Health Bill

I have to admit that I am one of those described by the hon. Member for Sunderland, North (Bill Etherington) as a zealot in favour of the total ban. I am in good company because I join the right hon. Members for Holborn and St. Pancras (Frank Dobson), for Rother Valley (Mr. Barron) and for North-West Hampshire (Sir George Young), and other right hon. and hon. Members. We must face up to the fact that the reason for a ban on smoking in public places is to protect the health of all workers. All workers have equal rights to a healthy environment. That is the answer to Ministers who claim that, because we are protecting 99 per cent. of workers, we are doing all right. The problem is that the 1 per cent. we are not protecting work in the most smoke-filled environments. People do not go to work in a factory or a shop to smoke, but many of them go to the pub to smoke. It is the 1 per cent. who are not protected who are the most worthy of protection. The Health Committee had to face the libertarian argument. A reader in biomedical ethics at Imperial college was asked, ““How do we defend the fact that we are attacking people’s liberty?”” He said:"““It is a simple idea, first set out most clearly by John Stuart Mill in the mid-19th century, the idea that the main way in which you can justify restricting someone’s liberty is where they are causing harm to others.””" Much as I object to restricting people’s liberty, if it causes demonstrable harm to others, it is justified. In relation to the trip to Dublin, I want to add some figures to facts that were mentioned by other hon. Members. Support for the total smoking ban in Dublin before it was introduced was 67 per cent., which included 40 per cent. of smokers. Within a year after its introduction, 93 per cent. said it was a good idea, 80 per cent. of whom were smokers. A total ban can be popular. Compliance is high. It is easily understood and enforceable, and it is now a pleasure to go into pubs in Dublin. The arguments against the partial ban have been mentioned at length. They include the worsening health equalities and the fact that it is illogical and unenforceable. The people who impressed me in the Health Committee were representatives of the Bingo Association. We all have a lot of little old ladies in our constituencies whose only outing in the week is to go to the bingo hall. They probably smoke and drink while playing bingo. However, the Bingo Association wants a level playing field. Without a level playing field, bingo would move to other places such as pubs that do not serve food and where smoking is allowed, which would be quite wrong. On our visit to Dublin, members of the Health Committee met a chest physician, Professor Luke Clancy, who reminded us of the effect of the Clean Air Act 1956 on London. I was a senior house officer at St. Stephen’s hospital when that Act was enforced piecemeal by different local authorities. Professor Clancy reminded us that it took a decade effectively to lower levels of smog and produce health benefits. Ireland has adopted a big bang approach to a ban, which has worked, and it is the only way forward for us. I shall take a leaf out of the book of the hon. Member for Southend, West (Mr. Amess) and look at other equally important parts of the Bill. I am glad that the Government are going to issue a code of practice with related sanctions on the prevention and control of health care-associated infections. I welcome the Secretary of State’s comments that the code will be based on existing good practice and that waiting list targets will not compete with infection control. However, there are some points that must be included in that code. Yesterday, with the right hon. Member for Rother Valley, who chairs the Health Committee, we met members of MRSA Action UK and MRSA Support, who expressed vitriolic anger about the lack of communication. One of my criticisms of the health service, particularly hospitals, is that communication between staff—nurses and doctors—and patients, is sadly lacking, possibly as a result of overwork. Members of those groups had relatives who had died of MRSA, but they had not been told that that was the cause of death. One of them alleged that they had received an unacceptable death certificate that just said, ““Multi-organ failure due to sepsis.”” In my day, no registrar would accept such a certificate, because one had to say what had caused the sepsis. Openness with the patient and the family is therefore needed, and to help with that, it may be necessary to formalise notification of those illnesses and make it mandatory. The list of notifiable diseases is under review, but diseases such as smallpox which, hopefully, has been eradicated, are still included. Hepatitis C and Legionnaire’s disease are not on the list, and hospital-acquired infections and bugs, including MRSA and Clostridium difficile, which are serious pests, have never been included. There is an MRSA surveillance scheme, but it is not tough enough, so will the Minister consider introducing formal notification of those illnesses? If that is too cumbersome and slow, can another method be used? As for the code of practice, most hospitals, if not all, have infection control teams, many of which follow protocols. During a previous Health Committee inquiry, our attention was drawn to the formulary used by University College hospital in London. Page 280 of the 2002 edition includes protocols for the eradication of staphylococcal infection and refers to protocols for the management of patients and staff with MRSA. I hope that such publications will inform the code of practice. The Healthcare Commission prepared a submission for our debate, which says:"““It will be vital that the code of practice is fully workable in practice and the Healthcare Commission urges that due time, consideration and consultation be taken over its content.””" Part 3 deals with drugs, medicines and pharmacies. There is no place for lax management of controlled drugs. When I was a house physician a quarter of a mile from here at old Westminster hospital, the control of scheduled drugs was lax. Much has happened since then, and controls must be tightened up. However, pharmacists have considerable worries about the Bill, as the hon. Member for Romsey (Sandra Gidley) will know. I hope that in Committee those worries will be taken on in detail. Pharmacists do not know in detail the supervision requirements. How many pharmacies will one pharmacist be able to supervise? They are worried that the Bill may exacerbate the shortage of pharmacists. To conclude, there are good parts and bad parts in the Bill. Returning to the subject of smoking, at the large cancer conference last week, an oncologist from Glasgow, who is very lucky to have the complete ban, said loud and clear that the one most important thing to improve the prevention of cancer was the total ban. Everything else, he said, was lip service.