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Smoke-free Private Vehicles Bill [HL]

Volume 738: debated on Friday 29 June 2012

Second Reading

Moved By

My Lords, I declare an interest as a past president of the Royal College of Surgeons of England and as a patron. As a doctor and a surgeon, I have seen and treated the long-term effects of smoking in adults and wish to prevent similar harm occurring in children.

I am grateful that so many noble Lords have stayed over on a Friday to take part in this Second Reading debate. We are supported by experts in the health field and others who bring a personal perspective on the effects of second-hand smoke, and I look forward to hearing their contributions.

I was encouraged by my noble friend Lord Howe’s response to my question on 19 June on the damage which smoking does to our children. He welcomed this Private Member’s Bill, which he hoped would lead to wider debate. He acknowledged the harm that second-hand smoke can have on people’s health and recognised the need to eradicate smoking when children are present. Where we differ is on the means to achieve that objective.

I acknowledge the excellent work that the Department of Health has done in undertaking an awareness and behaviour campaign over the past two months, with anti-smoking advertisements on television and the provision of advice to smokers who wish to stop. There were nearly 500,000 visits to the Smokefree website, compared to 100,000 last year, and 60,000 smokers requested Smokefree kits in response to the adverts. I encourage noble Lords to watch them. They are indeed powerful, and I am happy to forward the link to them.

However, awareness and behaviour change needs to be coupled with legislation. In responding to a question in the Welsh Assembly on 26 June this week on outlawing smoking in cars with children present, the First Minister said,

“if we find that people are continuing to smoke in cars, legislation will be required”.

He reported that one in five of 11-to-16 year-old children in Wales were being exposed to second-hand smoke when they travelled last year.

Simon Clark, the director of FOREST—Freedom Organisation for the Right to Enjoy Smoking Tobacco—is quoted as saying,

“it’s important to encourage parents not to smoke in a car where small children are present”—

but that he believes that a ban would be a step too far. This is a libertarian view that some hold, but for an organisation that promotes smoking to recognise the harm that smoking does to our children in a confined space is an acknowledgement from an unexpected sector, which I welcome.

The Bill is not an attempt to ban smoking for responsible adults in the privacy of their cars. It is intended to raise awareness of the risks of smoking in cars where children are present and to drive home the message that we as adults are responsible for the safety and protection of our children. I hope to convince your Lordships of the need for the Bill and will provide scientific evidence to support my case.

Last week a group of Peers heard evidence from Sharon Gould, a mother who smoked when her son Ben was quite small. She knew about the dangers of smoking when pregnant and stopped immediately she was diagnosed, but the stress of her mother’s terminal illness made her start again. She described to us how she never smoked in the same room as Ben and would not dream of taking him into a smoky pub, but felt happy to smoke in her car with Ben in the back because the window was open. She had no idea that smoke was concentrating in the back of the car.

Therein lies the problem. We can see a room full of smoke—we were used to seeing that in pubs when they had smoking, though they do not any more—and we would recognise the dangers that that would have for our children. Somehow, though, driving in a car with the window open is OK. Why? Because the smoke appears to be going out. In fact, that is not the case. The evidence for second-hand smoke entering the back of cars where children sit is high. Do not forget that these children are strapped in for their own safety and cannot move away from the smoke.

The evidence is compelling. Professor Fong of the University of Waterloo in Ontario, Canada, was able to prove that just one cigarette smoked in a car can provide levels of second-hand smoke many times higher than those in a smoke-filled pub or bar, and that commonly used methods to reduce second-hand smoke in cars—air conditioning and keeping the windows open—fail to reduce levels safely. Cigarettes release small, suspended particles, or particulate matter, less than 2.5 microns in diameter. These are inhaled deeply into the lungs. Particulate matter 2.5, which I will henceforth refer to as PM 2.5, is used as a measure of air quality internationally and was used by Professor Fong to assess the level of PM 2.5 in cars. A monitor was placed behind the driver’s chair with a probe between the front seats at the level of the child’s head. Recordings were made in five separate conditions: the engine of the car off, windows closed, no air conditioning; driving with windows closed, with no air conditioning; driving with the air conditioning on; driving with the driver’s window half open; and driving with all the windows open. Measurements were taken during a 30-minute drive while smoking one cigarette. Results in the two most common driving conditions—with the windows closed and air conditioning on, and the windows half open—showed levels two and a half times greater than a smoky bar when driving with the air conditioning on, and two-thirds the level when the window was half open—still a significant enough level to cause harm.

Children, particularly young children, are still developing physically and biologically. Compared with adults, children have smaller lungs and breathe more quickly. They absorb more pollutants because of their size. They have less well developed immune systems, making them prone to respiratory and ear infections. They are more vulnerable to cellular mutations. As a result, they are more susceptible to the harmful effects of second-hand smoke. A child’s immune system compared to an adult is considerably underdeveloped and lacks the necessary defences to deal with the damaging effects of second-hand smoke.

The medical evidence that second-hand smoke harms children is equally compelling, with over 300,000 primary care consultations a year, 120,000 new cases of middle ear infections a year, 22,000 new cases of wheezing and asthma a year, 9,500 hospital admissions a year and 40 sudden deaths a year. This is a huge drain on NHS resources, costing the taxpayer more than £23 million each year.

The impact of the smoking ban in public places has been dramatic. A sample of 41 pubs in Scotland saw smoke levels, as measured by PM 2.5, fall by 86% within two months of the legislation coming into force. Using salivary cotinine, a specific marker of tobacco smoke exposure, there was an 89% reduction in cotinine concentration in a cohort of 126 non-smoking bar workers one year after the legislation. The same study using personal PM 2.5 monitors during working shifts recorded an 86% reduction in exposure to PM 2.5, demonstrating the serious effects of smoking in the period before legislation. In the confined space of a car, levels of exposure are considerably higher than in a bar or pub, and for the children who are strapped in there is no escape from the toxic fumes.

The Bill is intended to reduce exposure to second-hand smoke, which is one of the six internationally recognised strands in the Government’s tobacco control plan, by adding legislation to the behavioural change which they seek. A survey of nearly 700 boys and girls between the ages of 11 and 15 by the NHS Information Centre in 2010 found that one in five children had been exposed to second-hand smoke in cars. This was similar to the finding in Wales. A survey by the British Lung Foundation in 2011 of over 1,000 children between the ages of eight and 15 found that only 31% of them asked adults to stop smoking, while 34% were too embarrassed or frightened to ask. Adults can look after themselves; children cannot.

This is, in effect, a public health Bill. It seeks to protect children from the effects of second-hand smoking, in the same way that legislation exists to protect children through the appropriate use of car seats for those under the age of 14. The 2006 legislation, which reformed the car seats law, made it the responsibility of the driver to ensure that children were correctly restrained. I believe it should also be the responsibility of the driver to ensure that children are protected from second-hand smoke. As Sharon Gould explained, it is often mothers who are faced with the day-to-day problems of caring for their children or finding carers for them if they work. Mothers who smoke put their children’s health, both in the short and long term, at risk. The Bill seeks not to punish mothers, carers or anyone who smokes in the presence of children but to educate and inform them of the risks.

Internationally, legislation has been in force since 2006. Laws banning smoking in cars carrying children exist in three countries—South Africa, Mauritius and Bahrain—and involve six of the eight states or territories in Australia, nine of the 13 in Canada and four of the 50 states in the United States, although nine municipalities there impose a ban. It is time to apply similar legislation to England and to follow the Welsh Assembly’s example by not ruling out legislation if behavioural change does not reduce the incidence of smoking in cars.

The Bill seeks to amend the Health Act 2006 by banning smoking in cars where children are present and to provide further education and awareness of the dangers of smoking through the provision of smoke-free awareness courses in place of a fine for first offenders. We have the evidence to support this Bill and I ask your Lordships and my noble friend the Minister to consider it in the interests of our children and grandchildren, if not ourselves. I beg to move.

My Lords, I thank the noble Lord, Lord Ribeiro, for this Bill,

“to make provision for a ban on smoking in private vehicles where there are children present”.

For a few moments, I want to tell your Lordships why I feel this Bill is so important. I think back to my childhood. One of my first memories, when I was about four years old, is of travelling down by train from Scotland to England. It was during the war and there were soldiers lying along the corridors. Most of them were smoking, and I remember telling them what an awful thing smoking was—how it hurt the eyes and had a terrible smell. I cannot think what they must have thought of me.

However, the Bill will support children. It will give them the power to tell parents or people smoking that they are breaking the law, and that they are damaging their health and that of children if they smoke in a car. It must be even more dangerous for babies and small children who cannot accuse their parents or carers of being irresponsible. Smoke, full of toxins, drifting over babies is of immense concern. I congratulate the British Lung Foundation for all that it is doing to make people aware of the dangers of smoking and passive smoke, and of all the other dangers to the lungs of so many people. Prevention is of utmost importance to try to prevent lung disease in later life. The British Lung Foundation’s briefing—I do not think it matters how many times we hear it—says:

“The particular harm that passive smoke causes to children's health is well documented. Although members of the public are protected by smoke-free legislation in public transport and work vehicles, large numbers of children remain exposed to high concentrations of second-hand smoke when confined in family cars”.

The BMA states that children are still developing physically and biologically and that compared to adults they breathe more rapidly, absorb more pollutants because of their size, have less developed immune systems and are more vulnerable to cellular mutations. I would add that surely we should want to try our best to protect the delicate and tender lungs of children. I agree that the ideal would be to introduce an absolute ban on smoking in private vehicles. An extension to the ban would also promote the message that tobacco smoke is harmful, regardless of who is present in the vehicle at any time. As has been said, smoke toxins can remain in vehicles long after a cigarette has been smoked. There could be a build-up of harmful toxins in vehicles where children and other passengers sit.

This Bill is a start. Children are more susceptible to the harmful effects of second-hand smoke. A child’s immune system is considerably underdeveloped compared to an adult’s, and lacks the necessary defences to deal with the harms of second-hand smoke. There is plenty of evidence of the dangers of passive smoking to children. To mention some, there was a report by the Tobacco Advisory Group of the Royal College of Physicians, Passive Smoking and Children, in March 2010. The Royal College of Paediatrics and Child Health, the Royal College of General Practitioners, the British Heart Foundation, Asthma UK, Action on Smoking and Health, the Faculty of Public Health and many other organisations have a multitude of evidence.

I am sure that we all know or have known many people who have suffered from lung or organ disease due to smoking or passive smoking. One such case was Lynn, who was an ambassador for the British Lung Foundation. She tragically passed away earlier this year from COPD at the age of 54. Lynn had never smoked a cigarette in her life but had been heavily exposed to smoking as a child, with both her mother and step-father having smoked around her since she was a baby. She suffered from a number of lung problems as a child. She first contracted pneumonia when she was 13 months old and was diagnosed with asthma at the age of 5. The family doctor never asked her parents whether they smoked. He suggested that it was her hair that was causing the asthma, so it was cut off, and then that it could have been caused by the family dog, so it was sold.

Lynn was diagnosed with chronic obstructive pulmonary disease in 2003, by which stage it was already severe and had put a huge strain on her ability to manage her condition for the rest of her life. Lynn said that she had less than 22% of normal lung function and had never smoked a cigarette in her life. She hoped that her experience would serve as a warning to others to think twice before smoking around children. She hoped that children would have a voice. I hope that the Bill will do just that.

Passive smoking results each year in more than 165,000 new episodes of disease of all types among children, 300,000 primary care consultations, 9,500 hospital admissions and around 40 sudden infant deaths. This comes at a total cost of more than £23 million per year in primary care visits, asthma treatment and hospital admissions in the UK. We are not leading the way in banning smoking in private vehicles, as the noble Lord, Lord Ribeiro, said. It is prohibited in four US states, nine Canadian provinces, six Australian states and in countries such as South Africa—for children under 12—and Bahrain. It has been found that educational campaigns in this area are most effective in changing behaviour when accompanied by legislation.

I was one of your Lordships who supported legislation about the wearing of seatbelts. There were some opposing views. In fact my husband, who was then a Member of your Lordships’ House, and I voted on opposite sides. The wearing of seatbelts increased in the UK from 25% to 91% after legislation was introduced alongside awareness campaigns. I wish this Bill a speedy journey through both Houses. Surely the Government realise how important healthy children are. They are our future.

I am delighted to be able to support my noble friend’s Smoke-free Private Vehicles Bill, but as he is aware, I have some reservations about how such an Act would be policed and enforced, and I regret the imposition of yet more “nanny state” legislation.

The noble Lord is right. He has expertly presented the evidence. It is difficult not to repeat some of the figures. The Royal College of Physicians Report in 2010 showed the extent of the problems that children face due to passive smoking. They found that 160,000 children were adversely affected, costing the NHS in England more than £23 million. Children who grow up with parents who smoke are twice as likely to become smokers themselves.

Cars and other vehicles are a source of high levels of smoke exposure for children and adults and are associated with adverse health effects, including an increased risk of respiratory and allergic symptoms. As the noble Baroness, Lady Masham, said, smoke toxins can remain in vehicles long after a cigarette has been smoked. An international literature review of 15 studies of public attitudes to laws for smoke-free private vehicles found high levels of support, including among smokers. Support for a ban on smoking in cars stresses the widespread desire to protect non-smokers, especially children.

My noble friend Lord Ribeiro has made his case and other noble Lords have made and will make their case. I have made my case, but why limit the legislation to cigarette smoke? What about all the other toxins that surround us every day? Should children be banned from helping in the kitchen, prevented from living below overhead electric power lines or banned from playing in our parks for fear of infection by toxicara canis? I could go on. The truth is that many of us are unaware of the numerous dangers in our homes and do not realise that the cheap poisons that are used in our toiletries, cosmetics, cleaning products and even our furniture are linked to a diverse range of chronic health problems from cancer to chronic fatigue syndrome.

A case in point is a recent study published in the journal Environmental Health Perspectives, which found that pregnant mothers exposed to chemicals such as butyl benzyl phthalate—BBzP—are up to 50% more likely to have children who suffer from eczema. BBP is widely used in vinyl flooring, artificial leather and other materials that can be slowly released into the air in our homes. Eczema, which is characterised by dry, itchy red skin on the face, scalp or extremities, is common in early childhood and often allergies lie behind the condition. These findings add to previous research results which found that exposure to BZB, BBz and other phthalates can delay motor skill development in young children and increase the risk of behavioural problems. Phthalates are also known to disrupt the body’s endocrine system. There is no doubt that levels of pesticides found in our bodies are dangerously above levels thought to be safe and could be responsible for many cancers and other symptoms. During crop growth, pesticides are used as insecticides, herbicides and fungicides, 40% of which are linked with at least one adverse effect. I realise that I am straying from the subject and have not said anything about the dental issues that I hope my noble friend Lady Gardner might cover in a minute or two.

While supporting my noble friend’s Bill, I believe that there are many other ways in which we can be harmed. Banning smoking in cars with children present might surely open the floodgates for other Bills that reflect the many harmful factors which affect us all at different times. I am not sure that the Government will have the time or the inclination to take on so much legislation.

My Lords, I rise to speak in favour of this slender but important Bill for several reasons. I am most grateful to the noble Lord, Lord Ribeiro, for pursuing this issue and for again setting out today in such a compelling way the danger to health of smoke in vehicles. I accept, of course, as the noble Lord, Lord Colwyn, pointed out, the other environmental hazards of various chemicals. However, I think that smoke in vehicles should be an easier one to deal with first, rather than looking at the others in general.

The serious damage to health from passive smoking is well known, and I shall touch on that briefly. Others have given case studies and other facts but I emphasise the one fact from the Royal College of Physicians that 160,000 are adversely affected each year by being subjected to smoke in vehicles, which costs the NHS £23 million.

The All-Party Parliamentary Group on Smoking and Health said that children exposed to second-hand smoke have a greater risk of all kinds of diseases—respiratory infections, asthma, middle-ear infections and meningitis—leading to about 8,500 hospital admissions a year. The noble Lord, Lord Ribeiro, pointed out that one cigarette smoked in a car during a 30-minute journey gives rise to real danger to children from second-hand smoke, even with the window open; and 19% of 11 to 15 year-olds have been subjected to smoke in cars. A paediatrician has said that most parents would be horrified that even a short car journey when an adult has been smoking would result in breakdown products of nicotine in their child’s urine. Do we need more evidence?

As has been pointed out, many countries have laws prohibiting smoking in cars where children are present, and one has banned smoking in all cars carrying passengers. Some may say—I suspect that the noble Lord, Lord Colwyn, would—that such laws interfere with the rights of car users, but we must balance that with the impact on others who are breathing in that smoke. There is public support for measures to ban smoking in cars where children are present, and I hope that legislation such as the Bill would also make drivers and passengers in vehicles think of the effect on adults as well as children.

There are other consequences. I was discussing this subject with a colleague the other day. She said that she had always been sick in her father’s car when she was a little girl. He was a heavy smoker. When he stopped, her sickness stopped. I admire the efforts of the British Lung Foundation to enlighten people about the effects of smoking. It conducted a survey in 2011 of more than 1,000 children aged between eight and 15. Forty per cent of the children said that smoking in cars made them feel sick and 44% said that it made them cough. A girl of 15 in Belfast said:

“I think smoking should be banned in cars because it’s bad for the people in the car. And whenever my mum or dad smoke in the car it makes me feel sick and gives me a headache. When I tell them this they don’t listen and carry on. They don’t know what it actually feels like when someone smokes and you don’t”.

It may be difficult for children to challenge adults on that. Perhaps most are not as brave as the noble Baroness, Lady Masham, when she was four.

That sends a strong message that we should support the teaching of health education in schools to include assertiveness and persistence to challenge others when they are doing harm. That applies to a number of health behaviours, such as sex, drugs and alcohol.

Parental behaviour can be altered by children. I had a cousin who stopped smoking because one of his daughters cried when he smoked and said, “Daddy, I don’t want you to die of cancer”—a tribute to her receiving and understanding health messages. Of course, health education is not the only answer. It often has to be backed by legislation, as the noble Baroness, Lady Masham, said—for example with the wearing of seatbelts and food labelling.

There are serious impacts on children apart from the immediate health impact. Children who live in households where adults smoke are much more likely to become smokers themselves than children in non-smoking households. For every 10 children from non-smoking households who start smoking, 27 children from households where both parents smoke will start smoking themselves. It has been estimated that if there is a smoker in the household, the chance of a child in the household starting to smoke is almost doubled.

There is support for legislation from both children and adults. The British Lung foundation surveyed 1,000 parents on to assess their thinking on the impact of smoking around children. That showed that 86% of parents would support a ban on smoking in cars carrying children. Recent research by YouGov for Action on Smoking and Health found that 78% of adults and 62% of smokers themselves support a ban on smoking in cars carrying children under 18.

There is good evidence of the harm to children from smoking in vehicles; there is good evidence of the wider impact of smoking. There is public support for a ban on smoking in cars when children are present. I hope that the Bill will have the impact it deserves on government thinking.

My Lords, I am delighted to support my noble friend Lord ibeiro on the Bill. It concerns a very important issue, and I hope that it will find favour and become law. It is most unfortunate that far too many Private Members’ Bills meet deliberate opposition when they reach the other place. I was defeated four or six times on my High Hedges Bill before, eventually, the Government agreed to put the whole 19 pages of it into the Anti-social Behaviour Bill, which flew through. It is a great shame that Private Members’ Bills are often not considered for their value; some people oppose everything on principle.

My noble colleague Lord Colwyn, who is now on the Woolsack, suggested that I might deal with dental issues. I am not aware of too many specifically dental issues about smoking, although I am sure that they exist. They are part of the general health picture: smoking is pretty bad in almost every way that you can imagine. I am delighted that the noble Baroness, Lady Massey, spoke, and I know that the noble Earl, Lord Listowel, would have done except that he was held up in traffic and did not get here in time to do so. They are two people who have done so much to help children. This House is very keen to do whatever it can to help children. So often in debates, we hear the statement made: “Whatever is in the best interests of the child”. Without doubt, the Bill would be in the interests of the child. I believe that it would be in the interest of all of us, but we in this House are always most concerned about children.

I was also pleased that the noble Lord, Lord Colwyn, said that there are widespread home hazards. I would not dare to repeat the names, which I hope that he has given to Hansard, of the various chemicals which he suggests are so bad, and I am sure they are, but when he started talking about safety in playgrounds, I thought that he was saying that we are being overprotective. One has to balance being overprotective against not being protective enough.

Smoking in cars is an important issue, but I think that smoking is a real hazard in a lot more places than cars. I tabled an amendment to the Localism Bill to give local authorities the power to state that a certain area, even outside, should be smoke free. I raised that because a woman I know who lives above a group of garages said that she was unable to open her windows because all the local workmen came to sit outside the garages to smoke and the level of smoke going up to her window was such that she could not even open it. I have also heard from various local councillors that they have found the concentration of smoke outside some pubs and cafes, particularly in the summer when everyone is outside, can be so bad that it is hard to believe.

When we first brought in outdoor-only smoking here, you could barely enter the ladies loo on the ground floor, because the smoking area designated for the House was the little area immediately outside its window? It was incredible. Once it was drawn to the attention of the House, of course it was moved, so that problem was solved fairly easily. I noticed that in Australia, they have now banned smoking in some streets. It varies from place to place, but in some areas, they will not have smoking even in streets; it is only in private that you can smoke.

This measure is anything but extreme and deserves the support of both Houses because it is so much in the interests of children. The future of this country lies in its children. I am pleased to support the Bill. I hope that it gets a Second Reading and becomes law.

My Lords, whenever we have a Bill before your Lordships where the issue of tobacco smoke is included, I always declare that I have severe brittle asthma and can become very ill, sometimes within a few seconds, when I inhale tobacco smoke.

I make no excuses for repeating what other noble Lords have said, because their comments are worth repeating. Some parents smoke without realising the damage that they can do to their children’s health, nor do they realise that, within the closed space of a car, the concentration of tobacco smoke is much greater than in other areas, resulting in a range of lung diseases. In the case of children, those diseases are aggravated because of their reduced lung functions. Moreover, children have faster breathing and less developed immune systems.

In many cases, people who smoke in cars are not aware of the dangers to their children because they rarely travel in the back of the car while others smoke in the front. Many children who are aware of the dangers feel unable to influence those who smoke in cars.

There have been a number of studies on smoking. Those on smoking in cars started in 2006. People who smoke will not agree with their findings, but the studies cannot be faulted. They are factually accurate and correct. In 1924, the city fathers of South Bend, Indiana, introduced a special ruling which has never been rescinded. It prohibits any monkey, orang-utan, chimpanzee or ape from smoking in a public place. If they can legislate for animals, is it not time that we protected our children from the effects of second-hand tobacco smoke?

My Lords, I congratulate the noble Lord on bringing forward this welcome and timely Bill. I was about to say that, with my speaking ninth, my arguments have already been made, but I think that I am speaking seventh. Nevertheless, those arguments have been made and I shall detain not noble Lords from lunch by very much.

The evidence is clear. There are five big points: first, passive smoking has been shown to be dangerous; secondly, smoking in the confined space of a car is particularly dangerous even with the window open—that is the bit that I think many of us did not realise; thirdly, children are worst affected; fourthly, we have a responsibility to protect them; and, fifthly, as with our experience of other public health measures, voluntary pressure and persuasion get us so far but legislation is needed to go the whole way. As the noble Lord, Lord Ribeiro, has said, the arguments are compelling.

The noble Lord, Lord Colwyn, is right that many things are dangerous in life, but this Bill is coming to this House because it is an issue of judgment. Where things are dangerous and where we judge that we should do something about them, such as introduce legislation, I would say off the top of my head that there are four questions to be asked: first, is there very clear evidence that it is dangerous? There is in this case. Secondly, are the dangers material and significant? Yes, they are—they affect people’s lives. Thirdly and importantly, is it about something that we are doing that affects other people? This is, because adults smoking in a car affects other people. Fourthly, what are the downsides? The downsides are pretty modest. They are about having the freedom to smoke in a car when your children are present. The noble Lord, Lord Colwyn, was right to draw our attention to the fact that there is a judgment to be made, but if those are the criteria by which one makes it, the arguments are compelling. It is a simple judgment.

I spend a lot of time abroad and am constantly gratified by the way in which the UK is held in such high regard in terms of health—everything from the basic principles of the NHS to research, services, professional education and all the great things that we know about. The UK is seen as an example to follow. I was recently with a group of Health Ministers from Asia and Africa who showed great interest in what we were doing to reduce smoking in this country, across the whole range of measures introduced by the previous Government and by this Government. Although some noble Lords have pointed to examples abroad, there are not very many of them yet and people still look to us for examples.

I have no doubt that this legislation, should it be passed, will be used as an example to encourage others in the worldwide campaign to reduce smoking and to implement fully the World Health Organisation Framework Convention on Tobacco Control. As noble Lords may know, this convention is the first international health treaty to be negotiated through the World Health Organisation and it has been rapidly adopted, but there is much more to do in implementation. This Bill provides a very welcome opportunity to show how it can be done and to lead by example. For this and all the other reasons that noble Lords have given, I look forward to hearing what the Minister has to say about the Government’s support for this Bill and to securing a speedy passage for it.

I congratulate my noble friend Lord Ribeiro on bringing forward this Bill. I worked with him for many years at the Royal College of Surgeons, where he was a very distinguished president. The Bill brings back some memories for me, for, 18 years ago, I proposed an amendment to a criminal justice Bill to ban smoking in public completely. I was very pleased that the House was full, even to midnight. I flattered myself that they had come to support my amendment. Little did I know that a horde of smoking Barons had come deliberately to vote against it and were waiting for me to say, “I beg leave to withdraw my amendment”. The person on the Woolsack would then ask, “Is it your Lordships’ wish that the amendment be withdrawn?” and they would all shout no. Unfortunately, by mistake, I said at the end of my speech, “Amendment not moved”, and they all looked very puzzled, because I had spent hours moving it. The lady on the Woolsack quickly moved on and they lost the opportunity to vote against the amendment. They were furious, and they came up to me afterwards and asked, “Who taught you that Machiavellian trick?”. I said, “No, no, I am just an innocent abroad”. Well, they did not believe me after that.

I have had many patients who have died of cancer of the lung who have never smoked at all, but they had spent a lot of time incarcerated in cars where the driver was smoking a pipe. Not only does the smoke cause cancer in those circumstances, but, as has been said, children can easily be precipitated into an asthmatic attack or they can spend their time in the car vomiting their head off. This Bill should have been passed many years ago and I very much hope that it will soon become law.

I, too, my Lords, thank the noble Lord, Lord Ribeiro, for bringing this important matter to the attention of this House and, I hope, of the public. Since July 2007, as we have heard, it has been illegal to smoke in virtually all enclosed public spaces and workplaces.

In May of that year, I had my last cigarette. While I have stopped, I still define myself as a smoker. I have had two periods of eight years each of not smoking. I am now in my third period of not smoking. For long periods, I continued smoking despite being aware of the dangers to my health. It is true that there were times when I really enjoyed a cigarette, particularly after a meal with a cup of coffee, but I knew that the real reason that I smoked was that I was hooked.

For me, the addiction meant that one cigarette smoked always led to more. Even the medical evidence was something I managed to put to the back of my mind. In fact, five years ago my doctor said that I had a 20% chance of a heart attack if I continued smoking. After coming out of the surgery, I convinced myself that that meant I had an 80% chance of not having one. At the time, I thought that that was not bad odds. It is amazing what addiction can do.

While I may have kidded myself about the risks and dangers of smoking, it was not something I ever thought that I should impose on others. However, the car was my space and I always thought that an open window would suffice. Like Sharon Gould, whom the noble Lord, Lord Ribeiro, referred to, I really did not appreciate the harm that I could have caused to the passengers in my car, especially my nieces and nephews. Now I know different. As the noble Lord said, research has shown that a single cigarette smoked in a moving car with the window half open exposes a child in the centre of the back seat to around two-thirds as much second-hand smoke as being in an average smoke-filled pub. I never really appreciated that. Levels increase to more than 11 times those of a smoky pub when the cigarette is smoked in a stationary car with the windows closed. I have also seen from the British Lung Foundation that research from the Chartered Institute of Environmental Health has found that smoking in cars continues to be dangerous even after the cigarette is extinguished.

Unfortunately, my noble friend Lord Rea was delayed today but I know that he would have spoken in more depth about the medical evidence of secondary smoking, particularly from his experience while working at St Thomas’s Hospital. He would have reminded us that children are particularly vulnerable to second-hand smoke. As the noble Lord, Lord Ribeiro, has said, children have smaller lungs, faster breathing and less developed immune systems, which make them more susceptible to respiratory and ear infections triggered by passive smoking.

Since the ban in public places, I thought that most people now understood that it is bad to smoke in confined spaces. Even the smokers’ lobby group FOREST accepts this. It says:

“It’s inconsiderate at least, and where children are concerned it’s probably best to err on the side of caution or, as some would say, courtesy”.

Although FOREST still does not accept the medical evidence, is it right about people understanding the need to err on the side of caution when it comes to having children in the car? Is it still an issue? As we have heard from many noble Lords today, last year, surveys conducted by the British Lung Foundation and the NHS Information Service for Parents show that 51% of children aged between eight and 15 said that they had at some point been exposed to cigarette smoke when confined in a car. Clearly, we need to do more to raise awareness of the dangers of secondary smoke.

However, I would like to ask the Minister if the Government truly believe that a one-off publicity campaign will be enough to protect children when so many are still subjected to the fumes of others? We have heard in this Chamber and outside both practical and ethical issues as to why we should not extend smoke-free legislation to cover smoking in private vehicles. I am sure that the Minister will highlight some of the practical issues about enforcement. Unlike the current ban in public places, it can hardly be left to public health officials to police. A partial ban no doubt would lead to difficulties over proof and clearly, as we have heard in the debate, a law that is difficult to enforce has the danger of bringing the law into disrepute.

The ethical issues—as I have mentioned, there are campaigners who defend the rights of smokers—will no doubt focus on the potential infringement of the privacy of the vehicle user. I cannot believe that this civil liberties argument can ever outweigh the harm to other private individuals who are in the car. I know that it could be argued that adults can exercise the right not to travel in the car but children rarely are in that position. One issue as regards the Bill, which I hope will be addressed by the Minister, is a possible situation involving a 17 year-old driver who could be subject to the ban. Perhaps the age limit could be looked at in that respect.

It is always argued that an adult can exercise the right not to travel in a car but can a car being driven along a public road be described as a private space? In the interests of public safety, we already accept restrictions on what people can and cannot do while driving. As many noble Lords have pointed out, surely holding a lit cigarette is as dangerous as holding a mobile phone. From my experience, I confess that I have dropped cigarettes while driving and they have gone in the most awkward places. As a consequence, I have nearly caused accidents.

As the noble Baroness, Lady Masham, reminded us, since 2007, vehicles used by more than one person for purposes of work, paid or unpaid, and whether they are travelling in the vehicle at the same time or not, are required to be smoke-free. Why should that right not be extended to children? As many of my noble friends have indicated and as my noble friend Lady Massey has said, awareness and raising awareness is not enough.

We need this debate and I am truly grateful to the noble Lord, Lord Ribeiro, for starting it. I know from personal experience that simply raising awareness of the risks and dangers of smoking is not always enough. Addiction is a powerful enemy. I ask the noble Earl if the Government would consider undertaking a more detailed study on public attitudes, particularly attitudes to smoking in vehicles. One-off public health campaigns did not stop me smoking but the ban in public places did and it has helped me to remain smoke-free.

My Lords, I congratulate my noble friend Lord Ribeiro on securing the reintroduction of this Bill, which seeks to amend the Health Act 2006 to make provision for a ban on smoking in private vehicles where there are children present. The Government welcome the role that my noble friend’s Private Member’s Bill has played in bringing this important issue to the attention of your Lordships’ House.

In answer to my noble friend Lady Gardner of Parkes, the good news is that this House can carefully consider a Private Member’s Bill. I have had exactly the same experience as my noble friend with my Road Traffic (Enforcement Powers) Bill. But how another place conducts its business is of course not a matter for me.

In addition, we have seen a valuable contribution to raising awareness and stimulating public debate on second-hand smoke achieved through the introduction of a similar Private Member’s Bill last year in another place, the All-Party Parliamentary Group on Smoking and Health’s inquiry and report on second-hand smoke, the Royal College of Physicians’ 2010 report entitled Passive Smoking and Children, and recent campaigns by the British Medical Association and the British Lung Foundation.

Smoke-free legislation has been in place since 2007. These laws have been particularly effective in reducing exposure to harmful second-hand smoke in enclosed public and work places. Smoke-free legislation is popular and levels of compliance are high. We need to maintain that. However, we cannot escape the fact that it is now enclosed places that are not covered by smoke-free laws where people are likely to be exposed to second-hand smoke, including homes and family cars. Importantly, research shows that there has not been displacement of smoking into the home since smoke-free legislation came into place. In fact, more and more people are making their homes entirely smoke free, and that can be only good news.

My noble friend Lady Gardner of Parkes mentioned the problem of smoke from outside smoking areas adversely affecting other residential smoke-free areas. I am aware of this, but it does not mean that the existing legislation is flawed. She asked whether local authorities could be granted powers to introduce by-laws to protect people from second-hand smoke in outdoor public areas. Local communities and organisations may also wish to go further than the requirements of smoke-free laws by creating environments free from second-hand smoke—for example, in children’s playgrounds and outdoor parts of shopping centres. This can also help to shape positive social norms and discourage the use of tobacco and has been introduced using voluntary mechanisms by some local authorities. Local authorities that have introduced smoke-free outdoor places will have done so voluntarily—for example, in children’s playgrounds that are the property of local authorities, and where a condition of entry is that smoking does not take place and signs are put in place. Local authorities do not need by-laws to do this.

I am sure that we would all like to see the end of smoking in cars in which children are being conveyed. There is a diversity of opinion on how to reduce exposure to second-hand smoke in the places not covered by smoke-free laws. The question is: how do we encourage smokers to modify their behaviour for the benefit of the health of others in private spaces such as the home and family car? For example, many, including my noble friend Lord Ribeiro, have called for legislation to prohibit smoking in private vehicles. Others say that the best way to afford protection from second-hand smoke is to encourage smokers to quit for good. The Government have an assertive and comprehensive tobacco control plan to reduce smoking rates and stop the uptake of smoking by young people.

As we have been reminded today, evidence of the harm to children from second-hand smoke is well documented, and that many children continue to be exposed, whether in family cars or in the home. I am sure that my noble friend Lord Ribeiro has convinced the House on the technical points. A key factor to assess when considering his Bill is that we do not know what proportion of the ill health among children attributable to second-hand smoke results from exposure in cars. It follows that we are not able to estimate what the likely impact on child health would be from the ban that the Bill would introduce. This problem is compounded by the likely problems of whether such a ban could be enforced in practice.

Smoke-free legislation in England, covering enclosed workplaces and public places, including public transport, is enforced by local authorities. Local authority officers do not have powers to stop vehicles in progress or even to detain those that have stopped. Even if the officers had such powers, in practice it is likely that they could not be exercised safely without the assistance of the police, extensive training and resource. Without being authorised to stop vehicles or easily identify offenders, enforcement by local authorities would be difficult. Therefore, we consider that the only realistic option would be for the police to enforce any ban on smoking in private cars. This additional task may not be welcomed by the police, on top of their many other responsibilities. The practicalities of enforcement may also be further complicated by the fact that small children may not be easily visible from outside the vehicle, and it may be difficult to identify whether passengers in a car where someone is smoking are under the age of 18. I do not believe that we should legislate in this area without first identifying how any law could be enforced effectively.

Additionally, there is the issue of creating new criminal offences or extending the locations in which current criminal offences are committed—a point made by my noble friend Lord Colwyn. The Government believe that we ought first to consider whether there are other more effective methods of reaching out to parents and other adult smokers to encourage them to want to modify their smoking behaviour to protect others, particularly children.

When considering legislation that seeks to require changes in the behaviour of people in private vehicles for public health rather than road safety reasons, we also need to consider human rights aspects. These might include whether there might be unjustified interference with people’s private space. I acknowledge, however, that such arguments need to be balanced against the rights of children to be protected from harm. One noble Baroness suggested a total ban on smoking in a vehicle. In human rights terms, that might well be a step too far, given the current levels of smoking in the general population.

Your Lordships will be aware that in the Tobacco Control Plan for England, published in March 2011, the Government undertook to run a marketing campaign aimed at raising awareness about the dangers of smoking in vehicles and in the home, particularly when children are present. This campaign ran after Easter and aimed to encourage positive behaviour change among smoking parents and other smokers in those places. I watch little TV but was certainly aware of the campaign. The Department of Health will be carrying out a full evaluation of the campaign, which will give us further information on changes in attitudes and behaviours in relation to smoking in the home and car and on quit attempts generated by the campaign. The results of this will be available for further consideration in the autumn. In answer to the noble Lord, Lord Collins, we will assess the effects of the campaign before determining what to do next to change behaviour.

The results of the campaign were very encouraging and we have some basic data on its results, including the fact that the campaign prompted nearly half a million visits to the smokefree website, which provided information on second-hand smoke, compared with 100,000 visits the year before. Well over 60,000 smoke-free kits were requested and delivered to families in response to the advertising campaign. We saw a parallel increase in quit-kit orders during the campaign and have sent out almost 40,000 of the kits since the campaign was launched. The evaluation will help to inform decisions about what other action, if any, is required to address the issue of second-hand smoke in the home and family cars.

My noble friend Lady Gardner of Parkes talked about dental issues arising from smoking. There is a clear link between smoking and dental health. Smoking is a cause of peritonitis, as well as oral cancer. However, we are not aware of any evidence that there is a link between second-hand smoke and dental health problems.

I was asked why we do not approach the problem from a different perspective and prohibit drivers from smoking in all motor vehicles on the grounds that this distracts them from driving safely. The noble Lord, Lord Collins, asked whether this was a road safety issue. I agree that smoking at the wheel of any road vehicle can cause driver-distraction, as lighting up and using smoking materials means that one’s hands are removed from the steering wheel. However, the Government have no proposals to introduce the same penalties for smoking while driving a vehicle as for using a hand-held mobile phone while driving a vehicle. There are many potential distractions while driving and it remains the driver’s responsibility to drive safely at all times.

The police use the existing offence of failing to have proper control, under Section 41D of the Road Traffic Act 1988, to deal with those who are distracted while driving. This attracts similar penalties to those for the specific offence of driving while using a hand-held mobile phone. It is worth noting that introducing a new law to ban smoking in cars only by drivers would not solve the public health problem that prompted my noble friend Lord Ribeiro to introduce his Bill. Other passengers in the car, either in the passenger seat or in the rear of the car, would still be able to smoke, and children and adults would still be exposed to the harms of second-hand smoke.

The Government are not persuaded that legislating for smoke-free cars is the best approach at this time. We believe that some significant issues need to be resolved before such legislation can be contemplated. None the less, I congratulate my noble friend on his efforts.

I thank my noble friend Lord Attlee for his reassuring comments—in particular, for saying that the Government are not persuaded “at this time”. I brought the Bill forward to raise awareness of this matter and to say that it should be introduced in conjunction with attempts to change behaviour. The Welsh Assembly has set a time limit of three years. I would hope that we would be able to make a decision within a shorter period.

I also thank noble Lords who have spoken in the debate. I know that two were unable to do so because the previous Bill went through much quicker than expected. I was particularly heartened to hear the noble Lord, Lord Collins of Highbury, speak, because he has personal experience as a smoker. It is very important to get that perspective because the feeling is that those who smoke have no concern for young children in cars. That is certainly not the case, as came through very clearly in many of the contributions. Noble Lords have given a general, wide view of the impact of smoking on children as well as, often, on themselves.

I accept the reservations expressed by my noble friend Lord Colwyn about the other toxic elements that children are exposed to, but the car is a very special place because children within a car are confined and unable to get away from the smoke.

The noble Lord, Lord Crisp, put his finger on it when he said that it was a matter of judgment. Have we identified the problem? Yes, we have. Are there downsides? Yes, there are. The question is: who is likely to benefit from such legislation? If you look at the issue in libertarian terms and try to make a decision about whether this is about the rights and freedoms of individuals to do what they want to do in their private space, then I think it is also necessary to consider the rights of the child in that private space and ask who is responsible for that child. Frankly, I am prepared to let my individual liberties go for the benefit of young children. This is something that the Government will need to take away and think about.

On the issue of powers and the police, I was careful to talk to two former chief commissioners of police in this House to find out their views. Their view was that this is a visual matter: you look to see whether somebody is using a mobile phone or whether someone who appears underage is smoking, and then you verify. Therefore, this is not an issue that we should get too worried about.

I agree with the noble Lord, Lord Collins, about the issue of age. I put in 18 because medically that is the age at which you move from being a child to an adult. However, I am perfectly aware that you can drive a car at 17. There may be a loophole here if the law stipulates 18 and a 17 year-old boy or girl driver is pulled over for an offence. There might even be a strange situation where a 17 year-old is driving and an 18 year-old in the car with him is smoking. In that case, the 17 year-old is the person who should have the authority to tell their passenger to stop smoking. This is something that we must come back to and look at.

This has been an excellent debate. I am glad that the Bill has got this far and hope that we will be able to take it further. I beg to move that the Bill be given a Second Reading.

Bill read a second time and committed to a Committee of the Whole House.