Health Bill

My Lords, I am a fervent believer in the rights of the individual and in personal freedom. That leaves me free to indulge in a habit, if I so wish, such as smoking, if I am alone, but it does not give me the right to indulge in a habit such as smoking in the presence of other individuals who thereby could be seriously harmed. That is one of the core principles underlying the Bill as amended. I am very glad to see the noble Lord, Lord Naseby, back in his place because the attitude of the medical profession has undergone a sea change over the past 50 or 60 years on this issue. Many years ago, when I was a medical student, the professors of anatomy and physiology recommended that we should all smoke, particularly in the dissecting room, as it would help to dispel the odours. More than 60 years ago, when I was in the Army as second in command of an army hospital ship in the Royal Army Medical Corps, I used to buy a 50-can of Senior Service every other day and I got through it in two days. It cost one shilling and eight pence and I smoked 25 cigarettes a day. Then, when Sir Richard Doll produced his first paper, with Bradford Hill and others, I began to see that there were some risks in smoking. However, the evidence at that time suggested that pipe smoking was less dangerous than cigarette smoking, so I moved on to a pipe. In another 10 years’ time, the risks associated with pipe smoking of tobacco—indeed all tobacco consumption—became increasingly clear and I gave up nearly 40 years ago. For a time I had that feeling, like Lady Macbeth:"““Is this a [pipe] I see before me, its handle towards my hand? Come, let me clutch thee! I have thee not, but yet I see thee still””." I give that personal history because, since that time, the evidence on direct, personal smoking has accumulated steadily and progressively, not only in relation to cancer of the lung or cardiovascular disease, but also in relation to many other cancers. I can quote to my noble friend Lord Skidelsky, although I shall not tonight, the massive volume of statistical evidence that has clearly underlined the facts relating to this matter. Some 20 years ago, I chaired a conference at Green College, where I followed Sir Richard Doll as the warden, on the effects of passive smoking. We took a lot of evidence from skilled individuals, such as statisticians, doctors, scientists, and from members of the public. We came to the conclusion that there was anecdotal evidence suggesting that perhaps passive smoking might be harmful. In the past 20 years, the statistics have steadily accumulated and the evidence is now absolutely cast-iron. There is a very large body of scientific literature that makes that point clear. As my noble friend Lady Howarth said, the BMA published evidence last March showing that second-hand smoke is likely to be responsible for the deaths of more than two employed people every working day—more than 600 deaths a year—and at least one employee in the hospitality industry dies each week—54 deaths a year—from passive exposure to tobacco smoke. I appreciate what was in the Government’s manifesto, but I congratulate the Members of another place on their good sense in introducing the amendments to change the Bill from what had originally been in the manifesto to enact a total ban on smoking in public places, including private members’ clubs. I would be delighted if the Bamburgh Castle Golf Club, of which I am president, enacted a ban on smoking. The noble Lord, Lord Geddes, who is not in his place, won a competition there a few years ago. I believe that will be very important because everyone, including those working in private clubs and pubs that do not serve food, has the human right to work without being exposed to poisonous and life-threatening substances. For that reason, the provision relating to private members’ clubs is very important. On the points made by the noble Lord, Lord Naseby, on ventilation, I commend to him the parliamentary brief from the British Medical Association with a series of very precise references to scientific research studies in Europe, which demonstrate that,"““displacement ventilation technology cannot remove the gases and particles from the air””." Perhaps that can be done partially, but it certainly cannot be done to an extent that will be really effective. Statistics have been bandied about. The president of the Royal College of Physicians, in evidence to the House of Commons Select Committee, said,"““there is nothing that this Government could do for health that would be better than to bring in this ban—absolutely nothing””." I agree with her entirely. The Royal College of Physicians estimates that some 12,000 deaths per year occur from passive smoking, but the great majority of those occur in the home. The figures for the workplace are very much smaller, at 500 to 600. Most of the deaths are caused by passive smoking at home, but exposure is particularly high for some workers in the hospitality industry. Preventing passive smoking at home, particularly for children, is, therefore, a public health priority. Home exposure is prevented only by encouraging parents and carers to quit smoking completely by making homes completely smoke-free. I agree entirely with what the noble Lord, Lord Colwyn, said. There is a widespread misconception that banning smoking in public places will lead to an increase in tobacco consumption in the home. In fact, the reverse is the case. There is now growing evidence that where smoke-free workplaces and smoke-free enclosed public places are the norm, parents report that they are more likely to try to prevent smoking in the home. In Ireland there has been a significant increase in the percentage of smokers who ban smoking in their own homes. I firmly and warmly support Clause 1 of the Bill as amended in the other place. I believe it will make a massive contribution to public health. I shall comment briefly on Parts 2 and 3. The Royal College of Nursing welcomes the action that is now proposed to tackle healthcare-associated infection. But they have some specific concerns, which the Minister may be able to allay, relating to the scope of the code of practice, the timetable for introducing the final code of practice and the need to ensure that the code for acute settings is not just transferred to the primary and independent care settings without consultation on its impact. That is particularly important in relation to care homes, as other noble Lords have said. Others have pointed out the concern expressed by the Royal College of Nursing about the definition of healthcare-associated infection. They much prefer the definition of the Health Protection Agency and not the one in the Bill. I hope that the Minister will be able to comment on that. I turn to Part 3 and the anxieties expressed by the Royal Pharmaceutical Society of Great Britain, which wants assurances that it will be an active participant in the drafting of the regulations which, as the noble Lord, Lord Colwyn, said, are likely to come thick and fast once the Bill has become law. The legislation should clearly define those activities that can be undertaken only when the responsible pharmacist is present and should include clear lines of accountability, provisions for the responsible pharmacist to be contactable when absent and in a position to return without undue delay, and provisions for the responsible pharmacist to justify any absence from the pharmacy. Clause 19 refers to,"““A constable or an authorised person””" being able to enter premises. Given the preparations for the transfer of that role to the RPSGB inspectorate, it believes that the role of the Royal Pharmaceutical Society in inspecting pharmacies should be stated on the face of the Bill, over and above the role of the constable. Those are the points that I wished to make at Second Reading. I hope that your Lordships will give warm support to the Bill in general, but will be prepared to look at some of the points that I have raised when it comes to Committee stage, in particular the strong support that we have heard from all sides of the House for the ban on smoking in enclosed public spaces.