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Northern Ireland (Health And Social Services)

Volume 958: debated on Wednesday 22 November 1978

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10.1 p.m.

I beg to move,

That the draft Health and Personal Social Services (Northern Ireland) Order 1978, which was laid before this House on 6th November, be approved.
The order has two main purposes. The first, which is set out in part II, brings the law in Northern Ireland into line with the rest of the United Kingdom with respect to the prohibition on the sale of tobacco to young persons under the age of 16 years.

It has long been accepted that smoking is potentially damaging to health, and this is particularly true in respect of children. It has also been asserted that the best way to stop smoking is never to start, and it is significant that the majority of children who may begin experimenting with cigarettes at the age of eight or nine go on to become regular smokers as adults.

At present Northern Ireland is the only part of the United Kingdom where it is legal to sell cigarettes to children under the age of 16, and this has been so since 1950. This part of the order is designed, therefore, to limit the access of such children and young people to sources of cigarettes and tobacco.

In January 1977 the Ulster Cancer Foundation launched a publicity campaign to motivate public opinion to press for the introduction of legislation to control the sale of tobacco to children and young persons. This campaign has received widespread support and I am now happy to introduce this legislation.

Article 3 makes it an offence to sell tobacco or cigarette papers to anyone apparently under the age of 16. An exception is provided, in respect of the sale of tobacco, if a shopkeeper did not know and had no reason to believe that the tobacco was for use by the person who purchased it. This will still, therefore, enable parents to send children on errands to purchase tobacco, but the exception does not extend to cigarettes or other material designed for immediate smoking.

Article 4 similarly seeks to limit the access of young people to automatic vending machines selling cigarettes, and provides for legal proceedings to be taken against persons owning machines, or on whose premises they are kept, where machines are used extensively by young persons apparently under the age of 16.

Article 5 provides for the seizure of tobacco and cigarette papers from persons apparently under 16 and for the disposal of seized goods. Following consultations with the Northern Ireland Chief Constable and the district councils, it was decided to restrict the powers of seizure to members of the Royal Ulster Constabulary and RUC Reserve. It is recognised that there may be difficulties in enforcement, but the deterrent value is seen as the main benefit of the legislation.

Article 6 provides exemption from the provision of this part of the order for persons employed in the trade, and article 7 defines some of the expressions used in this part of the order.

The other main purpose of the order, set out in article 8, is to improve the standards of primary care in the Northern Ireland Health Service. The article introduces, from a future date to be decided, a period of compulsory post-registration vocational training for doctors wishing to become general medical practitioners as principals.

The National Health Service (Vocational Training) Act 1976 introduced a similar provision in Great Britain. As that Act did not extend to Northern Ireland, a statement of intent was made by the Government at the time indicating the intention to introduce similar legislation for Northern Ireland, to be effective from the same date and on the same basis as in the rest of the United Kingdom.

A voluntary vocational training scheme has been in operation in Northern Ireland since 1966 and was one of the first such schemes in the United Kingdom. The training course lasts three years, two of which are spent in hospital posts relevant to general practice and the third year in a training practice. In introducing the mandatory scheme, the Government have the full consent of the medical profession.

Details of the new training arrangements will be a matter for regulations, but the order provides that the medical profession must be consulted before these are made.

I should, however, make clear now the categories to which the new compulsory arrangements will not apply. They will not apply to general practitioners already providing a full range of general medical services when the new arrangements start nor to doctors employed in general practice as locums or assistants. They will not apply to doctors who have in the past been general practitioners with the health services, although consultations are to take place with the medical profession to decide whether some conditions might be attached to this—for instance, that a doctor's previous practice should not have been too far in the past.

In Northern Ireland, control over entry into general practice as a principal is exercised by the health and social services boards there, which are responsible for making arrangements with doctors for the provision of general medical services in their respective areas. Under the order boards will be given power to refuse, and indeed from a date prescribed by the Department of Health and Social Services for Northern Ireland they must refuse, applications for entry to general practice as principals from doctors who have not been vocationally trained or who are not entitled to exemption from such training. The exemptions will be set out in regulations.

On the question of timing, I mentioned earlier that it was intended that the Northern Ireland provisions would take effect from the same date as those in Great Britain to ensure reciprocity. The Great Britain regulations have not yet been made and the appointed day is not expected to be before the end of 1981.

The remaining articles are concerned in the main with minor amendments to the Health and Personal Social Services (Northern Ireland) Order 1972. This order was the instrument by which the reorganisation of the health and social services in Northern Ireland was effected and experience has shown that these minor amendments are required for improved admini- stration. Likewise, certain miscellaneous amendments to other legislation dealing with the health services have also been found necessary.

10.7 p.m.

I shall not detain the House long in commenting on the order, to which the Opposition give their support.

Commendation should be given to the efforts of the Ulster Cancer Foundation, which drew the attention of the Government to the issues that the order is designed to meet and pressed for legislation on the sale of tobacco to young people. I am glad that Northern Ireland will be brought broadly into line with the rest of the United Kingdom as regards the sale of tobacco.

The term in article 3
"apparently under the age of 16"
will surely give tobacco sellers undue latitude. This feature concerns me slightly. Prime facie it would appear to enable tobacconists to defend sales to young people below the age of 16 years on the ground that they appeared to be over that age. The seller's judgment appears to have been made the sole criterion. Has that caused difficulty in the 1976 Great Britain legislation? I have heard this evening that there has been difficulty in enforcing that legislation and that the results have been disappointing.

Does the Under-Secretary of State know how many tobacconists a year have been convicted for selling their wares illegally? What sort of fines have been imposed? I think that the House would like to be in possession of that information.

We give our support to the second main object of the order, namely, the introduction of mandatory vocational training for doctors entering general practice.

The Conservative Party supported the 1976 Great Britain legislation and we support the order.

10.9 p.m.

It would be remiss of me if I did not address some of my comments to part II of the order, although I do not want to deal with it in great detail. I hope that my hon. Friend the Member for Armagh (Mr. McCusker) will catch the eye of the Chair as he is interested in the matters there contained. He has had that interest for a considerable time and he has done much to encourage the people of Northern Ireland—especially young people—to face the problem and danger of smoking. He speaks with greater authority than I as one who has never smoked. He is able to speak with a certain degree of authority and experience.

I welcome the articles contained in part II of the order. I hope that the reporting of the debate, even at this late hour, will be such as to encourage more and more people seriously to view the injurious habit of smoking.

I turn to part III of the order. As one reads the recurring and therefore operative phrases such as "suitably experienced", "prescribed experience" and "equivalent experience", when looking at the vocational training, some questions naturally arise. We appreciate that the order is based on the National Health Service (Vocational Training) Act 1976, and that in turn these provisions are consolidated in sections 31 and 32 of the National Health Service Act 1977. But nowhere, either in the two Acts or in the order, do we find a real or working definition of vocational training. I know that the Minister touched briefly on this point, but I should like him to return to it and to give us some definition of what he means by vocational training and suitable experience.

For instance, what types of training experience are deemed to be suitable? What criteria have to be met to satisfy the definition of "prescribed experience"? The Minister dealt at length with those kinds of people who would not be subject to this provision, but he did not at any length define vocational training. How does it differ, for instance, from the normal professional medical training, or from the normal academia involved in qualifying to be a medical practitioner?

I understand that protracted discussions have taken place between the medical profession, the British Medical Association and the Department of Health and Social Services here on the mainland. I would be interested to know whether Northern Ireland representatives from the medical profession in the Province have been represented in these discussions and have involved themselves in them. I was slightly perturbed to discover that the provisions would not become operative until 1981 at the earliest, but perhaps that is because of the very nature of trying to define and provide vocational training.

I turn to part IV of the order and to article 11. I read with interest the phrase
"a voluntary organisation managing any premises".
It is stated:
"The Department may make arrangements with any voluntary organisation managing any premises".
I appreciate that it is not envisaged to give either the authority or the power—or the finance, for that matter—to voluntary bodies to create massive residential homes. Nevertheless, we have discovered in Northern Ireland that even statutory bodies inaugurate residential homes and facilities in such a way as not to take into consideration the changes which those kinds of residential facilities effect in the neighbourhood.

If statutory bodies can sometimes fail to take cognisance of local feeling and local concerns, it is certainly conceivable that voluntary groups may not be aware, for instance, of the considerations of property value or even planning legislation. I ask the Minister to tell us what safeguards the Department can provide for residents who may be faced—not deliberately or not with any degree of antagonism but perhaps inadvertently—with a change in the character of a given area.

On article 12, I simply ask how the family planning service scheme has worked here on the mainland of Great Britain. There are those who will be tempted to feel that a family planning service such as that envisaged in this article might perhaps create two kinds of difficulty. There are those who feel that this kind of service may not easily, or with any degree of practicability, be introduced as a specialised pursuit into an ordinary practitioner's operation. What willingness has there been to incorporate this rather specialised service into the ordinary service provided by medical practitioners? Has the scheme neatly fitted into each practitioner's situation? Have any difficulties been encountered?

There is also a rather specialised problem for those of a particular religious persuasion, who may not be at home in offering family planning services. Even this has not been encountered to any degree in Great Britain, I think that we can safely anticipate that some doctors with a particular religious persuasion may find it difficult to incorporate this into their total and normal medical service. Have any difficulties emerged on the mainland? Does the Minister envisage such difficulties arising in Northern Ireland?

As to article 13, I should like in passing to ventilate a remuneration problem of dentists. We appreciate that the relationship which a dentist has with the NHS is rather involved and perhaps peculiar, but dentists have encountered great difficulties in trying to make a profit from National Health Service work. This has had a rather detrimental effect on residents in Northern Ireland, because in many places there are not nearly enough dentists to serve a given community.

My hon. Friend the Member for Mid-Ulster (Mr. Dunlop) recently drew attention to the fact that there were only four dentists in his area to service a large number of people. Perhaps there are a number of reasons for that, but one which must be looked at very carefully by the Government is that until 1st October this year the amount of money which dentists could charge for work done under the NHS scheme was not very attractive. However, from the beginning of October, certain improvements have been made in that respect.

Much of the dentist's work must involve work done by technicians in their own laboratories. Before 1st October, a denture repair for which a dentist received £1·80 from the State was costing him £1·50 because he had to pay the technician. Thus, he made a grand total of 30p on each job. From 1st October the State increased the remuneration to £3. That seemed to solve the problem. But because the technicians are not controlled by the Government, they were able to increase the cost of the repair work to the dentist accordingly. The cost of such a job was increased to £2·50, so the immediate effect was that that extra £1·20 was eroded. That has occurred because the technicians are not controlled by the Government and they can charge what they wish.

If in the determination of the remuneration paid to the dentists we want to maintain a comprehensive and viable service in Northern Ireland, we must control the prices paid to the laboratory technicians for National Health Service work. I commend that consideration to the Minister.

Article 14 deals with the provision of drugs, medicines and appliances. One must bear in mind the total well-being of society in this connection, and therefore the provision of drugs should include a description of what is contained in the various bottles, tablets and capsules. There is a growing feeling in this country, particularly among members of the medical profession, that we should adopt a system similar to that operating in the United States of labelling clearly all drugs. At present the Government are consulting the BMA on this matter.

The BMA held a conference this autumn and an important part of the agenda related to the issue of labelling drugs. Therefore, I suggest to the Minister that not only should drugs be provided but that their provision should be accompanied by safeguards, particularly in the case of poisonous drugs, in the form of proper and comprehensive labelling.

10.23 p.m.

Northern Ireland Members should be very glad that hon. Members from Scotland and Wales curtailed their oratory today and got through their business in the proper time. This has enabled us to have this debate today instead of tomorrow. I thank them for their generosity. I was surprised that part of this order, which has no effect until 1981, was to be debated between 1 a.m. and 3 a.m., had the Welsh and Scottish Members taken their full time. There are many more important matters with which we should concern ourselves rather than something which has no effect until 1981.

There is grave concern in Northern Ireland about the terrible disease of lung cancer. It is a matter of anxiety to everyone who is interested in the welfare of the community. I believe that the restriction being placed on the sale of tobacco to young people will be welcomed by those with the best interests of the community at heart. There has been strong pressure in this respect in Northern Ireland from the Church bodies and the other welfare organisations. Even the tobacco interests did not militantly oppose the propositon. That, too, is to be welcomed.

Does the Minister believe that the law can be effectively implemented? The hon. Member for Abingdon (Mr. Neave) made an important point. It is hard for a retailer of cigarettes, tobacco and cigarette papers to determine whether a person is 16 or over. Will the Minister elaborate on that, and also, given the pressures being put upon them by the upsurge of serious terrorist activity and the millions of pounds' worth of damage caused in the Province over the past few days, on how he sees the RUC and the RUC Reserve dealing with this matter?

I have certain questions to ask about vocational training for medical practitioners. Article 8, paragraph (2)(d) states that particulars of experience will be submitted to a "prescribed body." May we be told something about that body and its membership? Or are we to take it that this is related to the drawing up of regulations under the order? May we be told tonight something of the composition of that body?

My hon. Friend the Member for Belfast, South (Mr. Bradford) asked other questions on this matter. I think that the relevant point is who will constitute this body, who will decide on the question of prescribed experience, and who will have the applicant and the papers before them? Paragraph (5) of the article states:
"Before making any regulations under this Article the Department shall consult such organisations as appear to the Department to be representative of the medical profession."
Does the Minister therefore feel that there will be consultation with the British Medical Association? Will he consult when he lists the regulations? What consultations has he had with Northern Ireland representatives of the medical profession in preparation for laying this order?

The various amendments to the principal order are in part IV. Will the Min- ister confirm that the Departments have been making arrangements with voluntary organisations that manage certain premises to alleviate the conditions of certain people that the Government centres are unable to cope with? In Londonderry certain voluntary organisations have been called in continually to deal with those cases that the Government have been unable to handle.

To what extent does the Minister believe that the amendment will be put into operation across the Province, and in what spheres? At the moment there seems to be a degree of hardship because of the Department's inability to deal with certain matters. I am talking about people who have been "lifted" by the police and have had nowhere to. There has been the calling into operation of voluntary bodies to give them a bed for the night and to look after them. They are welfare cases, and these voluntary bodies are not receiving any Government payment for the services they render.

Will the Minister explain article 17 and why there has been a change of functions of these two Departments? Also, why is there a change in article 17(2)? Why are the functions to be changed over, one to the Department of Finance and the other to the Civil Service Department? Is there any strong reason for the changes?

I come back to my first point, and underline that the provision on the sale of cigarettes to young people will be greatly welcomed. Can the Minister give an assurance that the provisions of the order will be made clear in the schools so that the children may understand that it is now an offence to seek to purchase cigarettes? It is important that the young people should know the state of the law on this matter. I trust that the Minister will take steps to ensure that that is done.

10.31 p.m.

It is said:

"On average a smoker shortens his life span by about 5½ minutes for each cigarette smoked."
That is not my statement. It is a statement from the third report of the Royal College of Physicians, published last June. That is the message that we must get across in Northern Ireland, not only to the children under 16, who up to now could legally purchase cigarettes and experiment with smoking, but to everyone in the Province who smokes. Each time he smokes a cigarette, a smoker shortens his life by the equivalent amount of time it takes to smoke it.

However, the report held out some hope, because it went on to say that if a smoker gives up smoking his extra risk of dying before his time disappears in 10 to 15 years. It highlighted some of the problems that the order tries to deal with. It said:
"Between 2½ and 4 of every 10 cigarette smokers will die because of their smoking…cigarette smoking not only shortens life, it can also cause prolonged ill health."
It emphasised the importance of preventing young people from taking up the habit and said:
"Some children begin to smoke at 5 years of age, and it has been found that about one third of adult regular smokers began before they were 9. About 80 per cent, of children who smoke regularly continue to do so when they grow up. The earlier in life a person starts to smoke regularly, the greater is the risk of early death. In view of the effects on school children, we urge that more attention should be given to the smoking problem in teachers' training and that teachers will not smoke on school premises."
The college further highlighted the problem by stating:
"In 1975 a survey showed that out of a random sample of 50 tobacconists' shops in various parts of England and Wales 43 sold cigarettes to children who were obviously below the age of 16"—
even though this was unlawful. The college continued:
"In Northern Ireland there is no law against selling cigarettes to children. Steps should be taken promptly to make this illegal."
It welcomes that the Government have now taken that step.

Making it illegal will not solve the problem. More problems are associated with it and we require the active co-operation of the tobacconists to ensure that the law is effective. I hope that the tobacconists will bear in mind that my hon. Friend the Member for Antrim, North (Rev. Ian Paisley) said that the cigarette manufacturers support the order. The chairman of Gallaher Ltd. said:
"I can confirm that I did tell Mr. Harold McCusker, MP, that Gallaher would have no objection to legislation that would bring Ulster into line with the rest of the UK regarding the sale of cigarettes to children under the age of 16. It is our policy through our salesmen to encourage shopkeepers to abide by the law."
The Imperial Group Ltd. Stated:
"Clearly the introduction of legislation is primarily a matter for Government. It would, however, seem perfectly sensible to harmonise the present legal situation in the Province of Ulster with that in the rest of the UK. For what it is worth we as a company would have no objection to this."
Rothmans International Ltd. stated:
"We together with the other UK cigarette manufacturers, consider smoking to be an adult form of relaxation and do not direct brand advertising promotions at children, nor do we engage in any activities that might encourage children to commence smoking."
I wish that I could say a wholehearted "Hear, hear" to that.

Manufacturers recognise that it is wrong that cigarettes should be sold to children under 16 years and they support the order. I pay tribute to them, the Ulster Cancer Foundation and the organisation which is associated with it, Action on Smoking and Health, and to its director, Mr. Mike Wood, for his endeavours on this legislation. I hope that I also played a small part. With the assistance of the hon. Member for Belfast, West (Mr. Fitt), two and a half years ago I attempted to introduce a Bill on this matter.

The order contains the provisions in section 7 of the Children and Young Persons Act 1933. The wording is the same. It involves
"any person who sells to a person apparently under the age of 16".
The Government have removed the provisions of that Act to empower park keepers to intervene. I do not know of any evidence which shows that park keepers have done much in Great Britain to prevent young people from smoking. I can see that there would be little point in introducing that power in Northern Ireland. It is sufficient that the police and police reserve should have the power to act. There are 10,000 of them. They have many major problems, but they must deal with this as well. They have the opportunity. I hope that members of the Royal Ulster Constabulary will mention the dangers of smoking when they visit schools to talk about road safety.

One cannot overstress the problem. The Ulster Cancer Foundation found that in Northern Ireland schools coughs and phlegm were present to an alarming degree in children who smoked as opposed to those who did not. In spite of all the health warnings and voluntary support by tobacconists to prevent children buying cigarettes, the bad example set by parents and teachers did not help. Since it was legal to buy the cigarettes children thought that it was all right to continue smoking.

Even if the order is defective in some ways, and even if it is difficult for the police to enforce it, I hope that our action in making it illegal for children to purchase these products will have a deterrent effect. I hope that parents who smoke will now stop the practice of sending their children to buy their cigarettes and other accoutrements, because that in itself encourages children to adopt the same habit.

10.40 p.m.

I am in almost total agreement with what my colleagues from Northern Ireland have said.

I used to be an inveterate smoker. Until two years ago, I smoked 80 cigarettes a day, but it was not all that difficult to stop smoking. I have been in attendance, with the hon. Member for Armagh (Mr. McCusker) at associations and assemblies that were trying to advocate to young people not to start smoking and to those who were smoking to stop it.

Although there is no conflict in my own mind, I think that there must be conflict in those of other Northern Ireland Members. I do not want young people, or old people for that matter, to start smoking, because I believe that smoking has some relation to lung cancer. It is for that very important reason that I advise those who are smoking to stop and those who are not smoking not to start.

However, I am sure that my hon. Friend the Under-Secretary of State will understand me when I say that almost the same argument could be applied to the wearing of seat belts in Northern Ireland. I always advise people to wear seat belts, on the ground that their lives may thereby be saved in traffic accidents. But I do not have very much support from my colleagues from Northern Ireland. They believe that people should not be forced to wear seat belts on the ground that if they want to kill themselves they should be allowed to do so.

I support the legislation contained in part II of the order, but I have some reservations about whether it is applicable in Northern Ireland. I hope that the day is not too distant in Northern Ireland when we have law and order in every district. But I do not believe that it is really practicable and realistic under article 5 that
"A member of the Royal Ulster Constabulary or the Royal Ulster Constabulary Reserve may seize any tobacco or cigarette papers in the possession of any person apparently under the age of 16 whom he finds smoking in any street or public place."
Just let any member of the RUC, the RUC Reserve, or the British Army for that matter, try to implement that provision of the law in Turf Lodge, Ballymurphy or the New Lodge Road and see what happens. It is completely unrealistic, because great difficulty is experienced at the moment in trying to preserve other means of law and order. Certainly it will not be practicable or realistic within the foreseeable future, and it may be a long time before we can try to implement this provision.

I am taken aback by the crocodile tears which have been shed once again by the hon. Member for Antrim, North (Rev. Ian Paisley). He says that the RUC should be able to implement article 5, but he is not doing much to help the RUC with his counter-demonstrations all over Northern Ireland. Perhaps he will call off his proposed demonstration in Armagh next week in order to allow the RUC to seize cigarette papers from youngsters in the New Lodge Road.

Legitimate questions have been asked by other hon. Members from Northern Ireland. Other parts of the order are equally important. Dentists' needs, the qualification of doctors, remuneration for dental, ophthalmic and pharmaceutical services and the provision of drugs are matters of major importance. I have not received any representations, so I do not know whether there has been agreement or disagreement on the implementation of the order. Has the Minister had adequate discussions with the bodies involved? Has there been agreement? On matters affecting the livelihoods and qualifications of dentists and doctors, it is important to have adequate consultations with those who will be affected.

With those reservations, I welcome the order.

10.46 p.m.

I wish to use part III of the draft order to make a protest that in North Down there are not enough doctors for the people of the area. Many people there live in small towns and villages in rural areas and they often find it difficult to get a doctor. I hope that the Government will provide more doctors in North Down as well as providing all the facilities and vocational training mentioned in part III.

No one can object to the aim in parts I and II of persuading children and young people not to smoke. Indeed, I look forward to the day of enlightenment when all smokers will abandon the habit because they recognise that it causes lung cancer and death, but I have doubts about the draft order. Hon. Members enjoy using their parliamentary muscle to push through legislation, thinking that it will transform their fellow citizens—though most hon. Members qualify that attitude by recognising that it may not transform the people at whom it is aimed.

The first part of the draft order is devoted to the creation of a new criminal offence of selling tobacco or cigarette papers to a person who is apparently under the age of 16. In addition, the police are given power to seize tobacco or cigarette papers from anyone apparently under the age of 16 who is found smoking in the street or in a public place.

I wonder whether the Police Federation or, more important, the policemen on the beat were asked to comment on the proposals and whether there was consultation with those who have to operate the English Act. It is recognised by those who know about the problem of young smokers that the English Act has not stopped children and young people smoking.

It is difficult for shopkeepers to determine whether a young person is under the age of 16 and if a child who is obviously under 16 wants to smoke he sends his older brother or a friend to get the cigarettes for him. We should not be considering the possibility of putting a criminal offence on the shoulders of small shopkeepers. They already have a lot to put up with, especially in Northern Ireland.

Young people can get cigarettes from the automatic machines that we see all over the place. It is no use saying that the police can deal with that problem. We do not have enough police to stand guard on every cigarette machine in the Province. Indeed we have not enough policemen in the Province to man guard on essential services.

It is ridiculous for the Government to think that by legislating they can transform the young people of Northern Ireland. We must treat this matter seriously. I took the trouble to ask young people in my constituency what they thought about these proposals. They said "Why legislate against us? Why are not the elders giving a lead? Why do you not ban cigarettes altogether? If they are bad for us, they must be bad for adults. Surely the adults must give a lead."

It is sanctimonious and hypocritical for politicians in this House to lecture young people and children in Northern Ireland when those politicians do not take the opportunity to legislate on tobacco. No doubt the Minister will, in his usual flippant English manner, reply to the debate and stress the evils of cigarette smoking. We all recognise that cigarette smoking is an evil, but will he say why the Government only a few weeks ago gave a colossal sum of money to a cigarette firm in Northern Ireland to help it to manufacture more cigarettes to cause more lung cancer and more deaths? That is setting a terrible example to the young people of Northern Ireland.

The young people of Northern Ireland will say "You have given this colossal sum of money to a cigarette factory in the area, yet you seek to create an offence if a shopkeeper is tricked into selling cigarettes to an older boy for use by a younger one." The Government are giving policemen the power to go to a group of children who may be having a puff in the street or in a public place and seize tobacco.

What damage will flow from uniformed police descending on young people? Those young people already have a problem with the police—not just in Republican areas but in other areas, too. I have problems in my constituency because some young people are alienated from the police. There are some bad youngsters, as there are bad adults, in Northern Ireland and in England. Looking at the Labour Benches, I think that perhaps there are more bad English adults than exist in Northern Ireland.

Why do we cause more hostility to the police in these areas? They will be the instruments of this Parliament in enforcing this draft order. I should like to see the young people and the police drawing closer together. Already in my constituency great headway is being made in community action. I want young people to regard the police as their guide and friend. Surely we should not be using the police to enforce this law.

I have certain reservations of conscience on this matter. Is the hon. Gentleman saying that the Government should not have given financial assistance to the Gallagher tobacco concern in Ballymena or its factory in Belfast on the ground that they were perpetuating lung cancer? Would he rather see those tobacco factory employees in the dole queue?

I knew that the hon. Gentleman would pose such a question. The answer is simple. We all have a duty to set an example. What I ask those who spoke so sanctimoniously is: why not bring in a Bill to ban cigarettes altogether if they are bad for health and cause lung canger, as they do, and cause death?

If it is legal to smoke cigarettes, it would be nonsense to close down a factory.

Young children imitate their elders. They often see their heroes—pop stars, actors, actresses and others in public life —on television, on the cinema screen and on the stage smoking cigarettes. They smoke in imitation of them.

Should we not ban all smoking on television, on the cinema screen, and on the stage? Should we not ban all cigarette advertising? Let us allow cigarettes to be manufactured for those who wish to smoke, but let us not allow young people to be persuaded to smoke by what they see on television and on posters.

The police in Northern Ireland rightly take the objection raised by the hon. Member for Belfast, West (Mr. Fitt). Indeed, this was the reason for my objection to seat belts. The police in Northern Ireland already have enough to contend with in dealing with actual or potential criminality of the most serious kind, as well as with the fiendish gangs of terrorists, without having to cope with the phenomenon of the affluent society, for which they need special training.

It is the affluent society created by this Government, but that means a society in which inflation has whipped the people. That is the affluent society which the hon. Gentleman supports.

Why should we require the police to dissipate their energies on apprehending under-age smokers and seizing their smoking materials when they cannot cope with under-age drinking, which is a terrible problem? Why should we demand that they spend their time doing that when seemingly they do not have enough time to prosecute other offences?

The hon. Member for Belfast, West threatened that the trouble in Northern Ireland could continue for a long time.

Perhaps I misunderstood the hon. Gentleman, but he clearly stated that he believed that Northern Ireland would continue to suffer from terrorism.

The police in Northern Ireland cannot go into some Republican areas. The IRA has already threatened rough justice, including shooting, to officials of the electricity and gas undertakings if they try to cut off supplies to householders in certain areas who have wilfully and deliberately failed to pay their gas and electricity bills. If the police cannot operate there, they certainly will not see whether kids are handling cigarette papers and tobacco and rolling cigarettes.

We have to ensure that the law we enact will win respect. How can we win respect if the law is not properly enforced? People in Northern Ireland have to pay larger electricity bills than people elsewhere because those in Republican areas are not paying all their electricity bills.

Wherever they are not paying, I condemn it. Everyone should pay his fair dues. There are, in Northern Ireland, complaints that numerous serious offences are being committed—nothing to do with terrorism—and the Government and the bureaucracy do not seem to care. That is the feeling, whether it is right or wrong. The complaint is made that the police are busy dealing with terrorism, to the detriment of the detection of other grave offences.

For instance, proportionately more people died in road accidents in Northern Ireland than in other parts of the United Kingdom. Usually the deaths are the result of the driver of one car having had too much to drink. Yet there are not enough police available to catch all the offenders who drive dangerously or under the influence of alcohol, or to make some drivers drive with greater care and responsibility.

We have to ask whether this law will be respected. If it will not be enforced we should ask whether we are adopting the right attitude to this serious problem of smoking by children and young persons. We do not want to alienate young people from the police. We do not want young people to regard the police as the enemy. We should not create a situation which will lead to such hostility.

Is this new criminal offence, and the power to seize, the correct way of dealing with smoking, which is anti-social as well as being dangerous to health? The fact that a law has been enacted applying to England and Scotland does not mean that it is good law. Northern Ireland should lead the nation by putting forward proper proposals.

When I talked to young people they said "All right, if it is bad, ban it. Adults smoke, teachers smoke. Therefore, we think that it is all right." They will now have, unfortunately, the excite- ment of doing something illegal. This may be a further temptation. Why jump with the weight of the law on young people in this way? They learn by imitation and see their elders smoking, some of them like Black Country factory chimneys. They see all their heroes smoking. We must remove that image of smoking. We should ensure that smoking is regarded as an evil.

The only way to do that is to ban all smoking advertising. I want young people and children to stop smoking. I want all people to stop smoking. But this is not the right way to go about it. We should counsel children and young people but should not use the weight of the law in this wrong fashion.

11.4 p.m.

Article 14 of the order provides:

"(1) Every Health and Social Services Board shall, in accordance with regulations, make arrangements in respect of its area for the supply to persons who are in that area of—
(a) proper and sufficient drugs and medicines and listed appliances".
I wish to ask one or two short questions about the supply of listed appliances.

I understand that in hospitals in the more rural areas, certainly in Coleraine hospital, people in the hospital are entitled to the supply of certain appliances free of charge, but out-patients must pay for them. My understanding is that in those parts people can be in hospital and have an appliance prescribed but leave before it is to hand. This means that they must return for its fitting as an outpatient, and consequently have to pay for it. That does not happen in the city of Belfast, where it can all be done in one day.

I have already had correspondence with the Minister's noble Friend about this matter in relation to Coleraine hospital. If the Minister cannot tell us this evening the reasons for the problem that I have described, I shall be obliged if he will take steps to be able to tell us the reasons later, and if he will correct the anomaly as between the rural patient and the urban patient.

The second matter that I wish to raise is perhaps peculiar, but not necessarily peculiar, to the Western health and social services board. It relates to the supply of certain orthopaedic devices. I am told that, for example, broken appliances used by polio patients have taken up to three weeks to be repaired. I know of a recent case. One is never happy with the quality of the appliances. We recognise the great difficulties with which the designers have to contend, but the loss of a screw can mean that the person concerned is housebound, and possibly wheelchair-bound, or even bed-bound, for up to three or four weeks. This is unacceptable. What will the Government do about it?

11.7 p.m.

For the rest of this evening and perhaps a few days I shall be wrestling with the heavy import of the term "flippant English answer from the Front Bench", and wondering what it entails.

I heartily endorse all that has been said about the dangers of tobacco smoking and the incidence of tobacco smoking among young people. I was kicked into giving up cigarette smoking by fear of losing my job. I was a teenage apprentice in a multiple grocery concern, where there were strict instructions against smoking during working hours. I had been caught twice by an English inspector, and his observations to me were anything but flippant.

I went home with the threat of losing my job if I was caught again. The inspector said "Just once more, Dunlop", and there was heavy import in those words. I knew that if my dad learnt that I had lost my job because I was smoking during working hours his response would have been to say "I'll murder him." That was in the hungry 1930s, and no alternative job was possible.

Therefore, I gave up smoking, and I am thankful that I did. I heartily endorse what my hon. Friends and the hon. Member for Belfast, West (Mr. Fitt) have said. I emphasise the need to educate young people against tobacco, never mind legislating it out of the country. We need to show them the, dangers. When I was a young fellow I heard nothing about lung cancer, heart disease or any of the other diseases that could come through smoking. It was just fear of losing my job that led me to give up, and I am thankful that I did.

I wish to put two short questions to the Minister. He has been asked to define "the prescribed medical experience". I am sure that he will not give a flippant answer. I have lived for many years in the South Derry and East Tyrone district. I know of a doctor who came straight from college to practise in that area. He had no clinical experience. The comment of the general public in those days about that dear, good doctor and his operations was that he buried most of his mistakes.

In article 11(1) of part IV there appear the words

"any voluntary organisation managing any premises".
I hope that the Minister will comment on the near completion of the hospital complex at Stranmillis, which has been built by voluntary contributions and will be staffed by voluntary consultants, specialists, general medical attendants and para-military services. Will any use be made of that organisation by the health services generally?

11.10 p.m.

It would be a pity if the debate came to an end without a welcome being extended to the new Under-Secretary of State for Northern Ireland, the hon. Member for Stalybridge and Hyde (Mr. Pendry). We have all of us greatly regretted the circumstances in which the hon. Member for Liverpool, Kirkdale (Mr. Dunn) has for some months been not fully able to perform his duties. We have noted that the new Under-Secretary of State is an additional appointment. We hope that- before too long the hon. Member for Kirkdale will be able to return to his duties, and that the Government are being helped to realise the impracticability in the long run of attempting to discharge the local administration of Northern Ireland through the agency of Her Majesty's Ministers in the United Kingdom.

As the order in part amends the principal order, the unfortunate Minister in charge of the order has been the recipient of many comments that relate much more to the principal legislation than to the amendments that are being made.

The two minor matters that I wish to refer to relate to the amendments in part IV. One is in article 13, which inserts the words "the determination of". There is a story behind the amendment which is perhaps worth a brief mention. As the principal order runs, it states:
"Regulations may make provisions for the remuneration of dental practitioners."
That was interpreted as if it meant that a regulation may provide that the Department may prescribe the remuneration of dental practitioners.

Very properly that Argus-eyed individual the Examiner of Statutory Instruments raised the question whether a power by regulation to make provision for remuneration included the power to make provision that somebody else may prescribe the remuneration.

The principal order has been made rather more of an honest woman by the amendment, but there remains a residual and rather serious question, namely, whether even with the amendment the principle is correct that matters so essential to the working of the health services, matters which more than one hon. Member has observed involve co-operation between the professions and the administration, should be dealt with by less than regulation and should, as they are at present and as the amendment will make possible, be merely prescribed departmentally. Although we have put ourselves right by the law, I am not sure that the result is the optimum procedure.

My second point relates to article 15, which provides:
"For the purpose of giving effect to the provisions of any will, deed or other like instrument a reference therein to any hospital…shall be construed as a reference to the appropriate Health and Social Services Board."
I have no intention, let alone at this time of night, of reopening the ancient sorrows that that provision calls to mind. I merely invite the Minister—I think that he will be able to respond—to assure the House that, although we are making this provision—that a bequest made to a particular hospital may be treated as if it were a bequest for the general purposes of a hospital board—nevertheless, in the administration of this power and of moneys received in this way, the hospital boards do, as far as possible, comply with the intentions of those who make the bequests, and that as far as possible, where a bequest has been made for the benefit of a particular hospital, the boards so contrive that that hospital shall in some manner, if at all possible and reasonable, benefit as result of it.

I am sure that this is desirable and I am sure that it would have the sympathy of the House. I think it is undesirable that we should do anything—despite the overwhelming preponderance, of course, of public money—to cut off the propensity to private benevolence which, after all, is a sign of the participation and pride of the people in their hospitals and in their Heatlh Service.

Finally, I take advantage of an obiter dictum of the hon. Member for Belfast, West (Mr. Fitt) to draw attention to the narrow character of part II of the order. There is a difference between what is done, or permitted to be done, by juveniles and what adults do on their own responsibility at their own risk, even though it be to their own harm. There is, therefore, a justification which, of course, the House has long recognised in all kinds of legislation, for placing restriction upon what is lawful in the case of the young which do not exist on what is done, or may be done, by the adults.

That is the first distinction which I think needs to be drawn in this debate. The second, also implicit in what the hon. Member for Belfast, West said, is that there is a diffeence between actions which damage or may damage other people and actions which can only damage oneself. I literally only mention or breathe the words "seat belts" as an illustration of an action, or the omission of an action, which can only damage the person concerned.

In part II we are concerned with preventing actions, and making them criminal, which facilitate other people harming themselves by the sale of goods and appliances which, in the circumstances of the sale and the circumstances of a purchaser, cause harm. This is harm done to another person, and it is the whole purpose of the criminal law to prevent—or, if it cannot prevent, to punish—the harming of one member of society by another. I think that these are valid distinctions which justify what we are doing in part II of the order.

While in the correct context of article 5 one realises that the notion is grotesque of policemen primarily occupying themselves in snooping around to catch somebody smoking when he is under 16, it is perfectly obvious that in the context of part H of the order that power, and it is only permissive—"may seize"— is given to the police as a means of helping in the enforcement of the central provision, which is the provision on sale.

Since, as I understand, the English Act has failed to stop children or young persons from smoking, what hope has the right hon. Gentleman that this draft order will have any different effect?

In that respect the English Act, or the Great Britain Act, is no different from a great many other Acts which have not terminated the evils at which they are aimed. But that is not a reason on which any of us—even the hon. Member for Down, North (Mr. Kilfedder)—would argue for taking the prohibitions, on the sale of liquor and the rest, off the statue book, just because they have not eliminated the mischiefs at which they were aimed.

No one supposes that smoking by juveniles will be brought to an end. The question is whether it is likely, on the whole, to be diminished over the years by this provision. My opinion is that it is, and I hope that the order will be accepted by the House.

11.20 p.m.

When I was shown this order for the first time last week, I was told that it was non-controversial and that perhaps it might go through rather quickly.

Members of my own Department, actually—all Ulstermen. I had my doubts then, and the debate has confirmed them. However, the vast majority of hon. Members have supported the principal part of the order, which attempts to restrict the sale of tobacco to young people. With all the doubts which hon. Members have expressed—and I would be the first to accept them—I think that most people have welcomed the order which, after all, mirrors legislation which we have in Great Britain.

The hon. Member for Abingdon (Mr. Neave) congratulate the Ulster Cancer Foundation on pressing the Government to implement the legislation in Northern Ireland. We are grateful for the part that it played. We place great importance on the voluntary health bodies in Northern Ireland, and on this occasion we were only too happy to respond as quickly as we have—and we have responded quickly—to its request.

He asked a question, which other hon. Members raised, about the use of the word "apparently" rather than strictly defining the age at which tobacco should not be sold to children. This is purely a legal approach. Apparently, it is perhaps more beneficial in the long run to leave the matter as wide as this, to give discretion to the person who sells tobacco or tobacco products, than to define the age strictly. Again, this is a mirror of what we do in Great Britain. I could send the hon. Gentleman a lengthy legal explanation of precisely why we have moved in this manner, but it is precisely the same argument which was adopted when the legislation was passed for Great Britain.

The hon. Member for Belfast, South (Mr. Bradford) asked questions relating to a number of aspects of the order, and I shall deal with one or two of them. I do not have much time to deal with other points which hon. Members raised, and if I leave out any points I shall reply by letter. He asked about vocational training and what constituted vocational training. As I pointed out, this will be the subject of consultation with the medical profession. We shall leave no stone unturned, or any area of professional competence unapproached, in our determination to ensure that these proposals are acceptable to everyone involved in medicine in Northern Ireland. If the hon. Gentleman, or indeed any other hon. Member, wants to be kept informed of the way in which the regulations are to be drawn up, or the sort of questions which will be involved, I am only too happy to ask my noble Friend to keep him so informed

The hon. Gentleman also asked about article 11, as did the hon. Member for Antrim, North (Rev. Ian Paisley). I think that I can more suitably explain the questions raised by letter, and perhaps give some idea of the voluntary organisations which may be involved. He also asked questions about family planning. I ought to point out that the provisions about which we are talking are permissive. General practitioners may prescribe methods of family planning, as is the case in the rest of the United Kingdom. If someone wants to go to a doctor who will dispense family planning aids, then that doctor can be sought out.

The hon. Member for Antrim, North gave general support to the provisions of the order. He also raised an important question—the extent to which we shall try to educate children in our schools not to smoke. That is where the argument should start. On that issue I believe that I carry everyone in the House with me—even the lone dissenter, the hon. Member for Down, North (Mr. Kilfedder). My noble Friend Lord Melchett will do everything he can, not only to make the teaching profession aware of the contents of the order, but to press home the dangers of smoking generally, not only to children under 16, but to everyone.

The hon. Member for Armagh (Mr. McCusker), not surprisingly, welcomed the order, as he, together with the Ulster Cancer Foundation, was instrumental in bringing it forward. I add the thanks of the Government to the congratulations that he has received. As a former teacher, he is aware of the educational aspects. I hope that hon. Members will remember that they have a part to play, even though they may have doubts about the legislation. The Government, too, have doubts. The Royal Ulster Constabulary was mentioned, and it has doubts, but, like us, it wants the sales of tobacco to children under 16 to be limited.

My hon. Friend the Member for Belfast, West (Mr. Fitt) gave his qualified approval, for which we are thankful.

The hon. Member for Down, North provided the interesting sight of accusing the rest of us of being hypocrites. He also accused me of being an Englishman—a charge to which I am proud to plead guilty. I had not noticed my fellow countrymen, many thousands of whom are made welcome in certain parts of Northern Ireland, being refused hospitality and support by the people in the Province. I dare say that one or two of his constituents might approve of us.

The hon. Member for Londoderry (Mr. Ross) raised certain questions that he said he had raised in correspondence with my noble Friend concerning the differential between the cost of drugs inside and outside hospitals. He also mentioned the age-old bias of the cost of drugs west of the Bann compared with the cost east of the Bann. I shall make sure that my noble Friend's attention is drawn to these matters, and that he replies as soon as possible.

The hon. Member for Mid-Ulster (Mr. Dunlop) raised the question of what constitutes medical experience, and that will be the subject of consultation with the medical profession.

The right hon. Member for Down, South (Mr. Powell) very kindly inquired after the health of my hon. Friend the Under-Secretary of State. He has come out of hospital today, and we all hope that he will soon be back to full health, and back at work in Northern Ireland. The right hon. Member also raised the question of bequests to certain hospitals. I know that the detailed reply will satisfy him, but, as it is rather long, I shall write to him about it.

With all the reservations that have been expressed, most hon. Members welcome this attempt to restrict the sale of cigarettes and tobacco to children under 16. Perhaps this approach is not as watertight as we could make it, but it is a step in the right direction, and I sincerely hope that the people of the Province, particularly those who sell tobacco, will take note of what has been said this evening.

Question put and agreed to.


That the draft Health and Personal Social Services (Northern Ireland) Order 1978, which was laid before this House on 6th November, be approved.