Health Bill [HL]

My Lords, I also welcome the Bill. Obviously, it could have contained everything else—obesity, alcohol, in fact the world—but we often say to the Minister that we do not want more legislation. If we look around us and see the ads on television, we can see that the Government are doing a great deal about lifestyle in some of their advertising and other work, and I commend them for that. I am grateful that the Bill concentrates on the tobacco issue. In the view of some noble Lords, I am notoriously responsible for the amendment that stopped smoking in the Peers’ Guest Room. With the noble Lord, Lord Faulkner of Worcester, I introduced the two London and Liverpool Bills that pressed the Government onward and upward to introduce their total ban Bill in the other House. I obviously felt that I should come and speak about these issues in relation to children and this Bill. I will say a few words about two other issues, but I will mainly concentrate on that. Again, I congratulate the Government on progress already made on the smoking agenda and the impact that they have already had on the health of the nation. We must all welcome the news that prevalence fell in 2007 among all adults in England to 21 per cent in routine groups and 28 per cent in manual groups. But the Minister also told us that, from numerous surveys, 87,000 people a year continue to die from smoking-related diseases. Progress is welcome, but more needs to be done, particularly in the most deprived areas of the country, where rates can be as high as 50 per cent. Among children, it is estimated that 340,000 under the age of 16 try smoking and more needs to be done to discourage them from the habit. Four out of five smokers start before the age of 19. It is also estimated that there are currently more than 190,000 child smokers between the ages of 11 and 15 in the UK. Those are the ones whom the tobacco industry has already hooked and whose future health is in danger. I am quite sure that almost everyone is united in seeking to protect children from smoking and from second-hand smoke. I work for an organisation called Little Hearts Matter where we are doing everything possible to give a quality of life to children born with heart defects. It grieves me deeply that we have children born with healthy hearts and organs and we are failing to protect them from smoking and the damage that it will then do to these healthy organs in the future. To address those problems, a number of leading charities including Cancer Research UK, the British Heart Foundation and Ash have joined together, and I endorse the thrust of their aims that there should be a strategy to include measures to protect children from tobacco marketing by prohibiting the display of tobacco products at the point of sale. We have heard much about that and I will not repeat what has already been said, but I will simply say that being alert to this debate and entering my local post office at the weekend, I was utterly struck by the array of beautifully designed, brightly coloured packets facing me—I had several children standing around me—and next to them was the sweet counter. The associations that are being made early are quite clear. I could not see what difference it would make to have them under the counter or in white packages except to prevent children finding these things attractive in the future. Prohibition of point-of-sale displays has been implemented in nearly all provinces in Canada and has formed part of a range of tobacco control measures. These steps have coincided with a drop in smoking prevalence rates among 15 to 19-year-olds from 22 per cent in 2002 to 15 per cent in 2007. The Republic of Ireland will be bringing in a prohibition on point-of-sale displays later this year, and Scotland is considering a similar measure. I hope that the Government will not be left behind, but will keep themselves at the forefront of their previous work in terms of tobacco by making us another country that implements this vital health measure. However, I am pleased that the Government are considering the needs of retailers, particularly small shops, by allowing a proportionate time to implement the measures. I hope that the Government will set a firm timeline, from consultation to the laying of regulations, to enable all parties to plan ahead effectively to implement point-of-sale restrictions. Tobacco companies greatly value the marketing potential of point-of-sale displays and pack designs, even despite the introduction of health warnings. For example, Japan Tobacco International is marking the launch of a new, redesigned pack for its Benson & Hedges brand by holding a competition for retailers, featuring a grand prize of a store refit worth some £40,000. A spokesman for Japan Tobacco International was quoted in a retail news source as saying: "““The new pack designs for Benson & Hedges represent a very important chapter in its 130-year history””." Last autumn, the company also put out a special edition of its Benson & Hedges Gold brand with a modified pack design. In the media reports about the promotion, the company’s spokesman said that the special edition’s, "““striking designs will only serve to further enhance retailers' profits with their eye-catching appeal””." As yet no country in the world has taken steps to introduce plain packaging for tobacco products. While the Government are committed to study the packaging issue, I urge them instead to take decisive action in this Bill and commit to giving the Secretary of State an enabling power to introduce plain packaging. I am also pleased that the Government have recognised the problem caused by tobacco vending machines, but I am disappointed that Ministers have stopped short of prohibiting them entirely. I spend a good deal of my time with young people, and I reiterate the point made by the noble Lord, Lord Rea, that they have tremendous ingenuity in acquiring things that are prohibited by adults if they have any capacity of access. The Bill would require the introduction of some sort of system to prevent young people using the machines; I would like that. LACORS—the Local Authorities Co-ordinators on Regulatory Services—said that, in recent test purchases, young people were able successfully to access 41 per cent of vending machines. I do not believe that a successful method can be found to prevent usage by under-18s. Instead, the Government should move to prohibit immediately the sale of tobacco vending machines to block this channel of tobacco from reaching children. I will support any amendments to this end. I turn now to personal health budgets, on which I have rather a different view from my noble friend Lady Campbell. She has most delightfully, and with her usual eloquence, spoken about their benefits. I urge the Government to think carefully before they take a step in that direction, and to ask some questions. Will they support conditions within certain criteria? I can see how they might support my noble friend’s ripple bed, but will they include those with multiple needs such as learning difficulties, as the noble Baroness, Lady Young, said? How will that work for children or young people who are still in the care of parents but are able to express their own views on their treatment? There are specific issues around managing a budget on behalf of someone else, and Sense, the charity working for deafblind people and those with other multiple disabilities, is concerned about this. After all, some—in my experience, many—disabled people who receive direct payments for social care have found it difficult to obtain enough resources to meet their assessed needs. I speak from personal experience of caring for a cousin with Alzheimer’s, as well as experience gained as chair of the charity Livability. What will happen to their healthcare when the money runs out? Will they have to top it up, and what will this do to the principles of the health service? Although I concede that there might be benefits, even before the pilots go out, I hope that the department will look at these very serious questions. Finally, I want to say a word about the constitution, which I think needs to be broken down into its constituent parts. I would like the parts that relate to patients to be easily accessible to them when they go to a hospital without the need to have all the other parts, although the other parts could be accessible if they wanted them. I am very pleased to see within the list of responsibilities the need to ask patients’ nearest and dearest about organ donation. If there is one thing that could increase the health of the nation substantially, it is ensuring that we have all spoken to our nearest and dearest about organ donation and filled in the proper form. I welcome the Bill but I know that there will be some detailed debates and many amendments in some areas.