Health Bill

My Lords, I wish to speak in support of the Bill as it has emerged from its passage through the other place. In particular I wish to talk about two aspects: namely, the provisions to make enclosed public places and workplaces smoke free; and the clauses related to the Appointments Commission. I welcome the smoke-free provisions; they are health and safety measures. They do not represent a ban on smoking as some have sought to suggest. What the provisions do represent is the freedom for people not to be forced to inhale potentially lethal second-hand smoke in enclosed public places or in their place of work. Inevitably the measure has been opposed as an attack on the liberty of the individual to, in this case, smoke. The requirement to wear a seat belt was also opposed on the same grounds, but I do not think there are too many people now campaigning against that measure, which was also a health and safety one. Others—namely, many representatives of the tobacco industry—continue to deny the overwhelming evidence of the adverse effects of second-hand smoke, just as for many years the industry maintained that smoking itself was not a cause of concern, even though it has now emerged that it had known about the consequences of direct smoking for some years. If there is anyone who believes that all captains of industry are beacons of integrity and honesty they should take a close look at the tobacco industry in that regard. Second-hand smoke does kill. The Scientific Committee on Tobacco and Health, which advises the Government, has said that exposure to second-hand smoke increases the risk of lung cancer and heart disease to non-smokers by about a quarter. That exposure in the workplace has led to some 600 deaths a year; or three times the number killed in industrial accidents. It also causes illness and not least asthma attacks at work. It is precisely because this is a health and safety issue at the workplace that it was not acceptable, as originally proposed, to exempt membership clubs and pubs not serving food, neither of which could be regarded as having any similarity to places of residence. In the Irish Republic, where similar measures to those in the Bill have been introduced, one person in three used to smoke; this has now fallen to one person in four, which suggests that the measures will have a favourable impact on levels of smoking. Government figures suggest that the measures contained in the Bill will lead to hundreds of thousands of people in England giving up smoking to the benefit of their own health, differences in life expectancy between social classes and the National Health Service. Neither are the measures in the Bill likely to have an adverse economic effect. Bar sales in Ireland rose by more than 5 per cent in the year to October 2005 and I understand there was a similar trend in the year following the introduction of New York’s smoke-free air act. The case for these measures in the Bill is overwhelming, and once they have been brought in I am sure they will quickly be accepted as the norm and not subsequently be reversed. I also wish to talk about the measures in the Bill relating to the Appointments Commission. Under Clause 57 the Secretary of State will be able to direct the Appointments Commission to exercise all or part of her power to appoint, among others, non-executive members of strategic health authorities, primary care trusts, NHS trusts and special health authorities. I am sure that the Secretary of State believes that non-executive members have a vital role to play, and are not there just to be seen but not heard in order to give the necessary veneer of respectability to governance arrangements. If I am correct about the Secretary of State’s view, and I have every reason to believe that I am, it will be necessary to make sure that her view about the importance of non-executives and the need to support them in their role is reflected in the culture of her department and throughout the health service. The reason for my raising this issue is an example which has been brought to my attention, and over which my noble friend Lord Warner has been extremely helpful, of non-executives being treated effectively as peripheral figures in a health service organisation. That organisation is one of those that now have problems with their finances. We will neither attract nor, equally significantly, retain the calibre of person we want as non-executive members if they are left with the feeling that they are wasting the time they are prepared to give, in what are already full and busy lives, because they are either being thwarted in carrying our their role through being ignored or have repeatedly to fight and press to have any sort of meaningful involvement. People of ability who have something of real value to contribute will not accept that kind of treatment. Either they will not apply or, if they are already in post, they are liable to walk away. Perhaps the case that I have had drawn to my attention is the one exception to the rule. If my noble friend can assure me that it is, I will of course accept his word. However, if, like me, he has a feeling that this is not the case, I hope that he will make sure that the general issue of the level of involvement in practice, rather than in theory, of non-executives, and their role in the effective running of the National Health Service, is pursued. Otherwise, the appointments commission referred to in this Bill will be wasting much of its time in making such appointments.