House of Commons
Tuesday 29 November 2005
The House met at half-past Two o'clock
Prayers
Mr Speaker in the Chair
Oral Answers to Questions
Foreign and Commonwealth Affairs
The Secretary of State was asked—
EU Budgetary Reform
I am tempted to ask "Why?" The Secretary of State has told us that reform of the budget is predicated on reform of the common agricultural policy. What proposals for the reform of the CAP have the Government put on the table during their presidency? Has the Agriculture Council even met during the British presidency?
I am very happy for the hon. Gentleman to ask me why; that is the purpose of the House. The reason we have had many discussions on the European Union budget is that there is an awful lot to discuss, and even more to explain to some of our European counterparts about how, to take an example at random, the United Kingdom has historically been paid significantly more than France over many years, notwithstanding the abatement that was secured in 1984—
The hon. Gentleman—
Right honourable.
The right hon. Member for fancy ties reminds us that the abatement was secured by Mrs. Thatcher. That is true, although in the debate that took place thereafter, in which I took part, that deal was treated with some scepticism—
Not by me.
No, by me. And I was right, because, as we predicted at the time, the deal failed to ensure any long- term reform of the common agricultural policy or of the EU's budget. Twenty years on, it has been left to the Labour Government of my right hon. Friend the Prime Minister to secure that reform.
Interim agricultural reforms have been secured, above all, through the efforts of the United Kingdom, although perhaps the hon. Member for New Forest, West (Mr. Swayne) has not noticed. Thanks to my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs we have for the first time achieved significant—36 per cent.—cuts in sugar subsidies, which is a major achievement for the British presidency.
The cuts in sugar subsidies represent an important step forward in agricultural reform, but will my right hon. Friend ensure that the new arrangements do not disadvantage our traditional allies in the Caribbean? Will he also ensure that sufficient money is put aside for the right transitional arrangements for them?
I share my hon. Friend's great concern about the inadvertent but none the less powerful impact of the changes in sugar subsidies, which could affect many of the Cotonou countries—the African, Caribbean and Pacific countries. I discussed this issue with a delegation from the ACP countries at the United Nations General Assembly in September, and my right hon. Friend the Prime Minister discussed it with Commonwealth ACP countries at the Commonwealth Heads of Government meeting. We have been pushing the European Union for cushioning support, with a two-year phase-in. So far, there has been a proposal, which has still to be agreed, for €40 million for 2006. We are pushing the European Union to increase that and to ensure that there is sufficient provision in the 2007–13 budgets, which have yet to be agreed, for the ACP countries.
Ugly rumours are circulating that the Prime Minister is prepared to give away Lady Thatcher's rebate in return for some vague promise or undertaking on CAP reform. Will the Secretary of State give the House an absolute assurance now that there is no question of our rebate being given away without the absolute certainty now of substantive CAP reform?
I thought that Ugly Rumours was a band with which the Prime Minister was associated. I am happy to say that I have never heard any of its tracks—
Let's keep it that way.
Indeed.
My right hon. Friend the Prime Minister said on 20 June, as on many other occasions, that the rebate was an anomaly, but an anomaly that was justified by a much bigger anomaly, namely the distorted spending of the common agricultural policy. Yes, we are ready to discuss the removal of that anomaly, but only in the context of significant reform of the common agricultural policy.
Workers at the Nestlé chocolate factory in my constituency very much welcome the proposed changes to the sugar regime. They would have welcomed them even more had they gone a bit further. On the general question of the contributions, does my right hon. Friend agree that the question of who pays how much should be resolved among the richer countries of the European Union, and that the interests of the accession countries should be protected?
On the sugar subsidy, we would always like these things to go further, but I am grateful to my hon. Friend for his generosity. This was a significant deal, and it was achieved only as a result of the work of my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs.
I agree with my hon. Friend's second point. Let me make it clear, however, that whatever deal is agreed, the United Kingdom will pay a fair contribution towards the cost of enlargement. That is our duty and responsibility, which all parties have agreed. All parties in the House have supported enlargement. All the E15 wealthier member states must make fair contributions towards the cost of enlargement. That is a separate issue—although it is bound to mean that our contributions will rise— from whether or not we get rid of the rebate in return for reform of the CAP.
President Chirac is reported as saying that a deal on the EU budget is being impeded by the power struggle between the Chancellor and the Prime Minister. The former Minister for Europe, the right hon. Member for Rotherham (Mr. MacShane), warns Ministers in The Daily Telegraph today that he will not accept a one-sided deal that only moves on the rebate. Would not it help the Foreign Secretary to present a clear, united position if he were now to come clean, publish the Government's budget proposal and give absolute guarantees, first, that the whole rebate will be kept until there is fundamental CAP reform—delivered and not just promised—and, secondly, that no budget will be agreed that costs the British taxpayer more, not less? Does he agree that the worst of all worlds would be for Britain to give way on our rebate with no guarantee of real CAP reform?
Our—[Interruption.] There is a lot of chitchat among Conservative Members as they try to work out their policy. Our position on the rebate has been made clear, and I spelt it out again today. I intend to publish proposals to our EU colleagues—which, of course, will also be made available to the House—at the beginning of next week, for what has been delicately described as a conclave of European Foreign Ministers, which will take place tomorrow week.
Will the Foreign Secretary confirm that the majority of countries with which he must deal on this matter, and particularly the agri-protectionist countries, are governed by parties of the centre right, sister parties of the Conservative party? Is not it a real worry for Britain's future standing in Europe that the incoming leader of the Conservative party has said that he wants to break all political links with conservative parties in Europe? Is not it a fact that it is betraying British interests to uphold its anti-Europe—
Order. That question is totally out of order.
Israel
I am sorry that the previous question was out of order, Mr. Speaker, as I had a very good answer, but I am not challenging your decisions.
I had discussions yesterday in Barcelona with Ehud Olmert, Vice Prime Minister of Israel, and Mahmoud Abbas, President of the Palestinian Authority, about the middle east. Although, of course, many difficulties remain to be overcome, I am more hopeful about the prospects for a lasting peace between Israel and the Palestinians than I have been at any time in the past four and a half years. The withdrawal of the Israeli defence force from Gaza, and from some settlements in the northern west bank, was a hugely significant first step towards the creation of a separate and viable state of Palestine alongside a secure state of Israel, as was the opening of the border at Rafah between Gaza and Egypt, where the European Union is providing international monitors.
I have often commended Israel's Prime Minister Ariel Sharon for his courage in setting those events in train. I should like to do so again. He has now broken from the Likud party to form a new party, Kadima, which stands for "forward". A general election in Israel is due on 28 March.
The Secretary of State has acknowledged clearly that Israel's unilateral withdrawal from the Gaza strip and parts of the northern west bank is a major step towards a peace settlement and completion of the road map for that peace settlement. In the light of Israel's significant step and concession, will the Secretary of State guarantee to the House today that he will redouble his efforts to ask the Palestinian Authority to live up to its obligations under the road map, and to do everything it can to cease the attacks against Israel and its citizens by too many terrorist groups?
I have already placed on record my commendation of President Sharon, and I am glad that the hon. Lady agrees with it.
We must return to the road map as quickly as possible. The withdrawal from Gaza was a major first step, but there is much more to do. All sides have obligations that must be met. Under the excellent leadership of President Mahmoud Abbas, the Palestinian Authority is making significant moves forward. It is getting a grip on its security forces, although it needs to do more. Self-evidently, no attacks were perpetrated by the Palestinian Authority on Israelis, including Israeli citizens. Some rejectionist terrorist groups are still operating from within the occupied territories and from across the northern border, and we look to the Palestinian Authority to continue its efforts to control those organisations.
I thank my right hon. Friend for his answer, but he knows that no one can compromise from a position of weakness. We recognise the brave leadership that Ariel Sharon has given to Israel. Does my right hon. Friend recognise that it is incumbent on all parties in the region to leave their entrenched positions if we are to achieve a peace that the international community can support?
I do recognise that. Following a period during which everyone was digging into preordained or preconceived positions, there has been a dramatic change in the politics of both the Palestinian Authority and Israel over the past 12 or 13 months. The position now taken by Prime Minister Sharon and members of his breakaway party—including Ehud Olmert, whom I met again yesterday—has moved significantly from the position that the Israelis were taking four years ago at the height of the armed intifada. The Palestinian Authority is also moving. I believe that gradually both sides have recognised that the only future for Palestinians and Israelis lies in peace and in two states.
What will the British Government do to prevent the illegal encirclement of Jerusalem from continuing?
We continue to make strong representations both directly to the Israeli Government—I keep doing that—and to the Government of the United States, the Government with the most influence in the world over the Israeli Government.
The sooner we reach final-status negotiations, the easier it will be to resolve the issue of the wall. The Israelis say that they are ready to shift the wall, as they shifted an earlier line of control in the Lebanon, as soon as there is political agreement on the borders between the new state of Palestine and the state of Israel. Those issues are to be resolved in the final status negotiations. My reply to the Israelis is that while in one sense shifting a wall is straightforward, it would be profoundly objectionable for settlements to be built within the wall to pre-empt any shifting of it later.
As my right hon. Friend will know, there will be elections for the Palestinian Authority on 25 January. Does he agree that it will be impossible for the elections to be seen to be free and fair while more than 600 road blocks are operating in the west bank—an area the size of East Anglia—and that it is essential for everything possible to be done to allow the elections to take place freely? Otherwise, only the terrorists and those who oppose the peace process will benefit.
I accept that the election operation will become very difficult while the road blocks are there. That is a responsibility of the Government of Israel, but it is also a responsibility of the Palestinian Authority's security personnel and of the rejectionist terrorist organisations, which are subject to sophisticated political control from outside Israel. We look to all three parties to take steps to ensure that the elections can take place in reasonable order. The matter will be discussed at the ministerial level of the Quartet, which will meet in the second week of December.
Is not the key to further progress towards peace, and removal of the wall and the road blocks, further progress on the question of security for the Israelis themselves, so that moderate leadership in Israel can be supported? In view of what he said about rejectionist elements—including Hezbollah, which during the peace process has launched rocket attacks on northern Israel—will the Foreign Secretary do all that he can to bring international pressure to bear on rejectionists and the states that have supported and encouraged them, including Iran, whose leader has made such reckless remarks?
I share the views expressed by the hon. Gentleman. Putting pressure on Iran, but also on Syria, which hosts Hezbollah, Islamic Jihad and Hamas, is extremely important. That is the subject both of our private representations to the Government of Syria and of very public condemnation, which I issued during the debate in the Security Council three weeks ago in respect of the Syrian Security Council resolution.
My right hon. Friend referred to the encirclement of Jerusalem by the wall. Does he agree that the increasing destruction of Palestinian homes in and around Jerusalem is also a matter of concern, and that the international community needs to resist the "de-Arabisation" of east Jerusalem? Will he make urgent representations to the Israelis about that, and take up the suggestion of the EU heads of mission that we should press for the reopening of Palestinian institutions inside east Jerusalem, such as the chamber of commerce?
I accept what my hon. Friend says, and its implication—that if east Jerusalem were detached from the rest of the west bank, a functioning state of Palestine would be nigh on impossible to operate. That would be wholly unacceptable to the international community, as it would be to the Palestinians. We have made very strong representations to the Israelis—particularly about not encircling east Jerusalem and not continuing to build what is known as the E1 area, north-east of east Jerusalem—and we shall continue to do so. The suggestion by the EU heads of mission is an interesting one, which Ministers will consider within the EU General Affairs Council.
European Constitution
Following the rejection of the treaty in the French and Dutch referendums, the June European Council agreed unanimously on the need for a period for reflection to consider the right way forward for Europe. The position remains that the Council will return to the issue of the draft constitutional treaty at the June Council in 2006.
What discussions has the Minister had with his counterparts in Germany, given that Chancellor Merkel has said that she wants to press ahead with the constitution, but the British public clearly do not want it?
The Prime Minister has now met the incoming Chancellor of Germany, but it is to state the obvious to say that it is ultimately for the Germans to reach a decision on the ratification of the draft constitutional treaty on behalf of the German people, just as it is the perfect entitlement of the British Government, and ultimately the British Parliament, to reach a judgment on the right response of the United Kingdom to the decisive rejection of that treaty last spring by the French and the Dutch.
Clearly a period of reflection is in the interests of the whole of the European Union. However, there are elements of the constitution that match Britain's reform agenda. Is my right hon. Friend confident that during our presidency we have achieved what we set out to achieve in connection with reforming the structure of the EU? Will he assure the House that if we do not get those agreements by the end of the presidency, he and the Foreign Secretary will pursue this agenda until the EU is made more efficient and effective, irrespective of what happens to the constitution?
My hon. Friend's question contains a number of points. First, the judgment that the British Government reached, in the light of the decisive rejection in France and the Netherlands, was that the best use of the time during the British presidency was to engage in a broader conversation about the future of Europe. That explains the agenda that we set for the Hampton Court meeting in October in relation to specific future reforms of the European Union. Of course we have made substantive reforms in policy areas—for example, on the sugar regime, as was mentioned earlier—but in the coming six months further reflection is needed on the correct way forward, not least given the disparate range of opinions now being expressed in Europe on the future of the constitutional treaty.
Will the Minister confirm that existing treaties and EU rules remain in force, including guarantees on the rule of law, democracy and human rights? What is the UK presidency doing to clarify the serious allegations about detention camps and rendition flights, which are surely against all decent standards?
The hon. Gentleman may be aware that my right hon. Friend the Foreign Secretary has, on behalf of the European Union, written to the United States Secretary of State on exactly that matter.
Does the Minister agree that, rather than concentrate on what people might view as abstract issues of constitutional detail, there should be an emphasis on bringing home to the British people the benefits of EU membership?
I certainly agree that people in both France and the Netherlands were voting on the text, and we need to respect the judgment that they reached. The broader context of how Europe can meet the challenges of globalisation explains the broader conversation in which European leaders engaged when they met at Hampton Court in October.
As the EU presses on with the defence agency, criminal law code and the strengthening of foreign policy in many other crucial elements of the constitution, should not the Prime Minister keep his word to this House and the British people by holding a referendum in this country before the constitution returns to the EU agenda next year? The promise was unequivocal: we were told that we would have a referendum irrespective of what other countries did.
That was a worthy attempt, but the position of the British Government has been set out several times in the House and elsewhere. The draft constitutional treaty would be ratified by means of a referendum in the United Kingdom, but the right hon. Gentleman is right to recognise that there needs to be a legal basis for decisions taken by the European Commission and, indeed, by the other institutions of the EU. That continues to be the case, notwithstanding the period of reflection for the constitutional treaty.
Given the reality that the constitution is as dead as the Monty Python parrot, would it not be better for Britain to propose a more sensible alternative: the idea that, in future, Europe should be an association of independent, democratic states responsible for their own internal affairs—[Hon. Members: "Hear, hear."]—co-operating only where there is mutual benefit to be gained?
I think that the cheers of Conservative Members reflect the candour with which my hon. Friend has revealed his true agenda, which underlies so many of the questions that he asks—not only in Foreign Office questions but in wider debates on the issue. It is, however, continually the case and remains the case that the draft constitutional treaty was agreed by 25 member states, so it is not the role of any one member state to declare it dead. That explains the unanimous decision that was reached back in June, which will be the basis of further conversations in the European Council next spring.
World Trade
The Doha round provides an opportunity to tackle some of the most fundamental injustices at the heart of world trade. My right hon. Friend the Foreign Secretary chaired EU Foreign Ministers' discussions on the trade talks earlier this month. During our EU presidency, we have consistently made clear our ambition for a successful and balanced outcome to that round.
This year, the common agricultural policy will cost about £33 billion—equivalent to the gross domestic product of Ethiopia. Given that the Doha round talks are designed to liberalise trade and drive forward the millennium development goals and development more generally, does the Minister believe that the CAP should survive the World Trade Organisation talks in December?
We have consistently made it clear that we want a fixed date to be set for the removal of export subsidies—one of the central elements of the CAP. I am glad to say that other countries, including the United States, have joined us in setting a time scale that they would like to be agreed at Hong Kong during this round. It is important to recognise that agriculture should not crowd out the other elements of a necessary agreement in Hong Kong—whether that means non-agricultural market access or the issue of services. A great deal of potential benefit not just for Britain but for the whole of Europe will follow from a successful conclusion to this round.
Recent media reports have speculated pessimistically about the outcome in Hong Kong. Does the Minister share that pessimistic view?
It is correct to acknowledge that recent expectations, not least as a result of the comments of the new secretary-general of the World Trade Organisation, Pascal Lamy, have begun to be lowered ahead of the critical meeting in Hong Kong next month. The British Government's position, during our presidency of the EU, has consistently been to argue for the continuing need for an ambitious and balanced outcome. That remains the Government's position.
The EU Commissioner responsible for the trade negotiations in Doha is prepared to advocate reductions of 40 per cent. in some import tariffs, despite the fact that certain products—beef from Brazil, for example—cause considerable environmental damage and exploit labour. Will the Minister assure me that he will intervene and ensure that the reductions will not take place until those products are made without the abuse of environmental damage?
From the question, I am not entirely sure towards which products the hon. Gentleman directs his concern. There has been an offer forthcoming from the Trade Commissioner, and the European Union now looks particularly to Brazil, and also to India, to match the offers that it has made, in order to regain some of the momentum that was apparent in the early autumn but that appears to have been lost in recent weeks.
Where does the UK stand, in respect of the EU's negotiating position, on deregulation of services? In particular, what is our position on the potentially damaging impact of a prescribed list of services that must be privatised by developing countries?
Britain will not only be represented by Cabinet Ministers in Hong Kong, but will speak with the collective voice of the 24 other members of the European Union, and will be represented collectively at the world trade talks by the European Commission. That is right, because given the challenges that we face from countries such as Brazil, India and—not least—the United States, it is better to speak with the collective strength of 24 other members of the EU to maximise our influence. There are discussions at the moment on the issue of services and non-agricultural market access. I will ensure that my hon. Friend's representations are directed to the Department of Trade and Industry and that a reply is forthcoming.
Given that Benin, Burkina Faso, Mali and Chad depend on cotton for between 30 and 40 per cent. of their export earnings, will the Minister undertake to work with the EU as a bloc to exert remorseless pressure on the United States to end its obscene $3 billion annual subsidy to 25,000 large-scale and inefficient cotton manufacturers and stop dumping that produce on those four countries? That policy is morally wrong, economically counter-productive and serves to exacerbate the plight of some of the most destitute people on the planet.
I assure the hon. Gentleman that we are pressing the United States on that issue, but his very specific points also make a general point. All of us who are genuinely concerned for the interests of developing countries—I certainly count the hon. Gentleman in that group—have an interest in seeing the multilateral talks succeed. The experience after Cancun was not that it led to a radically better deal being offered to such countries as he mentioned. In fact, it led to the US signing bilateral trade deals, with great imbalances in negotiating strength represented within those individual bilateral discussions. If we want to avoid a rash of bilateral deals that are disadvantageous to the interests of developing countries, all of us—and certainly the British Government—have an interest in ensuring a successful outcome to the Hong Kong meetings.
I welcome my right hon. Friend's comments about the reduction in export subsidies from the EU, but will he stress—not only with the EU, but with other countries—that the huge potential benefits to be gained from the cancellation of world debt for developing countries could be undermined unless the developed world recognises the need to reduce export subsidies that undermine the economies of those countries?
I take my hon. Friend's point. We have always seen 2005 as the opportunity to align the progress that was made in June, when European Ministers agreed effectively to double bilateral overseas development assistance from the European Union, with the decisions reached by Finance Ministers—confirmed at Gleneagles in July—on the significant multilateral debt relief that my hon. Friend mentions. The third element of the trinity was the need to try to make real progress in Hong Kong. All of us recognise that if we have the right outcome in Hong Kong and when the round is concluded, it will offer the opportunity not only for more jobs and prosperity in the European Union but will be fairer for the developing world.
The UK has enjoyed traditional trading links over many years with Commonwealth countries, as the EU has with the ACP countries. In particular, sugar and bananas have had a great role to play in the Caribbean. What future will there be for those products and, in particular, for the Caribbean countries that export to the EU and to the rest of the world after the Hong Kong round?
A range of issues are related to the hon. Lady's question. First, on sugar, fundamental reform was agreed last week, thanks to my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs. There is ongoing consideration as to what level of support can be provided directly during a longer transitional period than was initially envisaged.
Secondly, there is the issue of economic partnership agreements. Before the European presidency, the British Government set out a position that, I am glad to say, has found favour not just with NGOs in the United Kingdom but with other countries that are affected by changes such as those of which the hon. Lady speaks; but we need to continue to work, as the British Government, during the British presidency to make these cases to our European partners. That is why, when my right hon. Friend the Foreign Secretary chaired a meeting on trade talks, I took the opportunity to make the case to other European partners that if we got this round right there would be an opportunity to be both pro-jobs in Europe and pro-poor in the world—and that, particularly in relation to the sugar and banana regimes, a successful outcome would provide considerable gains not just to those individual countries but to us all.
Given the Government's laudable commitment to millennium development goal 8, does my right hon. Friend agree that the issue of trade far transcends even crucial matters such as aid and debt; that the European Union can indeed exercise a substantial role, coupled with the United States; and that, on these matters, transparency would indeed be welcome?
My right hon. Friend makes an important point. It is hard to overstate the contribution that trade can make to the fulfilment not just of the millennium development goals but of those countries' potential. That point was driven home to me recently when I was reading speeches made by President John F. Kennedy during his term in office in the United States, when he spoke at the beginning of one trade round of the potential of helping developing countries such as Japan. If one looks around the world, one realises that it is hard to find an example of a country that has managed to lift its population out of poverty other than by having an open trading system. That is why we regard Hong Kong as having the potential to take forward the work that we have begun during 2005, but I fully accept the point that my right hon. Friend makes that it is a vital and very significant element in that trinity of increased development assistance, reduced debt payments from developing countries, and, of course, the fairer trade system that I know he favours.
St. Helena
The Government are firmly committed to the defence and security of St. Helena; and to working closely with its Government to ensure the highest standards of probity, law and order and good governance of the island. We want to see St. Helena develop socially, economically and in a sustainable way, to bring lasting benefit to the island while protecting the environment.
The Minister will be aware that St. Helena has a unique environment—indeed, Charles Darwin referred to the "unique flora" on the island—and that therefore the proposal to build an airport is highly controversial on the island. Does he agree that before any airport is built there should be a full environmental impact assessment, which should conclude that the flora and fauna of the island will be properly protected? If so, can he explain why Clive Warren, the Department for International Development's head of overseas territories, told a public meeting in St. Helena on 26 April that
"the airport will happen, come what may"?
Is that the Government's position?
I assure the hon. Gentleman that there will be a full and rigorous environmental impact assessment. That is ongoing and there has been extensive public consultation as a result of the inquiry.
We are not rushing headlong into anything. The first environmental analysis of airport options was carried out in 1999, and further environmental scoping studies were conducted in 2001 and 2004. We want to ensure that we can bring an airport to the island, but we want to do it in a sustainable way that does not damage the environment, and we shall continue to press forward with that objective in mind.
Middle East
Hezbollah's stated aim of the elimination of the state of Israel is totally unacceptable, as are Hezbollah's military and terrorist activities, particularly along the blue line, in the occupied territories and in Iraq. We call on Hezbollah to contribute to peace and security in the middle east by renouncing violence, disarming in compliance with UN Security Council resolution 1559, and entering into the democratic process on an exclusively non-violent basis.
Will my right hon. Friend join me in condemning the actions of Hezbollah, which attacked the Sheba'a farms in northern Israel last week, precipitating some of the worst violence on the border since Israel's withdrawal from southern Lebanon in 2000? I welcome the fact that Hezbollah is on the UK's proscribed terrorist list, but it is not on the EU's list. In the remaining weeks of the British presidency of the EU, will my right hon. Friend work to rectify that?
I do, and I have, condemned the attack by Hezbollah on the Sheba'a farms. I just point out that the Sheba'a farms are in Syria. They are not in Israel; nor are they, as Hezbollah claims, in Lebanon. They are unquestionably in Syria.
On the second point that my hon. Friend makes, we in the United Kingdom—I did this as Home Secretary—have proscribed, banned, the military wings of Hezbollah. We have not banned the whole organisation—the political wing. Discussions inside the EU continue about a wider ban, although I frankly do not anticipate that there will be any change on that by the end of our presidency.
What distinction does the Foreign Secretary draw between Hezbollah and Hamas?
As the hon. Gentleman knows, they are two distinct organisations. Hezbollah is partly a terrorist organisation, and it is partly operating within Lebanese law, as a legitimate political party in Lebanon. It has one Minister in the Lebanese Cabinet and another Minister is associated with Hezbollah. In that respect, they are different. In other respects, they are similar: they are rejectionist terrorist organisations and the way in which they operate in the occupied territories and against Israel is very similar. Those who have been the victims of terrorism would not notice the difference if they had been killed or injured as a result of that violence. That is why we call on both those organisations and on Islamic Jihad to stop their terrorist activity. We also call on the state of Syria to take action to prevent those organisations from operating, as they do, in its territory.
The Israelis are currently rehousing 1,000 settlers every month in the west bank—11,000 so far this year alone—which is greater than the number of settlers withdrawn from Gaza. Surely is that not also a threat to bringing peace between the two sides in the middle east?
We constantly make representations to the Government of Israel about their settlement policy, particularly where the settlements are on Palestinian land, and about the way in which some of the settlement activity is, in our view, intended to make unalterable facts on the ground and thereby restrict the opportunities available in final-status talks. That said, the quicker both parties get back to the road map and the current, more hopeful environment is pursued, the better it will be for Israelis and Palestinians alike.
The Foreign Secretary, Foreign Office Ministers and Foreign Office officials have pointed out to the British public that sophisticated munitions, probably supplied from Iran, have gone into southern Iraq thanks to Hezbollah and have caused death and injury to British troops. The Foreign Secretary has rightly, in a broad sense, condemned Hezbollah. He has obviously outlined that there are limits, perhaps outside the UK, on what the British Government can do, but the British public would be surprised to think that the political wing of Hezbollah is allowed to function in London, given the facts that the Foreign Secretary and his officials have produced. What practical measures does he intend to take against the political wing of Hezbollah?
I am grateful for what the hon. Gentleman said, overall. However, all organisations operating in the United Kingdom must do so within the law. Some organisations, including those that he mentioned, are kept under close scrutiny by law enforcement agencies. If there is any evidence that they are transgressing and they thus become candidates for proscription under the Terrorism Act 2000, my right hon. Friend the Home Secretary examines that evidence with great care. These are not just the usual warm words, because the matter is kept under continuous review.
Iran
European Union Foreign Ministers and their senior officials are in close and continuous touch on the issue of Iran. I spoke to Iranian Foreign Minister Manuchehr Mottaki last Tuesday—22 November. The issue was discussed at the EU General Affairs Council on Monday 21 November and at the International Atomic Energy Agency board of governors on Thursday last.
I thank the Secretary of State for that reply. Today, in a committee room at the CBI, the Prime Minister indicated that the possible expansion of nuclear power would be part of the review of Britain's energy requirements. What gives us the right to say that we can expand our nuclear energy, but at the same time tell other countries that they cannot have it?
I am glad that my hon. Friend asks that question because it highlights a popular misconception. Under article IV of the non-proliferation treaty, we are fully entitled to develop nuclear power, and so are the Government of Iran—we give them every support in doing so. However, under article II of the treaty, Iran, as a non-nuclear weapon state, which it has voluntarily declared that it is, has no rights whatever to use its nuclear power technology to develop nuclear weapons. It is on the latter point that the whole of the international attention is focused.
To continue that point, will the Foreign Secretary explain what efforts are being made to involve Russia, China and India in those discussions with Iran, given that those three powers have strong interests in obtaining fuel from Iran and a common interest with us in not permitting Iran to become a nuclear military state?
I am pleased to tell my hon. Friend that there has been increasing co-operation in recent months with India, Russia and China in respect of the Iran dossier before the IAEA board of governors. India helpfully voted with the E3 in the board of governors on 24 September, which meant that there was a significant majority, rather than a bare majority, when Iran was declared as non-compliant with its safeguards agreement under the non-proliferation treaty. We have been involved in intensive discussions with the Russian and Chinese Governments—at Head of State and Government level, as well as Foreign Minister and senior official level—and I believe that they are likely to bear significant fruit.
One of my concerns during the long-running saga inside the board of governors with my French and German colleagues on the Iran dossier has been to try to maintain effective international cohesion and solidarity, because that is the surest way in which we can bear down on those in Iran who are trying to use the nuclear power programme to develop nuclear weapons. If we are divided, we will end up in a position in which there are far too many opportunities for those in Iran to exploit the situation. That is why we work with such care. If and when we need to take tough decisions in the IAEA board of governors, I hope that India, China and Russia will actively support us.
Available evidence suggests that the Iranian regime is moving apace with the development of nuclear weapons and, equally importantly, the delivery vehicle, Shahab 5, which could well reach the channel coast. On the basis of the Foreign Secretary's last answer, will he tell us what specific plans he has to deal with a situation that the Israelis will call the doomsday situation in defence of this country's interests?
The fact that the Government of Iran are developing longer range missiles is incontrovertible, but whether they are using their nuclear power programme to develop nuclear weapons is not yet incontrovertible. There is a lot of circumstantial evidence that has raised significant anxieties in the minds of the international community. That evidence is published—it is not intelligence. I laid a significant amount of it before the House in January this year and am happy to do so again. We are taking steps through the IAEA, in which we, France and Germany have been in the lead for the past two and a half years. If we judge that Iran's non-compliance is continuing and is unacceptable, and if we have international support, it remains open to us to refer the matter to the Security Council, and we will do so. However, I believe that the approach by the three countries, now backed by a wider alliance, including Russia and China and, in terms of votes, the United States, is the best way forward in what is a very difficult situation.
Very worryingly, at the IAEA meeting last week, Peter Jenkins, the British delegate but speaking for the European Union, said that the EU
"is disturbed to see that Iran has now admitted to having in its possession a document which related to the casting and machining of enriched uranium metal into hemispherical forms . . . Such a process has no application other than the production of nuclear warheads."
Does not that make the case against Iran clearer?
It is my working belief that Iran is at the very least developing the options for a nuclear weapons programme. Given the beliefs that we had on the basis of some published information and some intelligence on Iraq, we have to look at the evidence with great caution and care. The evidence, which originally came from a document from AQ Khan Research Laboratories in Pakistan, tells us that the Iranians had in their possession information that could lead to the development of the hemispheres, which for certain have no purpose other than the development of nuclear weapons. What the evidence does not tell us for certain is what Iran intended to do with that. It is a piece of circumstantial evidence and we need to treat it as such. It is not incontrovertible evidence—it is not a smoking gun—that makes us certain that Iran has a nuclear weapon.
President Putin said that he is convinced that Iran is not trying to develop nuclear weapons, and we recently saw some to-ing and fro-ing on a potential deal between Iran and Russia. What contact has the Prime Minister had with President Putin on the subject? Will the Secretary of State guarantee that a potential deal between Iran and Russia, and the time taken to finalise that, will not be used as an excuse to delay or avoid referral to the UN Security Council of an increasingly dangerous state?
There have been a lot of discussions with the Russians at Foreign Minister level. I was also present at a detailed discussion on Iran between President Putin and our Prime Minister when the President was here a few weeks ago, and there have been many other discussions. I do not recall that comment by President Putin. I certainly recall his comments that he would be opposed to Iran developing a nuclear weapon. The Russians are very alive to the significant risks that would apply if Iran developed a nuclear weapon because it could destabilise not only the middle east, but the southern republics of the Russian Federation. It would be a serious development.
Russia is involved in the Bushehr refinery and in agreeing to supply the Iranians with a nuclear power plant, lock, stock and barrel, including the fuel. There are separate discussions on whether Russia, under international supervision, would be willing to enrich the uranium, which is converted in another facility in Iran. We are discussing that with the Russian Federation. It may be one way to provide what the Paris agreement described as the objective guarantees, which we are all seeking, that Iran's nuclear programme is entirely peaceful in its purpose.
Israel
We frequently raise our concerns on free movement and the route of the barrier with the Israeli Government. While we understand Israel's need to take security measures, the building of the barrier east of the green line is contrary to international law. Israel also has the obligation to ensure that Palestinian free movement is disrupted as little as possible.
With the illegal line of the Israeli wall forcing transfers of the Palestinian population that amount to ethnic cleansing; with the centre of Hebron emptied because Palestinians cannot move while illegal Israeli settlers move randomly and at will throughout Hebron; with illegal settlements on the west bank being expanded constantly; and with my right hon. Friend's representations, which I respect and admire, being utterly ignored by the Israeli Government, what can be done to stop the Israeli Government breaking international law every day of the year?
It is a frustrating situation, particularly for the Palestinians who are adversely affected by it. As I have already spelt out to the House, we are putting continuous pressure on the Government of Israel directly through the European Union and through our friends in the United States to convey the message that if they wish to secure what they say is their stated aim—a viable, stable state of Palestine living alongside a secure state of Israel—it is not in their interests to pre-empt the decisions that are necessary to that two-state solution.
In the Foreign Secretary's discussions with the Israeli Government would he make it plain that the need for those controls would be greatly reduced if there were early evidence of substantial movement on the status of Jerusalem?
I would do so, but the status of Jerusalem is the most difficult issue in final status negotiations, and it will not be resolved, if it is resolved at all, until then.
Despite reservations about my right hon. Friend's protests, will he repeat such protests, particularly about Bethlehem, as the opening of the new crossing at Rachel's tomb is an abomination? That district is deep inside Palestinian territory, and there is no justification for choking off its tourism industry and economy. In the run-up to Christmas, it is particularly important that reassurances are given and that my right hon. Friend supports, I hope, the "Open Bethlehem" initiative.
My hon. Friend should not have any reservations about the representations that my colleagues and I are making.
My reservations are about their success.
My hon. Friend can certainly have reservations about their lack of success and I share her frustration. It is not in Israel's interests, still less is it in the Palestinians' interests, for the Israeli Government to resist those representations. I welcome, however, the strong pressure that I receive from Members on both sides of the House, including the eloquent language of my hon. Friend. We shall certainly continue to make those representations.
Is it not the case that there would be no need for a defensive fence if terrorist attacks on the state of Israel did not take place? With that in mind, what steps are the Government taking to ensure that countries such as Syria and Iran, and perhaps even elements in Saudi Arabia who pay what some call protection money, do not support terrorist organisations that attack Israel through that fence?
First, it is legitimate for any state to erect a security wall to defend its citizens. The issue is not whether Israel is entitled to a security wall—the issue is the route. The objection is about where it goes not on Israeli land but on Palestinian land—let us make that clear. Secondly, I have made very, very strong representations to the Government of Iran and particularly to the Government of Syria, both privately and very publicly in the Security Council, to pressure Syria to do what it says it is doing but what, frankly, it has not done until now: force Hamas, Islamic Jihad and Hezbollah to wind up all the activities that operate out of its territories. As for Saudi Arabia, I am not aware of any provenance for the hon. Gentleman's statement. These days, however, the Government of the Kingdom of Saudi Arabia are strongly opposed to any terrorist activity anywhere across the middle east.
As the Foreign Secretary has acknowledged that the wall is illegal where it passes through Palestinian land, will he tell us what sanctions he proposes to take against Israel, since the Government of Israel clearly have not responded to the pressures that he and others have applied, asking them to abide by the World Court ruling that the wall should not pass through other people's territory?
There are no proposals in respect of sanctions, not least because I do not think we would get a resolution through the United Nations Security Council. That is a matter of fact. However, although it is a relative matter, I believe that the deep international concern about the line that the wall has taken and behind that, the even bigger concern about the settlements on Palestinian land, is having and should have an increasing effect on policy in the Government of Israel.
European Union
May I briefly take the opportunity to clarify for the House in relation to question 4 that Germany is one of 13 member states that have ratified the draft constitutional treaty?
In relation to the question from the right hon. Member for Wells (Mr. Heathcoat-Amory), I refer him to the answer given a few moments ago by my right hon. Friend the Foreign Secretary.
Among all the confused drift of the Government's European policy, at least they have been consistent about their promise not to give up the British rebate, which limits our contributions to the EU budget to about £3.5 billion a year. Does the hon. Gentleman remember the Prime Minister saying at that Dispatch Box on 8 June:
"The UK rebate will remain and we will not negotiate it away. Period."—[Official Report, 8 June 2005; Vol. 434, c. 1234.]?
In view of the earlier remarks by the Foreign Secretary which referred to the so-called anomaly of the rebate, was that earlier promise by the Prime Minister worthless?
It was not worthless. It reflects the fact that the rebate came into existence—we have already discussed this afternoon the historic origins in 1984 in Fontainebleau—because of the structural imbalance in a European budget which meant that Britain did not gain either through structural cohesion funds or through common agricultural policy funds the level of resource coming back from the European Union that many other large contributor countries to the EU did. It is therefore entirely consistent to recognise and acknowledge, as our Prime Minister has done, that the abatement is an anomaly, but that it is based on a much wider anomaly.
Points of Order
On point of order, Mr. Speaker. On 17 October, when I asked the Minister of State, Ministry of Defence if there were likely to be any advances on the £87 million cost increase in the troubled landing ships dock (auxiliary) contract with Swan Hunter, the Minister said:
"All that the hon. Gentleman has done is recite figures that we have already reported to the House in previous answers. To ensure the delivery of the ships from Swan Hunter, we amended the contract arrangements."—[Official Report, 17 October 2005; vol. 437, c. 624.]
Yet on 3 November, in a written answer to my hon. Friend the Member for Aldershot (Mr. Howarth), the Minister stated:
"Both companies have indicated likely cost increases to their programmes".—[Official Report, 3 November 2005; vol. 438, c. 1264W.]
The answer also revealed a further £62 million payment to Swan Hunter, which had yet to be revealed to Parliament. Following that, my hon. Friend learned that the Ministry of Defence learned about that in June. So why, when the Minister learned of these further cost increases in June, did he not indicate when asked by me directly on 17 October that further cost increases were expected? Will you ask the Minister to come to the House and correct that misleading statement?
Further to that point of order, Mr. Speaker. You will recall that in February this year, you were obliged to rebuke Ministers for failing to reveal that there had been cost increases of £87 million—no less than 60 per cent.—in the cost of those landing ships dock (auxiliary) vessels which had been contracted with Swan Hunter. When my hon. Friend the Member for Shipley (Philip Davies) failed to obtain from the Minister at oral questions last month an updated estimate of the cost, I tabled further questions and wrung out from Ministers the fact that in addition to the £87 million, they had sanctioned a further £62 million in payments to Swan Hunter for what they called lead yard equipment and services in support of the two ships being built to Swan Hunter's design by BAE Systems. That information was not revealed to Parliament at the time that you rebuked Ministers, although the additional payments had been agreed in 2001 and 2002. Although I have some sympathy with the Minister of State, who has to answer in this place for the noble Lord Drayson, is it not unacceptable that my hon. Friend was not given, in your words at the time of the rebuke,
"a full or up-to-date picture of the facts relating to the contract in question"—[Official Report, 9 February, 2005; vol. 430, c. 1522.]
by the Minister of State, and that it required persistent questioning by me for the information to be made available to all Members of the House?
I am grateful to both hon. Members for giving me notice of that point of order. I am happy to remind Ministers of their duty to give accurate information to this House. I note that the point is based on information provided by Ministers in answer to questions, and the hon. Member for Aldershot (Mr. Howarth) is now asking me to comment on the answers, which I am unable to do. I suggest that the matter will be best pursued by debate, and he knows the opportunities very well.
On a point of order, Mr. Speaker. You will recall that considerable disquiet was expressed on both sides of the House at last Thursday's business questions about the cancellation of the debate on police restructuring. Today, we had a one-and-a-half hour debate in Westminster Hall, which we are extremely grateful to you for granting to the hon. Member for Stockton, North (Frank Cook). Unfortunately, only six hon. Members were able to get into that debate—I am not making a special plea, but I reduced my contribution to two minutes to allow others to participate. [Interruption.] It was hugely appreciated.
During her closing remarks, the Minister for Policing, Security and Community Safety implied that the Government have already made up their mind about the restructuring of the police service. We all know that the expression, "Government consultation", is an oxymoron, but the Government should at least do the House the courtesy of discussing the matter on the Floor of the House and, I submit, they should do so in response to a substantive motion, so that all hon. Members affected—all those who represent English or Welsh constituencies—can properly discuss and bring to the House their constituency and area concerns.
My concern is that the Home Secretary and his junior Ministers are riding roughshod over the rights of this House. They refuse to have a debate because they do not want to have a debate; they are trying to box us into short debates in Westminster Hall, which are not adequate fully to discuss the issues; or they want to postpone the matter until the new year, because the consultation period finishes on 23 December, when the matter will be dead, so far as they are concerned. Will you invite the Home Secretary, in the reasonable way in which I have addressed you, to come to this House and explain himself. Otherwise, the Home Secretary will let down himself and this House.
Two-minute speeches by highly learned QCs are few and far between, and I only wish that I had heard such a short speech. Debates on the Floor of the House are matters for the usual channels, and the hon. and learned Gentleman has certainly put that matter on the record. Because there was one debate in Westminster Hall, it does not mean that we cannot have others. Ballots are held for Adjournment debates, and on a Thursday the Speaker can award an Adjournment debate. If the hon. and learned Gentleman applies for an Adjournment debate, I might be able to help him. I know that the matter is highly sensitive in England and, perhaps, Wales, and I am keen to see hon. Members debate it.
Further to that point of order, Mr. Speaker. Between now and Christmas, there are two non-sitting Fridays. Will you advise hon. Members whether one or both of those Fridays could be used for that debate, if the House is so minded?
Once again, that is a matter for the usual channels. However, I would not interfere with non-sitting Fridays.
Further to that point of order, Mr. Speaker. You have been kind enough to refer us to Westminster Hall debates and the possibility of securing another. That is fine, as far as it goes, but the problem is that it is not on a substantive voteable motion. That is why we want it on the Floor of the House.
I say to the right hon. and learned Gentleman what I said to the hon. Member for North Thanet (Mr. Gale)—that is a matter between the usual channels. The case has been put by several Back Benchers, and it must be heard by the usual channels.
Further to that point of order, Mr. Speaker. Can you confirm that if hon. Members scan Standing Orders carefully, they will find that under one of the very few remaining procedures left unravaged by the Government, application can be made to you for certain other kinds of debate that would bring matters before the House and could be on a voteable motion? Without wanting to pre-empt what your very wise decision might be, Mr. Speaker, that is the sort of process that colleagues might wish to pursue on matters as substantive and urgent as this.
I have always said that the right hon. Gentleman is an expert on Standing Orders, and he knows how to use them. I will say no more than that.
Further to that point of order, Mr. Speaker. You have an extremely difficult job in representing the best interests of the whole House, but do not you feel, Sir, that a fundamental change to the structure of the police force in this country is a matter on which the House should express a view, on a substantive motion, before the end of the consultation on 23 December?
My job is made very easy because hon. Members do not draw me into the debate.
On a point of order, Mr. Speaker. I want to raise a different matter that is causing me some concern. This week, I received a letter from the House authorities inviting me to have a Visa travel card. A few weeks ago, I mentioned to the Leader of the House that I was nearly being knocked off my motor cycle because of the change in the narrowness of the road outside the Palace. My staff cannot get passes. I am worried that the House authorities may not be doing as much as I would like to make life as straightforward as possible for us and our constituents instead of their departments. This is a difficult subject, Mr. Speaker, and I need your advice on it.
Let me say to the hon. Gentleman that the officials of this House have great difficulties with security. As he knows, that is not a matter that I would discuss openly on the Floor of the House. All I would ask is that hon. Members are patient with the security staff because, believe me, they have a very difficult job indeed.
Representation of the People (Reduction of Voting Age)
I beg to move,
That leave be given to bring in a Bill to reduce the voting age for parliamentary, local government and European parliamentary elections to 16.
Twenty years ago, at a Welsh party conference, I first heard a debate on reducing the voting age to 16. I was one of the youngest people in the room, but I voted against the motion. In the two decades since, I have been involved in many elections, seven of them as a candidate. In that time, I have moved from being a sceptic to a doubter. After the 2001 general election, I became a firm believer that the time had come to reduce the voting age.
Like all of us, I have visited many schools and colleges during, and in between, elections. I have always been impressed by the penetrating and incisive questions and by the open way in which ideas are debated. Contrast that with a typical wet evening during an election when one meets someone on the doorstep who has no time, is not interested, would rather be watching the television, or offers an opinion that they say is fact but actually matches what they read in the newspapers that morning. Reducing the voting age to 16 is an idea whose time has come. It is a shame that the Government failed to grasp that opportunity for change in the Electoral Administration Bill.
The parliamentary franchise was extended six times between 1832 and 1969. Each extension was met with opposition and scepticism. Indeed, after the Second Reform Act 1867, the Prime Minister of the day, Lord Derby, described his own measure as a "leap in the dark". Robert Lowe, who was to become Gladstone's first Chancellor of the Exchequer, remarked that the Government would have to "educate our masters".
In the 21st century, our eyes can be open and we can see that we have the best ever educated, informed and politically interested cohort of 16 and 17-year-olds. In recent times, young people's interest has been awakened in politics. Perhaps one of the few silver linings of the Iraq war is that young people take an interest in the Chamber's deliberations and the fundamental decisions that we can make in this place.
All hon. Members will have been lobbied here and in our constituencies by young constituents about issues such as third-world poverty and climate change. Young people will shortly take an interest in controversial education measures, which will be determined here, just as they recently took an interest in decisions that affected their access to higher education.
Like the rest of us, young people can pick and hoover up information 24 hours a day through television and the internet. In schools, citizenship is compulsory at key stages 3 and 4 for all 11 to 16-year-olds in England, stimulating community involvement and political literacy. In 1969, when Parliament previously decided to extend the franchise, the school-leaving age was 15 and most people left school at 15. Few went on to further education and even fewer to higher education. In 2005, the educational world is totally different. I am sure that today's teenagers have the same social interests as their counterparts in the 1960s, but this decade's 16-year-olds are better informed and of a similar maturity to 18-year-olds of nearly 40 years ago. It is now time for them to use their knowledge and maturity and for us to extend the vote to them.
The Prime Minister often talks about rights, responsibilities and respect. Young people already have various rights and responsibilities when they are under 18. At 16, they can leave school, go to work and join the Army. In both latter circumstances, they will pay taxes. They can marry or—shortly—enter into a civil partnership. All of us would agree that entering into a marriage is a long-term commitment and a fundamental decision that is far more important to someone's life and future than choosing between candidates in an election.
At 17, one can learn to drive. My hon. Friend the Member for Montgomeryshire (Lembit Öpik) could learn to pilot a plane but he was not trusted with the vote. We give young people many rights and responsibilities but, as politicians, we do not always give them the respect of listening to their opinions.
Many of us have expressed worries about democracy in our country and especially about turnout at elections. I believe that voting at 16 could boost turnout in the long run. The Social Market Foundation conducted some interesting research on the topic. It undertook a study of 17 and 18-year-olds who either just missed out or just qualified to vote in the April 1992 general election. Those who missed out in 1992 had to wait until they were 22 or 23 before they could vote in the 1997 general election. In 2001, that group of people was studied and it was found that 49 per cent. of 17-year-olds who had just missed out in 1992 voted in 2001 but that 65 per cent. of the 18-year-olds who qualified for the vote in 1992 voted in the general election nine years later. That is a 16 per cent. gain in turnout through an exercise of the franchise at the earliest opportunity.
Bristol's twin city, Hanover, has recently extended the vote to 16-year-olds and it was found that they are twice as likely to turn out to vote in elections as people in their late 20s.
Let me trespass briefly on the territory of the next debate. Cigarette manufacturers believe that a person whom they can get to take up smoking by the age of 16 is likely to be addicted for many years but that, of those who resist the temptation into their 20s, few take up smoking. Votes for 16-year-olds will be a healthier habit for people to take up.
What are the arguments against extending the franchise to 16 and 17-year-olds? Some people argue that there is pressure from families, campaign groups and political parties, especially in marginal seats in elections; that the voting age in all but a handful of democracies throughout the planet is the same as that in the United Kingdom. It is argued that young people are not mature enough, even with education. It is claimed that knowledge may be one thing but mature judgment is another and that young people do not see the broader picture. All of those opinions will have been offered in the past few years while the debate has been on the agenda, and I am sure that they will be offered in time to come. I obtained all of them through a perusal of Hansard from November 1968, when the House decided to reduce the voting age from 21 to 18. Similar arguments were advanced in the 19th and 20th centuries when it was said that middle-class paternalism could protect the interests of the working classes, or husbands could make decisions on behalf of their wives, or parents on behalf of their children. Those were Aunts Sallies then and I think that they deserve to be knocked down now.
Voting at the age of 16 is supported by Members of all parties in the House. Early-day motion 801, tabled by the hon. Member for Kingston upon Hull, North (Ms Johnson), now has the support of 90 signatures. Outside Parliament, the campaign is supported by children's charities and political campaigners from Barnardo's and the Children's Society to the National Union of Students and the YMCA.
Extending the franchise to 16-year-olds will not be a leap in the dark. Rather than having to educate our new electoral masters, we would find them the most responsive and responsible constituents. I believe that young people are informed, engaged and ready to vote. I hope that by introducing the Bill, I have contributed to a debate that will eventually lead to a franchise that is fit for the 21st century.
It is worrying that the hon. Member for Bristol, West (Stephen Williams) drew a parallel between smoking and voting. If the Labour party gets its hands on it, it will be banning voting just as it wants to ban smoking.
The Electoral Commission is investigating national voting at 16 at great length. Its report, which was published in April this year, concluded that the minimum age for all levels of voting in UK public elections should remain at 18, although it said that the minimum age for candidacy should be reduced to 18. I welcome the latter move, and that has been put forward by the Government in the Electoral Administration Bill. My party and I support that. Having candidates aged 18 would be valuable.
In its report on reducing the voting age, the commission, which conducted wide-ranging public consultation, concluded:
"On the little hard evidence available, it would appear that overall turnout would almost certainly drop in the short-term as a result of lowering the voting age and the longer-term effects on turnout are disputed."
It also said that
"lowering of the voting . . . age was unlikely to have as significant an effect as the much more fundamental cultural shift required in how young people are engaged in the wider political process."
In my constituency, Speech House—the home of debate—was host to much discussion on this subject when Forest sixth-formers met during local democracy week in the Verderers' court. The Royal Forest of Dean college, Wyedean school and Newent community schools sent students to debate whether the minimum age of voting should be lowered to 16. Even among an audience made up entirely of 16 to 18-year-olds, there was almost a 50:50 split. Even among the target age group there is not a clear wish for change.
The hon. Member for Bristol, West said that there are a number of things that young people are permitted to do at 16, but he did not give the full picture. It is true that someone can join the Army at 16, but that person cannot serve on the front line until 18. It is true that we can get married at 16, but until 18 people have to have their parents' permission. We make distinctions in this country and there are certain things that can be done only when someone achieves the age of majority, when he or she is deemed to be an adult. A line must be drawn somewhere. If we move to 16, no doubt there will be arguments to move the age even further. Without a clear line there is no obvious end.
The Electoral Commission conducted a wide-ranging survey that involved ICM. In an unprompted survey, 64 per cent. of the public said that 18 was the correct age. Only 18 per cent. thought that 16 years was preferable. When given a choice between 18 and 16, 78 per cent. said that 18 was the correct age. Interestingly, those below the age of 18 wanted the voting age to be lowered, but once they had reached the age of 18, they expressed overwhelming support for the 18 limit.
The Electoral Commission's survey, conducted by ICM, came up with some solid conclusions. It stated:
"These results represent a solid affirmation of the status quo. There may be valid reasons for reducing the voting age"—
the hon. Member for Bristol, West has outlined some that he found convincing—
"but the general public are . . . unimpressed by them. Indeed, a reduction in the voting age could only be justified . . . by attaching more importance to the wishes of current 16–17 year olds than to the views of the public at large".
It went on to say:
"Rarely does a research survey produce a truly remarkable statistic."
We have to draw the line somewhere, and traditionally we have set 18 as the age at which one becomes an adult. That is a sensible settlement. It is sensible to reduce the age of candidacy to parallel the voting age, but this measure does not deserve the support of the House.
Question put, pursuant to Standing Order No. 23 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business):—
Orders of the Day
Health Bill
[Relevant document: The uncorrected Minutes of Evidence taken before the Health Committee on 20th October, 17th November and 24th November 2005, HC (2005–06) 485 i-iii.]
Order for Second Reading read.
I beg to move, That the Bill be now read a Second time.
I am proud to introduce a Bill that is a landmark in the protection of public health and the improvement of our health services. It does three key things. It gives us power to ban smoking in enclosed public places and workplaces, it strengthens our hand in the battle against methicillin-resistant Staphylococcus aureus and other hospital infections, and it contains a series of measures that will strengthen control of dangerous drugs, improve pharmaceutical and ophthalmic services and help to deal with fraud in the national health service.
I realise that the House may be particularly interested in the provisions on smoking, but I want to make a few brief points about other aspects of the Bill first to ensure that they are given due attention. The first commandment of the medical profession is "Do no harm". Unfortunately, as we all know, there are occasions when patients are harmed, not healed, by their hospitals. It is not surprising that MRSA and other health care-associated infections are of great concern to members of the public, particularly if someone in the family or neighbourhood has suffered from them. Part 2 of the Bill—clauses 13 to 15—gives us stronger powers to reduce MRSA and other infections to the absolute minimum.
We were the first Government to require surveillance for MRSA, and we are already using the information to help drive down infection rates. We set a target of no later than 2008 for the halving of MRSA infections. Indeed, some of our specialist hospitals such as Guy's and St. Thomas's, which treat some of the most complex cases in the country, and in early 2004 had among the highest MRSA rates, had already nearly halved their infection rates a year later.
The Bill builds on the work that we are already doing; it provides for a legally binding code of practice on health care-associated infections, which will apply to any relevant NHS body. The code will be based on existing best practice, and a draft on which we consulted earlier this year was well received. It will be backed up by new duties for the Healthcare Commission to ensure that it is observed, including the power to serve an improvement notice.
The Secretary of State referred to the statutory code and the consultation held on it. Last year's National Audit Office report on hospital-acquired infections found that half of all NHS managers are struggling to reconcile meeting Government waiting time targets with managing hospital infections. That issue came through again in the response to the consultation on the code. The NHS wants to know what priority the Government will attach to the code, compared with other health priorities—so can the Secretary of State make that clear today?
The hon. Gentleman raises an important point. It is not acceptable to try to achieve infection targets at the expense of waiting list and other targets, nor is it acceptable to try to achieve waiting list targets by compromising on patient safety and infection rates. Throughout the country there are hospitals that are both improving the number of patients whom they treat, thus getting waiting lists and waiting times down, and getting a grip on infection control, thus bringing MRSA and other infection rates down. The answer is that hospitals need to do both.
I fear that the Secretary of State has not answered the perfectly reasonable question asked by the hon. Member for Sutton and Cheam (Mr. Burstow). The essence of the question, which we have asked Ministers time and again, is this: will the Secretary of State give a simple guarantee that when, after a suitable risk assessment, infection control teams in a hospital recommend that beds or wards should be closed for infection control purposes, they will not be overruled in pursuit of waiting time targets?
That would be a matter for the Healthcare Commission to consider, under the new code and under the Bill.
As we increase even further the capacity and the number of hospital beds available to the NHS, as we are doing, it will be possible to reduce occupancy rates in acute wards, which will help. It is not essential, but it will certainly help, as hospitals get their MRSA rates under control.
I shall give way one more time to the hon. Gentleman on this point.
The Secretary of State does not have to give way to me, so I am grateful to her for doing so again—but does she not recall that two weeks ago I presented to the House data that showed that although in 2000 the NHS started with 186,000 beds, with a target of 7,000 additional beds, the number went down by 4,000? On present indications, we estimate that this year, as a result of NHS deficits, the number is likely to reduce by another 2,500, so there will be fewer than 180,000 beds. The number of beds is going down, and bed occupancy rates are persistently far higher than the Government said they would be when they responded to the National Audit Office five years ago.
The hon. Gentleman is doing exactly what he did in that debate two weeks ago, and ignoring the fact that with modern medical techniques and technology, far more operations can be done on a day- case basis. He is also confusing acute beds with beds available for mental health patients, for whom far more treatment is being carried out within the community.
indicated dissent.
I make again the point that I have made before: thanks to our investment and unprecedented funding for the NHS, which the Conservative party failed to make available, and thanks to our reforms, we are bringing waiting lists down, and as more capacity becomes available to the NHS both in NHS hospitals and in independent sector treatment centres, as is happening now, it will be possible to get the waiting lists down even further, with lower bed occupancy rates, which in turn will help to build on the good results already being achieved with infections. The other point to consider on this particular issue is that, if a hospital is still failing to abide by the new code and to reduce its infections, even after an intervention by the Healthcare Commission, I—or in the case of the foundation trusts, the regulator—have the power to intervene.
Does the Secretary of State agree that the Government can have all the codes that they want to try and tackle ESBL—extended-spectrum-lactamases; VRSA—vancomycin-resistant Staphylococcus aureus; MRSA and all the superbugs, but if primary care workers are unable to obtain flu jabs this winter, patients will be put at direct risk? In my constituency, primary care workers are unable to have flu jabs, putting my constituents at risk.
As I have already told the House, more people are being vaccinated against winter flu than ever before in our country—even more than last year, when we achieved a level twice that achieved under the Conservatives.
The Secretary of State has been talking about the code of practice that will be introduced to enforce better standards in NHS hospitals. When we come to consider the enforcement of those standards within hospitals, will the Secretary of State explain why she is not planning to extend the sanctions regime that applies to private sector hospitals to their NHS counterparts?
The right hon. Gentleman raises an important point. As for private hospitals and the independent sector generally, the same standards will apply, using the same code provisions but under the existing legal powers of the Care Standards Act 2000. The obvious reason why we have a somewhat different enforcement regime is that we have direct management controls—or through a monitor, direct regulatory controls—on NHS and foundation trust hospitals that do not exist in respect of the private sector.
The new code that we are introducing, backed up by the new powers of the Healthcare Commission, will help to ensure that our NHS, which is treating more patients faster than ever before, will also provide the highest possible standards and quality of care.
I want to refer briefly to parts 3, 4, and 5 of the Bill, which deal with drugs, pharmaceutical and ophthalmic services and various other matters. We are strengthening the management of controlled drugs in response to some of the shortcomings identified in the Shipman inquiry's fourth report. Those provisions, which are UK-wide, will require every health care body to appoint an accountable officer who will have to take personal responsibility for the use of controlled drugs within that organisation.
We are also taking steps to continue improving pharmaceutical and other services. Community pharmacists are already playing a much wider role than they used to within the NHS—for instance, providing screening services and reviewing medicine use for people with long-term conditions. We know from our recent consultation on community health and social care services that the public welcome the work of community pharmacists and would like to see it increased. The Bill, by freeing pharmacists from the requirement personally to dispense every item, will allow them to expand the other services that they offer without in anyway compromising patient safety.
I thank my right hon. Friend for her remarks on community pharmacies. I am sure that they will be greatly appreciated by the many thousands of community pharmacists who work so hard to provide front-line health care services. Will my right hon. Friend ensure that, when she relaxes the requirements for pharmacists to be on the premises at all times as they are now, at least one pharmacist will be available so that we avoid the situation in which one pharmacist has, in theory, to manage more than one premises at the same time? I am concerned that that could compromise standards.
My hon. Friend makes an important point, which we will look into carefully when we draw up the detailed regulations to give effect to the provision. In order to ensure that patient safety is in no way compromised, a responsible pharmacist will have to be in charge of every pharmacy. However, because he or she may not have to dispense every item, it will be possible to make much better use of the range of skills within the pharmacy team.
We are also reforming the entry requirements governing the provision of pharmacy services by implementing in England the final elements of the balanced package of reforms that we published in response to the Office of Fair Trading report two years ago. Similarly, in modernising ophthalmic services, we are relaxing the current restrictions on who can provide them.
As someone who has been using opticians since the age of seven, may I ask my right hon. Friend about the logic behind devolving general ophthalmic services to PCTs? Will she give an assurance that PCTs will not be able to restrict the number of opticians who provide sight tests?
My hon. Friend raises an important point. We want to give PCTs the ability to secure the best services for people in their area, and that is exactly what we are doing by devolving responsibility for dental services—[Interruption.] Yes, they will be able to respond to some of the very real problems that we are addressing. On ophthalmic services, PCTs will be able to use a wider range of providers to obtain the services that people need. The changes will simplify entry requirements for the provision of NHS services and help to support better service provision.
I accept that PCTs are often well placed to drive up the level of provision in their area, but does my right hon. Friend understand the concerns of optometrists in my constituency, such as David Austen, who provides an excellent service but is fearful that quality may be reduced if the PCT is driven by the need to make economies? The changes should be about driving up standards, not reducing them to a level playing field.
My hon. Friend's final point is right. These changes will help to continue improving the quality of care that opticians are able to provide. My hon. Friend the Minister with responsibility for ophthalmic services has recently met the opticians to reassure them on that point, because it has been raised not only by the constituents of my hon. Friend the Member for Loughborough (Mr. Reed) but by many others.
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I wish to make some more progress, because I know that there are many other issues that hon. Members will wish to—
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Order. The Secretary of State said that she does not intend to give way.
The Bill will also strengthen the powers of the NHS Counter Fraud and Security Management Service, which has—
Will the Secretary of State give way?
No. The hon. Gentleman is very persistent, but I have already said that I will not give way, because I wish to make some progress and there are many other issues on which I anticipate hon. Members will wish to make interventions.
The counter fraud service has performed a highly important job since we established it in 1998. By the end of the last financial year, it had produced a financial benefit to the NHS of £675 million, which is a 13:1 return on its total budget since 1999. The service is an important part of ensuring that we get value for money for every additional £1 of taxpayers' money that we put into the NHS.
I come to my final point before I turn to smoking. In part 5 of the Bill, we respond to an important report published in 2003 by the Public Administration Committee, which was called "Government by Appointment", by establishing a new non-departmental public body, the appointments commission, to replace the current NHS Appointments Commission. In the Committee's estimation, the NHS Appointments Commission was working well and the Committee recommended that other Departments should be able to use its services. The Bill provides the legal framework to do that and reaffirms our commitment to an independent appointments process.
I am grateful to the Secretary of State for giving way before she discusses smoking. In her responses to interventions by Labour Members, she did not appear to give an assurance that she would not allow PCTs to restrict patients' choice of ophthalmic practitioner. Will she assure the House that she will carry out a full review of general ophthalmic services, in consultation with the profession, so that people in England receive the same quality of treatment as is available in Wales and Scotland?
The measures in the Bill are designed to increase the choice that is available to patients in England. The Bill will enable primary care trusts to contract with a wider range of providers, and indeed, as you would expect, Mr. Speaker, we have been discussing this very closely with the opticians, with the profession, and we shall continue to do so as we bring forward regulations on this matter.
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I am not going to take further interventions because I wish to turn to another very important matter—part 1 of the Bill, on smoke-free places. The provisions that we are introducing in part 1, which extend to England and Wales, fulfil the commitment that we made last year, in the "Choosing Health" White Paper, to legislate to shift the balance significantly in favour of smoke-free environments.
I am sure that my right hon. Friend is aware that many of us see a fatal flaw and contradiction in the Bill—[Interruption.]—in part 1, which is otherwise admirable in its intent. I am sure that everyone on the Labour Benches would wish to protect workers from being exposed to smoke in their workplaces, and probably all of us in the House would support that aim. Part 1 is fatally undermined, however, by providing exemptions for private clubs for instance, or pubs that do not serve food, where people still have to work and where, in practice, it is impossible to separate those working there from the smoke. My right hon. Friend must be aware that there will be serious moves to amend that part of the Bill.
My hon. Friend has raised early in this debate what the exemptions should be, but I would refer him first to the manifesto on which he and I were both elected earlier this year—[Interruption.] Perhaps I may just finish this sentence, which is rather an important one, if I may say so, for all my hon. and right hon. Friends. We were all re-elected this year on a manifesto that promised we would legislate to ensure that
"all enclosed public places and work places other than licensed premises will be smoke-free . . . that all restaurants will be smoke-free, all pubs and bars preparing and serving food will be smoke-free".
The Bill delivers on that promise by introducing a complete ban on smoking in enclosed public spaces and workplaces, but allowing for limited exemptions about which I shall say something more in a moment.
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I give way first to my hon. Friend the Member for Livingston (Mr. Devine).
My right hon. Friend will be aware that I was not actually elected on the manifesto, coming in, as I did, in October, and she will be aware that many of us in this place would like us to follow the lead of the Scottish Parliament and the Dail in banning smoking totally in all public places. But I wonder whether she is aware of the British Medical Association report that was produced in October, which compared the respiratory function of bar staff in Northern Ireland and in the Republic, before and after the introduction of the smoking ban. It showed that the respiratory function of bar staff in the south had increased substantially, and the conclusion was that the smoke-free law—
Order. Perhaps we can leave that for a speech. Interventions should be short.
Thank you, Mr. Speaker. My hon. Friend the Member for Livingston makes an important point, to which I shall return not only this afternoon but in Committee.
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I shall make a little more progress at this point and then I will take further interventions.
Today, only 51 per cent. of the work force enjoy a totally smoke-free environment. The Bill, even with the limited exemptions that we are proposing, will give 99 per cent. of the work force complete protection from smoking. That is an enormous step forward for public health and for the health and well-being of our people.
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I shall give way in a moment. Smoking is already—thank goodness—far less common than it used to be. Many of us can remember when it was the norm for people to spoke in cinemas, on trains and buses and in most factories and offices. Today, smoking is banned on almost all public transport and in many other public places. Thirty years ago, about half of men and almost half of women smoked; today, only one in four people do so. That number is continuing to fall, in part thanks to the excellent smoking cessation services provided on the NHS.
Can the Secretary of State clarify a simple factual question: did she try to persuade the Cabinet to go for a total ban?
My hand is always on my heart. We had a debate in the Government on how best to implement our manifesto promise, just as we will have a debate this afternoon and in Committee, but I stress that Labour Members are completely committed to legislating for public health and for a smoking ban to strengthen the provision of smoke-free places.
Will the Secretary of State give way?
I will give way to the hon. Gentleman, and I hope that he will tell us whether he proposes to vote for the Bill or against it.
I thank the Secretary of State for giving way, but I would prefer to put points to her. I do not smoke. I do not like going into smoky places, so I choose not to. Does she not agree that, if I own a pub, I should be free to decide whether or not people are allowed to smoke on my premises based on the feedback that I get from my customers and my employees? This should not be a matter for more nanny-state interference.
I take that as a statement that the hon. Gentleman and, no doubt, many of his hon. Friends will vote against the Bill, because they do not accept that the Government have a responsibility to act in this respect.
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I will take further interventions in a moment, but I want to make a little progress because there is an extremely important point of principle, which divides Labour Members from the Conservative party. Fewer people now smoke and more people demand smoke-free public places and workplaces.
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I have just said that I will make a little more progress before I take further interventions.
I have no doubt at all that, even without legislation, in the fullness of time, we would eventually see a self-imposed ban on smoking spread to virtually all public places and workplaces. The reason why that is not good enough is that it would take too long. Smoking kills and so does second-hand smoke. Even if the Opposition cannot make up their mind, the Government have a duty to legislate. The public consultation that we conducted made it plain that the public agree. They want the Government to speed up the change that is already happening. They want the Government to do more to protect people from second-hand smoke.
I do not know whether the Secretary of State managed to hear Mr. Tony Benn—a former Member of Parliament for Chesterfield, whom I am sure she knows well—on the radio on Saturday morning. He said that he found it rather odd that, at this stage of their life, the Government were allowing 24-hour drinking, with all the damage that alcohol can do to people, yet they somehow believe that smoking should be banned.
There will not be 24-hour drinking as a result of very sensible changes in the licensing laws, which, of course, Opposition Members have called for and which will enable responsible adults to drink rather more without the current restrictions—[Interruption.] We will enable responsible adults to drink without the restrictions that are currently imposed by out-of-date licensing laws, but we will give the police much tougher powers to deal with the minority who binge drink and then attack other people.
I accept that the Bill is a great step forward. I feel a bit like a bag of ailments this afternoon—as well as being short-sighted, I am asthmatic. Breathing in second-hand smoke doubles the chances of an adult developing asthma and inhibits the action of the drugs that are used to control asthma. Can my right hon. Friend explain why someone who works in a pub that does not serve food should be exposed to that risk, when someone who works in a different establishment is not exposed to it?
I will return to that very point in a moment. It is precisely the damaging effects of second-hand smoke that have led us to conclude—in striking contrast to the Conservative party—that we need to legislate on the matter.
The Government are putting forward a strong public health message. Will the Secretary of State examine the line of the Royal National Institute of the Blind on the effect of smoke on sight, especially on macular degeneration of the retina? Will she consider putting warnings on cigarette packets that smoking can cause blindness?
My hon. Friend raises an important point. We will shortly be consulting on strengthening the general health warnings on cigarette packets by putting pictures on them to illustrate the damage that smoking does to people's health.
My right hon. Friend will know that I admire what she tried to do at earlier stages of the Bill's life. Does she agree that we must set against the drift downwards of the prevalence of smoking in the general population—she accurately described that as about one in four people—the fact that two groups buck the trend? One such group is in working-class communities. Work done by SmokeFree Liverpool, which is an immensely effective organisation, shows that in the most deprived wards, as much as half the population smokes. From her observations and statistical analysis, my right hon. Friend will have noted that the number of younger women who are starting to take up smoking is increasing significantly. What does she believe can be done in that regard?
My hon. Friend makes an extremely important point. The prevalence of smoking in England and other parts of the country is going down among all groups, including working-class men. Indeed, the evidence on young women is not as clear cut as he suggests. Smoking rates are going down. They are going down even faster among better-off groups. Of course, we need to do more on smoking cessation programmes, in particular, alongside the Bill.
The Bill is an enormous step forward for public health. It will help to reduce the number of people smoking by a further 500,000 to 750,000 over time. It will help to reduce the number of deaths of people in the work force that are associated with second-hand smoke, which is estimated at some 500 to 600 a year.
In framing the legislation—this was the point of many debates and the public consultation that took place before the publication of the "Choosing Health" White Paper and, indeed, the election—we are striking a balance between two extremes: on the one hand, an over-prescriptive state; and on the other, which is represented by Conservative Members, an irresponsibly laissez-faire Government. We are responding to the clear wish of the public to be protected from other people's smoking in public places, especially restaurants, on the one hand, and on the other hand allowing people who want to have a cigarette with a drink to do so.
I am grateful to the Secretary of State for moving forward with the Bill, not least because in the Rhondda more people now contract chronic obstructive pulmonary disease from smoking than they did from the mines. She will know that the Welsh Assembly has made it clear that it will not introduce exemptions along the lines of those proposed in clause 3. Will she go a little further and consider time limiting any exemptions that might be in the Bill for just two or three years?
My hon. Friend makes an interesting point. I have made various changes in response to the consultation that we have had since May this year. For example, my hon. Friends will recall that the proposed implementation date for licensed premises was originally the end of 2008. I have brought implementation forward to the summer of 2007, when all the provisions relating to smoke-free places will take effect.
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I want to finish this point.
I have also made it clear that we intend to monitor the impact of the ban, with the exceptions, from day one and to complete that review within three years. As I said, the Bill provides for a complete ban, but exceptions can be made by regulation. If, in the light of that review and monitoring, the Government and Parliament decide that they no longer want some or all of those exceptions, it will not require further primary legislation. It would be a simple thing to change.
On the exemptions, my constituency, like many other former mining constituencies, has a large and lively network of miners' welfare clubs. They are not strictly speaking membership clubs. Do they fall under the exemptions?
I am confident that those clubs, which many of us have in our constituencies, will be covered by our proposed exemption for membership clubs. However, I stress that the membership clubs that will be exempted will have to comply with the much narrower definition of a genuine membership club contained in the Licensing Act 2003.
Will the Secretary of State explain how she came to the balance that she has struck and, in particular, why she appears not to have taken into account her regulatory impact assessment? It compares a comprehensive ban with a partial ban and shows that more than 200 additional people a year will die from second-hand smoking if we stick with a partial ban. Will not more people die if we do not go for a comprehensive measure?
Some 95 per cent. of deaths that are related to second-hand smoking occur as a result of smoking in the home. That is where the real problem lies. It is why we have to continue to invest in the smoking cessation programmes and, more generally, to raise awareness so that adults who choose to smoke do not do so either in their homes, where their children might be present, or, indeed, in their cars. Unfortunately, about a third of parents who smoke do so in the car when their children are with them.
Is the Secretary of State aware that according to Macmillan Cancer Relief, which is to be applauded for the excellent way in which it supports patients and families in the community, approximately 37,000 people in the UK are diagnosed with lung cancer each year? Surely that figure alone should mean that she considers completely lifting all exemptions so that there are none across the UK. There should be a total ban. Nothing else will do.
Macmillan Cancer Relief does excellent work. It is precisely because of the damage that smoking and second-hand smoking do to people's health that we are taking this enormous step. I remind the hon. Lady that 99 per cent. of the work force will be guaranteed a completely smoke-free environment as a result of the Bill, along with the ban on smoking in virtually every enclosed public space.
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I intend to make a little more progress before I give way.
On exemptions, clause 2 gives the National Assembly for Wales and, in the case of England, the Secretary of State the power to make exemptions, some of which I hope will be uncontroversial. They include private dwellings, along with premises that are clearly private space, such as bedrooms in a hotel or a bed and breakfast, and other places, such as care homes and prisons, that are a person's full-time place of residence for an extended period, although not necessarily as a matter of choice. We are respecting people's private lives and their freedom of choice.
Is the Secretary of State aware that the Under-Secretary of State for Northern Ireland, my hon. Friend the Member for St. Helens, South (Mr. Woodward), informed Smoke-Free Liverpool that the main reason that he wanted a total ban on smoking in Northern Ireland was that he did not want two classes of workers—people exposed to smoke and people not exposed to smoke? If that is good enough for Northern Ireland, why is it not good enough for workers and employees in this country?
Inherent to devolution and the constitutional settlement is the fact that different decisions will be made in different parts of the United Kingdom. Although the Northern Ireland Assembly is suspended, we are proceeding in Northern Ireland in the spirit of devolution. Just as different provisions are made on the NHS in Wales and in Scotland which we do not choose to follow, so we are making our own decision to strike the right balance on licensed premises.
The Secretary of State clearly acknowledges the position of Northern Ireland, Scotland and Wales, but does she think that it is fair that workers and the public in England should be treated differently from Wales, Northern Ireland and Scotland? Will she take into consideration the content of the Smoking in Public Places (Wales) Bill, which my hon. Friend the Member for Cardiff, North (Julie Morgan) presented in the last parliamentary Session?
As my hon. Friend is well aware, health is a devolved matter, so there are different approaches to NHS policy in Wales, Scotland and England. Not surprisingly, there are different approaches not to a general ban, but to the specific issue of whether there should be an exemption for licensed premises.
On a point of order, Mr. Deputy Speaker. The Secretary of State, no doubt inadvertently, implied that a decision made by a Northern Ireland Minister was a result of devolved government. Will you confirm that the Northern Ireland Assembly and devolution are not functioning, so that cannot possibly be a devolved decision? Can you help the House, Mr. Deputy Speaker?
The right hon. Gentleman must not draw me into the argument. I am sure that there are right hon. and hon. Members who can help themselves in this matter.
I am most grateful, Mr. Deputy Speaker. Indeed, I said that the Northern Ireland Assembly was suspended but that we were proceeding in the spirit of devolution.
In making our judgment about licensed premises, we have taken into account the fact that England already has the lowest smoking rates in the United Kingdom. Our smoking rates have fallen faster and to a lower level than in Wales, Scotland and Northern Ireland. We have also taken account of the tension in public attitudes. I referred earlier to the extensive public consultation that we conducted before publishing the "Choosing Health" White Paper. It demonstrated enormous support for a ban on smoking in restaurants and pubs where meals are served. People clearly want to be able to enjoy their meal without someone blowing smoke over their food and into their face. Similarly, people want an extensive ban in most enclosed public spaces, but when they are asked about membership clubs and pubs that do not serve food, most of those who do not smoke—the majority—believe that smokers, even though they are a minority, should none the less have some freedom of choice. They clearly view membership clubs as private clubs run by members for members. Such clubs have always been treated differently from other licensed premises because they are non-profit-making organisations.
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May I make this point before accepting further interventions? Those clubs are non-profit-making organisations in which the members make the decisions, just as people make their own decisions in their own homes. It is therefore right to exempt membership clubs, just as it is right to allow people who continue to smoke to do so while they have a drink, provided that they are in licensed premises that do not serve food. This is a difficult judgment to make. It is one on which there has been much argument. I shall give way to the hon. Member for South Cambridgeshire (Mr. Lansley), then I will take further interventions.
I am grateful to the Secretary of State for giving way. Given that we are debating a public health measure and that the public may take the view that we should not interfere with smokers' right to continue smoking among smokers, where is the public health evidence that the impact of second-hand smoke differs according to whether one is in premises where food is consumed, as distinct from other premises? What is the evidence relating food to second-hand smoke?
I regret that the hon. Gentleman did not tell us whether he supports the measure or not. It would appear that the Opposition cannot make up their mind whether there should be legislation. I have made it clear that in legislating on this matter, which is a matter that directly affects people's own choices about how they behave, we have made the judgment that the right balance to strike is between banning smoking in virtually every enclosed public space and work space, and exempting the membership clubs and the licensed premises that do not serve food, in order to protect freedom of choice for that minority of people whom nobody is forcing to go into a pub that allows smoking, but some of whom none the less continue to do so.
In respect of the consultation that my right hon. Friend carried out, what account has she taken of health inequalities?
The issue of health inequalities and reducing health inequalities is central to our purpose as a Government, whether it is in health policy and the work that we are doing to improve the national health service, or a series of other aspects.
The point I want to make in relation to the narrow but important proposed exemptions is that bar staff everywhere will have protection against smoking, which does not currently exist. There is at present no law at all in that regard. We will consult on the regulations in this and other areas, and ensure that even in the membership clubs and non-food pubs that decide to allow smoking, smoking will still be prohibited, at least in the area around the bar.
What constitutes that?
I hear my hon. Friend from a sedentary position. He anticipates the point that I was about to make. We will consult in particular on whether the best way to achieve that is to designate an area that does not include the bar to be a smoking area or smoking room—a discrete, separate smoking room or smoking area that does not include the bar.
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I give way to the hon. Gentleman.
Order. It would be helpful if the right hon. Lady could make it absolutely clear to whom she is giving way, when there is a forest of hon. Members rising.
On a point of order, Mr. Deputy Speaker.
Order. Would the hon. Gentleman wait a second? My second guess was that the Secretary of State was giving way to Mr. McFadden, but I shall take a point of order from Mr. Hesford.
I am obliged, Mr. Deputy Speaker. Should it not be an ASH of interventions, rather than a FOREST?
I am sure the House appreciated that. I call Mr. Pat McFadden.
Thank you, Mr. Deputy Speaker. Will my right hon. Friend clarify what she said a short time ago about the exemptions and a review? Is she saying that if the proposals go through the House in their present form, the Government will give the House an opportunity to review the exemptions in—I think she said—three years, and that those who favour a full ban will have an opportunity to revisit the issue then?
I am grateful to my hon. Friend for raising an extremely important point. As I have said, the Bill provides for a full ban with the power to make exemptions, which will be made by statutory instrument and which will be subject to the affirmative resolution procedure. If after the review, which we propose to complete within three years, the Government and Parliament decide that they do not want to retain some or all of those exemptions, the matter will simply involve the repeal of the relevant regulation and not further primary legislation.
What consideration has been given to making an exemption for what I term "inherently dangerous workplaces"? For example, Acordis Acetate Products has a large chemical site on the edge of my constituency, where there has been no smoking for 40 years because of the inherent danger. It has always provided smoking rooms, so there has been no mix between smokers and non-smokers. If an exemption is not made, employees, who cannot leave the huge site for a quick smoke, may, against all instructions and contracts of employment, smoke on site, and if they were to smoke in the wrong place, the repercussions for public safety would be serious. Has any consideration been given to granting exemptions for such sites?
As far as I know, that particular point has not been put to us—we have considered the specific issue of oilrigs, where workers cannot leave the site. I undertake to consider my hon. Friend's point more closely, but at this stage my response is that we expect workers in such factories, as in other workplaces, to go off the site to smoke, if that is what is required by safety regulations.
As I have said, we shall seek to protect all staff, even in the limited number of premises that allow smoking, through the consultation on smoking areas. We are following the example of virtually everywhere else that has considered how to legislate on smoking in public: California, New York, Norway, Sweden, Australia and many others either have moved or are moving towards a full ban, and they all began by exempting licensed premises and, in some cases, the hospitality industry, before removing those exemptions as public support for the ban grew.
On a point of order, Mr. Deputy Speaker. The Secretary of State keeps referring to the fact that licensed premises will be exempt. Is she aware that these days almost every pub serves food, so—
Order. The hon. Gentleman has been here long enough to know that that is not a point of order for the Chair. The Secretary of State is being very generous in taking interventions. Equally, she is taking a generous amount of time and, hopefully, other hon. Members will be able to contribute in due course.
I am drawing my remarks to a close.
It is important to remember that the Government cannot force people to be healthy. The clear message from the public consultation and the central proposition in "Choosing Health" is that people want the Government to help them become healthy and stay healthy, but they do not want the Government to dictate to them. The huge public health challenges that we face as a nation, such as smoking, drinking and obesity, concern people's lifestyles. We must move with public opinion, because we need to help people make different, healthier decisions for themselves, rather than trying to impose such decisions.
Will the Secretary of State give way?
I want to bring my remarks to a conclusion because I am keen that as many hon. Members as possible should contribute to the debate.
This part of the Bill has already aroused considerable debate. Yet the changes that we propose will transform our public places. They will provide a modest degree of choice to those who continue to wish to smoke outside their own home, far better protection for all employees, and far greater choice for workers in the hospitality industry who want to work in a smoke-free environment. The provisions will help us to reduce the number of smokers by a further 0.5 million or more and save up to £100 million a year for the national health service. The measures that I mentioned earlier will help to protect patients from MRSA and other health care infections and modernise the provision of pharmacy and ophthalmic services. I am confident—
On a point of order, Mr. Deputy Speaker. Some time ago, before she took a large number of interventions, the Secretary of State was moving on to discuss exemptions in respect of care homes, prisons and other establishments, but she has not continued with the relevant passages of her speech—
Order. I have to say to the hon. Lady, as I said to the hon. Member for Tewkesbury (Mr. Robertson), that that is not a matter for the Chair. I certainly cannot determine the content and shape of the Secretary of State's speech.
I am most grateful to you, Mr. Deputy Speaker. I did indeed say that we would legislate for prisons and for care homes, and that I trusted that those exemptions would not be controversial. If they are controversial, I am sure that they will be discussed in more detail, not only this evening but in Committee.
Will the Secretary of State give way?
I really want to bring my speech to an end.
The Bill is a landmark in the protection of people's health and of public health in our country. It will continue to improve our national health service. I am confident that all my right hon. and hon. Friends, whatever their views on the specific matter of exemptions, will join me in supporting it—unlike the Conservatives, who had 18 years in which they could have acted on this scourge to public health but chose to do nothing.
I commend the Bill to the House.
I am sure that the House is grateful to the Secretary of State for giving way so frequently, although I hope to be considerably briefer to allow time for the many Back Benchers who wish to speak.
We are not, I am afraid, presented with a landmark Bill in public health. It was our intention, had we been elected in May, to introduce a public health Bill that would have achieved landmark changes in public health. It would have reorganised public health to enable public health directors to use dedicated resources across the public and private sectors, ending the fragmentation of recent years. It would have addressed the whole range of public health issues, including sexually transmitted infections, where the Government have failed lamentably. I have discovered in the past few days that there is to be no advertising of positive sexual health messages to young people this year, in circumstances where sexually transmitted infections are at epidemic levels. A Government who abolished the Health Education Authority and have presided over the highest rate of rising obesity in western Europe have allowed sexually transmitted infections to reach epidemic levels, as compared with a Conservative Government who acted on the problems relating to HIV and AIDS in the 1980s and secured a much lower incidence of HIV. This country now has the fastest rising levels of HIV since 1997.
The Bill is not a landmark measure in public health even as regards smoking. The reduction in the prevalence of smoking was faster in the 1980s than it has been since 1997.
Why does the hon. Gentleman believe that it has taken more than 50 years since the epic work of Sir Richard Doll, who sadly died this year, to do something about the problem? The Conservative party was in office for a large part of that time and did nothing about smoking, although the evidence for second-hand smoking and smoking among doctors existed since the work of Richard Doll. Has that failure anything to do with the dirty tricks campaign of the tobacco industry, which tries to defend the evil weed in the United States?
I hope that the hon. Gentleman will have the opportunity to speak later when he can explain what he means by that last comment. I am not an apologist for the tobacco industry. I was simply pointing out that the reduction in the prevalence of smoking was faster in the 1980s. He knows that—I attended the conference that he chaired on the battle against cancer. There has been a long-term reduction in, for example, lung cancer mortality but there are worrying indications. It was wisely noted earlier that difficulties remain with the prevalence of smoking in elements of the population. That is especially true of working-class communities and young women. Smoking by young people has barely reduced in the past five years. He knows from the statistics that were presented to his conference of the all-party parliamentary group on cancer last Thursday that not only has the incidence of lung cancer mortality in young women risen, but overall mortality rates for women are not reducing compared with the substantial reductions in men.
The hon. Gentleman mentioned the proposals that a public health Bill would have contained if the Conservative party had won the election. Would such a Bill have provided for a full ban on smoking?
Before the election, we made it clear in a document that was published in February that we believe that individuals are primarily responsible for their health. Indeed, the Secretary of State made more or less the same point. We therefore want to proceed when possible through voluntary measures and self-regulatory solutions rather than legislative ones.
If I am to disappoint Labour Members, I will disappoint some of my colleagues, too. As we made clear before the election, we would have included provisions in a public health Bill to enforce a reduction in smoking in circumstances in which a self-regulatory solution had not been effective in three years. We did not propose a comprehensive ban. We proposed that, first, wherever non-smokers had access—including licensed premises as well as workplaces—they should not be exposed to second-hand smoke. That is different from private houses and private clubs. Secondly, wherever children had access, they should not be exposed to second-hand smoke. Thirdly—again reflecting a point similar to one that the Secretary of State made—workers in the hospitality industry, such as people who work behind a bar, should not be exposed to second-hand smoke.
Although not a comprehensive ban, our proposals bore a close resemblance to those that the Secretary of State reportedly pressed on her Cabinet colleagues before the publication of the Bill but was prevented from implementing. The proposals that we are discussing are not those that the Secretary of State wanted to introduce.
My hon. Friend makes some excellent points. On self-regulation and choice, does he agree that, for the Bill to be more effective, we need clarity on the position of private members' clubs, especially those that serve food, and the way in which they can hold annual ballots on smoke-free places in those clubs?
I accept my hon. Friend's contention that we need clarity. That applies to many provisions. The detail of many aspects of the Bill will be filled in later. That is an all-too-depressing characteristic of measures that the Government have presented in recent years.
Will the hon. Gentleman give way?
No, I want to answer the point of my hon. Friend the Member for Castle Point (Bob Spink) about private members' clubs. The Secretary of State appeared to accept that we were making substantial progress with self-regulatory solutions but claimed that it was not fast enough. She is not proposing to give the industry any additional time to achieve that. For the industry, the flexibility that is inherent in self-regulatory solutions is important commercially.
Whatever may be said about the desirability of limiting the liberty of smokers, private members' clubs should be treated as an extension of a private home in the sense that a club has members who can make decisions about what happens in their club. It seems burdensome for legislation to interfere in that and to prevent members from taking such decisions.
As far as I can understand the hon. Gentleman's argument, he is saying that, if the Conservative party had been elected, it was hoping that the market would provide, over the next few years, substantial numbers of clubs and bars where people would be able to go without having to suffer passive smoking. Can he name three bars, apart from those in the House, or pubs anywhere in the country that have gone non-smoking already?
Yes, there is one in Cambridge, which Greene King owns. There is also a large Wetherspoon pub. Unfortunately, it took the Regal cinema in Cambridge and turned the premises into the largest bar area in the country. As it is Wetherspoon, that is non-smoking. I think that I can find the hon. Gentleman at least three such pubs.
To correct the hon. Gentleman—having done so, I must move on to what is in the Bill rather than what might have been in Conservative legislation—I did not say that the market would deliver these things. I said that there would be a self-regulatory solution. I appreciate that there are market pressures, but such pressures can take a long time to have an impact. We were aiming for a self-regulatory solution. He should accept—although Ministers appear not to have accepted it—that, throughout the hospitality industry and in the British Beer and Pub Association and elsewhere, substantial measures have already been put in place to try to deliver smoke-free solutions for customers. The way in which the Government propose to interfere with what might otherwise have been achieved on that basis is excessive.
I am a shadow Secretary of State for Health, and in my view there is no acceptable outcome other than that we deliver much reduced smoking and smoke-free environments for everybody who wants them. There should be smoke-free environments for children, but there is no reference in the Bill to children. There is nothing that says that, wherever children are present, second-hand smoke should not be permitted, although the evidence of the Scientific Committee on Tobacco and Health points to the impact of second-hand smoke on respiratory disease, on asthma and on sudden infant death syndrome.
Will the hon. Gentleman give way?
No. I shall carry on because I want to get the evidence on the record. Curiously, the Secretary of State did not get the evidence on the record. I remind my right hon. and hon. Friends that it is not acceptable for us not to make progress. That was at the heart of what we were proposing at the election. We must make progress towards smoke-free environments because the evidence of health effects is increasingly strong.
The Scientific Committee on Tobacco and Health set out the evidence straightforwardly. The increase in the risk of lung cancer among non-smoking partners of smokers is about 24 per cent. for women. For non-smoking men who are partners of smokers, there is about a 37 per cent. increase in risk. For those who have workplace exposure, there is an 11 per cent. increase. It estimates a 25 per cent. increase in risk of coronary heart disease resulting from exposure to second-hand smoke. Insufficient attention has been drawn to this, but what has become most interesting most recently is the significant increase in the risk of coronary heart disease associated with small increases in exposure to second-hand smoke. I shall read the relevant extract from the committee's report:
"The increased risk associated with exposure to SHS"—
for coronary heart disease, it is about 25 per cent.—
"is . . . a substantial fraction of the risk from active smoking, although uptake of smoke by non-smokers is typically only about 1 per cent. of that by active smokers. Thus it appears that substantial risk arises from quite modest exposure to SHS."
That is the most important extract from the updated advice of the scientific committee. There is not a linear relationship between dose and risk; if anything, there is a non-linear relationship that shows substantial risks associated with modest exposure.
Did my hon. Friend discuss secondary smoking with the previous Health Secretary, who said that if smoking were banned in most pubs—as it will be, because most pubs serve food—people would be likely to stay at home to have a drink and smoke? That is exactly where their children are. People have a choice whether to go into a pub, but children do not have a choice about breathing in smoke at home.
I am grateful to my hon. Friend for that intervention. The essence of our proposals would have made it possible for non-smokers to be in a smoke-free environment. They would also have made it possible for smokers to continue to be in smoke-filled environments—[Interruption.] The Under-Secretary of State for Health, the hon. Member for Don Valley (Caroline Flint) asks how from a sedentary position. It is actually rather similar to what her right hon. Friend the Secretary of State was proposing, that is, if a public house can segregate smokers in smoking rooms, it would be able to allow smoking. If it could not, smoking would not be allowed. A public house is open to the public, but it would not be allowed to invite people in if they were likely to be exposed to second-hand smoke against their wishes.
I want to return to my hon. Friend's earlier point about children. Tomorrow, in the House, I shall launch children's cancer awareness month for CLIC Sargent, and that is an important issue. However, I want to raise exemptions on behalf of a company in my constituency. Does my hon. Friend agree that there should be an exemption under clause 3 for certain workplaces involved in the tobacco trade? A business in my constituency, Hunters and Frankau, is a specialist importer of cigars, but under the Bill, it will not be able to test its products on its premises. The business is located in one of Britain's most deprived wards. [Interruption.] Labour Members may well talk among themselves, but there was a majority for the governing party of only three votes in that ward. That company also imports products from some of the world's most deprived countries, including Cuba. Is it not therefore unreasonable that it should be banned from testing its products on site?
I am grateful to my hon. Friend for his intervention, and I hope to be at the launch of children's cancer awareness month tomorrow. I am also aware of his point about specialist tobacconists. I understand that they have made those points to the Government, but have had no clear answer. I hope that we shall be able to explore the matter further.
I shall come to the other issues in the Bill shortly, but I want to stay with smoking for a moment. I have talked about all the risks involved, but what has been the response to these points? Curiously, no one has mentioned the fact that the Government had plenty of advice on how they should respond to these issues. The chief medical officer's annual report in 2002 made it perfectly clear that he recommended a comprehensive ban on smoking in enclosed public places. He believed that that would lead to a 4 per cent. reduction in prevalence, from 27 per cent. to 23 per cent., which would represent a substantially greater impact on prevalence than anything that the Government anticipate from their own proposals.
How are other people responding to the risks? The Scottish Parliament—whether I agree with it or not—says that, from April next year, it wants a comprehensive ban on smoking in enclosed public places. As the hon. Member for Rhondda (Chris Bryant) pointed out, the Welsh Assembly wants to use the Bill to deliver a comprehensive ban. Speaking about Northern Ireland, the Under-Secretary of State for Northern Ireland, the hon. Member for St. Helens, South (Mr. Woodward) has said that
"no-one has a right to subject colleagues and workmates to the dangers and hazards of second-hand smoke and passive smoking. No-one has a right to subject members of the public who do not smoke to those same dangers in enclosed public spaces."
Responsibility on this matter is not devolved but held here in Westminster, and that Minister has decided that the only proper course of action would be a comprehensive ban.
In exactly that context, does my hon. Friend know whether there will be a total ban on smoking in prisons in Wales and Northern Ireland in order to protect the health of prison warders?
I am happy to confess to my right hon. Friend that I do not know, and perhaps the House does not yet know. I stand to be corrected if the necessary regulations have come forward in relation to Northern Ireland to make that clear. The issue arises in relation not only to prisons but to some care homes and mental health institutions.
The workplace argument does not apply to older people who have retired. Does my hon. Friend concede that large numbers of older people have a habit of decades, dating back to the days when the health risks were not known and tobacco advertising presented the habit as glamorous and sophisticated, and are often beyond smoking cessation programmes? Are they to be confined to their homes? Should not restaurateurs and publicans have a choice, so that if they wish to have smoking premises, those who wish to smoke can opt to go to them, and those who do not wish to smoke can go to non-smoking premises?
I understand my hon. Friend's point, which is important, and it is one of the reasons why exemptions would be needed for people who, to all intents and purposes, are at home, such as people in long-term care. There are limits to liberty, however, and the limit to the liberty to smoke is that one should not impose second-hand smoke and its risks and dangers on others. However sympathetic we might be about the addiction to or habit of smoking among older people, we should not allow that to turn into a risk to the health of others through second-hand smoke.
As a member of the Science and Technology Committee, I am much interested in the evidence and in what we are trying to achieve. Does my hon. Friend agree that it is most important to achieve air quality standards and that the debate is not so much about smoking and passive smoking as about air quality standards in public and other places?
I understand my hon. Friend's point and we might not have explored fully all the engineering solutions that might help to reduce exposure to toxins emitted through tobacco smoke. Indeed, the aetiology of the increased risk might not be entirely clear. Rather than the nicotine content, which is what is typically measured, other toxins might get into the system and change metabolic responses. We need to be clear about that. It might be intensely difficult, however, to remove the carcinogenic material from tobacco smoke that affects other people.
On prisons, care homes and other places where people might reside involuntarily, the Bill provides for an exemption of such facilities from the ban. I accept that a total ban might not be in the best interests of prison officers, carers or residents, but does the hon. Gentleman accept that people who are in prisons or care homes, who might have mental health problems or learning difficulties, are among the most disadvantaged, and might also smoke heavily due to the regime that they are under and the boredom factor? What proposals has he to deal with those health inequalities?
I am grateful to the hon. Lady, and she got the chance to make the point that she would have made to the Secretary of State. She will know that the Bill allows for the possibility of such exemptions, although, as on many other matters, it does not say what kind of exemptions the Government propose in respect of care homes, prisons or mental health institutions. Clearly, in many such instances, it will be necessary to construct a regime that protects staff as best one can while avoiding harm to inmates. If one were simply to introduce a smoking ban in mental health institutions tomorrow, for example, serious risk would be posed to some of the care and clinical plans for some of the people inside them.
My point is supplementary to what my hon. Friend said about mental health institutions. As he suggested, the damage to the health of people in such institutions would be great. Does he know whether the Government have made any provision for increased spending on mental health to try to repair that damage?
I do not know of any specific allocation by the Government. I only know that, in South Cambridgeshire, a significant reduction in mental health resources is expected, and I imagine that that is reflected elsewhere. If my hon. Friend will forgive me, however, I will not proceed down that path.
The debate in which we have engaged during the past few minutes illustrates the difficulty. Even if the Government proposed a comprehensive smoking ban, it would be necessary to explore in detail how it would be applied in specific circumstances. I do not pretend that that would be easy, but we should at least be clear about the objective, which is to enable people to live in smoke-free environments and, wherever possible, to create such environments in order to reduce the prevalence of smoking.
Where does the issue of food come into the debate? I asked the Secretary of State that question, but I am afraid she did not reply. When the Scientific Committee on Tobacco and Health published its otherwise admirable report to the Government and the chief medical officer—it appeared alongside the public health White Paper in November last year—it was clearly deficient in not mentioning the instrumental relationship, in health terms, between the consumption of food and exposure to second-hand smoke. That must surely have motivated the Government's conclusion that second-hand smoke was dangerous where food was being prepared, but where no food—or only shelf staples and pre-packaged food—was being consumed, it was not dangerous at all.
What will be the consequences of the structure that the Government propose for future regulations? In September, the British Medical Journal published the report of a survey conducted in Telford and Wrekin. I do not think that my hon. Friend the Member for The Wrekin (Mark Pritchard) is here. I should have told him that I was going to mention this—I apologise. The survey covered pubs, and all licensed premises, in the borough. Those who conducted it tried to work out what proportion of premises would be exempt, and concluded—on the basis of what they found in Telford and Wrekin—that two thirds of English pubs in deprived areas would be exempt, whereas only a quarter would be exempt in affluent areas. Action on Smoking and Health has made not dissimilar observations; if anything, it has slightly underestimated the proportion of pubs in deprived areas that will continue to be exempt. The survey of all licensed premises, including members' clubs, found that two fifths of establishments in affluent areas and four fifths in deprived areas would be exempt.
Can the Government really imagine that their proposals will result in anything other than a worsening of health inequalities? I am not arguing that the prevalence of smoking would not be somewhat reduced, but we should not exaggerate that. Last year's report to the chief medical officer on smoking in workplaces revealed that there was no smoking in 50 per cent. of workplaces, in 36 per cent. smoking took place only in designated areas and in 5 per cent. people worked alone rather than with others, so only 9 per cent. of people at work would be exposed to second-hand smoke if they did not wish to be. However, the Government's proposal to discriminate between premises on the basis of whether food is prepared and served clearly drives to the issue of health inequalities. It means that health inequalities will widen, when inequalities in health and mortality expectations between the most affluent and the most deprived areas have widened already.
I follow the hon. Gentleman's logic about health inequalities being exacerbated by the Government's approach, but does that not also apply to his own desire to keep the exemption for private members' clubs? Are they not too concentrated in less privileged places?
Yes, I am not disputing that. There is a balance to be struck between continuing to give smokers the right to choose and protecting everybody else from smoke. I have never pretended otherwise. However, I do not understand where the distinction in relation to food has come from. It will entrench smoking in many clubs and pubs in deprived areas, with no expectation of that ever changing. The Secretary of State said that things would improve over time, but what pressures will there be? When we enact legislation we introduce hard and fast distinctions, and I suspect that this will be one of those.
I would like to clear up some confusion in my understanding of the positions of those on both Front Benches with regard to private clubs. As I understand it, both the Opposition spokesman and the Secretary of State are saying that even in private clubs, people will not be able to smoke at the bar because of the duty of care to employees. But what about another point, which the hon. Member for South Cambridgeshire (Mr. Lansley) has already raised? What about the duty of care to children in clubs in working-class places? If there is a duty of care to one category of people—staff—surely there is a duty of care to children in private clubs. I thought that the hon. Gentleman was with me on that subject.
Actually, I am with the hon. Gentleman. I said that we had three objectives, the first of which was that non-smokers should not be exposed to second-hand smoke. The second applies wherever children are present, so if a private members' club wants to admit children, it should have to choose whether to do that or whether to allow second-hand smoke. It should not be able to do both. I want to speak about other aspects of the Bill as well as smoking, so I shall finish talking about this issue now.
The Government know perfectly well not only that there is no evidence to support their supposition, but that 90 per cent. of the 57,000 responses to the consultation opposed their partial ban and wanted something more comprehensive, in many cases, or something more voluntary, in other cases. People on both sides of the argument regard the Government's proposal as the worst outcome. Astonishingly, when appearing before the Health Committee last week, even the chief medical officer made it clear that in terms of health inequalities this is the worst outcome—worse than no ban at all.
This is the last time that I will give way on the subject of smoking.
Will the hon. Gentleman clarify something for the House and extend his earlier comments? It is true that more than 90 per cent. of the 57,000 responses were hostile to the proposed exemption—but he should have gone on to say that those people supported a simple, comprehensive, workable and enforceable ban.
I thought that I did go on to say that most people said that, although some who opposed the Government's proposal wanted a more voluntary approach. However, that is not the point. The point is that people on both sides of the argument do not see any merit in the Government's proposals.
It is for that reason, and considering the range of views in the House, that my right hon. and hon. Friends have agreed to have a free vote on this issue. This is a genuine issue of judgment, which Members of Parliament are perfectly capable of dealing with, and it is not proper to use whipping to try to constrain people to exercise their judgment contrary to their conscience. The official Opposition will have a free vote, and I hope that the Secretary of State will take the opportunity to say that she has thought hard and concluded that there should be a free vote on the Government side as well. [Interruption.] Apparently not.
I now come to the other measures in the Bill. On infection control—a curious theme appears to be emerging—the chief medical officer told Ministers in October 2004 that they should act, through legislation, to provide additional statutory backing. It was not that the Government did not already have the powers, as the Health and Social Care (Community Health and Standards) Act 2003 more or less gives Ministers the power to set standards and it is possible to proceed in a similar way with respect to standards in the codes of practice. In 2004, however, the CMO said that we needed additional focus then, but Ministers did nothing about it that year. I cannot blame the Secretary of State for that as she did not hold her present position then, but action could have been taken earlier.
Many things might have been done earlier. The story of MRSA and infection control over the past few years has been one of continuous failure to take the urgent action that is required. I shall provide just one example. The Secretary of State is fond of making a comparison between food hygiene legislation and the responsibilities that should be met in the NHS. The CMO, in "Winning Ways", published in December 2003, said:
"The new Inspector of Microbiology and the National Patient Safety Agency will work jointly to ensure that the techniques of 'root cause analysis' and the methodology of Hazard Analysis and Critical Control Point . . . are developed for healthcare associated infection and applied in every local NHS organisation."
That is a direct transfer of experience from food hygiene legislation into infection control. I have searched for any evidence to demonstrate that the inspector of microbiology at the NPSA has acted on that or that it is being applied in any local NHS organisation, but I simply have not found it.
When the Secretary of State arrived in office after the election, she discovered that there was a big difference between food hygiene legislation and what went on in the NHS. Anyone could have told her that and anyone could have told her that things could have been done about it. We know that some measures will make a difference: hand hygiene, isolation facilities, clear lines of management accountability, pre-admission screening before operations, post-discharge surveillance after operations, accurate reporting of infection data by clinical departments, optimum bed occupancy—the Secretary of State appeared not to know that the number of beds in the NHS was reducing—24/7 access to high standards of cleaning and expert infection control teams. We know that all those things work, but we also know that, in too many cases, those measures are not being taken.
The Government say that they will bring in a code of practice, so let us look at the draft code to see whether any of those actions that will make a difference are reflected in it. There is no requirement for one board member to have responsibility for infection control and cleanliness. There is no requirement for the standards of cleaning to be in line with the model cleaning contract. There is no requirement for access to 24/7 cleaning on wards. There is no quantitative measure for the availability of isolation facilities. There is no specific requirement for the number of infection control nurses. There is no specific requirement for pre-admission screening before operations. There is no reference at all to post-discharge surveillance. There is no requirement to reduce excessive bed occupancy rates, although we know that there is a strong correlation between that factor and infection rates. There is no requirement for the comprehensive recording and reporting of infections in the terms recommended by the National Audit Office report of more than five years ago.
Although it has many other elements that are laudable in themselves, the code is not actually about outcomes or enforcing actions that we know will have effect. It is actually about processes and policies. Time and again, we have seen what the Government approach to infection control amounts to—a tick box to say that the policies are in place or that the appropriate processes are being undertaken, but too little emphasis on the actions that will make a difference. Patients have a right to know that action that has been demonstrated to work is being actively pursued within the NHS.
We need to know—I note that the Secretary of State refused to answer a question on this matter—that targets and financial pressures will not lead to the compromising of patient safety. We must be sure that the NHS is putting infection control at the forefront of its priorities because all the evidence now shows that that is at the forefront of the public's priorities. If it is to deliver, the draft code must be made stronger. The Government's draft code will not survive. At the moment, the Government propose not to supply us with the final code of practice, which would facilitate debate as the Bill passes through Parliament, but to delay it until after the Bill has been passed. That, frankly, is unacceptable to the House.
I am grateful to my hon. Friend for raising the issue of hospital-acquired infections. Does he agree that while many of us are worried about the uncleanliness of many of our local hospitals, it is a particular concern for vulnerable elderly patients, many of whom are now sadly frightened of going into hospital because of the infections they may pick up there?
I understand exactly the point that my hon. Friend makes and he is right. At the heart of what we need to achieve is an assurance that action will be taken by the NHS that delivers vastly improved infection control procedures across the board, so that our constituents are reassured. I have visited Kettering district general hospital and I know that it is a very good hospital, but—as my hon. Friend knows—the public need reassurance.
I shall give my hon. Friend an example of the kind of measures that need to be taken. We have pressed on the Government for a long time the need for more comprehensive recording of data on infections by clinical department. That is not only because that is the basis on which action should be taken inside a hospital, but because it provides more meaningful measures for those outside the hospital. For example, when I visited the Lister hospital in Stevenage, there was much local concern about the level of MRSA infections. When I talked to staff, it became clear that the hospital's problem was associated with the fact that as well as being a district general hospital it was also a regional centre of excellence for kidney dialysis. It had problems with access to operating theatre time and the extent to which patients on dialysis had to be catheterised, which led to infections. Those distinctions were not known and understood by the local public, because the one figure published by the Government showed that the hospital had a lot of MRSA. The public need to know what is really going on. Information is at the heart of the issue, but the Government continue to resist the National Audit Office's proper call for data to be published by clinical department.
In Scotland, over a 15-year period when the Conservatives were in power, compulsory competitive tendering and cuts in cleaning services led to the loss of 15,000 jobs. MRSA increased as the number of domestics in hospitals was reduced. At least this Government have faced up to a problem that the Conservatives denied was happening.
The hon. Gentleman should ask the Department of Health and the Secretary of State about that. The Department published a report that showed that there was no correlation between the contracting-out of cleaning services and the levels of infection. NHS hospitals with contracted-out cleaning are as likely to have high levels of infection as those with in-house cleaning. However, there is a correlation between the quality of cleaning and rates of infection, and that is why I mentioned the model cleaning contract. The code of practice should directly reflect the standards in the model cleaning contract.
The Government propose to legislate to transfer the responsibility and budgets for general ophthalmic services to PCTs, which raises three issues. First, why are the Government pre-empting the review of general ophthalmic services that is expected to report shortly? Would it not be more sensible to legislate after the review? It will be difficult, in the circumstances, for people to take seriously the Government's approach to the review. Secondly, the Secretary of State made the comparison with dental services, but that is exactly what people working in ophthalmic services are afraid of. How many letters of complaint have MPs had in recent years, before the publication of the Bill, about the quality of local ophthalmic services compared with the number of letters about quality of and access to dental services? Those figures tell the story. As with the 2003 legislation, the Government propose to legislate for a transfer of responsibility to primary care trusts. The National Audit Office made it clear that PCTs did not have the expertise to conduct the commissioning of dental services and still less, probably, do they have the expertise to conduct the commissioning of ophthalmic services.
What will PCTs do? Under current circumstances, in which—in the last financial year—91 PCTs broke their statutory duty to break even, they will be given an additional budget that they will use to try to offset their overall financial problems. People working in ophthalmic services are rightly worried that the consequence will be a reduction in quality and a reduction in access. From a Government who say that they are about choice, what will we have? A reduction in choice for patients, because it will no longer be true that those who are registered with the General Ophthalmic Council will automatically be able to supply services locally to NHS patients; that may be restricted by primary care trusts in ways that we cannot at the moment even anticipate.
Finally, the Secretary of State transferred from the Department of Trade and Industry, where she was previously responsible for competition policy, the issues relating to community pharmacies after the consequences of the review of control of entry regulations. I told her before, in that respect, that one needed to have regard to the health issues associated with maintaining community pharmacies—and I say it again. We should not underestimate the difficulties that might accrue if, in the course of this legislation, we were significantly to shift the balance of advantage towards the large stores with their new pharmacies, which are able to provide a service with relatively limited amounts of professional pharmacy cover. The pharmacists are concerned—and I share their concern—that we strike the right balance in the span of control of pharmacists and the responsibility that they take for the provision of services.
At my count, the Bill has nine issues. Perhaps I have not done justice to any of them, but we will do them all justice later in the Bill's passage. Most of it is a shell, into which regulations are intended to pour decisions. During its passage, we in Parliament should make a few decisions about what goes into it and what happens to our constituents. I hope that we shall do that in a substantive way in respect of smoking by striking out the Government's partial ban, and I leave it to my colleagues and those across the House, perhaps on a free vote, to determine what goes in its place.
I hope that we will get to hard outcomes and clear measures for reducing the impact of health care-associated infections. I hope that we will maintain choice in ophthalmic services, that we will give certainty to pharmacists and protect the profession, and that the Bill, while making progress, will be amended substantially during its passage. On the basis that I hope and expect that the House will amend the Bill, it is not my intention to ask my colleagues to divide against the Bill tonight.
rose—
Order. I remind the House that Mr. Speaker has placed a 10-minute limit on Back-Bench speeches, which operates from now.
I shall first declare an interest—I am a lay member of the General Medical Council. I have been very conscious in recent years of the events surrounding the deeds of Dr. Harold Shipman, so I want to start by commenting on the measures in the Bill that go some way to redress some of the issues that were found when the Shipman inquiry reported in July 2004 about the regulation of controlled drugs in the community.
The case of Harold Shipman was a very dark chapter in the history of doctors in this country. The fact that he was able to obtain such large quantities of controlled drugs, and the failure of the system to detect his inappropriate use of those drugs over many years, had to be not just found, but corrected if we are to ensure that, hopefully, it never happens again. Dame Janet Smith identified serious weaknesses in the system of regulation of controlled drugs and highlighted the need to introduce a number of changes to strengthen the system, while accepting—as I think we all must—that no system can be totally immune from fraud.
I congratulate the Government on clause 16, which relates to the appointment of accountable officers and provides details of their responsibilities. I understand that those new senior executive posts were proposed in Dame Janet's fourth report, although the report uses the term "proper officer" rather than "accountable officer". Under clause 16, accountable officers will have overall responsibility for the management and use of controlled drugs in such organisations, as well as the arrangements for the audit, inspection and training of staff who work with controlled drugs, thereby ensuring better patient safety than in the past.
Dame Janet concluded that the control of such drugs should be passed to the Royal Pharmaceutical Society, yet clause 18 refers to a constable or other officer being responsible. Do you think that that point needs clarification? Does my right hon. Friend agree that that needs to be brought out properly before the Bill is passed?
Order. There were two things wrong with that intervention: first, the hon. Gentleman used the second person when he should not have done so; and secondly, most of his remarks were not addressed to the Chair.
I will leave clause 18 to my hon. Friend the Minister, who may talk about that issue. I am more concerned about the fact that health trusts other than strategic health authorities will have someone specifically responsible for such drugs. That is the most important thing, no matter who in the system does it.
I am concerned that the hon. Member for South Cambridgeshire (Mr. Lansley) talked about the weakness of the codes that are likely to come into being to protect us from health-care acquired infections. I may be wrong, but I thought that he said that the draft code was not good enough, but that he had not seen it. That seems a bit of a jump that should be addressed. I understand that the Bill will give the Secretary of State the power to provide a statutory code of practice and to place a duty on NHS bodies to comply with that code, as well as the power for the Healthcare Commission to issue improvement notices to non-compliant bodies. I spoke to Healthcare Commission representatives at a meeting yesterday and they want the Bill to ensure that that can happen. They also want the existing intervention powers of the Secretary of State and Monitor—the Independent Regulator of NHS Foundation Trusts—to be used to take enforcement action.
I will certainly give way to the hon. Gentleman, but I would have thought that he was reasonably happy with that aspect of the Bill. Given that that seems to be the only health policy on which the Conservative party fought the last general election, I would have thought that Conservative Members were cock-a-hoop about the fact that what they said that they would do with health care within about 12 to 18 months of winning a general election has been done.
For the purposes of accuracy, I did not say that I had not seen the code of practice on health care-associated infections, but simply that the Government consulted in July on a draft that struck me as deficient and that they are not proposing to show us a new code, following the consultation, until after the Bill has completed its passage.
I misheard the hon. Gentleman.
I want to move on to the aspect of the Bill that is more contentious. I am very conscious of the fact that I am the Chairman of the Select Committee on Health, which is investigating smoking in public places. The Select Committee has not yet reported to the House, so I want to limit my remarks to the three evidence sessions on 20 October and 17 and 24 November, which are marked on today's Order Paper as relevant to the debate on Second Reading.
The Government's intention to exempt drink-only pubs and membership clubs has inevitably caused frustration and anger, not just among the health community but in large sections of the leisure industry that did not want to ban smoking in the first place, but would now prefer a comprehensive ban as that would create a level playing field for them. They do not want to have to consider whether or not they should get out of food and into drink only, given that some sort of ban will be introduced under the Bill.
During a number of evidence sessions, I talked about my apprenticeship as a young man drinking in South Yorkshire pubs. They were largely full of smoke and men and there was little food beyond a packet of crisps. I hope that that culture has changed in many of those public houses, which I sometimes frequent, and that food and families can be seen in them. They are a lot better than they were in years gone by. I would hate to think that we were going to reverse that change in the culture of drinking in our public houses by introducing a Bill that was not specific.
Does the right hon. Gentleman agree that it is more than likely that pubs serving grub will eventually give up food and that massive redundancies will therefore take place in the catering trade?
I am not too sure whether that is the lesson of the Irish Republic. None the less, there is a danger, and no one knows what will happen on day one if exemptions are granted in the way that the Government propose.
The Health Committee has obviously considered enforcement. Under the Government's proposals, enforcement will be more difficult to achieve, more open to misinterpretation and more costly than under a comprehensive ban. The Health Committee went to Ireland for two days, and one thing that jumped out at us when we talked to people there is that the ban was enforced by people who used the pubs, not by people who work in them or own them, or by people whose duty it is to visit pubs occasionally to ensure that they are run properly. The people who went into the pubs had the opportunity to complain if their pubs were not meeting the requirements set down by their legislation.
Of course, another issue that has been touched on several times in the debate is health inequalities. Exempt pubs and clubs are more likely to be found in areas where health inequalities already exist. The current proposals are likely to work against meeting the Government's targets. My right hon. Friend the Secretary of State, who is not in her place, said in her opening address that health inequality targets are central to Government policy. Some of the information received by the Health Committee would suggest that the proposed exemptions will not help to reduce health inequalities.
Most Members have received correspondence from the Local Government Association, whose research shows that in Newcastle 47 per cent. of pubs and clubs would be exempt; in Northamptonshire, 54 per cent. would be exempt; and in Corby, the figure is as high as 85 per cent. Not every pub in my constituency has changed the culture in the way that I explained earlier, and quite a large number of pubs and clubs that are on the wrong end of health inequalities will suffer if the proposal is introduced unchanged.
Does my right hon. Friend agree that by exempting bars that do not serve food, young people will be particularly at risk? Certainly, in many city-centre pubs in Cardiff, young people tend to stand in big groups, drinking without food. Would not such an exemption be very dangerous?
It is likely to be very dangerous, but I do not want to go into all the issues about drinking. I see that the clock is ticking away and I do not know whether I have any added time for interventions this afternoon, so I will move on very quickly to what I want to say.
Listening to the Government's arguments, one of the conclusions that I reach—it may be that no one else, including the Health Committee, reaches this conclusion—is that the Government do not want to introduce a complete ban because they believe that it is unpopular. I think that they are wrong. I beg to differ with them. I will briefly look at two issues. First, hon. Members will know that the Office for National Statistics conducts an annual smoking-related behaviour and attitude survey. In the autumn of 2003, 20 per cent. of people believed that no smoking should be allowed anywhere and 51 per cent. believed that there should be mainly no smoking, but that there should be separate areas where smoking could take place. In the autumn of 2004, those figures had changed to 31 per cent. and 47 per cent. respectively. The fact that the second figure had dropped a bit is understandable.
Action on Smoking and Health got YouGov to do the same survey in August 2005. First, people were asked the straight question that the ONS asks in its surveys. It found that 41 per cent. of people believed that no smoking should be allowed anywhere in places they visit when they go out, while 39 per cent. of people believed that there should be separate smoking areas. YouGov then told people about the science of secondary smoking before asking the question again, and found that the proportion of people who said that they would ban smoking in all public places rose to 52 per cent. The evidence shows what has happened in other parts of the world where a ban has been brought in, so I would like to think that we could act a bit more strongly.
Will the right hon. Gentleman give way?
No, I will not give way again.
The Health Committee and I did an experiment with "You and Yours", the well-known and popular Radio 4 programme. I went on the programme the other week and did a half-hour phone-in. A mixture of people phoned in and all the evidence from the letters and e-mails that the programme received was collated. Some 60 per cent. of listeners—626 people—said that there should be a complete ban.
All I want to say is that what can happen in the rest of the UK should happen in England as well. It is inequitable and I find it—
Order. The right hon. Gentleman has had his allocation.
It is a pleasure to follow the Chair of the Select Committee, the right hon. Member for Rother Valley (Mr. Barron), who made a thoughtful and well-informed speech. His and his colleagues' evidence sessions have informed our debate, so it is a shame that the Secretary of State had a higher priority than listening to what he had to say.
I congratulate the Secretary of State and the Government on consulting extensively and listening to what they heard. We cannot deny that the Government consulted the right hon. Member for Airdrie and Shotts (John Reid) and listened to him. They have done what he asked them to do, so they were consulting and listening. They did not listen to what 90 per cent. of the public wanted, but the right hon. Gentleman is obviously the person who counts.
The priority for Liberal Democrats is the freedom of people to work in a smoke-free environment. As far as I am concerned, this is an issue about the health and safety of employees in England. The health and safety of employees of England is just as important as that of employees in Scotland, Wales, and north and southern Ireland.
I can cite examples of what has happened around the world. I want to take you, Mr. Deputy Speaker—albeit not literally—to the land of the free. No fewer than 300 cities and seven states in the United States have a total ban. Since a ban was introduced in California in 1998, the respiratory health of bartenders has significantly improved. That shows the point of the exercise and where we are coming from. After a six-month trial in Montana, there was a 40 per cent. drop in hospital admissions due to heart attacks. People who are sceptical about the evidence should look at what is actually happening on the ground.
There are those who say, "You may be worried about the welfare of workers, but it is their choice because they can choose to work in a smoky bar or somewhere else." However, if asbestos was found in the roof of a bar, people would not say, "You don't have to work there—go somewhere else." We would say, "It's bad for your health, so we'll do something about it." The onus should be on the workplace to be good for the health of the people who work there and not to harm it.
I am listening carefully to the hon. Gentleman, as I do to all his speeches. However, if we were to follow his point to its logical conclusion, we could not allow people to work down coal mines. I am not aware that the Government are going to introduce a ban on that.
Because you closed them all.
Yes, the hon. Gentleman and his colleagues went a long way towards achieving that. I draw a distinction between avoidable and unavoidable risk. Being exposed to second-hand smoke is not an inherent part of working behind a bar, so we can, and should, do something about that.
I want to say a word or two about the two major exemptions. As several hon. Members have eloquently said about the exemption for food, there is no logical basis for saying that whether food is served has anything to do with whether second-hand smoke is bad for people. As far as I understand it, people may smoke if pork scratchings are served, but if pork chops are served, they may not. If pork sandwiches are served, it might depend on where they were cooked, whether they were hot or cold, and whether they were brought on to the premises. Nothing in the exemption has anything to do with the welfare of people working in pubs. It is entirely irrational.
Allowing people in so-called wet pubs—I have never quite followed that phrase—to be exposed to second-hand smoke seems to be in conflict with a recent campaign of which I have become aware. The campaign is an attempt to raise awareness of something called the "invisible killer". There will be adverts to
"highlight the fact that 'Secondhand smoke is a killer'".
One of the main advocates of the campaign says:
"smokers and non-smokers don't appreciate the full dangers of secondhand smoke. Tobacco smoke contains around 4,000 different chemicals, including . . . 50 known cancer-causing substances, such as arsenic, formaldehyde and ammonia".
The campaign is, of course, the Department of Health's. The person who gave that evidence was the Under-Secretary of State for Health, the hon. Member for Don Valley (Caroline Flint), who will wind up the debate. The NHS campaign was launched on the Department's website this autumn. How can the Department cite all these terrible things about second-hand smoke, which are true, yet say that it is all right for people who work in pubs that do not serve food to breathe it in? I do not understand how the Minister can simultaneously hold those two opinions.
I want to warn the House about the rise of death burger. Many of us who went to university will remember the burger vans that used to ply people on the high streets and what their products used to do to our health. If people can smoke in pubs provided that no food is served there, there will be an explosion—if that is the right word—of death burgers. Burger vans will park outside pubs, and people who want to smoke and eat will go out of the pub to buy a burger and quite possibly bring it back into the pub to eat it. As the burger would not have been provided on the premises, that would be no problem. Such people would get a triple whammy. They could go out to drink, nip outside for a burger and go back into the pub and smoke. The Department of Health is approving that behaviour, so I think that we are missing the point.
It is not only the exemption for food that is irrational, but the link between that exemption and the alcohol policy. It is clear that pubs that serve only a bit of food and do not make much money from that will stop serving food altogether. We will see more of what is inaccurately called vertical drinking—I have never quite understood why it is called that. There will be more pubs in which people will stand and drink, rather than sit and eat. All the concerns about alcohol abuse will increase.
May I assist the hon. Gentleman? He says that it is difficult to define food and to determine whether a particular type of food constitutes cooked food. I met one of my constituency's publicans at a public meeting last night who made the interesting point that beer, by definition, is a food. Does that not rather confuse the situation under the Bill because any pub that sells beer will technically be selling food?
I had not considered that point, but I am glad that the hon. Gentleman is keeping in close contact with his local publicans, as ever.
I have a further worry, which I have not really thought through, about the exemption's link with alcohol policy. Given the extension of licensing hours—we do not necessarily need to be talking about 24-hour licensing—the situation for bar staff will get worse. If licensing hours are longer, they will be exposed to second-hand smoke for longer. The case for doing something about that, which is the case against an exemption, thus becomes more pressing.
I think that we understand the hon. Gentleman's position on smoking tobacco. I hope that he will comment on his party's position on smoking cannabis. There appears to be some confusion about why he is focusing on smoking tobacco, but ignoring cannabis.
The hon. Gentleman's comment gives rise to the interesting point that enforcement will be difficult if what is being smoked effectively has to be inspected. Some environmental health officers argue that if we stick strictly to addressing tobacco products, people could always claim that they were smoking something else, which would mean that an investigation of what was being smoked would be required. A broader definition of smoking could thus make enforcement action easier.
The exemption for private members' clubs also makes no sense. As the hon. Member for South Cambridgeshire (Mr. Lansley) accepted, that exemption will increase health inequalities. Again, we must ask why the health and welfare of people working in private members' clubs is less important than that of other people. What can the Minister say about the danger of "The Rose and Crown" becoming a private members' club, which would allow people to circumvent the ban by becoming members of "The Rose and Crown"? It would not be beyond the wit of a landlord to circumvent the ban by setting up a membership scheme. How can a ban that is full of exemptions that allow it to be circumvented so easily be worth the paper that it is printed on?
There is an instance of that in my constituency, where one pub is considering redesignating itself as a membership club. Does my hon. Friend agree that one of the perverse results of such a potentially powerful ban is that establishments will market themselves as smoker friendly, thereby undermining much of the health promotion activity in recent years?
My hon. Friend helpfully illustrates my point. The ban will be easy to circumvent and therefore possibly ineffective.
The issue of unfair competition may appeal to Conservative Members. With a partial ban, which the hon. Member for South Cambridgeshire seems to support, a private membership club can have smoking, but that may not be possible for the pub down the road. If they are the only two establishments in a town, the private membership club has an unfair advantage over the pub, which is covered by different and broader legislation. That is unfair competition. It is neither logical nor fair.
There is another problem with the partial ban. A disabled person—registered or not; it does not matter—who has a debilitating respiratory disease may feel entitled to use measures in the Disability Discrimination Act 1995 and take a case against a landlord or licensee who enables smokers to use their premises. The disabled person may feel discriminated against by not being able to use those premises because it could further damage their health. Does the hon. Gentleman agree with that assessment?
That possibility has been raised in the context of employment rights. Provided that there continue to be smoking pubs, a disabled person who might otherwise be able to work in a smoke-free environment will be effectively debarred from applying for a job in those pubs. The implications for people who have those sorts of disabilities need to be considered.
We touched on health inequalities. There is a danger that we think of the problem as a north-south issue, but even in relatively prosperous areas it is clear that the inequalities in health will be exacerbated by the Bill. My director of public health in south Gloucestershire—a relatively prosperous area—tabulated the pubs that do and do not serve food across the authority. The director found that all the pubs in the most prosperous fifth serve food, but 41 per cent. of the so-called wet pubs are in the poorest fifth of the area. So the partial ban will increase inequalities within areas and between areas, not just across the country as a whole.
I draw my hon. Friend's attention to the initiative undertaken recently by Smoke Free Bristol. The city is next to south Gloucestershire. It found that only 12 per cent. of people in the Henleaze ward in my constituency smoke. However, just a quarter of a mile away in the Southmead ward in the constituency of the hon. Member for Bristol, North-West (Dr. Naysmith), smoking is at nearly 50 per cent. Those health inequalities, in a relatively small area, will be perpetuated and expanded if the Bill goes through.
My hon. Friend is right. For the Government to say that tackling health inequalities is a key priority and then to put in place a measure that will make them worse does not stack up. When they launched the embarrassing statistics in the summer that showed that health inequalities had risen under them, the answer was, "We have these things called spearhead primary care trusts, which deal particularly with deprived areas." When the spearhead PCTs responded to the consultation, they said:
"Many spearhead PCTs suggest that the proposed legislation will make it harder for them to meet their targets on health inequalities".
In reflecting on the comment on conflicting targets, we have one bit of the Government setting targets for relatively deprived areas to reduce inequality while another bit of the same Department is making it harder for them to reduce inequality.
We have heard, and the Health Select Committee was advised in its oral evidence, that enforcement is more difficult with a partial ban. Presumably, I will have to go up to the bar and ask the barmaid whether she sells pre-packaged ambient shelf-stable snacks before I can decide whether to light up. That is the criterion. It is absurd to have separate categories. We heard about Ireland, and if the other customers do the enforcement, they need to be clear about the legislation. If a place serves food at lunchtime but not in the evening, a customer who uses it in the evening is supposed to know that to determine whether he can smoke.
I notice that the Minister is trying to be helpful by saying, from a sedentary position, that signs will help people in such circumstances. May I relate my experience as a director of the Watershed Media Centre in Bristol? We tried to ban smoking from a large part of the café bar by, at one time, placing signs on every table. As there is a mix of where people can and cannot smoke, people use the element of doubt to ignore the signs and carry on smoking. Signs are not always the right answer.
My hon. Friend is right. Essentially, we are partly talking about a cultural shift towards smoke-free workplaces. That message will be hampered by the phased introduction of the Bill and by different rules for different establishments. The picture will be confusing and will not make a clear statement about the rights of the people who work in such environments.
On phasing, there will be confusion if certain establishments have a ban first, if others follow on later and if some are not covered by the legislation. The Secretary of State said that she expects a total ban and that we will get there eventually. We heard that the chief medical officer used the phrase to the Select Committee about states around Europe and beyond falling like dominoes towards a total ban. The Secretary of State said that the people who introduced total bans often did so in stages, but in many cases they realised that it was unworkable to do it partially and got on with it. Why do we have to repeat their mistakes?
The Chairman of the Select Committee, the right hon. Member for Rother Valley, put his finger on it when he said that the Government have not introduced a total ban because they are afraid. They are afraid to lead public opinion and want to follow it. We need a courageous visionary Government, who are willing to take the lead and set an example. I imagine that the full ban will come into effect and, two or three years later, no one will conceive of turning the clock back.
Does my hon. Friend acknowledge the research by groups such as Action on Smoking and Health which recognises that four in five smokers wish that they did not smoke? We are talking largely about liberty and freedom. Many people think that an addiction is an encumbrance on their freedom and would welcome the opportunity to go to work or to a social setting where smoking is not rammed down their throat and temptation is removed.
My hon. Friend makes an interesting point about the liberty argument, which our party considered. We are primarily concerned with the liberty of those who work in such environments, but where addiction is involved, we may, in many cases, going with the grain. Individuals who want to give up but who have found it difficult might appreciate such a measure. It is not patronising or nannying. It could assist people to do something that they want to do. Perhaps the most appropriate day to introduce the ban is 1 January, although midnight might create operational problems if everyone had to stub out their cigarettes halfway through the evening. Noon on 1 January might be a better time because it would assist those who want to make a new year's resolution to follow the grain of that decision.
I asked the Secretary of State what she had said to the Cabinet and did not get the straightest of answers. However, we are reliably informed that she pressed for a total ban. If she wants that, then I agree with her. However, it means that her argument that the Labour manifesto said that there would be only a fudgy ban falls down. If she pressed to go beyond that, how did she justify going beyond the terms of the manifesto? She did so because it was right and the best policy to adopt. On smoking, the Westminster Government have got it right, but only for Northern Ireland, where there is a total ban. How, therefore, can they adopt a different approach for England? I can see nothing about the situation in Northern Ireland that would warrant its workers having a different level of protection from those in England.
The Bill deals with other important subjects. On health care-acquired infections, a group of people who had been bereaved by MRSA held a lobby yesterday. That group—MRSA Action UK—presented a petition to Downing street. I think hon. Members on both sides of the House joined them. I laid a wreath with them at Westminster abbey in commemoration of their friends, relatives and loved ones who had died.
One thing that the group is calling for is mandatory national reporting of all health care-acquired infections, which we do not have. The estimate is that only 6 per cent. of all infections have to be reported. That relates to bloodstream MRSA only—not all cases of MRSA have to be reported. I hope that the Minister explains why there is not more mandatory national reporting. The scale of the problem is immense and although we heard reassuring words from the Secretary of State about the progress that is being made, across Europe we have one of the worst rates of Staphylococcus aureus infection. It is about 40 per cent. in the UK—one of the highest in Europe—and the right hon. Lady's reassurances were complacent on that front. Having met relatives of those who have died from MRSA, I urge her to listen carefully to what they say and to take much more serious steps.
I echo the question of the Public Accounts Committee—how can the 80 per cent. or so of infections not covered by the Department's mandatory surveillance programme be measured and managed? If they have not even been reported, how does the Department of Health know what is going on?
We have already heard about things that can be done to tackle infection and about infection control. As for bed occupancy rates, my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) pressed the Secretary of State on what trusts will do if they have two conflicting targets. The answer was "Meet both". I accept that that is the ideal solution, but what if one target conflicts with the other? As the hon. Member for South Cambridgeshire rightly said, what if there is pressure to close a ward because of infection, but that decision is overruled by the trust managers? There is nothing in the Bill to prevent such conflicts, so the Government must make it clear that infection control is a priority.
The right hon. Member for Rother Valley, the Chair of the Health Select Committee, spoke about the Shipman inquiry, and said that the Bill will improve current practices, which we welcome.
The Bill includes some worrying provisions on ophthalmology. All I can say is that if dentistry is the precedent, heaven help us. If access to ophthalmology services is cash-limited and restricted, as Opposition Members have said, many of our constituents will be concerned. The Bill was originally to be called the Health Improvement and Protection Bill. The Government dropped the words "Health Improvement" and "Protection", because this is a missed opportunity to do far more of both.
I should like to make one or two simple points.
Smoking in enclosed spaces kills people. It kills smokers themselves, and it kills non-smokers who inhale second-hand smoke. It is obviously a good idea to try to stop people smoking in enclosed public spaces if possible. There is no longer any "if" about it, however, as we know that it can be done. Smoking in enclosed public spaces has been banned in Ireland, where the sanction has proved both workable and enforceable. It has stopped people inhaling second-hand smoke, and it has helped smokers to give up. Fewer cigarettes are being sold in Ireland, and fewer people are smoking. The ban in the Irish Republic has been so successful that our Government are to introduce a total ban in Northern Ireland. Having checked with the Clerks, I believe that that will require a vote in the House before it can be brought into effect. The Scottish Parliament is introducing a similar ban in Scotland, and the Welsh Assembly intends to use the measure to do the same thing.
Will the right hon. Gentleman give way?
No, I would like to make progress, as other hon. Members would like to make a contribution.
The Government want only a partial ban in England. Smoking is to be banned where food is sold, but it will not be banned where food is not sold. Pubs, clubs and bars serving booze but not food are mainly located in poor neighbourhoods, and serve working-class people, so the partial ban will be good for the health of middle-class people but bad for the health of working-class people, who are ill more often and die sooner than the middle classes. The partial ban introduced by the Labour Government will widen the health gap between the social groups. No one has mentioned the fact that the partial ban will concentrate smokers and smoke in pubs where smoking is permitted, because smokers will move to them from places where smoking is banned. The partial ban will therefore make the situation worse for people in those pubs. It is hard to believe that a Labour Government are knowingly widening the health gap.
Smoking is one of the major causes of the health gap. Headlines in two Sunday papers said "Glasgow is Britain's smoking capital" and "Glasgow people have the shortest lifespan". There is a clear connection between smoking and early mortality, as has been pointed out by the chief medical officer in his advice to the Government and in his public statements. Professor Sir Liam Donaldson believes that there should be an outright ban, but the Government have decided to ignore his professional advice. It is his job to try to promote good health, but the Government have ignored his advice, just as they have ignored the advice of the distinguished doctor, Professor Dame Carol Black, president of the Royal College of Physicians, who also gave evidence on the matter.
The Government proposals are half-baked and half-hearted, without any merit at all. Most members of the catering trade take the same view, and they would rather have no ban or a full ban, because half a ban is a great deal of trouble for them. The environmental health officers responsible for enforcing the measure believe that a half-ban is unworkable and difficult to enforce. Under the measure, smoking in bar "areas" will be prohibited. What is the bar area? I represent an enormous number of lawyers, and I am sure that they have spotted that wording in the Bill. Some establishments that do not serve food consist only of a bar. Hon. Members may not visit such places, but they exist, so I think that the lawyers will do well. If anyone thinks that they can make a distinction between one part of a room that does not have any smoke and another part that does, they should have tried flying Iberia when the airline banned smoking on one side of the aisle, but permitted it on the other. That ban did not work very well.
May I tell my hon. Friend the Minister, who has the task of defending the Government's policy, that Professor Alex Markham, the chief executive of Cancer Research UK said yesterday that the Government had a huge number of achievements in tackling cancer to their credit. They have quite a few achievements in promoting the reduction of smoking and helping people to stop smoking, thus reducing the incidence of cancer and improving recovery rates. We should not be distracted and throw that credit away by coming up with this half-cocked measure.
We have had many debates in the House in the past few years about weapons of mass destruction. The worldwide weapon of mass destruction is the cigarette, which has killed more people than all the weapons, bombs, mines and bullets since the second world war, far exceeding anything that we have managed to do by trying to blow one another up or to shoot one another. In our country alone, it kills more than 100,000 people every year, but we are giving up an opportunity to make progress.
Finally, last year, I had the singular pleasure of speaking on the same platform in Edinburgh as Sir Richard Doll who, in his 90s, made a fine speech about his initial work to identify the link between smoking and cancer. I made the people present, who were from across Europe, stand in honour of a man who had saved millions of lives. We seldom meet people who save millions of lives, but he has left us an enormous legacy—a better legacy than most politicians are likely to leave, I might add. It would not be a bad addition to his legacy to persuade the Government to introduce an outright ban instead of a partial ban that will not do any good. It will not be enforceable. That partial ban should be avoided by a Labour Government who, as the Secretary of State has said, are dedicated to reducing social and health inequalities, because it will serve to do nothing but increase them.
I agreed with two things that the right hon. Member for Holborn and St. Pancras (Frank Dobson) said. The first is that we all owe a great debt to Sir Richard Doll, and I am sure that the right hon. Gentleman spoke for the whole House in what he said on that subject. Secondly, the Government's policy on the subject of statutory smoking bans is, in the right hon. Gentleman's opinion and in mine, half-baked and unenforceable. The difference between us is that, unlike the right hon. Gentleman and the hon. Member for Northavon (Steve Webb), who both draw from that the conclusion that we should proceed to an outright ban, I shall speak against the principle of statutory smoking bans.
I do so, as the House is aware, as a former Secretary of State for Health. It would have been an unpopular argument for a Secretary of State for Health in office to advance. I also do it from a personal point of view, as a lifelong non-smoker and somebody who has a deep dislike of smoky atmospheres—so much so that when I go into a pub that has a smoky atmosphere, I go out again, because I do not like it. That is my freedom as an individual, and it is that freedom which lies at the base of my remarks.
As Secretary of State, I of course received advice from the chief medical officer, and successive chief medical officers have argued in favour of statutory action against smoking. I also met many, many clinical staff who were emotionally committed to the principle that it was part of the Government's job to tilt the system more heavily against smokers. However, we should not proceed on the basis of the Government's half-baked proposal, and still less in the direction that the right hon. Member for Holborn and St. Pancras and the hon. Member for Northavon advocate. I shall set out briefly why.
At root, my reason is that, like my hon. Friend the Member for Witney (Mr. Cameron), I have always described myself as a liberal Conservative. By that I mean, among other things, that I think it is part of our job in this place to defend private space against the well-meaning aspirations of a well-meaning state. I have no doubt that the clinicians who argue for statutory smoking bans do so for the very best of motives. I accord to the Secretary of State and to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who argued from the Opposition Front Bench for a different form of compromise, the best of intentions, but sometimes we in this place should defend private space, particularly the private space of unfashionable minorities, among whom we should now number smokers.
Against that background, I shall go through the arguments that are used to justify the proposals for smoking bans. First—this is the weakest argument of all, which, with respect to him, was advanced by an hon. Member from the Liberal Benches—there are those who say, "It will help me give up smoking". It is not a safe guide for public policy to legislate to encourage somebody to do something that they want to do for their own private benefit. Of course, as a private citizen, one to another, I would encourage people to give up smoking. As a result of the work of Sir Richard Doll and his successors, we all acknowledge that smoking causes cancer and therefore premature death. We should not be mealy-mouthed about that, but we should not use the power vested in us as legislators to impose on people a private benefit that they may wish for themselves, but which they apparently cannot deliver for themselves without legislative backing. That is no basis for public policy.
Is not the right hon. Gentleman guilty of not giving due balance to the right of the non-smoker and of classifying a space as private when, in fact, it is public? We are speaking about balancing liberties. As a liberal Conservative, surely he recognises that some liberties encroach upon the liberties of others and should therefore be curtailed.
I shall come on, if I may, to that argument. I was trying to respond specifically to the argument that "a ban on smoking will help me give it up", which I do not think is a guide to policy.
When the right hon. Gentleman was Secretary of State for Health, he did not spend anywhere near the amount of money that the present Government have spent on smoking cessation. Ireland had a smoking prevalence of one in three before the ban. After 18 months of the ban, the smoking prevalence is one in four. Does the right hon. Gentleman agree that there is a lot to be gained from taking such action—not banning smoking, but banning it in places such as pubs and clubs?
I shall make two points in reply to that. First, during our years in government, tobacco consumption fell, and I think I am right in saying that it is starting to rise now, particularly among teenage girls. Secondly, the argument that if we deliver a reduced level of smoking, we deliver a public health gain is transparently true; that is not in dispute. The question is whether that is a basis for legislative action. That is the second argument that I shall come to.
I shall give way once more, then I shall make progress.
In his liberal Conservatism, the right hon. Gentleman—who usually talks more sense than he is talking now—predicates his entire argument on the idea that smokers can come to a voluntary decision. They are smokers because they are addicts, and we owe it to addicts to help them break their addiction.
I do not agree with that argument. There are very few people, if any, who are clinically unable to give up smoking. I entirely accept that it is difficult, but the right hon. Gentleman needs to be careful of that argument. He is in danger of saying that the people of whom he spoke, in low-income and disadvantaged groups, are unable to make on their own behalf decisions which, from the level of tobacco consumption, one can see that better off people have made. That is not true and it is a patronising argument for us even tacitly to endorse.
The next argument is closely allied to the argument that a ban will help people give up smoking. It is the argument behind public health targets related to tobacco consumption. As Secretary of State for Health, I was always uneasy about public health targets that could be delivered not as a result of Government action, not as a result of collective action, but only as a result of private decisions by private citizens. It is not a proper basis for public policy to introduce a measure that I find objectionable for the reasons that I am describing, in order to deliver some public health objective about reducing tobacco consumption, which can be delivered only by private citizens making a private choice about their own private behaviour. The job of the public health Minister is to use resources in a way that is targeted at health need, but always to understand that private citizens should be free to make their own decisions about the way they lead their lives.
The third argument that is advanced is that we should introduce a smoking ban in order to create a more pleasant environment for people like me who do not like going into smoky pubs—again, not a good guide for public policy, and not a reason for compulsion, though a very strong reason for individual publicans and restaurateurs to introduce no-smoking policies in their establishments, which attract people like me and presumably do not attract those who want to go in and be able to smoke.
On the final argument, it was interesting that the hon. Member for Northavon rested his argument in favour of a smoking ban almost exclusively on the grounds of a safer working environment. All around the country, employers and employees have for a generation been agreeing no-smoking policies in their establishments, without the assistance of the Government. I applaud that. In my own business we operate a no-smoking policy because that is the decision that the individuals on the sites have collectively reached. I do not believe that a ban should be imposed from here, because individual employers and employees should be free to decide the matter for themselves.
In addition to the public health driver that explicitly informs smoking bans, there is a strong whiff of political correctness—we know the scientific facts and what is good for the people who send us here. Our righteousness is reinforced when we present that argument, because we can quote scientific evidence to support our assertions of what is good for people. We then make the fatal leap—this is where I part company from the prevailing majority—that because we know how people could better lead their lives from a health point of view, we should use our available powers to lead them to do things that they would not choose to do for themselves.
The Prime Minister is fond of talking about respect, and he is dead right when he says that we should learn better to respect each other. We should understand, for example, that two adult citizens in a free society—this is almost the definition of a free society—can look at the same set of facts, come to two diametrically opposite conclusions and both be right. We will have learned the real meaning of respect when we respect the conclusions that other people reach when they are presented with the same facts as us, but reach opposite conclusions.
I have the greatest respect for medical officers, and when the right hon. Member for Charnwood (Mr. Dorrell) was responsible for the health service, a substantial body of medical opinion called for bans such as those in the Bill. I congratulate the Government on going so far with what will hopefully be a landmark Bill on smoking. After 18 years of Tory Government, we should now make as much progress as possible.
The Bill could have gone much further than a partial ban on smoking. As I said in an intervention, my greatest concern is what the Bill will do for health inequalities. That concern is shared by not only Sir Liam Donaldson in his evidence to the Health Committee, but many other distinguished people. The Under-Secretary of State for Health, my hon. Friend the Member for Don Valley (Caroline Flint), who has responsibility for public health, must satisfy herself that the Government are dealing with health inequalities.
My primary care trust, which is a spearhead trust, is getting extra money to deal with health inequalities—the increase is some 9.4 per cent. this year and 8.4 per cent. next year. We do not want legislation that makes the matter worse, and the more that I look at the evidence and the situation on the ground—I speak as an ex-smoker—the more I believe that the Government should use the time between now and Royal Assent to make sure that they are doing everything that they can to reduce health inequalities. The issue concerns changing behaviour, because nothing can be done by legislation alone. It involves hearts and minds as well as legislation, and properly trained enforcement officers will be important, too.
I was interested in the contribution by my right hon. Friend the Member for Rother Valley (Mr. Barron), who is Chairman of the Health Committee. On 24 November, the Committee took evidence from the Chartered Institute of Environmental Health, of which I am vice-president. In its comments, the CIEH makes it clear that it strongly opposes the proposed exemptions for pubs and clubs that do not serve food. The CIEH position is that all workers should be afforded an equal level of protection.
I have this to say to hon. Members who have already spoken: we are not discussing private places; we are discussing public places. There is no justification for exempting premises where workers are exposed to the greatest risk. The CIEH believes that its members will face the serious ethical issue whether it is professionally acceptable to participate in the enforcement of a law that unjustifiably fails to protect whole categories of vulnerable people and may be open to subsequent challenges under human rights legislation. I urge my hon. Friend the Minister to speak to those who will enforce the legislation.
I know that time is limited and that many other hon. Members want to speak. In the short time remaining, I shall refer to the issues that concern my local spearhead PCT. Smoking is the single most important cause of illness and death in Stoke-on-Trent, where it kills more than 450 people each year. Are we sure that it is right to leave the most vulnerable workers at risk from the dangers posed by breathing other people's tobacco smoke?
Exposure to second-hand tobacco smoke has been linked to lung cancer and heart disease since the 1980s, when many people started to campaign to bring about a ban on smoking. In my constituency, 64 per cent. of licensed premises do not serve food and will therefore be exempt from the smoke-free legislation. In the most deprived wards, however, 84 per cent. of pubs will be exempt, leaving both workers and the community at risk and contributing to the social acceptability and normalisation of smoking within those communities. Moreover, the PCT in Stoke-on-Trent and I believe that two out of every three smokers who want to quit are hindered by the environments in which they socialise.
Hon. Members have already covered many aspects of the debate. I shall briefly refer to the views of Charles Pantin, a consultant physician at the University hospital of north Staffordshire. He has written to me setting out the medical evidence on the risks to health from second-hand smoke, including the links to heart disease, asthma, reduced lung function, chest discomfort and all other associated illnesses.
This is a momentous opportunity for the Government to make a positive impact on smoke-free workplaces. We must make sure that we are doing everything that we can to help those who want to quit to do so and to prevent people from starting to smoke. This two-tier legislation does not send a simple, concise message. The Bill should contain a comprehensive, simple law to end smoking in the workplace. I urge the Minister to examine carefully the concerns raised by those hon. Members who want to see more being done to reduce health inequalities.
My two least favourite words in the political lexicon are "modernisation" and "prohibition". When I looked through the Bill, I found that although the first of those is, happily, not present, the second one, sadly, is—right up front. I also found that "regulations" occurs 18 times, "offence" occurs 20 times, and "enforcement" occurs 10 times. In schedule 1, "penalty" occurs 19 times, "offence" six times and "enforcement" three times. What have we come to, that we are being asked to take this approach in order to do what many people see as the right way forward?
I very much agree with the approach taken by my right hon. Friend the Member for Charnwood (Mr. Dorrell), who succinctly set out the case that is in danger of going by default in this debate: in a mature, informed society, we should surely leave individuals as much opportunity as possible to exercise their choice and discretion. That should be informed, of course. There is a duty on the Government of the day, and on us, to do what we can to inform people about the risks that they may be taking in terms of their health and safety.
Does the right hon. Gentleman agree that the logic of his position is that he would legalise class A drugs?
The policy on drugs has been such an overwhelming failure until now that it is time that we had the courage to look at the issue properly, instead of being afraid of it and cringing from it. That is for another day, however. I shall happily engage in a debate on that subject with the hon. Gentleman, but not here.
I would certainly want to push as far as I could the freedom of adult, informed individuals to decide what they do with their bodies, and indeed with and between each other. That is my preference. I always recoil when I have presented to me proposed legislation that seeks to impose on a large number of people the wishes of experts or politicians, because that is not why I came into politics or why I am here.
Another irony is that all of us, in all political parties, pay lip service to local community decision making. I agree with that. However, when we are faced with it as a reality, we tend to recoil from it and resort to centralised decision making and imposition. My solution is that we should encourage workplace decision making of the kind that my right hon. Friend the Member for Charnwood mentioned. I see no reason why proprietors and work forces in offices, factories, restaurants and pubs should not be able to get together to make their own decisions about whether their premises should allow smoking, ban smoking or allow different things in different parts of the premises.
Last night, I went to St. Stephen's tavern, right next door to us here in Westminster, to assess the effectiveness of the removal of smoke from the atmosphere. I even lit up a cigarette and puffed at it energetically to see what would happen. Everyone present in the room agreed that although people were smoking, there was no trace of cigarette smoke at all. I can see one or two hon. Friends who were also there. Instead of instinctively saying, as so many politicians do, "We're going to try to use the force of the law to make you good people out there do what we think is right for you", why cannot we challenge people to take a sensible approach to the vexed subject of smoking? Why cannot we challenge proprietors to ensure that their premises are smoke-free by using the technology that is now freely available and was demonstrated to some of us last night? Why not allow that element of choice to prevail?
As my right hon. Friend the Member for Charnwood said, we can use our power as consumers to try to persuade people to do what we think is right. In other words, if we find smoke offensive, we can decide not to use bars, pubs, restaurants or other premises where it is present. If sufficient of us were prepared to do that, their proprietors would have to make a decision on whether to deem them smoke-free or partly smoke-free.I see no reason why we, as consumers, as well as proprietors and members of the work force, cannot make rational choices in the workplace and in the community. That is preferable to having us here reaching for the law—as we so often instinctively, and wrongly, do—and seeking to impose our view on our citizenry and voters.
I shall reluctantly support the Bill on Second Reading in the hope that we can water it down in Committee or on Report to move it towards a more truly liberal approach than the rather heavy-handed approach that it takes at the moment. I am not terribly optimistic, but I shall do my best to move it in that direction.
Unlike the right hon. Member for Bromley and Chislehurst (Mr. Forth), who could by no stretch of the imagination be described as a zealot about anything, I admit to being a bit of a zealot when it comes to smoking. Indeed, I have been a virulent anti-smoker for many years. If someone put my name into Google or looked me up in "Who's Who", they would see that I once described smoking as a dirty, filthy, stinking, antisocial, expensive, bourgeois habit. [Interruption.] That is my weird sense of humour. We all know that these days smoking is generally a working-class habit.
I approach the subject with an almost missionary fervour. About 10 years ago, when the issue of not smoking was not particularly fashionable, I was leader of Derby city council, where we brought in an anti-smoking policy. We stopped all smoking in the work force and required people who indulged in this dirty, filthy, stinking, antisocial and expensive habit to go to little nicotine-ridden rooms where they could have a quick drag in clouds of smoke. We did that because there was a huge conflict between smokers and non-smokers in open office areas.
We introduced that policy in June 1995. In November 1995, we went further and wrote it into people's contract of employment and stated it in all job adverts. Applicants were advised that we had a clear non-smoking policy and that, if they wanted to smoke in the workplace, they need not bother to apply for a job at Derby city council. I came in for some heavy criticism. I was told, "You're denying the city council the chance of employing the very best employees around." I replied, "I think that people who smoke are stupid, and why would Derby city council want to employ stupid people?"
If someone wanted to work in a pub that allowed smoking, would my hon. Friend use exactly the same argument and therefore argue for allowing smoking in pubs?
Yes, there is an argument for that.
By now, anyone would have concluded that, as a virulent anti-smoker, I would be very much in favour of a total ban across the piece. I took that view until about six months ago, but I have finessed it a little because of some of the impositions that have been put on the statute book. I do not want to drag up banning hunting with dogs, but we have seen that people are circumventing that legislation and operating illegally, or with dubious legality.
I have changed my position and, if there is a Division tonight, I shall support the Government. The Bill gets us 90 or 95 per cent.—some would say 99 per cent.—of the way to achieving our aim. In talking to heavy smokers, I have found that some accept that smoking is bad for their health, colleagues and families, including their children, but have no intention of kicking the dirty, filthy, stinking, antisocial and expensive habit. Those people will smoke, come what may.
Will the hon. Gentleman give way?
No, I shall not take interventions.
The Bill gives people such as me an element of choice, which I do not currently have. Most pubs allow smoking in part of their establishment. Perhaps they do not allow it in the restaurant or perhaps they have a no-smoking area, but most restrictions are ineffective in practice.
Will the hon. Gentleman give way?
No, not even to the previous Conservative Member for Derby, North, whom I was pleased to defeat at the time.
The non-smoking facilities in many public houses are inadequate. Under the new arrangements, I shall have a choice. I will be able to go to a wide variety of establishments if—as I do—I wish to socialise in a non-smoking environment. Those who want to smoke, insist on smoking and demand the right to smoke will be able to go to establishments that are full of cigarette smoke where they can indulge their dirty, filthy, stinking, antisocial and expensive activity. The Bill provides an element of choice that hitherto did not exist.
Some Conservative Members suggested that public houses would decide to junk food and become drinking-only establishments so that they could get the punters in, chuffing away fast and furiously. I do not believe that that will happen. If we consider how social activity and public houses have changed in modern Britain, we realise that most establishments need to sell food to stay in business. In my locality—I guess that it is not very different elsewhere—all country pubs, pubs on the fringes of cities and those near city centres sell food. If they did not, they would not survive. If they decided to get rid of food to attract people who wanted to indulge in the dirty, filthy, stinking, antisocial and expensive habit, they would go out of business. Market forces mean that there will be public houses full of smoke and—thank God—public houses that have a clean environment, where people such as me can go and breathe reasonably fresh air and, perhaps for the first time, enjoy the wonderful aroma from the head of a good pint of Marston's Pedigree.
The Government have got it just about right. That is why I shall support the Bill.
It is a pleasure to follow the hon. Member for Derby, North (Mr. Laxton), who runs a serious risk of serving on the Committee because, until he spoke, the score was: Secretary of State 0, Labour rebels 3. I hope that the Committee of Selection reflects the variety of opinion on the Back Benches when it chooses a Committee to consider the detail of the Bill.
Before I deal with part 1, I should like briefly to mention clause 34 on ophthalmic services. The Macular Disease Society is based in Andover in my constituency and it and the Royal National Institute of the Blind have raised some issues that are best considered in Committee about the services that are optional and those that the primary care trust must provide. However, as smoking at least doubles a person's chance of losing sight in later life, that brings me to part 1 and the wisdom of my party's allowing us a free vote. I take a substantially different view from that of my right hon. Friends the Members for Charnwood (Mr. Dorrell) and for Bromley and Chislehurst (Mr. Forth).
My right hon. Friend the Member for Charnwood prefaced his remarks with a definition of what an individual was entitled to do in a private space. I agree with him. However, the Bill does not deal with what an individual does in a private space. Clause 2 makes clear the spaces that we are discussing.
We have made great progress in reducing the number of avoidable premature deaths that are caused by smoking. The Bill offers an opportunity to build on those achievements. However, there is a risk of a missed opportunity because of the political compromise on which it is built. That is an unsound foundation for a credible public health policy. If, as the Secretary of State implied at the weekend, it is right to introduce a total ban in three years, it is right to do it now. It would be absurd to have two bites at the cherry and two different regimes. It is worth reminding hon. Members, especially Labour Members, of the Prime Minister's words at the Labour party conference:
"Every time I've ever introduced a reform in government, I wish in retrospect I had gone further."
That applies to this measure.
When I was first elected, the House of Commons sold its own cigarettes, with the green portcullis on the pack. My first modest engagement against the tobacco industry was with the then Catering Committee. I asked it to withdraw the product on the ground that it gave parliamentary validation to an activity that killed thousands of our constituents. I failed, but it agreed to reduce the cigarettes from high to low tar. The product was subsequently rightly removed from the shelves.
Parliament has not hesitated to use legislation to combat smoking. The ban on television advertisements dates back to the 1960s. More recently, we have introduced legislation to ban advertising except at the point of sale. I welcome that. We have also used voluntary agreements but they have been less satisfactory because the industry has been reluctant voluntarily to concede anything that would do it serious harm.
The Bill is a legacy from the previous Secretary of State for Health, the right hon. Member for Airdrie and Shotts (John Reid). He was not quite as bad as the chain-smoking health Minister in "Yes, Minister", but he did the Department's reputation no good in proposing the compromise a year ago. I recall telling him in the House at the time that it would not work. However, due to secondary lobbying, his influence is pervasive and visible in the Bill. From next March, his constituents will enjoy enclosed public spaces that are free from tobacco smoke, and the risk of lung cancer will fall by 24 per cent. for those helped by that measure in Scotland. However, he has used his influence in Cabinet to ensure that my constituents in Hampshire will not share that advantage. It is not so much the West Lothian question as the West Virginian question.
It is hard to find a subject on which the Cabinet agrees nowadays. The disagreement on smoking was the best advertised since that on prescription charges 50 years ago. At business questions a few weeks ago, I asked the Leader of the House for a free vote on the matter for Labour Members, but the request was dismissed.
Conservative Members have a free vote. I understand the libertarian argument that my right hon. Friends the Members for Charnwood and for Bromley and Chislehurst presented but a person's freedom to smoke ends where my nose begins. I remind my right hon. and hon. Friends that it became compulsory for motor cyclists to wear crash helmets and car passengers to wear seatbelts under a Conservative Government. When I was a health Minister some 25 years ago, I remember advocating the application of fluoride to water supplies in the interests of dental health. Despite the comments of my right hon. Friend the Member for Charnwood, his Government did exactly the things in the interests of public health that he claims that they should not have done. Our party has, in some circumstances and in the broader public interest, curtailed the liberty of the individual to harm himself and others. It is an extraordinary Bill. Indeed, one wonders whether it is a Bill or a Green Paper. Clause 3(2) refers to
"Examples of descriptions of premises which may be specified".
I have never come across a Bill with language of that type, being wholly unspecific as to what it is that will be exempt.
Members have asked whether there are already smoke-free pubs. There are some—12 in Hampshire are already smoke-free. Presumably, that is because it makes financial sense. I say that to reassure those in the trade who are worried that the consequences of going smoke-free will be injurious to their profits.
It is worth reminding the House that, in 2001, the Prime Minister promised in the Labour party manifesto that we would have a more democratic second Chamber. He then voted for a wholly appointed second Chamber. I hope that the Government Whips extend to all Labour Members the latitude enjoyed by the Prime Minister on the occasion when they get to vote for a total ban.
I recall negotiating with what was then the Tobacco Advisory Committee in the 1970s, trying to get the health warning not only on the pack of cigarettes but on individual cigarettes. I was told that that was not possible as the ink has carcinogenic properties. My negotiations with the committee taught me one thing, which was that the industry can live with tax increases, health warnings and a larger budget for those with responsibility for health education. It really feared that smoking would be branded as an antisocial unhygienic and unacceptable activity. A ban on smoking in public places would do just that. The industry would do all that it could to qualify that statement, hence its reliance on the ventilation argument and its enthusiasm to have as many exemptions as possible. It will do anything to give legitimacy to the activity by permitting it.
The industry wants confusion among the public as to where it is and is not legal to smoke. It wants different regimes in different parts of the United Kingdom. That is because the argument would be blunted and the waters would be muddied. The industry most fears a clear statement from Parliament that smoking is an unacceptable activity in an enclosed public space. It is that statement—not an impracticable, illogical compromise—that I hope the Bill will embody when it leaves the House.
I praise the Government for the positive and strong efforts that they have made in addressing the problems of smoking. I shall make a simple plea, and that is to say to the Government that they should grasp the nettle, go further than the proposals set out in the Bill and follow the lead from Smoke-Free Liverpool, which proposes a comprehensive ban on smoking in enclosed workplaces, including all licensed premises.
Smoke-Free Liverpool brings together the city council on a cross-party basis, the primary care trusts, John Moores university, the Roy Castle foundation, the chambers of commerce and the trades council. It has brought those organisations together to introduce a private Bill, currently in the other place, that proposes a comprehensive ban on smoking in enclosed workplaces in Liverpool. The Bill has had its Second Reading in the other place and awaits detailed scrutiny. It is important. It is an initiative that comes from Liverpool. It shows realistically what can be done.
The impact of Smoke-Free Liverpool has been profound, even in the short time in which it has been in existence. It has been working closely in the community and there has been a 25 per cent. increase in the number of people who want to stop smoking approaching smoking cessation services. There has been work across the communities and work with young people. There has been significant correspondence and discussion with the chief medical officer. Indeed, Sir Liam Donaldson wrote to Smoke-Free Liverpool on 7 November and stated:
"Finally, I have made it clear that I am totally opposed to the various hybrid proposals that were discussed and my view was made known to members of the relevant Cabinet Sub-Committee."
He supports the major thrust of the proposals coming from Smoke-Free Liverpool. In his letter, Sir Liam drew attention to the significant change in public opinion on this issue over the past two or three years. It is clear that public opinion is changing. Following the Government's own consultation, it was found that 90 per cent. and more of the 57,000 respondents opposed the exemption for pubs not serving food. Did that include the 11,700 postcards and 8,500 e-mails which were sent as a consequence of that consultation from Smoke-Free Liverpool? There appears to be no reference to those replies in the official report on the consultation. It is significant that that should have happened.
There have been references to the situation in other parts of the world, including the United States. Scotland has decided to impose a complete ban from next March. Wales has decided to do so when it receives the necessary powers, and they will not be long in coming. The Republic of Ireland has already taken its decision. Northern Ireland Ministers have already proposed similar action there. The Under-Secretary of State wrote to Smoke-Free Liverpool on 26 October and stated that the main reason for his making the proposal was that
"a key factor in my decision was the evidence that partial controls would create a two-tier workforce whereby some employees would be protected from second-hand smoke while others would not."
An obvious question has to be asked. If it is right for employees in Northern Ireland—which is not at present under a devolved assembly—to be protected from second-hand smoke, why should that same protection be denied to employees in England? That does not make sense. The statement made by the Minister was clear and unequivocal.
The issue is about smoking in general. It is also about health and equality, given that that is a major thrust of Government policy. It is particularly about the impact of second-hand smoke and the effect of that on those who are not smokers. Employees must be a prime category in that consideration.
One reason why Smoke-Free Liverpool emerged was that Liverpool has had, regrettably, the title of the lung cancer centre of the United Kingdom. Indeed, the Roy Castle foundation had its headquarters in Liverpool for that very reason. That is a sad fact, given the prevalence of smoking in Liverpool. We see that 34 per cent. of the population are smokers. If we look more closely at the work done by Smoke-Free Liverpool, we see that that figure increases to 50 per cent. in some of the most deprived areas in the city.
There is the Government's evidence and the reasons for their current recommendations. They state that throughout the country, presumably, between 10 and 30 per cent. of pubs will be exempt from the ban. That is because they do not serve food. In Liverpool, that figure is 59 per cent. In Liverpool, an area suffering great ill health, six out of 10 pubs do not serve food and a third of pubs currently serving food say that they would stop doing so if the proposals in the Bill came into force. The impact of that would be to increase health inequality.
The report to the Department of Health from the Scientific Committee on Tobacco and Health underlines the significance of second-hand smoke. The increased risk of heart disease goes up by 25 per cent. The increased risk of lung cancer goes up by 24 per cent. Even low levels of second-hand smoking increases the risk of adults developing asthma by up to five-fold. That is clear, and it should not be accepted. All those risks will be exacerbated for bar workers, who will be subject to second-hand smoking in a concentrated form. That concern should be foremost in our deliberations.
My hon. Friend mentioned in passing the question of displacement, but she did not give it sufficient attention. If we are to measure the effect on health of a complete ban on smoking, we must also take into account the effect that such a ban would have on displacing smoking into the home. Some people will be discouraged from going to pubs and clubs and will therefore smoke and drink more at home. Should not that be taken into account when we consider the effects of this legislation?
My hon. Friend is correct to say that that matter should be taken into account. However, the evidence shows that stopping smoking in public places does not increase smoking in the home. Indeed, it encourages people to stop smoking, wherever they are. On those grounds alone, we should encourage the Government to drop these exemptions. I hope that, during our deliberations on the Bill in Committee, the Government will reconsider the whole question of exemptions. They should consider their workability and inequity, and I hope that they will decide not to introduce exemptions that will increase health inequalities. I hope that that will apply across the whole country. If the Government cannot do that—I hope that that will not be the case—perhaps they will look carefully at the example that is being set in Liverpool.
This is not the first time that Liverpool will have set an example in relation to public health. Indeed, the first public health legislation to be introduced related to Liverpool. The very first medical officer of health was appointed there in 1848, and that initiative was then copied throughout the rest of the country to very good effect. So Liverpool has a record of setting a good example, specifically in the field of public health, and Smoke-Free Liverpool is a current example of Liverpool leading the way.
The Government have spoken a great deal about the importance of devolution when asked why a complete ban will not be introduced in England when smoking is to be banned in enclosed public places and workplaces in Scotland, Wales and Northern Ireland. We might not have devolution for the north-west of England—I wish we did—but would the Government consider running a pilot scheme in the city of Liverpool, which has, after all, introduced its own private Bill for a smoke-free city?
All my life, I have been chary of having good done unto me, and I am afraid that I put the part of the Bill that relates to smoking into that category. That part of the Bill is all that we appear to be talking about tonight. I have always been uneasy about a nanny state. I loathe smoking—I have never smoked—yet I am having to come to terms with an attempt to stop people doing something that they have every right to do. The hon. Member for Derby, North (Mr. Laxton) made a much better speech in favour of the partial ban than the Secretary of State, who did not do at all well in persuading anyone of its merits. Indeed, apart from the hon. Gentleman's rather good speech in support of her argument, most of the contributions from Labour Members will, ironically, probably give her a headache. Unfortunately, she is no longer here to listen to the sad tales that are being told.
I do not want to talk about smoking; I want to move on to a subject that has not been explored in great enough detail. An optician in my constituency has explained to me the problems that that profession fears will result from the Bill. The Bill, rather than a public health Bill, seems to be a rag-bag of ideas that the Department has been trying to get off its chest for many years. This is probably the first legislative slot that it has had in which to achieve that.
On the August bank holiday, the Government announced a review of the general ophthalmic service. Usually, when a Government sneak out such an announcement, it comes under the category of burying bad news. I understand from members of the profession that subsequently there has been absolutely no information on how the review is to be conducted, who is to conduct and chair it, who is to be invited to give evidence, what the time scale will be, whether it is to be an independent review, and when the outcome can be expected.
At the same time, the Bill is trying to change the terms of practice for a profession that is probably unique in the health service in that it has no waiting lists at all. Anyone who wants an eye appointment with a fully qualified eye specialist can get one at their convenience. If anyone can think of any other part of the national health service where that holds true, I would be interested to know what it is, because I cannot think of one.
To answer the hon. Lady's question, another part of the health service in which a person can get an appointment there and then is with a community pharmacist. Such pharmacists are front-line providers of extremely high-quality services, and the new pharmacy contract has enabled them to extend their range of services far wider than ever before. I know of no one who had to wait to see their community pharmacist—and they are often open for extended hours and at weekends.
I also seem to remember that it can often take two days to get a prescription filled.
We can make an appointment with an optometrist to get a full eye test using the most modern technology, and such tests are provided free for certain categories of people. The review of the general ophthalmic service is talking about ensuring that the service remains non-cash-limited, and that any properly qualified practitioner can continue to practise. Meanwhile, the Bill is proposing that the primary care trusts should take over the management of the general ophthalmic service. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) made the point very clearly that, because the PCTs are cash-strapped, it is likely that budgets that are now non-cash-limited will become cash-limited and that the PCTs will restrict the number of practitioners and transfer the money to other parts of the service that they provide.
It would be useful if the Minister could put on record the details, timing and process of the review, so that those who are interested can give evidence. Will she guarantee that the GOS will continue not to be cash-limited, and that the PCTs will not in any circumstances restrict access to the wide variety of optical services that are currently available? If she can do that, this part of the Bill will be acceptable. If she cannot, I fear that many people in the profession will find it exceedingly difficult to live with the proposals in the Bill.
I welcome the Bill. My constituency suffers from grave multi-deprivation, and in the most deprived wards life expectancy is five to six years lower than the national average—so anything that we can do to bring about health improvements is extremely welcome.
I particularly welcome part 2 of the Bill, because Lewisham hospital in my constituency has had a serious problem with MRSA. The Conservative party, in its election campaign, asked sarcastically:
"I mean, how difficult is it to keep a hospital clean?"
In my experience, it is extremely difficult. A hospital can have floors so clean that one can eat off them and still have MRSA. There is a huge need to introduce a new raft of measures, many of which are being pioneered at Lewisham hospital as part of a campaign waged by the Deptford Action Group for the Elderly led by Harry Heyward, me and others to get MRSA rates down. I am delighted to say that rates are now going down. We need to take account of the fact that one in 10 people are found to be already infected in hospital pre-entry testing, and of those who are infected, 40 per cent. come from nursing homes.
The wide range of measures that the hospital has introduced require a constant battle—a battle to keep infection control regimes in place, maintain the vigilance of health care staff and get the co-operation of visitors. I therefore very much support the proposal for a statutory code of practice and its associated protocols. I am also pleased to note that while the Bill does not cover care homes, the Government have expressed their intention to apply similar measures to cover such bodies.
My welcome for part 1 of the Bill, however, is not as enthusiastic. When I was growing up in south Wales, I did not know anyone who did not smoke. I started smoking at the age of 14. Fortunately, I did not get addicted, and when I learned the health messages I gave up, as did the rest of my family, with the exception of my father. He was a man who worked in a factory but came home every day to his garden. He got plenty of exercise, was never overweight and had the most healthy diet, having grown his own fruit and vegetables. He died when he was just a few years older than I am today, of an entirely preventable smoking-related disease.
Today, thousands of my constituents face the same chronic illnesses and eventual premature death as a result of their smoking habit. Twenty-seven per cent. of the people of Lewisham smoke—thankfully, it is no longer the majority that it was in the borough as a whole. As we have heard from others, the incidence is higher in the most deprived communities. Alarmingly, the highest incidence of smoking in my population is among those between the ages of 16 and 34. Interestingly, twice as many white people as black people smoke, and substantially more women smoke. As is the case everywhere, more manual workers smoke. My primary care trust has made huge efforts on smoking cessation and will continue to do so. It can deal with but a few thousand people each year, however, and the problem is so much greater than that. That is why it supports a complete ban on smoking in workplaces.
The toll of deaths from entirely preventable smoking-related disease is a scandal. In London as a whole, there are more than 10,000 such deaths each year—that is one death every hour in this city, and 120 hospital admissions every day, at a cost of £105 million to the NHS per annum. As others have said, we have known of the hazards of smoking for a very long time. It is gratifying that the majority of smokers now want to give up because of those messages.
Our willingness to protect others from the effects of second-hand smoking has been much slower to gain public approval. When I entered the House in 1987, at the first meeting with the Whips—who were less kind, of course, than the Whips today—I asked whether it would be possible to have a non-smoking office. They looked at me askance and said that I would be jolly lucky—they did not use those words exactly—to get an office at all. A decade later, one of my colleagues, Anne Campbell, who was suffering from asthma, was heard to protest one day that we should not have smoking in our dining rooms. She attracted a huge amount of hostility. Many of us have had to fight hard to introduce the sensible and basic no smoking measures that we have in this place today. How much more difficult will it be in those areas where establishments are supposed to be non-food bars, bars that serve a bit of food, bars without smoke around the bar, or bars with a bit of smoke at the back of the room? It will be extremely difficult, and the Bill as drafted is unworkable.
One of the most telling statistics that many of us have received came in a briefing from the Trades Union Congress, which compared the 235 deaths at work from accidents with the estimated 700 deaths of non-smokers from second-hand smoking. In the case of accidents, the first thing that we ask is, "Could this accident have been prevented?" Well, smoking can be prevented. The second question that we usually ask is, "Was the employer negligent?" It is my view that, in future, any employer who exposes his or her workers to second-hand smoking will indeed be negligent.
My right hon. Friend the Secretary of State stressed the limited nature of the exemptions in the Bill. She also stated her passion for legislating for public health. Therein lies a contradiction. We cannot legislate to protect the majority of people and choose not to protect a minority, however small. We will also ill serve those customers who might wish to be protected in continuing to go to the non-food pub that is their local and that they would like to use in the same way as everyone else. As local consultations and other hon. Members have indicated, it is also clear that a proportion of those pubs that currently serve minimal food will cease to do so in future and become smoking pubs. We want them to keep offering food, not to give it up, because giving it up will exacerbate the difficulties that we have with our drinking culture.
For all those reasons, I and many Members will seek every opportunity to remove exemptions for licensed premises and private clubs from the Bill, and to establish a total ban that will protect all employees and the public at large and further encourage the many people of this country who are seeking to give up smoking.
I want to speak to parts 1 and 2 of the Bill, starting with the section on infection control issues in part 2.
I have some doubts that the code of practice will make any more difference than all the guidance and circulars that have preceded it. What constitutes best infection control practice, as we have just heard from the hon. Member for Lewisham, Deptford (Joan Ruddock), is already clear. There is plenty of guidance around to be followed. For example, in 2000 the Department of Health issued a circular setting out a programme of action for the NHS on the management and control of hospital infections. To this day, there has been no national audit of compliance with that circular, and Health Ministers have consistently made it clear that the Government have no plans to undertake such an audit. Ensuring compliance with the existing guidance should have been a priority, and the fact that a statutory code is now felt to be necessary is, in truth, an admission of eight years of failure by this Government in controlling infections both in the community and in our hospitals.
The problem has been where infection control sits in relation to the Government's other health priorities. From reading the summary of responses to the Department's consultation on the code, it is clear that many are worried that the guidance in the code will
"conflict with other policies that are already in place, such as those relating to bed occupancy."
It is therefore no surprise that the report goes on to say:
"Many felt that the Code of Practice should specify which guidance is meant to take priority."
That is absolutely right—it must do that. It is disturbing that more than a year after the National Audit Office published its progress report, that remains a concern among many in the NHS. The NAO found, at the time of its report last year, that half of NHS managers were struggling to reconcile the competing demands of Government waiting time targets and the management of hospital infections. The question is, will the code make clear what takes precedence—political targets or infection control? The response to my earlier intervention suggested a "have the cake and eat it" approach to that question, and to the issue generally. I hope that the Minister will clarify the matter later.
Against a background of increasing financial instability and rising deficits there is cause for concern that NHS organisations will struggle to tick all the Government boxes and meet their obligations under the new code, but if a statutory code of practice gives infection control the priority that it needs, I for one will support it and consider it a worthwhile measure.
Part 1 deals with the partial ban. Like others who have spoken today, I hope that a majority in the House will amend the Bill to provide for a comprehensive ban on smoking in enclosed public places. For many, it is a question of social justice. How can it be right to legislate to protect workers from the harmful effects of second-hand smoke in the majority of workplaces, and then fail to extend that protection to bar workers, who are often most at risk? During an average eight-hour shift, a bar worker can inhale environmental tobacco smoke that is equivalent to smoking a pack of 10 cigarettes a day. It is the overwhelming evidence that smoking harms non-smokers that leads me to support the introduction of a comprehensive ban on smoking in enclosed public places. If it were simply a case of smokers putting their own lives at risk I, as a Liberal, would respect their right to make that choice, but the right to smoke must be balanced against the rights of non-smokers in general and workers in particular.
Second-hand smoke does harm. It can and does kill. There is no safe level of exposure to it. Last November, the Scientific Committee on Tobacco and Health reported that exposure to second-hand smoke significantly increased the risk of heart disease and lung cancer in non-smokers. In April this year, a study published by the British Medical Journal estimated that it was responsible for 617 deaths a year. Those are preventable deaths, but the health effects are much wider. According to Asthma UK, four fifths of the country's 5 million asthma sufferers say that second-hand smoke makes their condition worse.
I believe that a ban on smoking in enclosed public places must be seen first and foremost as a health and safety measure. Protecting workers from second-hand smoke should be the goal. The Government's policy, however, does not achieve that end. It is not sufficient to argue that because the vast majority of workplaces will be covered by a ban, it is somehow acceptable to set aside the evidence and allow bar workers to be exposed to second-hand smoke. Proposals for a smoke-free buffer zone around the bar are pointless, unless the Government plan to legislate to change the laws of physics and stop smoke from drifting around the bar.
Ventilation is not an answer. The best that it can offer is comfort for the customer. It does not provide safety for staff because it does not extract carcinogens from the atmosphere. Research suggests that more than 10,000 air changes an hour would be necessary to achieve ambient levels of particulates. That is equivalent to a mini-tornado blowing through the pub.
A partial ban will fail, and not only on grounds of principle.
Will the hon. Gentleman draw a distinction between an ambient atmosphere and an occupational setting? When considering occupational settings of the sort that he describes, should we not consider occupational exposure standards that could be attained through the engineering measures to which he has referred?
On the basis of the research that the Select Committee has seen so far on the efficacy of ventilation systems, in terms of both cost-effectiveness and practicalities, I am not convinced that that can be achieved—not least because the level of air change required for the achievement of the necessary safety standards would be high enough to make patrons uncomfortable. It is likely to be really effective only when the bar is empty, which rather defeats the purpose.
A disproportionate amount of time and money will be invested in defining, and then enforcing, the exemptions. The more complex the regulatory system, the greater will be the burden on business and the cost to consumer and taxpayer. As we have heard, the Health Committee has received evidence from the hospitality trade, the Health and Safety Executive and local authority enforcement officers. They all agree that a partial ban will be more expensive to enforce.
During the Committee's visit to Dublin earlier this month, it was clear that the ban in the Republic was working well. One reason is that it is easily understood and, as a result, largely self-enforcing. Compliance is currently 94 per cent. Enforcement action has been necessary, but in only a small number of cases. The Secretary of State cited experience in Norway as evidence that comprehensive bans do not come along in one go, but must come along in stages. In Norway, however, the partial ban was abandoned in favour of a comprehensive ban because it was proving unfair, unpopular and unenforceable. As my hon. Friend the Member for Northavon (Steve Webb) said, why should we make the same mistakes in this country and then implement a full ban later?
The fact of devolution should not mean that Ministers in Westminster ignore the lessons from Edinburgh and Cardiff—and, indeed, from non-devolved Belfast. Why should Health Ministers in Scotland, Wales and Northern Ireland be wrong and Health Ministers in England be right? It has been suggested that Ministers here feel that England is not yet ready for a comprehensive ban. Even if we accept that argument, however, surely it is the Government's duty to act on the basis of scientific evidence.
Let me respond briefly to points made by the hon. Member for Lewisham, Deptford and the right hon. Member for Charnwood (Mr. Dorrell). Surely the choice is between comprehensive and comprehensible legislation after we in the House of Commons have debated and framed the law, and allowing the courts to drive bans through by means of individual decisions under health and safety legislation or precautionary steps taken by employers. I do not consider the latter a satisfactory basis on which to proceed. We should be legislating in a comprehensive fashion.
During the Select Committee's visit to Dublin, I was struck by how quickly public opinion had moved on in the Republic. There is now a tangible sense of pride at what has been done in Ireland. The Irish Government saw the need and gave a lead, and that is what should happen here. Public opinion in England is moving and it is time for the Government to move as well, not least on the issue of exemption for bars that do not serve food. Of the 41,833 people who responded to the Department's questionnaire, more than 90 per cent. said that there was no basis on which they would accept such an exemption.
The Secretary of State has achieved an unusual feat. At the same time as dividing the Cabinet, she has managed to unite ASH and the British Beer and Pub Association in opposition to a partial ban. Public opinion in England is already more supportive of a comprehensive ban than it was in the Republic of Ireland before its introduction there.
There can be no doubt that a partial ban will widen health inequalities, as a number of Members have pointed out. According to a survey by ASH, following a partial ban two out of five pubs would close their kitchens permanently and adopt non-food status so that they could allow smoking. Last Thursday, when the Health Committee took evidence from the chief medical officer, Sir Liam Donaldson, I asked for his professional opinion on a partial as opposed to a comprehensive ban in terms of health inequalities and outcomes. He said
"It . . . signals to the public that a drink and a smoke go hand-in-hand when all the efforts on smoking and tobacco control have been aimed at de-normalising smoking".
He said that it put Britain among the laggards of public health policy internationally rather than among the global leaders. Laggards not leaders: that must surely be the consequence of ignoring the chief medical officer's compelling advice.
When I intervened on the Secretary of State earlier, I mentioned the regulatory impact assessment. The detailed tables show that the difference between a partial and a comprehensive ban is 200 preventable deaths a year. The idea of exempting pubs that do not serve food is ill-conceived. It is a classic case of doing what is expedient rather than what is right. Health policy should be evidence-based, not evidence-blind. I agree with the chief medical officer that when it comes to the question of freedom, the smoker's right to smoke stops at my nose.
This has been an interesting debate. There appear to be two diametrically opposed views. There are those who want smoking to be banned altogether in all enclosed public spaces such as public houses or working men's clubs, and there are those who say "Just let it go".
I should like to think that the Secretary of State has got it right, although I am not sure whether that has come about for good reasons. I see the Bill as an interim measure. I think that we will see more progress after this, and I wonder which way that progress will go.
I entirely accept, as most people do, that no employee or customer who does not want to breathe another person's smoke should have to suffer that. There is no argument about that, but we could look at the issue in another way, and I would like to see a bit more lateral thinking in this debate. I use the term "segregation". I have heard a lot of nonsense spoken here tonight about it being impossible to eliminate smoke by ventilation. With a proper segregated room and a proper extractor fan, a vacuum is created, and the only air that moves has to come into the room and go out through the fan. Decent doors are needed to make a smokeproof room, but we have one of those in this building: we have a Smoking Room in the House of Commons. The only problem with it is there is no protection for the person who serves there; that is wrong.
However, there is no reason why people in a segregated room should not be required to go and get their own drinks and bring them back to that room. Most pubs have more than one room, and very few public houses, working men's clubs or private clubs could not provide a room for smokers, properly ventilated and properly looked after. That would eliminate the problem.
I accept the fact that 75 per cent. of the public do not smoke and do not want smoke around them, but I am also concerned about the one in four—the 25 per cent.—and I do not want to see those people marginalised. That is not necessary.
If there is the political will to do something, and make provision for smokers as well as non-smokers, the problem could be overcome—but whether the Government have the gumption to do that, I do not know. I hear what the zealots say, and it seems to me that those who shout loudest generally get their own way. A tremendous head of steam is being generated on this issue, and those who want a total ban will probably succeed eventually, unless we start thinking in a different direction—not being defensive, but using a bit of lateral thought to get round the problem.
I do not believe that only one in four of the people who go into public houses smoke. In my area, nearly 50 per cent. of the people who frequent pubs, private clubs, working men's clubs and the miners welfare are smokers. If they are prohibited from smoking in those places, no doubt they will find other ways out. As a result, the people who want to go into a bar but do not want to see any smoke might find that they are not only devoid of smoke but devoid of a bar to go to. It may no longer be feasible or economic to keep premises open if people cannot go there and smoke.
That is just a suggestion. I am not arguing about people's right to avoid smoke, and I think that the Government are heading in the right direction. However, we need less simplification and more profound thought on this issue. It is quite a complex subject; it is not just about banning or not banning, but about thinking about how to satisfy people and make progress.
We need more education, and we should try to imbue young people's minds with the disadvantages of smoking. I am a smoker myself, although I am a bit of an oddity, because I did not smoke until I was about 45. [Interruption.] That was before I came here; it had nothing to do with this place, although being here probably could drive somebody to smoke.
If we alienate what I think is the more likely estimate of 50 per cent. of people in clubs and pubs who smoke, we will cause tremendous trouble. People whom we might have been able to persuade by education and good practice will be alienated if they believe that they are being coerced.
I have no great truck with the tobacco lobby, which only wants to sell its product. We have all been glad enough to take the tax that comes from smoking; that applies to both parties. If we think that smoking is so bad, why the hell do we not ban it altogether and have done with it? We do not do that. We do not live in that world. That is not the way things work. Instead, we try to do things gradually—and that is what we are doing now.
I hope that we can cut the number of people who smoke. Let us hope that eventually we will be able to get rid of the habit, and the problem, altogether, but we will not do that by alienating minorities. We have to carry them along with us. I beseech the Government to consider the fact that by proper scientific segregation, we could achieve all that the people who favour a total ban want. They might not agree with that, but I believe that it is true.
For anyone to say, as one of my hon. Friends did earlier, that it is impossible to get rid of smoke by ventilation, is nonsense. I am not talking about the nonsense described by my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson), who mentioned some obscure airline with smoking on one side of the plane and non-smoking on the other, or about someone saying, "If you sit at one end of the room and smoke, non-smokers can sit at the other end." That is unsatisfactory and does not solve the problem. We need a proper scientific approach, with segregation so that those who do not want to breathe smoke do not have to, but also so that we do not alienate the people who do smoke, and who want to continue to go out and meet their friends in an ambient atmosphere in a pleasant pub.
Does my hon. Friend not remember the train operating companies' system, with a no-smoking section and a smoking section in each train? The doors were not secure enough to keep the smoke away from non-smokers, and the only way to get round that was to ban smoking altogether on all trains.
I thank my hon. Friend for that contribution, and I am pleased to be able to give her a detailed answer. I have travelled a lot on GNER services, and that company spent hundreds of thousands of pounds creating segregated smoking areas. The doors did work, and the smoking area was ventilated. Indeed, it was so well ventilated that people complained that it was too cold. All the air was sucked out of the non-smoking area; no air went back there. Why, after all that expense, the company then decided to stop smoking altogether, I do not know; it was not because the system was ineffective or inefficient. The system worked, and I shall never know the answer to that question.
The real answer to my hon. Friend's point is that I suspect that train operating companies, like some companies that operate bars, just do not want to spend the money. They will give all sorts of reasons why something cannot be done, but it all comes down to the simple answer that they do not want to make that investment. For example, Eurostar trains had a separate coach for smoking, and no smoke went out of that into other coaches—but Eurostar stopped it, because it could get more passengers and more flexibility if that coach was turned into a non-smoking one.
A lot of myths circulate about such matters, and all that business about needing 10,000 changes of air an hour to clear a place out is utter palpable nonsense.
My hon. Friend has been talking about alienating minorities, but what does he think the difference is between what is happening in Ireland and what he thinks might happen here? I assure him that during the Health Committee's visit to Ireland it was clear that a total ban, introduced very quickly, has been accepted by almost everyone—including smokers in pubs, who go outside to have a smoke. What is the difference between Ireland and here, that makes him anticipate trouble?
We all get to hear different views. Yes, the thing might have been accepted in Ireland, but many things are accepted, and that does not always mean that the situation is totally satisfactory. I do not think that it is very satisfactory if someone has to go outside to have a smoke. I do not like to see people huddling in shop and office doorways having a smoke. I would have thought that a decent employer, who did not want smoking in the workplace, would make proper provision for employees to have a smoke in a room such as I have suggested. It always come down to investment and a lack of will.
All that I am asking the Minister to consider is the possibility of integrating smokers into our pub scene without making things impossible for them. I believe that it can be done. All we need to talk about is scientific segregation. As I say, it can be done; all it needs is the will.
I make no apology for the fact that I intend to speak principally about the smoking ban. It would be remiss of me, however, to let pass without comment the views of the hon. Member for Sunderland, North (Bill Etherington), who spoke about those who shout the loudest winning and about the importance of carrying minorities with the majority. I wish that the same could be said when we speak from the Northern Ireland Benches. I wish that our voices were heard—and we are certainly not a minority within the Northern Ireland context.
I have found the debate on the partial ban on smoking in public places, which the Government are in favour of, most interesting. I am grateful that, after extensive lobbying in Northern Ireland, plans have been announced for a total ban on smoking in public places there. Again, it would be remiss of me not to point out how ironic it is that the Government are willing to protect the health of Northern Ireland citizens by introducing a comprehensive ban on smoking in public places while they are also willing to give an amnesty to on-the-runs who have murdered men, women and children, allowing them the freedom to return home to the Province and move freely among their victims.
There is no logical reason why staff in one pub or club should be protected from the dangers of passive smoking, while those in another should be exposed to them. As already highlighted by hon. Members, a partial ban allowing smoking in pubs where food is not served fails to protect workers in the hospitality industry, who are often at risk of the greatest exposure. On account of the inequalities contained in the Bill, I suggested to the right hon. Member for Rother Valley (Mr. Barron) that pubs serving food will simply get rid of the food business in order to attract the smokers and maximise the takings on alcohol sales. That will inevitably lead to redundancies in the catering trade. The right hon. Gentleman claimed that it did not seem to be an issue in the Republic of Ireland, but, with respect, I would point out that the population of the Republic is approximately 5 million, compared with a population in England of approximately 55 million, so there is no real comparison to be made in terms of job losses.
Many hospitality workers are low paid, and failing to protect them from the effects of smoke at work will only increase health inequalities in that group. Such a policy would be impractical, unfair and lacking in rationale. As I said in an earlier intervention, Macmillan Cancer Relief pointed out that more than 37,000 new cases of lung cancer are diagnosed each year in the UK. Perhaps the Minister will tell us why the Government have chosen to ignore the advice of the chief medical officer, Sir Liam Donaldson, who proposed a total smoking ban, and why the views of 90 per cent. of respondents to the Department of Health's own consultation who supported a full ban without exemptions have also been ignored.
The BMA has stated that second-hand smoke increases the risk of lung cancer by 20 to 30 per cent., increases the risk of heart disease by 25 to 35 per cent., doubles the risk of stroke and causes asthma, respiratory illness and ear infections in children. Those particularly vulnerable to second-hand smoke include 8 million people with lung disease, 2.1 million people with angina, 1.3 million people who have had a heart attack and 300,000 who have had a stroke. There are also an estimated 10.8 million women of child-bearing age, some 750,000 pregnant women and 1.5 million children with asthma who would all be at risk. Short-term exposure to tobacco smoke also has a measurable effect on the heart in non-smokers. Just 30 minutes' exposure is enough to reduce coronary blood flow.
Nicotine addiction is the main motivating factor behind smoking. Smoking is the greatest cause of preventable illness and death and giving up smoking at any age confers substantial health benefits. Individuals who wish to stop smoking must be offered appropriate support and smoking cessation services must be widely available. Extra training should be provided to doctors and other health care professionals to enable them to assess and refer individuals to specialist services. Similarly, those services should be offered to workers at places where smoking is now to be outlawed.
If the Government fail to implement a total ban, England and Wales will trail behind many other parts of the world. The hon. Member for Northavon (Steve Webb) pointed out earlier that seven US states have now banned smoking.
Is the hon. Lady aware that the Welsh Assembly has already voted in favour of a complete ban?
I am aware of that and I withdraw the point about Wales.
I was about to say that New Zealand became a smoke-free zone on 10 December 2004. Dr. Tricia Briscoe, chair of the New Zealand Medical Association, commented that that country's
"experience shows that introducing smoke-free legislation makes people more aware about the health impacts of second-hand smoke. And the legislation is popular. Polls now show that 9 out of 10 New Zealanders support the right to work in a smoke-free environment."
Dr. William Glasson, federal president of the Australian Medical Association said:
"The Australian experience shows that when workplaces are smoke-free, families are more likely to have smoke-free homes. The proportion of family homes with smoking restrictions more than doubled in 8 years. That means that fewer children are at risk from chest and ear infections, asthma and cot death."
I hope that that supports the argument advanced earlier by the hon. Member for Liverpool, Riverside (Mrs. Ellman).
Environmental tobacco smoke is also detrimental in terms of the economic effect that it has on businesses due to loss of productivity from sick days and increased insurance due to fire risk. Effects on businesses have often been cited as a reason not to pursue a smoking ban, but evidence from countries that have become smoke-free show positive, not negative, effects on businesses. In New York, receipts in bars and restaurants increased by nearly 9 per cent. in the first year of going smoke-free and reports in the Republic of Ireland suggest that there were no negative effects on sales in bars and restaurants. In fact, many more non-smokers are now going out to restaurants and bars.
Research found that air quality in pubs in the Irish Republic improved significantly in the first year after the introduction of the smoking ban. According to the findings, the level of carbon monoxide among non-smoking bar workers fell by up to 45 per cent. Among ex-smokers, the levels dropped by 36 per cent. These are compelling figures, as I am sure all right hon. and hon. Members would agree.
Studies also show that smoke-free workplaces encourage smokers to quit or reduce consumption—hence addressing a major cause of ill health. The fall in tobacco sales in the Republic of Ireland provides further evidence of that. Dr. James Reilly, president of the Irish Medical Organisation, has stated:
"Over 7,000 smokers gave up in the 6 months before the law came into force. The new law has encouraged many more smokers to quit—as is evident in the continuing drop in tobacco sales—and they say that they are less likely to start again because their workplaces and social venues are smoke-free."
The Republic of Ireland introduced legislation in March 2004 to ban smoking in all public places and workplaces. That has proved to be very successful and highly popular, and no major compliance problems have been encountered. Useful lessons could be learned from that approach. The key to success in the Irish Republic was a clear policy, an effective public information campaign outlining the rationale and clear enforcement laws.
The health and economic evidence is clear and there is widespread support for such a policy. I urge the Government to ensure that any ban is total. That will protect the health of all workers and tackle a major cause of ill health by providing environments that encourage smokers to quit or reduce their consumption. Partial bans rarely work. They please no one in the end. As my dear mother taught me long ago, "If you stand in the middle of the road, you'll get knocked down." The partial ban is morally wrong: it should be a comprehensive ban. Just as extending opening hours for drinking alcohol is morally wrong, all we will succeed in doing is to fill more hospital beds.
Three weeks ago, we commemorated the 400th anniversary of the gunpowder plot. Received wisdom has it that the plotters against the monarchy were alienated Catholics. More perceptive historians blame a group of 17th century cigarette manufacturers, because a few months before 5 November 1605 His Majesty King James I of England and VI of Scotland issued a decree banning tobacco from his kingdom in the following terms:
"Loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs and in the stinking fume thereof nearest resembling the horrific Stygian smoke of the pit that is bottomless".
Clearly, he was not a native of Airdrie and Shotts. And he was not wrong.
Four hundred years later, after mounds of medical evidence, tax rises, warnings on packets, laws about sale of cigarettes to children, and bans on advertising, more than 100,000 people a year in the UK still die from smoking-related disease. That appalling total included my own father when I and my sisters were adolescents.
Smoking is still the biggest cause of preventable death in our country. It is an addiction that brings misery, illness and bereavement to countless families. It is therefore a political issue of great importance.
May I assist my hon. Friend by pointing out that if smokers use the product as intended by the manufacturer, 50 per cent. of lifelong smokers will be killed by their habit? Can he think of any other legal product in the world of which that is true?
In just a sentence, my hon. Friend has demonstrated the lunacy of the case of the tobacco manufacturers.
Speaking as a Labour MP, I would argue that smoking is all the more important because of its impact on social and health inequality. The chances of a man in social class 1—the richest—living until the age of 70 are, on average, two in three. For a man in social class 5—the poorest—the chance of living that long is less than one in two. Half that difference is down to smoking. More poor people smoke than rich, and more poor people die as a result from lung cancer, emphysema, vascular disease and all the other terrible conditions that smoking causes.
We must lighten that burden of preventable suffering, not widen the gap. I shall look favourably on Government interventions with that objective. Part 1 of the Health Bill is just such a major intervention. A giant step is being taken to protect the great majority of workers and members of the public from carcinogenic second-hand smoke. However, the proposed exemptions will fail to protect a large group of employees and customers in the hospitality industry. They will introduce further market distortions, lead to unfair competition between licensed premises and generate public order problems. That latter point has not been made so far today.
No wonder affected groups have been so vociferous about the Bill, including those with pre-existing medical conditions such as asthma. Asthma UK has calculated that one in five people with asthma may still be prevented from using parts of their workplace where people smoke because of cigarette and other tobacco fumes. The best estimate of the number of premature deaths caused by workplace exposure to other people's smoke is 600 a year, although other estimates have been quoted today. Compare that to the 200 or so people who die in this country every year from all other industrial injuries and accidents. Let us stop pretending that smoking is not a workplace health and safety issue.
Bryan Ferry and other popular singers of recent times were only partly right. Smoke gets in your eyes, but it also gets into your hair and clothes, into your blood stream and on to your death certificate. Many workplaces still permit smoking and they are generally in sectors with the highest levels of exposure and, therefore, the greatest health and safety risk. Most of them are operated by small firms that employ relatively low-paid staff. Workplace smoking is particularly common in the hospitality trades, including restaurants, pubs and casinos, but it is not confined to such places. The latest Government survey shows that more than 2 million people in Great Britain work in workplaces that allow smoking throughout. A further 10 million people work in places where smoking is allowed somewhere on the premises. In total, that is almost half of the work force.
In Ireland, as we have heard, smoke-free legislation was introduced to tackle a similar starting position. Since its inception in March 2004, it has received wide public support and is well on the way to proving a great success. I was able to visit Dublin in September last year in a delegation drawn from the all-party group on smoking and health, which I chair. There were representatives from both Houses, including that excellent campaigner in the other place, Lord Faulkner. We talked to Irish parliamentarians at the Dail, including Health Minister Micheal Martin, licensed victuallers, cancer consultants, trade unionists, and drinkers and smokers in the Temple Bar area—the Dublin equivalent of Leicester square. The reaction to the then six-month old ban was hugely positive. I hear that the Health Committee visit this autumn had very similar findings. Objective Irish evidence does not bear out the claims of the tobacco lobby here and parts of our hospitality trade that smoking restrictions have been bad for business, which is in fact improving.
Welcome as the Health Bill is, the exemptions for pubs that do not serve food and for membership clubs make no sense at all. They will increase health inequalities. They will make the law harder and more expensive to enforce, and they will, as I have said, produce unfair competition right across the hospitality industry. On health inequalities, a major survey of more than 1,200 pubs, conducted by survey firm IFF Research Ltd., has shown that those not serving prepared food are concentrated in poorer communities—no great surprise—where smoking rates are already highest. On average, about 14 per cent. of pubs in the richest areas do not serve food, compared with 45 per cent. in the poorest areas.
Worse still, if the current exemption survives the parliamentary passage of the Bill, publicans say that many will stop serving food. The IFF survey suggests that in future the percentage of pubs not serving food in the richest areas will rise to 20 per cent. and in the poorest areas the majority will not serve food. That shift would also be disastrous for the Government's alcohol strategy, a key part of which is to cut binge drinking by encouraging consumption of meals when alcohol is drunk.
After the devastating evidence from, and indeed near resignation of, the chief medical officer last week, I have no doubt that the Health Committee will report in favour of the comprehensive legislation that was indeed the overwhelming choice of the 60,000 respondents to the Government's recent consultation. I suppose that it is possible that the Government might be able to keep the exemptions in the Bill if they are prepared to rely on Tory support to do so, although more and more Tory MPs are recognising the case for comprehensive legislation, too. I know that the Prime Minister will not be unaware of the political fall-out that such a situation could cause.
Thus an end to all smoking in workplaces and enclosed public places would protect non-smokers from the damaging effects of second-hand smoke, and would encourage many smokers to quit.
I have been listening—
You've only just come in.
I have not. I have been listening to the hon. Member for North-West Leicestershire (David Taylor), and I wish to reassure him that the Opposition have a one-line Whip on the issue. I shall vote with him for an all-out ban, so he should not characterise Members on party lines.
I stand second to none in the Chamber in my admiration for the upright stance and integrity of my near-neighbour in Lichfield. I look forward to having a chat with him in the Lobby.
On health and safety grounds, there should be no exemption for any pub or membership club. It is wholly unacceptable to exempt any category of worker—I say that with great respect for my hon. Friend the Member for Sunderland, North (Bill Etherington)—from an identified, controllable and significant risk. Good gracious me, the bulk of Labour Members were trade unionists in another life.
Exempted pubs and clubs will be in less well-off areas, where smoking prevalence rates are higher, and general health and life expectancy are worse than elsewhere. We have heard that that is shown at its starkest in Liverpool, with its sad and unique position as the lung cancer capital of England, and with average smoking prevalence in the most deprived areas at around 50 per cent. No wonder the call for change is even stronger on Merseyside than elsewhere. I commend the Smoke-Free Liverpool campaign; I wear its wristband proudly as a token of my support—the first such wristband I have ever worn.
While the partial ban proposed in the Bill will protect many workers and members of the public, it will leave some of those at most risk still exposed to the health risks of second-hand smoke. In summary, it will also reduce the number of smokers quitting as a result of the legislation, worsen health inequalities and produce perverse and unfair competition between licensed premises.
Smoke-free legislation is essentially a yes/no question, ideally suited to a Chamber with just two Lobbies. Once the health and safety case and the public health benefits are conceded, it is not possible to find a compromise, whether exemptions for some premises, ventilation systems or separate smoking areas are incorporated. All of that is lunacy. It is impossible to find a compromise that is practical, logical and enforceable.
There is still time for the Government to ensure that workplaces and enclosed public places in England will have the same protection from second-hand smoke as will soon be available in Scotland, Wales and Northern Ireland and which already exists in the very enlightened Irish Republic. The benefits and popularity of such a measure would be enormous.
My parliamentary neighbour, the Secretary of State for Health, my right hon. Friend the Member for Leicester, West (Ms Hewitt), has said that a comprehensive workplace smoking ban will be in place by 2007. I hope that she is right, and that second thoughts and sound advice will prevent my Government from snatching a wholly unnecessary defeat from the jaws of a much-needed historic victory. For then, 400 years after the first tobacco ban was promulgated by an absolute monarch, an absolute ban in enclosed public and workplaces will at long last be a reality. If that is not a reason for public rejoicing, celebrations and, yes, bonfires, then I do not know what is.
I am beginning to feel sorry for the Under-Secretary of State for Health, the hon. Member for Don Valley (Caroline Flint), who has to reply to the debate. It has been fascinating, and I certainly enjoyed the speech by the hon. Member for Sunderland, North (Bill Etherington), but I must say to the House that we have another Health Bill—another piece of legislation, more regulation—and we must ask ourselves: are these measures sensible and practical and will they be enforceable?
I shall start by commenting on smoking, because everyone else has. I do not smoke—I do not think it is very clever to do so—but I defend to the end people's right to smoke. The question for the House is whether other people's smoking affects our health adversely. During the course of the debate, well over half of the Health Committee has been present. As the House knows, we are currently carrying out an inquiry into passive smoking, and it would be wrong for me to pre-judge that report, in spite of what the hon. Member for North-West Leicestershire (David Taylor) has said. We shall see in due course whether there will have to be a minority report. I hope that the House will have another chance to read the interesting evidence that we considered during the inquiry.
The question on passive smoking that the House must consider is very difficult indeed. I just wonder whether we are being sensible about this. I have been influenced by a variety of points that have been made in today's debate, but I shall also bear in mind the evidence that the Health Committee heard. The Minister gave evidence to the Committee, and I hope she enjoyed it, but she followed the chief medical officer, and during his evidence, as everyone now knows, he said that he came within a hair's breadth of resigning. I would simply say to the Minister that, given that this is a Government Bill, it does not look terribly good if the chief medical officer has made those remarks and is clearly in total disagreement with the Government.
I am disappointed that we have not spent much more time today talking about MRSA. These things seem to go in and out of fashion, and months ago, before the general election, MRSA was a big issue, so it would have been nice if one or two hon. Members had shared with the House their explanations as to why we have so many infections in our hospitals today. Is it because we no longer have Hattie Jacques as matron? My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries), who I believe was a nurse, will no doubt hope to catch your eye, Madam Deputy Speaker, to tell us all about it. Is it because we no longer wash our hands? It is worrying that there has been only a small drop in the number of cases since 2001, when there were 7,684. The present situation is just not good enough. I represent an area with a huge number of elderly people, and as one hon. Member said earlier, they now worry that when they go into hospital, they will come out with a life-threatening illness.
The Bill provides for the publication and enforcement of a code of practice, but as my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) said, the code is not included in the Bill, and until its content is revealed I am anxious about the effectiveness of the measures. It is a great shame that my party did not manage to convince the British people with our proposals in the general election, because I think they would have been a little bit more effective than those proposed by the Government.
I agree with my hon. Friend the Member for Beckenham (Mrs. Lait) about ophthalmic services—I certainly share her doubts on the issue. All Members have received correspondence from their local organisations, and I am no exception. The joint Essex local optical committee has worked with our 13 primary care trusts to devise shared care schemes, providing enhanced services to diabetic patients, post-cataract cases and the visually impaired. It has worked with both ophthalmologists and primary care trusts to streamline the entry of acute cases into the hospital eye service, so that the widest choice of treatment can be offered to cataract patients. It does not oppose the proposed reforms in theory; indeed, it has proposed a clinical governance accreditation scheme for optometrists, paving the way for the new contracts. However, I believe that it is essential that the Government continue to consult optical professionals on the details of the Bill, as the Minister of State, the hon. Member for Doncaster, Central (Ms Winterton), told the conference that she addressed in October.
On ophthalmic services, I urge the Minister to consider the rural aspects of ophthalmic services, currently provided by relatively small practices, and the fact that the current contract, by reducing the fees available to those small practices, puts them at risk, which is a danger to public health in rural areas.
Many hon. Members wish to speak, so I shall simply say that I agree with my hon. Friend.
Clauses 24 to 30 propose changes to the level of personal control held by pharmacists. Again, there has been very little mention of that in the debate, which has been entirely about smoking. The relaxation of legal procedures would free up those health care professionals so that their skills and experience could be used more widely in the community, in health centres and clinics.
I apologise to hon. Members for not being present for the whole debate. As the only pharmacist in the House, I know that there is a great deal of concern about the possible relaxation of the supervision arrangements. Some people regard that as an opportunity to provide more services, but what could be lost is the presence of a qualified health professional in the high street at a known time. Has the hon. Gentleman an opinion on that?
The hon. Lady was a member of the Health Committee and has great knowledge of the subject. Again, so as not to annoy the House, I shall simply say that I agree with her.
I also agree with the Royal Pharmaceutical Society in highlighting the fact that, once again, the Bill allows for much of the detail of the changes to be written into the regulations that must be carefully drafted to deliver the benefits of flexibility for supervising pharmacists, while maintaining patient safety and ensuring that the Bill is not a short cut to spreading pharmacists over two or three pharmacy businesses.
Part 4 addresses the deregulation of pharmaceutical services. I welcome that with caution. Several aspects of these proposals come on the back of the recommendations of the "Over the Counter" report of 2003. However, although the control of entry regulations 2003 report by the Health Committee, of which I was also a member, concludes that the current system of control of entry regulations is
"overly inflexible and in need of reform",
it goes on to say that the
"recommendations of the OTC report have the potential to make certain pharmacies unviable, potentially leaving some of the most vulnerable communities, who have the greatest health needs and are least able to travel long distances, without any local pharmacy provision, a situation that would be unacceptable."
Therefore, I certainly stand by the Health Committee's 2003 report.
Although it is sensible that some of the restrictions on applications for contracts to dispense NHS prescriptions should be relaxed to deliver the best possible service to NHS patients, PCTs must retain the ability to plan the provision of local pharmacy services, and any reform to the regulatory framework should be unfolded in tandem with negotiations for a new payment system for pharmacies. Competition in the pharmacy sector should be supported only if it is proven to be compatible with a planned provision of pharmacy services that ensures provision in deprived areas.
This is another Health Bill—more legislation, more regulation. It is true that the Bill frees up health care professionals from the restrictive regulations and requirements of previous legislation. However, my concern in all the points that I have made is that, by reforming the frameworks in which infection control, ophthalmic services or pharmacy and pharmaceutical industries operate, the Government must be careful and consistent throughout the drafting of the regulations so that this opportunity to provide more freedom and flexibility in local health care provision is not squandered by the creation of more targets and bureaucracy, because that burden will hit the health service even more heavily, given its already over-burdensome regulation.
rose—
Order. Several hon. Members hope to catch my eye. If they could be brief in their remarks, more of them may well be successful.
Thank you very much, Madam Deputy Speaker, for calling me to speak in the debate on the Second Reading of this very important Bill, which will improve the well-being and health of women, men and children in the UK. I want briefly to concentrate on two aspects of the Bill: smoking in public places and the proposals for the ophthalmology service.
I was fortunate enough to be drawn fourth in the ballot for private Members' Bills in the last Session of the previous Parliament. In fact, I think that mine was the last Bill to be debated on Second Reading before the general election was called. The title of my Bill was Smoking in Public Places (Wales), and I was aided in proposing it by my right hon. Friend the Member for Rother Valley (Mr. Barron), who is Chairman of the Select Committee on Health, and my hon. Friend the Member for Conwy (Mrs. Williams), who is not in the Chamber. The purpose of my Bill was to call on the Westminster Government to enable the National Assembly for Wales to make its own decision about any smoking restriction that would apply in Wales. I am very pleased indeed that that is proposed in the Bill. Under part 1, decisions about smoking in Wales will be delegated to the Assembly, which will be able to determine its own restrictions, so I warmly welcome that delegation of power to the Assembly.
The Welsh Assembly has a long-standing commitment to ban smoking in workplaces and public places. It first debated and voted on the subject almost four years ago, when the Culture Minister in Wales, Alan Pugh, AM, proposed that
"the National Assembly for Wales . . . calls upon the UK Government to bring forward a public Bill relating to Wales which would provide that the Assembly could . . . prohibit all smoking with tobacco in . . . public buildings . . . The purpose and effect of any such Bill . . . would be to reduce the exposure of employees and members of the public to the well-documented and proven life-threatening dangers caused by environmental tobacco smoke".
The motion was passed by 39 votes to 10 and received the support of all parties. Four years later, we are enacting such a Bill.
Subsequent to that vote, and after the introduction of private Members' Bills in the other place by Baroness Finlay, a well-known palliative care consultant in Cardiff, and Lord Faulkner, who has already been mentioned, the Assembly set up the Committee on Smoking in Public Places, which was chaired by the Swansea, East Assembly Member, Val Lloyd. The purpose of the Committee was to examine developments in Ireland and other countries in which a ban had been enacted and to look at the debate in the UK. The Committee reported in May and the Assembly debated its report on 25 May. A motion in support of the report was carried by 40 votes to nine. I thus have absolute confidence that smoking will be banned in all public places and workplaces in Wales after consultation and an introductory period. I am pleased that that will be able to happen as a result of the Bill.
The Committee asked for powers to introduce a Bill to ban smoking in all enclosed workplaces and public places within two to three years. It recommended several exceptions, some of which have been mentioned today, such as
"private dwellings, which may also be a place of work; . . . designated areas in long-stay hospital units . . . residential and nursing homes . . . prisons"
and
"designated bedrooms or suites in hotels and guest houses, which are occupied solely by a smoker."
That is what happens in Ireland. I am glad that Wales will be able to go its own way on smoking.
I hope that the Government will rethink their proposals for a partial ban in England. There is overwhelming evidence in support of a total ban and the weight of opinion is in favour of that. The Government have a unique opportunity to use the Bill to help to prevent some of the misery that is inflicted by smoking. Why wait? I know that my right hon. Friend the Secretary of State has said that most countries have progressed to a complete ban by stages, starting with a partial ban. However, we have the experience of those countries behind us. Why do we have to wait until more people die because of smoking-related illnesses that could have been avoided? We also know about the example of Ireland, which I visited a year ago with the all-party group on smoking and health. In Ireland, we have a near neighbour that had the vision to move ahead with a complete ban. The Government want to be bold and radical, so this is their opportunity to move ahead with a complete ban.
As other hon. Members have said, the hospitality industry wants a level playing field with no exemptions. The protection for people who work in pubs in which a ban will not be in place will obviously not be the same as that for people who work in places in which there is a ban. There is a suggestion that smoking will be banned in the bar areas of pubs in which food is not served, but it is impossible to draw a line around a bar across which smoke may not pass. The proposal is unworkable.
The Bill, as it stands, will not protect the health of all bar staff. Such a disparity cannot be fair. A partial ban would cause smokers to move from pubs to clubs and some pubs will stop serving food. The hospitality industry says that the proposal is unworkable. I think of city centre pubs in which no food is served and to which lots of young people go. Those young people are the ones who will continue to be exposed to cigarette smoke under the present proposals. I am sure that that is not what my right hon. Friend the Secretary of State wants.
Hon. Members have mentioned health inequalities. The health arguments for a complete ban are overwhelming. The fact that Liam Donaldson told the Health Committee that he considered resigning when his advice was not accepted is overwhelming evidence that the Government should not go ahead with their present plans.
My first job was in Sully hospital, a heart and chest hospital in the Vale of Glamorgan, south Wales. Many people coughed their lives away in those wards and I clearly remember their painful deaths. We cannot stop people smoking—indeed, one could say that they have the right to do so—but we can stop them inflicting their smoke on other people so that in public places, at least, people will not have to breathe other people's smoke.
The debate and public opinion has moved ahead rapidly. What would have been inconceivable five years ago is now, I think, totally acceptable. The Government have to move too, so I urge them to reconsider and, at the very least, allow Labour Members a free vote on the issue.
On optometry, I visited a community optometrist and a representative of the community optometric committee, at his request, in Pontprennau in my constituency last week. He wanted me to mention the concern felt by opticians and ophthalmologists in Wales about the proposals. They will not affect Welsh practitioners as things stand, but he was concerned about devolving the budget to primary care trusts. The opticians think that that will inevitably be capped and allow the PCT to select the people with whom they wish to contract. They fear that that could lead to a restricted service to patients.
Huge progress has been made in ophthalmology in Wales. Optometric practitioners can refer eye patients directly to consultants and surgeons in the hospital without going via the GP. They fear that the progress will be affected by the proposals if they go ahead in England. I ask the Minister to consider the implications of those on ophthalmology and to reconsider the proposals on smoking.
I have to admit that I am one of those described by the hon. Member for Sunderland, North (Bill Etherington) as a zealot in favour of the total ban. I am in good company because I join the right hon. Members for Holborn and St. Pancras (Frank Dobson), for Rother Valley (Mr. Barron) and for North-West Hampshire (Sir George Young), and other right hon. and hon. Members.
We must face up to the fact that the reason for a ban on smoking in public places is to protect the health of all workers. All workers have equal rights to a healthy environment. That is the answer to Ministers who claim that, because we are protecting 99 per cent. of workers, we are doing all right. The problem is that the 1 per cent. we are not protecting work in the most smoke-filled environments. People do not go to work in a factory or a shop to smoke, but many of them go to the pub to smoke. It is the 1 per cent. who are not protected who are the most worthy of protection.
The Health Committee had to face the libertarian argument. A reader in biomedical ethics at Imperial college was asked, "How do we defend the fact that we are attacking people's liberty?" He said:
"It is a simple idea, first set out most clearly by John Stuart Mill in the mid-19th century, the idea that the main way in which you can justify restricting someone's liberty is where they are causing harm to others."
Much as I object to restricting people's liberty, if it causes demonstrable harm to others, it is justified.
In relation to the trip to Dublin, I want to add some figures to facts that were mentioned by other hon. Members. Support for the total smoking ban in Dublin before it was introduced was 67 per cent., which included 40 per cent. of smokers. Within a year after its introduction, 93 per cent. said it was a good idea, 80 per cent. of whom were smokers. A total ban can be popular. Compliance is high. It is easily understood and enforceable, and it is now a pleasure to go into pubs in Dublin.
The arguments against the partial ban have been mentioned at length. They include the worsening health inequalities and the fact that it is illogical and unenforceable. The people who impressed me in the Health Committee were representatives of the Bingo Association. We all have a lot of little old ladies in our constituencies whose only outing in the week is to go to the bingo hall. They probably smoke and drink while playing bingo. However, the Bingo Association wants a level playing field. Without a level playing field, bingo would move to other places such as pubs that do not serve food and where smoking is allowed, which would be quite wrong.
On our visit to Dublin, members of the Health Committee met a chest physician, Professor Luke Clancy, who reminded us of the effect of the Clean Air Act 1956 on London. I was a senior house officer at St. Stephen's hospital when that Act was enforced piecemeal by different local authorities. Professor Clancy reminded us that it took a decade effectively to lower levels of smog and produce health benefits. Ireland has adopted a big bang approach to a ban, which has worked, and it is the only way forward for us.
I shall take a leaf out of the book of the hon. Member for Southend, West (Mr. Amess) and look at other equally important parts of the Bill. I am glad that the Government are going to issue a code of practice with related sanctions on the prevention and control of health care-associated infections. I welcome the Secretary of State's comments that the code will be based on existing good practice and that waiting list targets will not compete with infection control. However, there are some points that must be included in that code. Yesterday, with the right hon. Member for Rother Valley, who chairs the Health Committee, we met members of MRSA Action UK and MRSA Support, who expressed vitriolic anger about the lack of communication. One of my criticisms of the health service, particularly hospitals, is that communication between staff—nurses and doctors—and patients, is sadly lacking, possibly as a result of overwork. Members of those groups had relatives who had died of MRSA, but they had not been told that that was the cause of death. One of them alleged that they had received an unacceptable death certificate that just said, "Multi-organ failure due to sepsis." In my day, no registrar would accept such a certificate, because one had to say what had caused the sepsis.
Openness with the patient and the family is therefore needed, and to help with that, it may be necessary to formalise notification of those illnesses and make it mandatory. The list of notifiable diseases is under review, but diseases such as smallpox which, hopefully, has been eradicated, are still included. Hepatitis C and Legionnaire's disease are not on the list, and hospital-acquired infections and bugs, including MRSA and Clostridium difficile, which are serious pests, have never been included. There is an MRSA surveillance scheme, but it is not tough enough, so will the Minister consider introducing formal notification of those illnesses? If that is too cumbersome and slow, can another method be used?
As for the code of practice, most hospitals, if not all, have infection control teams, many of which follow protocols. During a previous Health Committee inquiry, our attention was drawn to the formulary used by University College hospital in London. Page 280 of the 2002 edition includes protocols for the eradication of staphylococcal infection and refers to protocols for the management of patients and staff with MRSA. I hope that such publications will inform the code of practice. The Healthcare Commission prepared a submission for our debate, which says:
"It will be vital that the code of practice is fully workable in practice and the Healthcare Commission urges that due time, consideration and consultation be taken over its content."
Part 3 deals with drugs, medicines and pharmacies. There is no place for lax management of controlled drugs. When I was a house physician a quarter of a mile from here at old Westminster hospital, the control of scheduled drugs was lax. Much has happened since then, and controls must be tightened up. However, pharmacists have considerable worries about the Bill, as the hon. Member for Romsey (Sandra Gidley) will know. I hope that in Committee those worries will be taken on in detail. Pharmacists do not know in detail the supervision requirements. How many pharmacies will one pharmacist be able to supervise? They are worried that the Bill may exacerbate the shortage of pharmacists.
To conclude, there are good parts and bad parts in the Bill. Returning to the subject of smoking, at the large cancer conference last week, an oncologist from Glasgow, who is very lucky to have the complete ban, said loud and clear that the one most important thing to improve the prevention of cancer was the total ban. Everything else, he said, was lip service.
The hon. Member for Wyre Forest (Dr. Taylor) spoke about MRSA and the massive cover-up that has gone on for years about the scale of MRSA. He makes a true and valid charge. I, along with others, had made it over many years and particularly drew the attention of the House to death certificates recording that a person had died of pneumonia or septicaemia, when in fact the underlying cause of death was a hospital-related infection.
In fairness, the previous Member of Parliament for Welwyn Hatfield—a Minister who lost her seat at the general election—instructed hospitals that death certificates were to be filled in with clarity and precision. Unfortunately, that was not enforced. I called on the House and I call again for it to legislate to discipline or sack civil servants at any level who do not spell out in detail the cause of death on death certificates. I include hospital managers, members of trusts and officials right up to the Department of Health who cover up and conspire to keep the facts from Parliament and the public. I feel strongly about that.
The hon. Member for South Cambridgeshire (Mr. Lansley), who spoke from the Opposition Front Bench, and the hon. Member for Southend, West (Mr. Amess) spoke about MRSA. Plaudits are due to the present Government, who have belatedly begun to address the matter. I wish that they had done so earlier. In the closing stages of the previous Government, I drew attention to the scale of the cover-up of MSRA. Lord Fitt, in another place, drew it to the attention of Baroness Cumberlege, a Minister of Health. It is on the record. In a special debate in the House, I drew the matter to the attention of the hon. Member for Orpington (Mr. Horam), a decent man. I do not blame him, but he warned me from the Dispatch Box not to make party politics of it. It rubs me up the wrong way when I hear people accuse the Government of something that was neglected by the previous Administration. Two wrongs do not make a right. To some extent, both Governments are to blame.
No, I cannot give way; I do not have time.
We want more effort from the Government. They have begun to deal with the problem, but the message is that Ministers, Labour and Tory, should listen to Back Benchers more, instead of listening to civil servants, and give us at least some credit for possibly knowing what we are talking about. Legislation and administration would be much better, and we could have started to combat MRSA a lot earlier, had people listened.
On smoking, we are told that the chief medical officer nearly resigned. He should have resigned, in my view. It is not very brave of him to say that he nearly resigned. It is an extremely important issue. In a small way, I quit one course of my career partly because of smoking. When I was first elected to this place, I was persuaded to be a Whip. Let me share with the House the fact that I did not like that at all and found it very uncomfortable. I aspired to more than reading out the folder every night and being a choreographer. In opposition, the Whips were all men, so I qualified on that count, but they were all smokers—it was like pea soup in the Whips room—which was one of the things that made me quit. The situation was offensive and I could not alter it. I remember sitting there thinking, "I don't need to put up with this", which is when I went to see Mr. Foster and said, "I don't want to be a Whip." The rest is history.
The right hon. Member for Loughborough—
Charnwood.
A large part of England, anyway.
Earlier, the right hon. Member for Charnwood (Mr. Dorrell) said that employers and employees are working gradually to provide smoke-free workplaces. The truth is that employers are now moving to insist on smoke-free workplaces because they fear litigation. Whether or not we pass the Bill, employers are receiving a growing weight of advice that they could face some serious class actions in the future, because they failed to provide their workers with a smoke-free environment.
The right hon. Member for Bromley and Chislehurst (Mr. Forth), who is not in his place, has mentioned prison officers. We have a duty of care to prison officers and prisoners, regardless of whether we pass this legislation, and future Governments may face serious litigation by them.
I support the Bill, although it does not go far enough. I am deeply disappointed that it contains exemptions that will muddy the waters, that will not provide clarity and precision, but will provide the chemistry for division, argument and lack of enforcement. The burden of enforcement will be placed on bar owners and bartenders, whereas the ban in the Irish Republic has been enforced by peer pressure.
The Minister's notes state, "Keep repeating the mantra, 'It's in the manifesto.'" It will not wash. This is a good Bill, and I shall join the overwhelming majority of hon. Members in supporting it tonight because we want a ban. However, the manifesto did not say, "Thus far and no further." Does the Minister want me to conduct an audit of the policies that have not been implemented, although they were included in the manifestos on which we have stood, and the policies which have been implemented even though they were not in a manifesto? The Bill is in line with the manifesto, but so are my hon. Friends who are calling for a comprehensive and immediate ban along the lines of the policy introduced in the laboratory conditions provided for us by the Irish Republic, where the ban has worked.
I represent quite a poor, working-class area, which has the highest indices of heart disease, respiratory complaints, diabetes and asthma. I resent it when hon. Members who represent constituencies where a ban will be implemented because of devolution tell me that a different duty of care will apply to my working-class constituents. I should have thought that a Labour Government would not want the West Lothian question to be raised, and I did not raise it—other hon. Members raised it by interfering in the health care of my constituents and of others in England.
I believe that there is a majority in this House for a comprehensive ban. A week and a half ago, the Government were comprehensively defeated—they persuaded me to join them in the Lobby, which I rather regret now. They are not reading the political tea leaves because there is a majority in this House for a complete ban, but if they want to go down to a further defeat, that is their decision.
When the Secretary of State discussed the Bill, she said that she was proud to introduce it. She should be proud because, as she said, when the Bill goes through—flawed as it is—hundreds, nay thousands, of people will live longer as a consequence. Why would she allow it to be spoiled or diminished by not introducing a total ban on smoking in public places?
Libertarians say that people have the right to choose. I believe in full knowledge and full consent. However, in this case, we cannot provide full consent. We will have a ban in pubs, but not in working-class clubs. Young children are entitled to go into those clubs, and they do. We need to recognise that fact. The Secretary of State says that the ban will apply not only in the bar area but in other areas. That is nonsense, because it cannot be defined. There is bound to be argument and avoidance based on that fudge.
I hope that the Government will have the humility and common sense to reconsider the one area that has aggravated many Members on both sides of the House, but particularly among their Labour colleagues, who welcome the Bill and are proud to support it but see it flawed by sheer cussedness. The problem is that—
Order. The hon. Gentleman's time is up.
Thank you, Madam Deputy Speaker, for calling me to speak in this important debate.
My father died at 46 from throat cancer. I am an ex-smoker who smoked a lot. We both made our choices. I might therefore be expected to speak in favour of a total ban, but far from it. I have read the briefs from the learned gentlemen and organisations proposing a ban— the chief medical officer, the British Medical Association and the British Heart Foundation. They are all experts and they all want the Government to implement a comprehensive ban on smoking. I congratulate the Government on having the courage to say, "Yes, you are experts, but the role of Parliament is to balance the interests of various groups, non-smokers and smokers." If Dr. Liam Donaldson wanted to have a hissy fit because he is an expert and the Government would not implement his advice, they would have been well advised to accept his resignation.
What confuses me about this debate is why we get so pious about second-hand smoke even though the science is still a little shaky. We all experience the implications of second-hand alcohol—drunks who turn our town centres into war zones, drink-drivers who maim and kill thousands of people on our streets, and alcoholic parents and children who destroy families. When, Madam Deputy Speaker, was the last time you smoked 20 B&H and went home and beat up your husband or partner? It simply does not happen. If we are interested in protecting innocent parties, why on earth did this House vote to have 24-hour drinking? The implications of alcohol are far more pronounced and far better known than those of smoke.
Is smoking the ultimate evil afflicting our modern society? I talked to a headmaster at one of my local comprehensive schools who said, "Yes, smoking is a bad thing, but what really worries me is young people coming to school hungover or drunk and unable to participate in the day from beginning to end. A few of my students may be smoking behind the bike sheds two or three times a day. I disapprove of that, but at least they can take part in the school day." We compare cigarettes to drugs and alcohol. Cigarettes are addictive, but they do not rob people of their free will as drugs and alcohol do.
We have several extremely bold and courageous charities in Hertfordshire that help people to break severe addictions that lead them to violence against others and themselves. Several of them smoke and I am pleased that the Bill provides for people in residential situations to be allowed to continue to smoke. However, the charities also provide day-care services. It would be appalling if the Bill did not allow those who receive treatment for drug and alcohol addictions to smoke and, because they could not smoke to relieve their tension and angst, they went back on to the streets and pursued a life of violence again to feed their habits.
I have probably spoken for too long—I am full of passion and I would love to go on for longer. I shall make one final point. In Scotland, it appears that £66 million will be provided over the next three years for enforcement. If that were extrapolated to the UK, the figure would be £660 million for smoking-cessation officers. If the British public were presented with a choice between £660 million for smoking-cessation officers and the same sum for 4,500 new police officers, I believe that they would opt for the latter.
I congratulate the hon. Member for Broxbourne (Mr. Walker) on his passionate speech.
I begin with the killer health care-associated infection in the hospital setting. I am proud of my local acute hospital in Stafford. It was a delight to write to the hospital recently to congratulate the management and staff on hitting the December target for waiting times two months early. No one now waits more than six months for an in-patient operation or more than 13 weeks for an out-patient appointment.
However, Stafford hospital featured in the general election campaign in a different light because of some misinformation from the Conservative party, which suggested that the rate of MRSA infections at the hospital was the equivalent of that for every infection in the past year in the west midlands region. When challenged, it said that that was a mistake. However, a similar incident occurred in Harrogate at the same time. Again, the Conservatives said that they had accidentally cited a regional rather than a hospital-specific figure. One such mistake may be misfortune, but two reek of gross carelessness if not worse in trying to frighten voters into making a particular choice at the election.
The infections are serious and Stafford hospital makes a conscientious attempt to test every vulnerable patient who enters the hospital. When I tour the laboratories at Stafford, I never cease to be impressed by the dedicated work of the scientific staff who carry out the tests. I know that my local hospital takes the matter seriously and we welcome the provisions for a new statutory code of practice coupled with a duty on the hospital to fulfil the standards, which the Healthcare Commission will enforce and inspect.
I should like to focus on the provisions that presage a much greater change in primary care services. We await the White Paper in the next few months, but the Bill contains some evidence of the Government's intention to make primary care services much more responsive to patients' needs. First, let me consider the provisions for pharmacists. I have been impressed by the willingness of pharmacists in my constituency to extend their role in primary care services, whether through help with smoking cessation, prescribing medicines—they are very much up for that—giving confidential contraception advice or helping people with long-term medical conditions to manage their medicines. They are a tremendous benefit to my local health economy. I visit local pharmacists regularly and have seen the changes that they have made in the skill mix of their staff and in their physical premises, which now include private places for confidential consultations. I therefore know that the changes on supervision and charges for which the Bill provides will rightly help to contribute to a greater role for pharmacists in primary care.
The same goes for my recent visit to the optometrists Webb and Lucas in Bridge street, Stafford. Like other hon. Members, I was lobbied about the changes in the Bill to the general ophthalmic service contracts. The optometrists are angry because their negotiations on a new GOS contract were proceeding unremarkably when the Bill, which refers to a new contract about which they had clearly not finished consulting, was published. I know that meetings have been held and reassurances given since the Bill was published, and I think that it is now accepted that this primary legislation opportunity was taken to put the framework in place, and that the consultation will continue on what the services will involve.
I would like to say how impressed I was by the members of the local committee whom I met that evening, and by how much they are up for improving their contribution to primary care services. They showed me what they are doing about diabetic eye screening, with the latest camera and computer technology to aid them. They told me about their joint management, with the paediatric services at the hospital, of children with visual problems. They also told me about the "red eye" service, and explained how they were developing a multi-disciplinary community approach to supporting elderly patients with failing eyesight. These are some of the remarkable provisions that they can add to our primary care services.
I know that the great debate tonight has been about smoking, but I will say only that the Bill's proposals on that issue fit with the small contribution that I have made to the debate about primary care services. So many people in primary care services are involved in smoking cessation and in helping people to overcome their addiction to smoking, thereby preventing second-hand smoking among those of us who do not smoke. Health visitors, pharmacists, GPs and practice nurses are all involved in that same aim.
A ban that gets us nearly to where we want to be is better than no ban at all, so I shall certainly support the proposals tonight. The right hon. Member for North-West Hampshire (Sir George Young) described how, when he joined the Administration Committee, he wanted to take the big bang approach to a total ban on selling tobacco in this place. He went on to describe how the ban was actually achieved over a number of years, a stage at a time. We will perhaps not achieve the big bang approach to a ban on this occasion, but I am sure that we will get there pretty soon.
I see that a fixed-penalty notice scheme is being proposed for those who break the law on smoking. As I have the ear of the Minister with responsibility for public health, I should like to ask her whether she would be willing to extend that approach to a subject close to my own heart at the moment. Will she consider introducing legislation to prevent people from interfering with women who are breast-feeding in a public place? Last week, once again, we saw the scandalous situation of a man complaining to the police about a woman breast-feeding discreetly in a public place. The police sent a squad car and a uniformed officer to stop her. We will never achieve the rate of breast-feeding in this country that we see in the Scandinavian countries, with the consequent public health benefits—
Order. I hope that the hon. Gentleman will confine his remarks to the Bill before us.
I will indeed, Madam Deputy Speaker. I hope that the Bill will receive our support on Second Reading, because it brings significant measures to reduce smoke-related ill health, health care-associated infections, and the risk of the misuse of controlled drugs. It contains useful measures that will precede further reforms at primary care level. We are moving in the right direction by improving public health awareness, supporting public health services and cutting premature deaths, so I hope that the Bill will receive a Second Reading.
I am a smoker, but I consider myself to be a very considerate smoker. I would not smoke in someone else's house, car or office, or near anyone who was having a meal. It is because I have that consideration for others that I find the parts of the Bill that relate to smoking totally objectionable. I agree with my right hon. Friend the Member for North-West Hampshire (Sir George Young) when he suggested that it would impinge on his liberty if someone else's cigarette smoke reached his nose. I entirely agree with that, and there is no reason why the rights of smokers and non-smokers cannot be accommodated. The hon. Member for Sunderland, North (Bill Etherington) mentioned extractor units, which can be installed in pubs and can do a very good job. We live in a society in which people can make choices.
Many hon. Members have quoted figures relating to the number of people who want smoking to be banned in pubs. I think that those figures are probably exaggerated, but if we accept that they are right, and if there is such a large demand for non-smoking pubs and restaurants, the market will deliver those places, as it will in any other line of business. We will then end up with pubs in which people can smoke and have a meal, and pubs in which people do not smoke. We will also have pubs in which smoking is possible in some areas, and banned in others. In those circumstances, it seems to me that everybody would be happy.
The Government, however, make a play of protecting staff. In today's debate, nobody has asked how many people behind the bar of pubs smoke themselves. I have asked the Minister a parliamentary question about that, and the Government have not carried out such a survey. We are therefore trying to protect people from smoke who, in many cases, already smoke.
I also draw an analogy with people going down coal mines. I understand that there are 400,000 outstanding claims by miners or their families relating to people injured in coal mines, many of whom have died already. I do not know of a proposal to stop people going down coal mines, however. When I raised the issue with the hon. Member for Northavon (Steve Webb), he said that it is not necessary for people to smoke in pubs, but it is necessary for people to work down coal mines—I paraphrase him, but I think that that it is what he said. That is not true. People do not have to work down coal mines—we do not have to generate electricity through burning coal, as there are many other ways of doing so.
I worked down coal mines for many years, and the National Coal Board had to take action to protect me from ill health. I have not made a claim, and neither have many other people like me. It is up to the employer, however, to be responsible in terms of how their employees are treated.
For goodness' sake, I do not think that it is possible to go down a coal mine and discover it to be a very healthy working environment.
The Government say that the ban is about protecting the health of people who work behind bars, and I accept that their health should be protected, but there are many licensed premises and a great shortage of catering staff, which is why so many illegal immigrants are employed in catering. Surely if there are different kinds of pubs and restaurants, bar and restaurant staff can find employment in those that suit them.
As many Members have mentioned, if we take the assertion that staff are the primary concern a step further, how can it be right to expose some people in some pubs to smoke, and yet say that in other pubs where food is served people will be protected from a smoky atmosphere? That defies logic. It is nothing to do with liberty. We know why the Government have adopted this position—because the Cabinet could not agree. Everybody would have more respect for the Government were they just to admit that. It is absolute nonsense to suggest that they are protecting some people's liberty.
If we are talking about protecting staff in pubs, as we should, I will mention my pub—I do not own it, but I go in it, as it is in my village. It is the Village Inn in Twyning, if anyone wants to look it up, and it is a fine establishment. The landlord and his wife run it, they both smoke and they do not employ any staff. How does the Government's logic stack up in that case? The pub serves food—it has a very small menu, as it is a country pub. If the ban goes through, let us say that the pub stops serving food, as I think that it would, because many people in that pub smoke. If the landlord chooses not to serve food so that we can continue to go in his premises and smoke, will I be banned from personally requesting a meal? Will I be stopped from going to the landlady and saying, "I am aware that you smoke, that your husband smokes and that it is a smoky atmosphere, but I want to exercise my choice to have a meal"? If I have a meal prepared at home, it is prepared in a smoky atmosphere. Why cannot I exercise that choice? Why should that choice be denied to me? It is ridiculous.
I thank the hon. Gentleman—my neighbour—for giving way. I am sure that he is right about what a wonderful establishment the pub at Twyning is, but he will surely accept that Twyning is not typical of either of our constituencies. We share a primary care trust. The difference in life expectancy between the most and the least affluent areas is eight years, which is considerable. A large part of that health inequality is due to smoking. The Bill in its present form aims to deal with it partially; we would deal with it completely.
The hon. Gentleman has made his point. If he will forgive me, I shall not respond to it in detail because there is not enough time.
If the Government are serious about stopping people smoking, which I do not doubt, and if smoking is so bad for us, which I do not doubt either, why do they not ban smoking altogether? There is a one-word answer: tax. We have heard from a number of Members how much smokers cost the national health service. By means of a parliamentary question, I established that not much research is done on whether those admitted to hospital are smokers. Let us, however, accept what the Minister told me in a separate answer—that the estimated cost of smoking-related diseases to the NHS is £1.8 billion a year. That is a lot of money, but we should also bear in mind that smokers put £8.1 billion a year into the Exchequer—more than four times as much. That is why I cannot see the Bill as anything other than a load of confusion, and rather hypocritical.
I want to speak mainly about part 1, but I shall not repeat what has already been said. Essentially, there are two points of view. I shall only say that I believe that the Government will have to accept a full ban on smoking in public places, whether they do it now or later.
Will the hon. Gentleman give way?
Certainly not. Some Labour Members may not be able to speak because of all the interventions that have already been taken, and I am not going to take any more interventions.
An important issue relating to part 1 has not yet been raised. I refer to the possibility of raising the age of sale of tobacco from 16 to 18 to bring it in line with alcohol and other age-restricted products. That is a glaring omission from the Bill. I have tabled two early-day motions on the issue, and on 18 October I presented the Age of Sale of Tobacco Bill under the ten-minute rule. Its aim is to raise the age of sale of tobacco and tobacco products to 18. I am delighted to say that the Government have made good progress in adopting a more consistent approach to age-restricted products in recent years. Under the Gambling Act 2005 the use of many gaming machines will be restricted to those over 18, and through the Violent Crime Reduction Bill the Government intend to raise the age of sale of airguns and dangerous knives from 17 to 18.
The Government must now extend that important policy to tobacco sales, a move that enjoys popular support. In a recent survey carried out by the BBC, 80 per cent. of the public—particularly those aged between 18 and 24—expressed support for it. We should bear in mind that 80 per cent. of smokers start smoking as teenagers. Moreover, the proposal is supported by the Trading Standards Institute, the body responsible for enforcing the laws relating to age-restricted sales. In a recent press release, the TSI said
"We believe that raising the age limit to 18, combined with stronger penalties against shopkeepers who repeatedly make underage sales, would make it more difficult for young people to regularly get their hands on cigarettes."
Order. I wonder if the hon. Gentleman would relate his remarks to the content of the Bill that we are discussing.
But, Madam Deputy Speaker, I feel strongly that the issue should be considered when we debate the Bill's later stages. I intend to table an amendment, although I believe that the issue is relevant on Second Reading. I have raised it in the House before. I will take advice from you, Madam Deputy Speaker, but I think that the issue ought to be considered in greater detail.
The hon. Gentleman has made passing reference to that. Will he now confine his remarks to the content of the Bill before the House?
Obviously, I have to accept your ruling, Madam Deputy Speaker.
I have already made the basic point that I wanted to make. Will the Minister, in her closing remarks, give me a steer on whether the Government would be willing to consider an amendment along those lines? If they are reluctant to accept one, I would like further guidance from her on the ways and means by which I could bring the question to the Floor of the House in future debates.
I wanted to speak on three parts of the Bill, but as so many Labour Members seem so agitated about the Bill, and want to speak about it, I shall confine my remarks to one part of it, and to a few moments.
I want to talk about hospital-acquired infections and the code of practice. Would the Minister consider putting a statutory obligation on the code of practice? I ask that because a number of practices in hospitals are bringing about hospital-acquired infections, and that requires more than guidelines. Many guidelines and publications have been issued over the years, but as some hon. Members have said, our general election policy, the cleaner hospitals campaign, was probably the right way to go about things.
Staphylococcus aureus, the bug at the root of hospital-acquired infections, has now become vancomycin resistant, too. It is a nasty little bug. Most people here will not yet have eaten this evening, so I shall not go into great detail about it, but it is very vicious in hospitals. What will the hospitals move on to from vancomycin? Heaven only knows. Vancomycin was held back because of complications caused by renal infections and other renal problems when it was given. The fact that MRSA is now becoming VRSA is extremely worrying to people who work in health care.
Hot-bedding seems to be one of the main problems. I never thought that I would say, "In my day", but when I was a nurse I was a good nurse, because I was terrified to be anything else. My matron was a good matron, and when she walked down the ward I shook in my boots, because if our ward was not spotless, and the bedside lockers and tables were not clean, we were in trouble—and we did not have MRSA in the hospital.
Let me give the House an example. When a patient went home or, unfortunately, died, the bed and the bedside cabinet would be cleaned down with chlorhexidine solution, as would the bedside table, the window sills, the floors and the metal on the bed. Everything would be stripped out. Now, when a patient passes away in hospital or is discharged home, the bed gets a quick wipe down and the next patient is in.
A hospital administrator told me recently that the reason for that practice was targets: the hospital had to meet targets and get patients through quickly. I was told that there was a patient with MRSA at the end of the ward that I was standing in. Unfortunately, the administrator had not been allowed to close down the ward, or have it barrier-nursed or sterilised. Why not? Because the hospital management had told him that they had a target to meet.
Will the hon. Lady give way?
No, because other Members want to speak. [Interruption.] Labour Members want to speak, too.
The reason why the ward had not been closed was that the hospital had a target throughput of so many operations to do that day from that ward. The patient was moved to the end of the ward, and new admissions were taken into a ward containing a patient with MRSA. That is targets.
Another factor that contributes to hospital-acquired infections is also illustrated by what happened in my day. We were not allowed to go home or travel back to work in our uniforms. Now, one sees nothing else but nursing and medical staff going home in their uniforms. They may not even wash them, and then they travel back in them. Even if the ward is clean, 25 per cent. of infections are brought into the hospital from outside.
We could have a statutory code of practice saying that medical staff must not wear their uniforms to go home, that there is to be no hot-bedding in the wards, that the wards must be clean, and that auxiliary staff are to be brought back into the wards. We used to supplement the cleaning staff.
I shall not continue, Madam Deputy Speaker, because I want to finish my speech in less than my five minutes, but I hope that the Minister will take what I have said on board, and will consider making the code of practice statutory.
I will be brief. In the time available, I would like to make one or two points. Some hon. Members—including the right hon. Member for Charnwood (Mr. Dorrell), the hon. Member for Tewkesbury (Mr. Robertson) and my hon. Friends the Members for Derby, North (Mr. Laxton) and for Sunderland, North (Bill Etherington)—have spoken against the ban, but I would have to characterise their speeches as disingenuous. They all failed to address the issue of the work force—precisely the point of principle at stake in the Bill.
When my right hon. Friend opened the debate, she was right to say that a point of principle was at stake. That, indeed, is the issue that is exercising many Labour Members. I carried out a survey in my constituency and the results were similar to those that emerged from the consultation that my right hon. Friend very properly instituted after the election. In my survey, too, 90 per cent. of people wanted a ban.
Hon. Members will recognise that we receive more letters on certain subjects than on others. I have to tell my right hon. Friend that I have received many letters on many issues during the past eight years and that a smoking ban is about the fourth most commonly raised with me. Many people have written to ask for a complete ban and I have to say that my sympathies lie with them.
What is the point of principle? It is this: in a public health context, the Bill could be seen as a missed opportunity. It could help to transform people's lifestyle, particularly that of younger people, in a way that we want. We want to help them to lose the habit of smoking. The Government have an opportunity to use the Bill to send out a message to protect the work force and bring about, as I say, an important cultural change. It has even happened in New York of all places. Mayor Bloomberg, a Republican—not on the socialist wing of American politics—introduced a smoking ban. Similar measures have also been introduced in California, Sweden, Ireland and Norway.
I ask my right hon. Friend and her ministerial colleagues to imagine that the House had legislated on clause 3 exemptions and stated that drinking and driving was illegal, but said, "Well, after 2 am, it will not be, because there are not many cars on the road". Imagine if we made seatbelts compulsory, except in cars whose drivers had more than 30 years' experience and a clean licence. Another parallel—[Interruption.]—I ask the House to think of the principle behind it: imagine saying that children were not allowed to work in factories, save where the factory owner had children. Some kind of sensitivity may be built into that, but I would have to point out to my right hon. Friend that the illogicality behind such thinking is stark. Similarly, if we leave the current anomaly in the Bill, we will leave those not covered by the legislation to the harmful, smoke-filled environment.
I understand that my hon. Friend the Under-Secretary will have a difficult task in making her winding-up speech. I would like to assist her. I have with me a speech that was prepared earlier, but it is not my speech that I would like to offer her, it is the speech given by the Under-Secretary of State for Northern Ireland, my hon. Friend the Member for St. Helens, South (Mr. Woodward) when he announced the decision on the total ban in Northern Ireland.
The Secretary of State for Health said that this is a landmark Bill, and so it has proved for the Government. I have counted the speeches by Back Benchers today. We have had a total of 25—a remarkable effort—of which those from Labour Members for the Government counted three, but eight were against, and I am honestly not clear about two others. That is something of an embarrassment for the Secretary of State.
The right hon. Member for Rother Valley (Mr. Barron) spoke eloquently about health inequalities, a theme that ran through the debate. He specifically mentioned that 85 per cent. of pubs in Corby were likely to be exempt under the Bill and he was very concerned about the inequalities that that might engender. The hon. Member for Northavon (Steve Webb) was pressed on cannabis and he needs to construct a more cogent response. The Liberal Democrats support the Government's ban on smoking, but wish to liberalise the smoking of cannabis. I am not sure whether we heard a change of policy today, but the hon. Gentleman may wish to revisit the issue at some point.
The right hon. Member for Holborn and St. Pancras (Frank Dobson) also talked about health inequalities and made the valid point that there is a real risk that smoking will be concentrated in those pubs that do not sell food, which risks turning such pubs into smoking dens. Like my right hon. Friend the Member for Charnwood (Mr. Dorrell), I am a liberal Conservative, but I am persuaded that the do-nothing option is untenable, given the evidence that we now have about the effects of second-hand smoke. We have to act, given the evidence that second-hand smoke causes problems. If we do not do so, we are failing our constituents. The question is how we reach the situation in which the majority of our constituents do not smoke and we reduce the incidence of lung cancer, cardiovascular disease, sudden infant death syndrome and so on.
The hon. Member for Stoke-on-Trent, North (Joan Walley) also talked eloquently about health inequalities. Last night, my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth) was with me in a pub. We were not drinking; he was smoking, but I was not. He gave a classic "cry freedom" speech, which was very stimulating. The hon. Member for Derby, North (Mr. Laxton) was the first supporter of the Government. He gave a tour de force in which he attacked the bourgeoisie and I was thrown back 50 years to a time of class warfare. If his thesis were correct, perhaps the best way to reduce health inequalities would be to increase smoking, because then the bourgeoisie would get sicker and those whom he defined as working class would get healthier. I may be confused: the hon. Gentleman certainly sounded confused in his contribution.
My right hon. Friend the Member for North-West Hampshire (Sir George Young) made a fantastic speech that drew an important distinction between private and public spaces. He and I agreed on the Tobacco Advertising and Promotion Act 2002, when I was very new to this place, and we share a passion for reducing smoking. I certainly have that passion, both professionally and politically. The hon. Member for Liverpool, Riverside (Mrs. Ellman) rightly talked about Ireland and its experience and the lessons that we can learn. She also pointed out that 59 per cent. of pubs in Liverpool do not serve food and therefore could fall into the smoking den trap, about which many of us are concerned.
My hon. Friend the Member for Beckenham (Mrs. Lait) talked about optical services and the other aspects of the Bill that risk being sidelined by our passion to address the smoking elements. The hon. Member for Lewisham, Deptford (Joan Ruddock) said that the Bill is unworkable, and that point was echoed by several of her colleagues.
In bringing forward the measure, the Secretary of State has asked the House to give her more or less a blank cheque, which will allow her and her successors to fill in the important detail at leisure through regulation. I believe that the chief medical officer is relying on that blank cheque in withholding his threatened resignation. I presume that he hopes for a comprehensive ban through regulation at some point in the future.
Although the Bill is primarily about smoking, we should not ignore its important additional features. We can agree on many of them, although we shall seek clarification and improvement in Committee. For example, why does part 3 contain no clarity over pharmacy supervision or standard operating procedures? We need the detail on how many pharmacies one person will be able to supervise. Why does part 4 apparently give PCTs carte blanche to charge pharmacists to set up new contracts? Will part 4 indeed favour larger chains at the expense of the high street, and therefore reduce choice?
Why have ophthalmic services been bolted on to the Bill in advance of the Government's consultation on general ophthalmic services? Will the Government accept that PCTs that are strapped for cash will be tempted to degrade eye tests that they buy? To what extent will small high street opticians struggle under the new regime? Will the Minister outline the intended contents of the hospital-acquired infection code of practice? Will its benefits outweigh the cost of the yet more paperwork, tick boxes and administrative hassle that our hard-pressed professionals have to cope with? Why have the Government ignored Sir Nigel Crisp's view that target-driven high bed occupancy lies at the heart of our high MRSA rates?
The hon. Member for Sutton and Cheam (Mr. Burstow) did not talk about smoking cannabis, but he laid into ventilation without offering any evidence when pressed. That brings me to the very good speech by the hon. Member for Sunderland, North (Bill Etherington). He is something of an expert in this sphere because he has industrial experience and is a smoker, and in his useful contribution he defenestrated the argument that ventilation has nothing to offer. It is a pity that Ministers have not at least considered the possibility that ventilation might have something to offer in all this.
The hon. Member for Strangford (Mrs. Robinson) supported a total ban on smoking and cited international experience, particularly in the Republic of Ireland, quite rightly. The hon. Member for North-West Leicestershire (David Taylor) is a complete ban man, and brought to mind the hon. Member for Derby, North in his reference to King James's counterblast to tobacco.
I am sorry that I missed some of the speech by my hon. Friend the Member for Southend, West (Mr. Amess). I understand that he spoke extremely knowledgeably about pharmacy and ophthalmology, and wondered whether either would be improved by the Bill.
The hon. Member for Cardiff, North (Julie Morgan) asked for a free vote. The Conservative party will be offering its Members a free vote on this issue, and I call on the Minister to do her own Members the courtesy of offering the same.
The Bill is chiefly about a smoking ban, which, in part 1 weighs most heavily on issues to do with personal choice and freedom, and has the greatest capacity to improve public health. Evidence-based public health is the only basis on which we should consider a ban. We must separate it entirely from amenity and nuisance, which are more properly dealt with elsewhere. Nowhere is the Government's conflation of nuisance with ill health more obvious than in the great play made of banning smoking within some arbitrary distance of the bar. The Government have admitted that there is no evidence that banning smoking at the bar would yield health benefits. Their consultation document referred to it as a "courtesy measure". We cannot legislate for courtesy, but we can legislate for public health. I submit that the public health argument for the red line on our carpet here in the Chamber is stronger than that for the arbitrary line that the Health Secretary wants to scratch on pub floors. At least the two swords' separation carries some logic in public health terms, and 80 per cent. of consultation respondents seemed to agree with that.
The Government's muddle-headedness extends to the artificial distinction between pubs that serve food and pubs that do not. To be fair, the illogical association of food and smoking was made by the Health Secretary's predecessor. She may regret it—the chief medical officer certainly does—but this is her Bill and she is responsible for it. Sir Liam Donaldson is supported by the results of the Government's consultation exercise, which showed that 90 per cent. of respondents were against exempting pubs that serve food.
Clause 4 introduces the possibility of a ban on smoking in a range of outdoor places. If it is not expedient to remove a toxin by banning it, we must control exposure to it by other means. If airborne contaminants in industry settings can be removed satisfactorily using ventilation, we should not dismiss out of hand such an engineering solution in the hospitality sector, yet that is precisely what Ministers have done. Exceptions to the ban are likely to be made by the Minister. Surely an insistence on such ventilation and acceptable levels of atmospheric contamination would be both a reasonable compromise and a possible benefit to exempt establishments that may have future employee claims to defend.
The hon. Member for Wyre Forest (Dr. Taylor) is a self-confessed anti-smoking zealot. He talked about the Clean Air Act 1956. I am pleased about that because that Act was introduced by a Conservative Government. He continued to give us a tour de force of the rest of the Bill—quite a task, given its complexity.
The hon. Member for Thurrock (Andrew Mackinlay) is one of the two supporters of the Government whom I counted—[Interruption.]—in respect of the Bill, I hasten to add, and unusually so. He talked with passion about MRSA. He also told us how smoking ended the sparkling ministerial career that was otherwise surely his for the taking.
My hon. Friend the Member for Broxbourne (Mr. Walker) made a thoughtful, passionate speech that balanced libertarianism, good sense and pragmatism. The hon. Member for Stafford (Mr. Kidney) rightly praised the extended role of pharmacists and reflected the annoyance of opticians about the appearance of clauses 34 to 40 in the midst of the consultation on general ophthalmic services.
My hon. Friend the Member for Tewkesbury (Mr. Robertson) rightly drew our attention to the illogicalities of the Bill and the division that it has caused in the Cabinet. The hon. Member for Barnsley, East and Mexborough (Jeff Ennis) referred to raising the age of sale of tobacco to 18—an interesting concept that perhaps contrasts with the ten-minute Bill and the comments made by the hon. Member for Bristol, West (Stephen Williams) earlier today.
My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries)—a nurse, of course—talked about MRSA and VRSA. Interestingly, the Nursing Standard pointed out on 8 March that 40 per cent. of nurses said that they did not have time to clean bed space between patients. Finally, the hon. Member for Wirral, West (Stephen Hesford) talked about drink driving.
Tobacco is surely captain of the men of death. I spent 20 years trying to persuade people to stop smoking. As a politician, I had rather hoped to have a Bill that would be more likely to address smoking than this one. It is a missed opportunity. My hon. Friends will use their judgment and will vote freely. I hope the Minister will allow Labour Members to have a free vote, too.
We have had a very interesting debate, which very much reflects discussions not only in Cabinet, but among the public, about an issue that commands a range of arguments about personal choice and health. We have heard 25 Back-Bench speeches this evening. That is welcome. I absolutely respect the views of my colleagues who would like to see a total ban. I understand their passion, but I hope that, as I proceed, they will understand what we are trying to achieve with a focused package not just on smoking, but on tackling health inequalities across the piece.
Given the comments by the hon. Members for Westbury (Dr. Murrison) and for South Cambridgeshire (Mr. Lansley), who had some difficulty earlier in describing Conservative party policy, I am still not clear about their policy. [Hon. Members: "What policy?"] Exactly—they raised health inequality issues, but as far as I could see, they would leave such things to self-regulation and they had no immediate plan for any legislation whatsoever. We are going a lot further than that. Given the responses of many Conservative Back Benchers—not just the right hon. Member for Bromley and Chislehurst (Mr. Forth), but many others—it was clear that they were unsure about exactly what the hon. Member for South Cambridgeshire was suggesting.
We are debating the Bill in the context of a national health service that is providing faster treatment, with more nurses and more doctors. Survival rates for more major cancers are improving and more people are surviving heart attacks. If people need a heart operation, they will be treated within three months and usually much sooner. There is more choice about health.
Services such as NHS Direct and walk-in centres are all helping to turn the NHS from being just a service for sickness into a health service that is about prevention. That is why NHS stop smoking services have helped more than 500,000 people to quit and stay quit after four weeks. It is one of the reasons why we are considering how we can support families with a better diet. It is why 2 million children get a free apple, pear or satsuma every day through the school fruit and vegetable scheme. Such measures are part of a health service in its widest possible sense and, having succeeded in making progress in all those areas, the Bill will tackle issues surrounding patient safety, primary care and public health.
Let me deal first with issues that hon. Members have raised about measures in the Bill outside those on smoking. My hon. Friend the Member for Lewisham, Deptford (Joan Ruddock) and others talked about MRSA. I am pleased to hear that the rates are going down at Lewisham hospital. She made a good point about testing because many people who arrive at hospital are already infected. She also mentioned care homes and the co-operation of visitors, which will be important if we are to deal with MRSA rates. There is still a lot of work in progress. We are in discussion with the Healthcare Commission about how to make the code stronger, even though consultation indicated that the content was thorough. Another draft will be available before the Bill is passed—it should be available early in 2006.
Hon. Members talked about the choice between controlling infections and closing wards. Decisions on ward closures are made locally. There must be a balance between the risk of patient infection and risks associated with clinical delivery. However, not closing wards could prevent the control of outbreaks, and thus be more of a risk to meeting other targets. The situation is not clear-cut.
My hon. Friend the Member for Lewisham, Deptford and the hon. Member for South Cambridgeshire asked about the private sector. We propose to consult on proposals next spring on, among other things, introducing provisions of the new code to regulations under the Care Standards Act 2000. There will also be a consideration of issues surrounding care homes and the voluntary sector.
My hon. Friend the Member for Thurrock (Andrew Mackinlay) asked about death certificates. They will be completed by doctors. It is doctors' responsibility to identify the underlying cause of death. However, patients with MRSA who die are often already seriously ill with other conditions, so it is sometimes difficult to identify that cause. However, the situation regarding death certificates is being examined.
Several questions were asked about ophthalmic services. The review is examining what scope there is to make greater use of the primary care sector when delivering such services and how to make the best use of available skills in primary care. My hon. Friend the Member for Stafford (Mr. Kidney) set out exactly the sort of services that are being provided in some areas. Such services could be provided further. There is no immediate change to the payment to practitioners and no change for patients. There will still be a central budget for reimbursement for local sight tests. I do not think that there will be any impact on rural areas. In reply to my hon. Friend the Member for Cardiff, North (Julie Morgan), the provisions will not impact on Wales.
My hon. Friend the Member for Dartford (Dr. Stoate) made a point about clause 18 and controlled drugs. We have held discussions with the Royal Pharmaceutical Society. There is already the power of entry into community pharmacies, but we can consider setting out in regulations other specific persons who could enter and inspect relevant organisations. The pharmacy provisions are all about bringing services closer to people. Our "Your health, your care, your say" consultation showed how much people valued their pharmacists and the health care that they provide.
On smoking, I say this from the outset. Several hon. Members talked about young people, especially teenage girls. I am pleased to inform the House that the prevalence of smoking among teenage girls has gone down. In 1996, 13 per cent. of 11 to 15-year-olds smoked, but the figure had gone down to 9 per cent. by 2004. The figure for all women between the ages of 16 and 19 in Great Britain went down from 31 per cent. in 2001 to 25 per cent. in 2003. That is to be welcomed.
My hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) and I have had several discussions about raising the age at which people may smoke, and I am considering the matter. We need to examine some of the evidence that he presented to the House when he introduced his Bill.
In relation to the provisions on smoking, let me quote two opinion formers. Deborah Arnott, the director of ASH, said:
"This Bill will be a big step forwards for public health. If passed into law, it will save thousands of lives every year, as vulnerable people are no longer exposed to dangerous second-hand smoke at work, and as thousands of smokers are encouraged to cut down or quit altogether."
Giles Thorley, chief executive of Punch Taverns, one of the largest operators of public houses, said:
"If self-regulation is no longer possible for the licensed trade industry, then legislation that offers both licensees and pub customers some degree of choice is certainly the next best thing. Although we acknowledge that the proposed non-food/food split will present some landlords with difficult decisions, nonetheless we feel that the distinction is relatively straightforward and workable as well as preserving some degree of choice."
The measures are a huge step forward. They will make enclosed workplaces covering more than 99 per cent. of the work force completely smoke-free. They will give choice to many millions of people in England. The number of smokers in England has fallen by 1.2 million since 1998. That is because of the considerable work done by the Government to tackle not only NHS services, but tobacco control, advertising and so forth.
Many hon. Members commented on the consultation. It is important to remember where the policy started. We consulted widely on "Choosing Health: making healthier choices easier", the most significant public health White Paper for generations. We learned that both smokers and non-smokers overwhelmingly wanted us to restrict smoking in public places, but the support was not as high for a total ban. Although support for that has increased, as my right hon. Friend the Member for Rother Valley (Mr. Barron) said, figures for the latest survey show that 31 per cent. of the public support it. There was, however, considerable support for banning smoking in places where there is food and in restaurants. We have had to grapple with the problem of reconciling health issues with what the public want in order to decide how to move forward.
Public opinion is important. It is not about popularity, but about taking the public with us. Several hon. Members talked about enforcement. That is important, but one reason why we know that voluntary bans, which we have seen for many years on transport, in restaurants and in other public places, have succeeded is because the public—smokers and non-smokers alike—supported them. That is why enforcement of the proposals—they are radical and far-reaching, but they have the support of the public—will be light touch.
Many countries decided to have exemptions in the first instance, especially in the hospitality sector. It is not a case of simply jumping ahead. They did that for the very reason that they could command public support and take the public with them. That is why we have chosen to do the same thing. That goes for California, New York, Norway and practically every country in the European Union.
Let us not forget that Ireland also has exemptions. In response to hon. Members who mentioned Northern Ireland, I acknowledge that there was a consultation, but I have yet to see a public survey based on those conducted by the Government and ASH, through MORI and other companies, in which the public were directly asked for their views. [Interruption.] That was its choice.
We are working to tackle the things that affect health, in particular health inequalities. The biggest determinant of health outcomes is poverty. If I believed that a total smoking ban would affect the problems that I have seen in my constituency, in my life and as Minister with responsibility for public health, I would sign up to it tomorrow, but it is not as easy as that. We know that smoking takes place in the home. We know that people are affected by many other things that have an impact on their health inequalities. We have a package that will take us far further forward in reducing health inequalities and that shows that we are willing to act in an important area.
Question put and agreed to.
Bill accordingly read a Second time.
Health Bill (Programme)
Motion made, and Question put forthwith, pursuant to Standing Order No. 83A(6) (Programme motions),
That the following provisions shall apply to the Health Bill:
Committal
1. The Bill shall be committed to a Standing Committee.
Proceedings in Standing Committee
2. Proceedings in the Standing Committee shall (so far as not previously concluded) be brought to a conclusion on Tuesday 10th January 2006.
3. The Standing Committee shall have leave to sit twice on the first day on which it meets.
Consideration and Third Reading
4. Proceedings on consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.
5. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.
6. Standing Order No. 83B (Programming committees) shall not apply to proceedings on consideration and Third Reading.
Other proceedings
7. Any other proceedings on the Bill (including any proceedings on consideration of Lords Amendments or on any further messages from the Lords) may be programmed.—[Tony Cunningham.]
Question agreed to.
Health Bill [Money]
Queen's recommendation having been signified—
Motion made, and Question put forthwith, pursuant to Standing Order No. 52(1)(a), (Money resolutions and ways and means resolutions in connection with bills),
That, for the purposes of any Act resulting from the Health Bill, it is expedient to authorise the payment out of money provided by Parliament of—
(a) any expenditure incurred by the Secretary of State by virtue of the Act,
(b) any increase attributable to the Act in the sums payable out of money so provided under any other enactment.—[Tony Cunningham.]
Question agreed to.
Delegated Legislation
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),
Immigration
That the draft Asylum (Designated States) (No. 2) Order 2005, which was laid before this House on 24th October, be approved.—[Tony Cunningham.]
Question agreed to.
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),
International Immunities and Privileges
That the draft European Forest Institute (Legal Capacities) Order 2005, which was laid before this House on 26th October, be approved.
That the draft European Court of Human Rights (Immunities and Privileges) (Amendment) Order 2005, which was laid before this House on 3rd November, be approved.—[Tony Cunningham.]
Question agreed to.
European Union Documents
Motion made, and Question put forthwith, pursuant to Standing Order No. 119(9) (European Standing Committees),
Reducing the Climate Change Impact of Aviation
That this House takes note of European Union Document No. 12790/05 and Addendum 1, Commission Communication: Reducing the Climate Change Impact of Aviation; welcomes the work of the European Commission in taking forward the work programme on reducing the climate change impact of aviation; and supports the Government's approach to continuing to press for the inclusion of aviation in the EU Emissions Trading Scheme from 2006 or as soon as possible thereafter.—[Tony Cunningham.]
Question agreed to.
Tax Law Rewrite Bills (Joint Committee)
Ordered,
That Mr Kenneth Clarke, Mr Nick Clegg, John Healey, Kali Mountford, Mr Andy Reed, Mark Tami and Peter Viggers be members of the Select Committee appointed to join with a Committee of the Lords as the Joint Committee on Tax Law Rewrite Bills.—[Gillian Merron, on behalf of the Committee of Selection.]
Petitions
BUPA Care Services
I would like to present a petition on behalf of my constituent, Mrs. Dee Sedgwick, about the care given to her mother, Mrs. Joan Gaddes, a resident in a care home for the elderly owned by BUPA Care Services. The petition states:
Wherefore your Petitioner prays that your Honourable House will urge this Government to take effective steps to bring BUPA to account and that the avoidable suffering and death of a dearly loved mother is not so easily excused in future.
To lie upon the Table.
Scottish Regiments Campaign
I take enormous pleasure in presenting a petition on behalf of Andrew Nigel Hamilton of 16, Lynedoch place, Edinburgh and formerly of the Black Watch. He makes material observations to the effect that the abolition of the Scottish regiments is disgraceful and counter-productive. He make the point that the collapse in recruitment to the Scottish division amply demonstrates that the Government's policy is leading not just to a betrayal of tradition but an operational disaster for the Scottish division. Some 165,000 people in Scotland and far beyond have endorsed the petition, which will be taken to Downing street tomorrow. It states:
To the House of Commons
The Petition to Save the Scottish Regiments Campaign
Declares that Her Majesty's loyal army is at "overstretch" and is also facing the hitherto unforeseen threat to her country's homeland security posed by the London suicide bombers.
The Petitioners therefore request that the House of Commons urge Her Majesty's Government:
To re-examine with immediate effect, by means of a Defence Review, its decision to reduce the number of infantry battalions from 40 to 36.
To cancel, subject to the outcome of the Defence Review, the decision to amalgamate The Royal Scots regiment with the King's Own Scottish Borderers regiment.
To cancel the decision to replace the six historic Scottish infantry regiment with a single large regiment.
And the Petitioners remain, etc.
To lie upon the Table.
Mines Rescue Service
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Dhanda]
The main town in the constituency of North-West Leicestershire is Coalville—a place created by an industry that provided it with work, shaped its community, fashioned its landscape and gave it its name. My constituency office is close to the town centre and just a few hundred yards from the old No. 5 pit of Whitwick colliery. In the early hours of 19 April 1898, 42 men were in that pit when a fire broke out, 34 of whom were cut off and perished. Of the eight men who escaped by the main roadway or by the return airway, one bravely returned to the smoke and fumes in an attempt to help his workmates, but tragically he, too, died. That man, Charles Clamp, a 27-year-old onsetter, was heroically doing a job that has developed in the past century into a key role in the modern-day Mines Rescue Service, the courage, skill, knowledge and professionalism of which are renowned wherever coal has been mined in our nation.
I was privileged to unveil a statue on the centenary of that worst disaster in the history of the Leicestershire coalfield, and ever since then I have kept in touch with the MRS through visits to its original local headquarters in Ashby and its modern base at nearby Moira. Generations of mining communities have looked to the MRS and its predecessors for assistance. Now the MRS needs our help as it carves out a new future in a country with just a handful of remaining deep mines. Tonight's debate will summarise its present position and the options available to us.
Following the privatisation of the mining industry by the previous Conservative Administration, the Mines Rescue Service was formed on 17 January 1996 for the purpose of taking over the operations of the Mines Rescue Service and associated activities previously undertaken by the British Coal Corporation. Its turnover in the year to 31 March 2005, including £2.5 million from the Coal Authority, was around £6 million and its operating costs were £7.1 million. The MRS has, over the past nine years, followed a strategy designed to counteract the decline in membership fees paid by the coal mines by increasing other income earned by its employees.
I will happily give way to my hon. Friend, who advised me in advance that he wished to participate in the debate.
I congratulate my hon. Friend on securing this important debate. Today I spoke with Steve Kemp, the general secretary of the National Union of Mineworkers, who believes that the Mines Rescue Service should be treated in much the same way as the ambulance and fire service. He also believes, as I do, that it should be taken back into public ownership, along with what is left of our deep mine coal industry. Will my hon. Friend deal with these matters?
I hope the Minister will do so too. My hon. Friend knows from previous conversations that I fully agree with such an outcome. We shall see whether the Minister announces it in his response.
The other income that the MRS has tried to develop has been earned by the provision of health and safety services to industry in general, and it has so far successfully enabled funding gaps to be covered. The strategy has enabled the MRS to retain its highly trained personnel during a time when confidence in the future of the coal industry has been very low. The past 12 months, however, has seen a sudden and marked decline in output from the deep mines—13.1 million tonnes falling to 9.5 million tonnes—at a time when the industry itself has been in some financial difficulty. An anticipated fee income of £2.3 million has declined to £1.5 million, leaving a shortfall of £800,000.
My hon. Friend probably knows that I still have a deep coal mine in my constituency. I am one of the few people who believe that there is a future for deep mining in this country because we have access to millions of tonnes of reserves, but without the MRS on standby I do not know how the ordinary services could do the special job that it does if they were ever needed—God forbid—to go underground to rescue people at Maltby colliery.
That is a topic for a separate debate. There are 800 million tonnes of coal left in north-east Leicestershire, and I agree that we need to work those reserves in the future. The need for the MRS will be acute at that time.
Every effort is being made by the MRS to increase other income and reorganise services to the remaining underground mines without reducing standards. It is anticipated that the shortfall of £800,000 can be reduced by some £500,000, leaving an actual shortfall of £300,000, which can be carried this financial year, but losses cannot be sustained for next year. Action must be taken now to stop the decline.
I have a mines rescue station at Houghton-le-Spring in my constituency, which has a proud and brave history. As we have lost the last deep coal mine in the northern region, the service has diversified into other areas, particularly specialist training in the fire service. Does my hon. Friend believe it would be a good idea for the Government to consider some seed-corn resources, as such diversification can be very expensive to develop? That would give the MRS the support that it needs to develop such training.
I am pleased that my hon. Friend mentioned that and I thank him for it. I shall deal with the point at the end of my speech.
The MRS is in discussion with the Health and Safety Executive, mine owners, trade unions and its own employees about a more efficient use of the mines rescue resource. Operational personnel cover 24/7 and they will, within the constraints of the legislation, provide an overall framework of emergency cover to the mines as efficiently and effectively as they can. These changes will not reduce numbers overall, but will release operational personnel for income-generating work elsewhere.
The expertise of the MRS is unique and its advice and training is much sought after by industry, fire brigades and the civil resilience directorate. I know that it will continue to work with these as long as it is financially able. The UK coal industry has an enviable record for safety worldwide and the MRS will hopefully continue to play a major role in ensuring that that continues as long as underground mines exist in the UK.
May I instance just one example of how the MRS has diversified in recent times? On 11 May 2004, a huge explosion at the ICL Stockline plastics factory in Maryhill, Glasgow caused a four-storey building to collapse, killing nine people and injuring 40. In the three days of intense rescue and stabilisation activity that followed the collapse of the factory building, more than 200 firefighters were involved in freeing trapped workers from the wreckage. Time is, of course, the crucial factor in such search and rescue operations, and the work of the Strathclyde fire and rescue service was greatly assisted by the presence at the scene of staff from the MRS office in Fife.
The chief officer of the Strathclyde fire and rescue service, Brian Sweeney, has praised the role that the 14 members of the MRS staff played at Stockline over that tense three-day period, which has subsequently led to training and development links of the sort that my hon. Friend the Member for Houghton and Washington, East (Mr. Kemp) mentioned being forged between Strathclyde fire and rescue service and the MRS. When my office contacted Mr. Sweeney, he said:
"The expertise and commitment of the Mines Rescue team from Crossgates, Fife was invaluable during the search and rescue phase of the tragic incident at Stockline Plastics, Glasgow . . . The knowledge, skills and experience of the Mines Rescue staff provide a much valued resource to enhance the skills and safety of firefighters in the area of Urban Search and Rescue."
That endorsement of the specialist skills and professionalism of MRS staff clearly illustrates the enduring importance of such skills in reacting to disasters of a potentially bewildering diversity, particularly in urban areas.
In discussing with the MRS its experiences at Stockline, I have been struck by the impact on search times that its expertise brought to the situation. Minor details suddenly become extremely significant when the clock is ticking on a search and rescue operation in such a hazardous environment as a collapsed building. The fact that the breathing apparatus that the MRS carries as standard has a minimum of four hours air supply increases in importance when one realises that the standard air supply carried by a firefighter is 20 minutes. That is not a criticism of firefighters or the fire and rescue service—far from it—it merely provides further demonstration of the flexibility, adaptability and specialised nature of the skills and equipment possessed by MRS staff.
In my county, Leicestershire, the MRS has supported and assisted the fire and rescue service in a number of ways, most significantly in the development of Leicestershire fire and rescue technical rescue team. As a result of that partnership, Leicestershire is one of the leading fire and rescue services in the new dimension urban search and rescue roll-out programme. Ian Holden, the manager of Leicestershire's technical rescue team, has commented:
"Our joint collaboration with the MRS . . . has increased our capacity to assist members of the public who are in need of rescue. There is no other organisation that has this technical expertise within the United Kingdom."
I appreciate that the fire service comes under the remit of the Office of the Deputy Prime Minister, but I am sure that the Minister agrees that that is powerful testimony.
The continued decline of the domestic coal industry is an obvious challenge for the MRS, and UK Coal's sudden and unexpected closure of the last working coal mine in the north-east of England, Ellington, was an unwelcome shock for all concerned. However, the MRS has been able to mitigate the impact of the loss of working mines in the UK by planning for it. The sale of land assets, not least the former headquarters at the Selby complex, and a 29 per cent. increase in income from non-traditional streams in the past year, have enabled the MRS to address its pension fund deficit, invest in its national network of rescue stations and training centres and upgrade vital search, escape and rescue equipment.
I thank my hon. Friend for giving way and congratulate him on securing the debate. He has mentioned other income streams: the MRS headquarters in Mansfield has recently been used as an estate agents to sell holidays and holiday cottages and flats abroad. A recent case involved land and property in northern Cyprus owned by refugee Greek Cypriots, one of whom resided in my constituency. Such practices do not suit the operation of the MRS, and I urge my hon. Friend to urge his friends to desist from such activities.
That is not the sort of diversification that I had mind, and I will certainly raise the matter with the MRS.
The growing range of emergency escape and rescue services provided by the MRS offers an alternative source of income that benefits not only the company, but society as a whole. The Government have provided financial assistance to the MRS to the tune of £2.5 million in each of the past two years, but that is not the whole picture. The Minister for Energy, who is unable to respond today, has said:
"This funding enabled Mines Rescue Services Ltd. to reimburse to UK deep-mine operators the production-related levy sums which the latter had paid to the company throughout that period."—[Official Report, 6 July 2005; Vol. 436, c. 464W.]
The payments from the Coal Authority to the MRS have gone back to the mining companies, which are thereby assisted by the Coal Authority in that regard. It is a source of regret to the MRS, its staff and its many supporters that the £2.5 million payments from the Coal Authority to itself via the MRS have been the extent of a Labour Government's financial help to a service that is increasingly needed beyond the shrinking confines of its industrial origins. The MRS only ever budgets to break even and still performs its statutory duties at the remaining deep coal mines in the UK to a high standard. Although the Government have helped to prolong the existence of some of the remaining pits by making those payments from the Coal Authority to the MRS over the past two years, I feel that they should make a continued further contribution to secure the continued existence of the MRS.The long-term strategic aims of the company are working, and it is anticipated that its continued diversification will reduce net costs and enable it to become less reliant on the UK deep coal mine industry. Yet member companies running underground coal mines in the UK continue to have access to a fully functioning and cost-effective emergency escape and rescue capability.
Consolidation of the role of the MRS in the provision of escape and rescue emergency services in the mining sector has been achieved in the form of a three-year contract with the Coal Authority. The deal is to provide 24/7 emergency response call-out for surface hazards associated with legacy coal mining activities. A year into the contract, the MRS is meeting stringent service delivery targets and creating an excellent working relationship with Coal Authority representatives. During the past year, the MRS has successfully bid for several large training contracts in mining and non-mining sectors. The outsourcing of health and safety training requirements has benefited it, and the acquisition and use of mobile training facilities has increased its competitiveness.
Many Members have been consistent advocates for the MRS since 1996 and are well aware, often through the bitter industrial experiences of their communities, of the origin of the skills that it has honed so well for a broader search and rescue application. I pay particular tribute to my hon. Friends the Members for Mansfield (Mr. Meale) and for Elmet (Colin Burgon), who are both present, and to others who have intervened.
As my hon. Friend well knows, I am the Member of Parliament for Mansfield. In the 18 or 19 years for which I have been a Member, the MRS has been in contact with my office on no occasion other than the recent case that I mentioned. When I inquired of other Members, they said that they have had no personal one-to-one communications with it. I wanted to put that right.
I am happy for my hon. Friend to do that. I know that he has recently asked questions about the future of the MRS.
Those Members are rightly proud of, and reassured by, their constituencies being bases for the MRS, and have consistently lobbied the Government on its behalf.
So what of the future? Industrial accidents on the awful scale seen yesterday at the Dongfeng mine in north-east China may be regarded as a thing of the past in this country, but the skills, knowledge and expertise developed first by the British Coal Corporation and continued by the MRS have the potential to be of crucial benefit in a wide range of disastrous circumstances in many parts of the world.
Our industrial history has bequeathed us an exceptional search and rescue service that we risk losing at a time when we face a distinct threat from our past—international terrorism. That is most likely to strike in urban areas, as the appalling events in parts of London on 7 July this year tragically confirmed, and the MRS is the only organisation adapted purely to the needs of emergency search, rescue and escape situations. We cannot afford to lose those skills at this time.
We have come a long way since the heroic efforts of Charles Clamp and the many other miners who perished trying to save lives that some pit owners disdained as mere numbers. I hope that we will hear some recognition from the Minister of the Government's duty to recognise the past legacy, current value and future potential represented by the MRS. Some companies appoint themselves to a tier of the emergency services in their advertising. The MRS can legitimately claim that through its training and development of a growing number of fire and rescue service staff across the UK. As my hon. Friend the Member for Elmet said, that suggests a continued public sector involvement. No fanfare is required, just Government funding to meet the present shortfall if we are to continue to benefit in the medium term from the skills, courage and professionalism of the MRS, to which all Members here would pay tribute.
I congratulate my hon. Friend the Member for North-West Leicestershire (David Taylor) on securing an important debate. I thank him, my right hon. Friend the Member for Rother Valley (Mr. Barron) and my hon. Friends the Members for Mansfield (Mr. Meale) for Elmet (Colin Burgon) and for Houghton and Washington, East (Mr. Kemp) for their contributions. I also thank my hon. Friend the Member for North-West Leicestershire for understanding why my hon. Friend the Minister for Energy is not replying to the debate.
It goes without saying that underground coal and other mining operations take place in highly hazardous conditions. A fire or explosion underground can produce large quantities of carbon monoxide and other noxious gases. Old workings and mine waste can release asphyxiating fumes. Serious machinery or transport accidents can also occur. However, for me, the most harrowing possibility is a roof fall that leaves miners trapped underground, perhaps miles from the safety of the pithead.
Despite those ever-present dangers, I am glad to say that the coal mining industry's recent safety record in this country is excellent. There has been one fatality this millennium and only 53 major injuries occurred in 2004–05. Of course, that detracts neither from the fact that it is vital for mine operators to have access to the specialist underground rescue services to respond to emergencies on the thankfully rare occasions that they occur, nor from the courage and dedication of those whose business is to provide those services.
In the United Kingdom, local authority emergency services generally deal with fires, explosions and gas leaks on the surface in residential, commercial and industrial premises. However, they do not have the specialist skills and experience necessary to cope with underground emergencies, which require specialised breathing apparatus and other equipment, and important specialist training.
Mines rescue services are principally relevant to the deep mine coal industry. However, other underground mines such as salt, gypsum, stone, potash and storage mines may also use them. In addition, their services may on occasion be called on to rescue members of the public from abandoned mine workings, culverts and confined spaces.
Against that background, the Escape and Rescue from Mines Regulations 1995 provide the current legislative framework for mines rescue in the UK. Under the regulations, owners of all types of mine must make what are termed "effective arrangements" for the rescue of persons operating below ground. However, the owners of coal mines in particular must ensure that sufficient trained and fully equipped rescue team members are available as required to provide a continuous 24-hour rescue service. To that end, coal mine operators must participate in a Government-approved mines rescue scheme.
The scheme requires: the maintenance of an adequate pool of full and part-time rescue workers; the operation of a common command structure with suitably qualified and competent rescue offices to supervise the training and operation of rescue teams; the maintenance of regional mines rescue stations at suitable locations, with common communication systems; suitable equipment that is common throughout the country; similar training for all rescue personnel, and the co-ordination of arrangements for mutual assistance between members in an emergency situation at any member's mine.
As we all know, privatisation of the coal mining industry in 1994 led to the creation of several new deep-mine owners. In the 1993 White Paper "The Prospects for Coal", the Government of the day clearly reaffirmed a commitment to ensuring that health and safety standards would be maintained after privatisation. The document states:
"Safety must, of course, continue to be paramount. The Government is determined to ensure, in consultation with the Health and Safety Commission, who remain responsible for safety regulation in the industry, that the existing high safety standards in such mines are maintained after they pass into the private sector."
The maintenance of effective mines rescue provision clearly was, and continues to be a vital part of that equation.
For a period following its effective withdrawal from mining, British Coal provided to its successor deep-mine operators a fully trained mines rescue service, which, at the time, numbered around 100 full-time and 500 part-time rescue workers. In 1996, the assets, employees and liabilities of British Coal's mines rescue operation were transferred to a stand-alone company. Mines Rescue Service Ltd. has fulfilled the requirements of the statutory scheme ever since.
As my hon. Friend the Member for North-West Leicestershire said, Mines Rescue Service Ltd. operates from headquarters in Mansfield in Nottinghamshire and from a network of rescue stations in the proximity of the remaining deep mines, whose operators, principally UK Coal and Tower colliery, finance the service by means of a production levy, currently standing at 16p per tonne.
In 2002, the Health and Safety Executive commissioned an examination of alternative structures for the provision of mines rescue arrangements in Great Britain and to assess their relative merits against credible scenarios for the future coal mining industry. The resultant report concluded that, from a structural perspective, the existing arrangements provided the most flexible and lowest cost means of ensuring rescue cover to both large and small mine operators.
However, it would be remiss of me if I did not acknowledge that, in examining the funding aspects of the service, the 2002 report propounded several alternatives to the status quo, recognising the further contraction in the industry that had taken place since the service's creation. It suggested that there were cogent arguments for partial or total Government funding. In doing so, it noted that, in other countries with active deep mine coal industries, Governments provided funding or at least a subsidy. International comparisons suggested that it was common for operators to contribute to the funding of mines rescue provision up to a specified limit, and for the balance to be met centrally. Such a system obviously provides operators with greater certainty that they will be insulated against cost escalation.
We were sufficiently persuaded by the case for Government assistance when, in 2003, we were considering how best to formulate a package of support for the coal sector. The principal element of what emerged was, of course, the coal investment aid scheme, from which we have awarded more than £58 million to deep-mine projects. At the same time, we pledged to endeavour to provide funding for the MRS over the three-year period from 2003 to 2006. However, finding those funds was always going to be an uphill struggle. None the less, I am glad to say that last year and the year before, our efforts were successful, thanks to the Coal Authority.
The authority, as most hon. Members will know, is the industry's licensing body and the inheritor of much of the environmental legacy of past mining. Some of its functions are self-financing but, for the others, it receives grant-in-aid funding from my Department. As well as inheriting a raft of liabilities, the authority was heir to a good deal of former British Coal land and property, and it has been disposing of this over the years. In both 2003–04 and 2004–05, we allowed the authority to direct windfall gains on property sales towards the MRS. The £2.5 million paid in each of those years enabled the service to reimburse deep-mine operators for the levy payments that they had made over the period. Regrettably, however, it looks highly unlikely that we will be in a position to repeat the process this year or in the future.
I know that my hon. Friend will discuss these matters with the Minister for Energy tomorrow, but may I just tell him that the decline in coal mining production has been sudden and steep, and what we are seeking is bridging support for 12 months or so, to allow the MRS to diversify even further in the successful way that it has in the past?
I thank my hon. Friend for his intervention. I shall come to that matter shortly. I know that he, too, is going to meet my hon. Friend the Minister for Energy.
My hon. Friend mentioned the diversity that the MRS has been proactive in seeking. It has been shaping its destiny in a way that helps to minimise the need for industry funding. The company has valuable and, in certain respects, unique experience and expertise in first aid, fire fighting, the use of breathing apparatus and, most significantly, working in confined spaces. It has skilfully marketed this expertise, principally to the other emergency services, in the form of training programmes. At the same time, it has exploited its ability to provide an emergency response throughout coalfield areas to secure a contract to provide the Coal Authority with a surface incident service which involves experienced mines rescue staff being the first to arrive on the scene when hazards such as ground collapses arising from historic mining are reported. I know that, in the constituency of my hon. Friend the Member for North-West Leicestershire, the MRS is in discussion with the east midlands fire and rescue service with a view to entering into a memorandum of understanding that will provide for collaboration in the provision of life-saving intervention at collapsed structures and other similar incidents.
All of these activities are helping to support the core deep-mine rescue service that the company was originally established to provide, and are instrumental in ensuring, for the meantime at least, that there will be no increase in the industry levy. While I appreciate that the service might have to dip into its limited reserves to make good a modest budget shortfall this year, I have some confidence, given its excellent track record up to now, that its tireless pursuit of new and different business opportunities should see it fair for the future.
That is the spirit in which my hon. Friend has asked us to try to resolve the difficulty in the short term, and I know that my hon. Friend the Minister for Energy will look at ways to protect and develop the service in conjunction with the other emergency services along the lines that my hon. Friend has described.
As the Minister rightly says, I hope to discuss these matters with the Minister for Energy when he becomes available. Tomorrow, will he ask the Minister for Energy, who has a good track record in response to the coal mining industry, to strain every sinew and tap every fund that might be available to give breathing space to this important organisation, as it has tried so hard in its professional life to give breathing space to trapped miners? It is trapped in a position not of its choosing. It seeks an escape route, and the Government can offer that escape route, which is required for a brief period. I hope that he will put that case strongly and vigorously to the Minister for Energy when he next discusses the matter with him.
I will certainly do so, echoing how my right hon. and hon. Friends have put the case this evening. We value what the service does, and we will try to find ways to be of assistance. The Department is in a tight financial position anyway, but discussion about what the service is already trying to do to diversify will help. I am prepared to add my voice to my hon. Friend's to make sure that there is a successful outcome.
Question put and agreed to.
Adjourned accordingly at half-past Ten o'clock.