Health Bill [HL]

My Lords, it is a great pleasure to follow such a useful, moving and amusing speech. On behalf of the whole House, I thank the noble Baroness for her contribution. Although the Bill is entitled ““Health Bill””, the first two parts are concerned with improving the arrangements for the administration involved in running the National Health Service and the delivery of care and only the first section of Part 3 is concerned with health itself by reducing the damage caused by tobacco products. Later I shall concentrate on that part, but first I have a few comments on the earlier sections. First, I refer to the constitution. Of course, it is right that there should be a document stating the basic principles of the National Health Service and what patients and staff should expect from it. I have looked through it and could not find a paragraph describing the refusal of treatment to patients who did not follow healthy lives, as the noble Lord, Lord Naseby, who is not in his place, mentioned. I am sure that it is not there. It is rather remarkable that the NHS has run for 60 years without such a guide. As an aside, I add that the whole country has run for a millennium or so without a constitution. In the NHS, we have understood and largely kept to Aneurin Bevan’s basic tenets that it should be free at the point of use, paid for out of general taxation and available to all, regardless of wealth, race or religion. Nevertheless, my friend and former colleague Julian Tudor Hart’s inverse care law still applies in many places, despite the often complex funding formulae that have been designed to rectify it. That is why it is good that the constitution states that the NHS, "““has a wider social duty … to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population””." Because deprived people have a higher burden of disease, both acute and chronic, than those who are better off or better educated, their care costs are higher. The distribution of healthcare resources does not yet reflect this, despite much work having been done on the funding formulae to which I alluded. I know that my noble friend and the Secretary of State are aware of this and will support continuing measures to take these issues into account. However, a criticism of the Bill regarding the constitution is that accountability for ensuring that its requirements are carried out is weak and lacking in detail. Paragraph 7 states: "““The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose””." Perhaps my noble friend can outline how that statement of accountability will be translated into action, as I cannot find it in the Bill. Let me say a word about pilot schemes for direct payments. Nothing that I say can possibly compare with what the noble Baroness, Lady Campbell, has just said. The precedent has been set by direct payments for social care, but I can see all sorts of difficulties and potentially a rapid exhaustion of any NHS funds granted in this way if patients are to pay for private medical care through direct funding. However, there is provision in the Bill for regulations to control the amount of funding and how it is used. My noble friend could perhaps briefly describe how these regulations will operate. Page 8, line 16 of the Bill requires pilot schemes to be reviewed after a specified period. Who will carry out that review? Will it be done by an independent body using scientific methods of investigation? If the results are negative, will the scheme be dropped or modified? In the past, lessons from pilot projects, if carried out at all, have sometimes not been followed up, or a project has carried on regardless without a full assessment. Like other noble Lords, I think that the plan to award prizes for innovation is a good one and is itself innovative. Can my noble friend give any details, as other noble Lords have asked, on how the scheme will operate, or will this be left to the advisory committee that is to be created? Will my noble friend say approximately what resources will be made available? I turn to the tobacco section of the Bill. As one who has seen first hand the devastating effects of smoking tobacco products, I am very pleased that the Bill carries forward the legislation that the Government have already put in place to curb and control their use. As the noble Lord, Lord Krebs, said last week in the debate on choice and equality, smoking levels have fallen significantly in recent decades, partly as a result of legislation in both Houses of Parliament. However, they have fallen much less in the less well off and less educated section of the population. Among that group are subgroups with very high levels of smoking. Some studies have found levels of 70 per cent almost the norm among women in certain deprived so-called sink estates. Many of them may wish to give up, but they regard it as the one small luxury available to them in a debt-ridden and stressful life. Of course, it exacerbates their debt and may contribute to their depression. The measures in the Bill will not greatly affect hardened smokers such as them; they will continue to go to their local tobacconist and give him their custom. They would get what they wanted even if tobacconists were banned; they would get cigarettes from men in white vans, perhaps. I shall talk more about them in a minute. In order to keep its sales up, the tobacco industry needs to recruit new smokers to replace those who die or quit smoking, whose numbers are increasing thanks in part to the work of Parliament—I refer here not to the number of those who die, but to those who quit smoking. Children go into retail tobacconists in large numbers because those shops also sell sweets. In those shops, cigarettes are often colourfully and prominently displayed on gantries, which seem to have got bigger since the advertising ban and are often placed close to chocolate and sweet displays. Obviously, children are interested in these displays and will want to sample the wares so attractively presented. The Bill gives plenty of time for tobacconists to prepare for the removal of the displays. The measure is considered and sensible. The restrictions in the Bill on the placement of vending machines are a start. However, 12 to 16 year-olds have great cunning and skill in finding their way through adults-only rules and in going to places where they are not supposed to be. The answer is to ban cigarette sales from vending machines altogether, as some other countries have done. There will be amendments to this effect in Committee. Along with every public health body in the country, I think that we should take the opportunity that the Bill provides to go one step further and require all tobacco products to have plain paper wrapping, though perhaps with the health warning preserved. I shall back amendments to bring this about. Finally, I would like my noble friend to tell us what additional measures the Government are considering to counteract the possible effect that this legislation might have in increasing the smuggling of cigarettes. The situation is bad as it is; we do not want it to get worse, whether the smugglers use white vans, family cars, boats or aircraft. It is already a big problem that threatens to diminish the effectiveness of tobacco control measures such as those in this Bill. This is a useful Bill that deserves the support and scrutiny of your Lordships’ House.