a number of public places and workplaces.

The hon. Member for Westbury raised the question of the 1 m rule. I note from one of their amendments that the Conservatives would like voluntary bans to continue without any interference from the Government. The 1 m rule has resulted from a voluntary ban that is often used by the pub and leisure sector. We asked a question about that in our consultation; it is probably the one example of something that is currently used in the pub and leisure sector.

There is a debate about which of a number of measures would be most helpful in meeting our manifesto commitment to protect bar workers from exposure to smoke. We are continuing to consult on that. One measure is the 1 m rule, but we are not stuck with that. It was put in the consultation as a chance to debate how it might work and what other measures were available. Obviously, we will keep the House informed as to the results of that consultation when we come back with regulations on that.

The hon. Member for South Cambridgeshire asked an important question. He asked what was the point of the consultation that we carried out over the summer—a question that was echoed by the hon. Member for Westbury. There was a point to the consultation. First, it was on the proposals in the “Choosing Health” White Paper and was based on our manifesto commitment. There were 16 or 17 specific questions about enforcement, fine levels, the definition of food and non-food establishments, the bar area, timetabling and whether substances other than tobacco should be included. I will get to that final point eventually.

We got a huge amount back from that consultation. Yes, most responses were clearly in favour of a total ban. However, although people might want to go further, the measures that we suggest represent a step change: for the first time there will be a law that can be enforced to prevent smoking in certain places. There are aspects of the consultation on which we are not in agreement, such as the total ban. However, we have   taken on board issues that people have mentioned in relation to the timetable. We brought that forward by 18 months.

We have listened to people on clause 1 and the definition of smoke, and we are still listening to representations on some of the exemptions. We are in discussions with the Ministry of Defence and the Home Office about areas that they cover where there is a residential connection. We are talking to people in mental health about the issues that affect them. We have also taken soundings about fines, enforcement and signage. That will be reflected in our draft regulations. So it is not true to say that we have had a consultation and have not listened. Based on our principal position, we have listened to many points about how it will be implemented. We will discuss that further in Committee, but we still feel that our position, as set out in our manifesto, is right.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health 11:30 am, 6th December 2005

Question 5, to which the Minister did not refer, invited views on the merits and practicability of the proposal for creating a distinction between pubs that serve food and those that do not. There were 41,833 responses. The Government summary states:

“The majority of responses to this question (over 90 per cent.) are against any exemption for pubs not serving food.”

In the face of such overwhelming opposition, why have the Government proceeded in precisely the same way as they originally proposed?

May I also ask a question about the evidence base for the “Choosing Health” White Paper proposal? The then Secretary of State for Health—the present Secretary of State for Defence—said that his reason for not having a total ban included the idea that that would lead more people to drink and smoke at home. We have previously discussed the fact that much of the scientific evidence about the negative effects of second-hand smoke relates to people who are exposed to it at home. Does the Minister think that that is a good reason for not having a total ban?

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

That is an interesting point. Regardless of the legislation, people in other countries, as well as in this one, have increasingly taken to drinking at home. Videos, CDs and DVDs have contributed to the increase in the number of people pursuing their leisure activities at home.

There is evidence from Europe, which I cited at the Health Committee, that people are increasingly buying alcohol to consume in their homes—hence the increase in beer sales. We need to address that, for the same reason as we need to address the problem of second-hand smoke in the home: we know that 95 per cent. of deaths from smoking are the result of smoking in the home.

Hon. Members expressed their concern to me before the summer that our proposals might push people into the home to smoke more. So far as I am aware, on the basis of a report that the Royal College of Physicians published in July, and another report that was published in Ireland, there is no evidence to that effect. I would be happy to write to the Committee to confirm that. I believe that I referred to those reports at the   Health Select Committee’s evidence inquiry. Those reports of the past six months seem to suggest that our proposals will not do that.

Our proposals recognise the fact that there is still a view that there should be choice about smoking and having a drink in certain social settings. That is what we are reflecting here, but we do not believe that removing that choice will lead to an exodus into the home. I hope that my earlier remarks put the matter into context. We are concerned about the amount of smoking at home, and our efforts to tackle that by giving people access to smoking cessation services, and by increasing awareness through campaigning, are designed to ensure that we do not lose sight of the health dangers to individuals, particularly children, of smoking in the home.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

Perhaps I am beginning to see the light. We are concerned about smoking at home, particularly as that means smoking in front of children. We are particularly concerned about things such as sudden infant death syndrome, which we know are causally related to tobacco smoke. If I understand the Minister correctly, she is saying that the reason for having a distinction between food and non-food is that that will preserve some sort of smoking den to which people can go, so that they do not go home with their six pack and smoke in front of their children. Is that a fair interpretation?

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

No, that does not at all reflect what I have just said. Again, this discussion is very interesting, because it makes me want to ask Opposition Members whether they support a full ban. On the one hand, they tease us with indications that the evidence leads to such a ban, but they do not actually step up to the plate and argue for one. They do not, in fact, step up to the plate and argue for any legislation whatever.

I believe that I was clear when I said that we were concerned about smoking in the home. That is why the Department of Health does a lot of work, and why a lot of work is done at local level by PCTs, Sure Start units and schools to address smoking in the home. Our proposals are clear about the distinction between public houses that serve food and public houses that do not serve food, and are not dependent on the idea that not offering the option of smoking in a public house that did not serve food would necessarily lead to an exodus of people to the home. I cited two reports from the past six months that have given us the latest evidence that there would be no such exodus.

I have tried to be very frank about the distinction between food and non-food, which we believed that the public were ready to accept in legislation.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

What about the consultation?

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

I am coming to that. The consultation in the summer was, as I said, one part of our deliberations. I respect the sincerely held views of people who took part in the consultation, but it involved many organisations and individual groups   that were very clear about their expectation or desire for a total ban. The number of responses was based on their campaigning for such a ban. We acknowledge their views, but we must set them against the attitudinal surveys of members of the public. There is an imbalance between the views of those who responded to that consultation, and the views of the public sought through other means. Governments take those views as soundings on where they feel public policy should move. The Government lead, but still reflect public opinion. Smoking is not an illegal activity, and we must take the public with us. Our view is that the legislation, which represents a total ban with exemptions, sets us on a journey to seek to win further public support in the future. The Bill is one way in which we can take the public with us.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I shall not bore the Committee by quoting myself, but the Minister keeps talking about the Opposition not having wanted to put any provisions into legislation. I refer her to the Official Report of 29 November 2005, column 161, which records my words clearly setting out what we proposed. We shall return to the concept of a self-regulatory solution, backed up by legislation, in subsequent debates. We made it perfectly clear before the election that we were contemplating legislation.

The Minister has not disputed the fact that the regulatory impact assessment suggests that Government policy would have half the benefits of a comprehensive ban in terms of reduced mortality from exposure to second-hand smoke. However, the Government do not illustrate how that reduced mortality will be distributed, and the exacerbation of health inequalities that would result. If I understand the chief medical officer’s argument against the Government proposals, it is essentially that not only do they not deliver the maximum health benefits, but, in so far as the benefits are substantially less than they might otherwise be, the loss of benefit is disproportionately concentrated in poorer and more deprived areas where the mortality and morbidity rates are highest. How does that weigh with the Minister? She has not mentioned the objective of reducing health inequality; we know that that is getting worse, if anything. Where does that figure in her thinking?

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

Of course that is an important matter. I have learned over the last six months that we must look closer and in more detail at why more affluent, better off and better educated people are more likely to follow health information. We must grapple with that fact in order to close the gap. There has been some significant good work in some of our poorest communities on smoking, including the availability for pregnant mums to access services to help them give up smoking, and work through Sure Start. However, there is much more to be done; there is no doubt about that.

The overall rate of smoking prevalence for manual workers has come down to about 31 per cent., compared to 27 per cent. for non-manual workers. That shows a significant shift, but there is, of course,   more to be done. We recognise that tackling health inequalities is not done through one policy, but through a series of policies.

To tackle health inequality we must tackle poverty, access to employment, access to quality housing, and access to an environment in which people have aspirations for themselves and their families. That is at the heart of addressing health inequalities, and that is why I am in the Labour party. Alongside that is the recognition that there is no one-size-fits-all policy. We must bear down on what is preventing people from coming forward.

“Your health, your care, your say” asks, particularly in those poorer communities, why health services are not accessed in the same way as in more affluent areas. Are they fit for purpose and reaching need? Examining some of our spearhead primary care trust areas, it is quite interesting to see the impact that, for example, Sheffield has had in certain areas of health inequality compared with others. We can all learn from that. It is important to have a package of measures.

Dr. Murrisonrose—

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

Before I take another intervention, I wish to say how pleased I am that the number of homes in which smoking is banned in increasing. It has risen from a reported 45 per cent. in June 2003 to 58 per cent. in June 2005. That is to be welcomed. It underpins the strong message in choosing our health. Ultimately, it is about people choosing health for themselves, as much as it depends on legislation or intervention by the Government or others.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

I am pleased that the hon. Lady joined the Labour party to reduce inequalities—but by that measure, clearly her membership has failed, because health inequalities are becoming worse. Does she understand that making the distinction between pubs that serve food and those that do not will heighten health inequalities in both relative and absolute terms? Smoking dens will be created, especially in least well-off areas. Surely she understands that.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health) 11:45 am, 6th December 2005

Tackling health inequalities involves a range of measures. That is why, under the Bill, more places where people from deprived communities both live and work will be covered than ever before. Statistics show that there are more workplaces that are currently smoke-free in middle-class professional areas than in manual working areas.

I take the point about pubs that do not serve food. We have said that we shall monitor and review the situation. People, especially workers in manual professions, a huge swathe of bar workers whom I would incorporate into the group that we are discussing, and those who work elsewhere in the hospitality industry, will be protected for the first time. They will be able to work in an environment without smoke, or be protected at the bar as they have never been protected before. That is a step forward in dealing   with health inequalities. We are clear about what we are saying here. On Second Reading the hon. Member for South Cambridgeshire tried to claim that his proposals were the same as ours.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

They are close to ours—I am just looking at the Hansard report of those proceedings. The hon. Gentleman referred to self-regulation followed possibly by legislation. He was not clear about how for how long he would continue to allow self-regulation.

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

I shall give way to the hon. Gentleman if he will make matters clear.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

On Second Reading I said:

“As we made clear before the election, we would have included provisions in a public health Bill to enforce a reduction in smoking in circumstances in which a self-regulatory solution had not been effective in three years.”—[Official Report, 29 November 2005; Vol. 440, c. 161.]

Photo of Caroline Flint Caroline Flint Parliamentary Under-Secretary (Department of Health)

That underpins an amendment that the hon. Gentleman has tabled. It suggests that if there were a Conservative Government, we would have a system under which with voluntary bans would be allowed to continue. When we discuss that amendment I shall explain why we shall not accept it. It would not help to move the agenda forward. It would raise more questions about how to determine whether someone had self-regulated to a proper extent to reduce smoking environments, as well as a lot of issues in connection with regulations—but we shall come to that when we deal with the amendment.

Now I want to say a little about clause 1 and our definition of smoking, which was picked up by the hon. Member for Northavon. The definition of smoking covers being in possession of tobacco, substances that include tobacco or other substances that are alight. That means that the Bill will cover non-tobacco cigarettes, such as herbal cigarettes, and that being in possession of any sort of lit substance—for example, smoking a hookah pipe—would be classified as smoking. We have included non-tobacco products following consultation responses, which pointed to published evidence of the harmful emissions from non-tobacco cigarettes. I think that that was provided by Action on Smoking and Health.

We also received consultation responses that recommended widening the definition to allow easier enforcement. With a narrow definition involving only tobacco, there is a risk that smokers will claim that their cigarette is herbal, which would result in dispute and practical enforcement problems for both the owner of the premises and the enforcement officers. That has been a problem in Ireland, which did not have such a definition to start with. We do not want enforcement officers to have to send cigarettes for testing, at a cost disproportionate to the offence, or altercations between members of the public, or premises owners and members of the public, over whether a cigarette is tobacco or herbal based. I hope   that I have answered questions sufficiently. I will follow up in writing some of the points raised this morning.

Question put and agreed to.

Clause 1 ordered to stand part of the Bill.