Children and Families Bill

Baroness Hughes of Stretford Excerpts

Wednesday 29th January 2014 Lords Chamber

[Lord Walton of Detchant (CB)]

My Lords, different views have been expressed by a number of noble Lords and I shall speak very briefly. The accumulated evidence relating to plain packaging of cigarettes that has arisen over the past few years is incontrovertible, and for that reason the Government’s amendment is extremely welcome.

So far as smoking in cars is concerned, there is no doubt whatever that passive smoking is extremely dangerous. The concentration of the effects of passive smoking within an enclosed space such as a motor car is particularly dangerous for children. Again, the medical evidence on this is incontrovertible. The point made by my noble and learned friend Lord Scott, on the issue of people smoking in a pony and trap, is an interesting one but could readily be dealt with by regulations under the amendment to restrict the provisions to enclosed motor cars and so forth.

I listened exceptionally carefully to the very erudite and persuasive speech by the noble Lord, Lord Cormack, whose views I normally fully support and accept. Unlike him, who was disgusted by smoking two Woodbines behind the bike sheds, I first smoked a Woodbine in a mining village in County Durham at the age of 10 and I enjoyed it. By the time I was a teenager, I was a regular smoker. When I was in the Army in the late 1940s as second in command of a hospital ship, I could get a can of 50 Senior Service for one shilling and eight pence, which lasted me two days, so I was a heavy smoker. It took me a long time to get over it.

The question I would put to the noble Lord and the noble Earl is this: the noble Lord, Lord Cormack, took a great deal of time to talk about the difficulty of policing this amendment if it were carried into law. But is it any more difficult for the police to recognise someone smoking in a vehicle containing children than it is to recognise someone who is not wearing a seatbelt or using a mobile phone illegally? I do not believe that it is. For that reason, I support the amendment.

[Baroness Hughes of Stretford (Lab)]

My Lords, this has been an important but very long debate. However, my name is attached to three of the amendments in the group and I beg the indulgence of the House to make a few comments in, I hope, concluding the debate before the Minister responds. I want to thank the Minister in particular for his role in responding to the widespread support for standardised packaging within and beyond the House. The crucial role that he personally played in the Government conceding on this measure is recognised across the House. I am also grateful for his commitment on the record today that it is the Government’s clear intention to implement these measures as soon as possible, subject to the outcome of the evidential review. I hope that he can further confirm that the action will follow very swiftly in response to the questions raised by my noble friend Lord Hunt and the noble Baroness, Lady Howarth, about the timetable.

The Government’s intention to bring forward at Third Reading measures to ban proxy purchasing of cigarettes and e-cigarettes, taken together with this amendment on standardised packaging, will make a significant difference to the exposure to and take-up of cigarettes by young people. However, there is one other distinct and significant health hazard to children from smoking that we should include in this package of measures, and that is in relation to smoking in private vehicles and enclosed vehicles.

Our Amendment 57BB would simply enable the Government to bring forward regulations to make it an offence to expose children to tobacco smoke in cars, once the Government, with others, had reviewed the detailed implications and practicalities that such a measure would entail. That process of review and developing regulations would take account of all the questions raised across the House today about what if, would it mean this and would it mean that. It is an enabling amendment.

When it was first proposed by the noble Baroness, Lady Finlay, in Grand Committee, I was profoundly struck by the power of her argument about the particular vulnerability of children in this very enclosed situation and the impact on their health and development at their immature stage. It is obvious. I have heard no dissent in the House today about why passive smoking by children in cars is a very bad thing and ideally should not happen. I will not rehearse those arguments, which have been very well made again today by Members across the House.

However, I want to focus briefly on concerns that have been expressed about the amendment and the arguments against it. There have been three main arguments. One is the basic libertarian argument that people should be free to do what they like in their cars because they are private spaces and should not be fettered. But when we are considering freedoms, as we have done in our history, there is always a balance. Freedom for some is often at the expense of freedom for other people. The balance we are considering here is between the freedom for adults to smoke in cars when they like and the freedom for children not to breathe in that smoke in a situation from which they, by definition, as several noble Lords pointed out, cannot escape.

When responding to the noble Baroness, Lady Howarth, the noble Lord, Lord Cormack, for whom I have great respect, as he knows, said that there is a difference between smoking, which is a legal activity, and other things that we have prohibited in the home in relation to children. But the things that we were talking about then, such as neglect of children and the beating of children, have not always been illegal in the home. They were made illegal because they are particularly harmful to the well-being of children. We take it for granted now that such things are illegal but they were not always. We invaded that private space because of the need to protect children. The same argument applies. Because of the degree of damage that we know smoking in cars causes, we should apply the same argument here.

[Lord Cormack]

I have been thinking a lot during this debate. Is not the answer to make it obligatory for all new cars to have a smoke alarm fitted?

[Baroness Hughes of Stretford]

That particular measure would not deal with the issue of prohibition, so I cannot see how it would necessarily help. The alarm may go off, but if it is still legal for adults to smoke with children in the car, there would be no consequence to its going off. There are precedents, because this is a child protection issue, for our proceeding along this route.

The second argument was: if cars, why not private homes? There have been contributions today that have made it clear, citing research by the British Lung Foundation and other bodies, that there are real and qualitatively different levels of risk to children from the smoke in a confined space, from which they cannot escape, compared to that in homes. Yes, children will be harmed in some homes where space is limited. That is undoubtedly true. But the potential for children to escape those spaces is clearly there in a home situation. They can go outside as well. In a car, the toxicity levels and the fact that the child is trapped make that a distinctly different situation, of which we should take account with this amendment.

The third argument has concerned the difficulty of enforcement.

[Lord Forsyth of Drumlean]

I know that people want to make progress, but just on this point about private space—where the noble Baroness is making the distinction between a motorcar where the children cannot escape and, say, a room in a small flat where there are smokers—what about a baby in a carry-cot? They cannot move to another room.

[Baroness Hughes of Stretford]

No, that is true. I know that the noble Lord is very exercised by these issues, and I respect his point of view. A baby of itself could not move to another room. However—we have these arguments in many ways—the fact that we cannot remove the harm to all children in all situations presented by passive smoking is not an argument in itself for not taking the action that we could take to reduce the harm to the majority of children in the most dangerous situations. That is the argument in support of this amendment.

The third argument we heard was about enforcement. Again, we had some helpful contributions which I was going to make myself, but I shall just mention them. This is primarily not about enforcement, and we have precedence here with the ban on using mobile phones in cars, the mandatory use of seat belts and the ban on smoking in public places. All of those were hotly contested before legislation came in. I particularly remember the ban on smoking in public places because I was involved in it. That measure not only established smoke-free common areas for people but, equally importantly—and it is true of the other two measures—precipitated the biggest reduction in smoking we have seen: a significant and beneficial change in behaviour on a massive scale. That is the issue here, as the noble Baroness, Lady Tyler, pointed out. I have no doubt that this would precipitate a very significant change in behaviour in relation to smoking in cars with children. Particularly when we see so much public support for the measure, I think that we could anticipate that.

I say again that Amendment 57BB is enabling. It would entail further discussion about the practicalities and the detail of the regulation. We fully accept the need for that and welcome it. However, it is an important measure for children and I hope that the House will support it.

[Earl Howe]

My Lords, this has been a fascinating and very helpful debate and I am very pleased with the support that I have heard for the government amendments on standardised packaging. I would like, if I may, to commend noble Lords for their continued work in supporting tobacco control. We all want to drive down rates of smoking in this country and, in particular, to stop young people from taking up smoking in the first place. Let me address the points on standardised packaging first.

The noble Baroness, Lady Finlay, the noble Lord, Lord Faulkner, and my noble friends Lady Tyler and Lord McColl tabled a revised amendment following discussion in Grand Committee, and I see that they reflected the comments that I made in redrafting it. I particularly welcome their support for the Government’s amendments and can reassure them that our amendments would achieve all of the things that they seek to do.

My noble friend Lord Naseby raised a number of legal issues. I would like to reassure him that we have given very careful consideration to the legal situation. We believe that the government amendment gives us sufficient room to proceed with the regulations, should we choose to do so, and introduce standardised packaging, if that is what is decided. He queried the fact that the amendment is drafted in such a way that the devolved Administrations and Assemblies have to give consent, but it is the Secretary of State and not Parliament who gives consent in England. We do of course want Parliament to have a say, which is why we have introduced Amendment 63B to make the regulations subject to the affirmative procedure.

The noble Lord, Lord Stoddart—whose robust state of health I very much welcome—indicated that there has been no proper consultation on standardised packaging. In fact, in 2012 the Government ran a full public consultation and received almost 2,500 substantive responses and well over half a million postcard and petition responses. The consultation asked 15 specific questions and invited comments on the consultation stage impact assessment, which was also published. So it was a very thorough exercise.

The noble Lord, Lord Stoddart, suggested that this was the thin end of the wedge, if I can put it that way, and might herald similar measures in relation to junk food. I think we need to remember that tobacco is a uniquely harmful consumer good. Tobacco kills one in two long-term smokers. There is no safe level of smoking. That is why we have a range of specific legislation and an international treaty around tobacco control.

My noble friend Lord Naseby referred to illicit tobacco. We received a wide range of responses to the question in the consultation on illicit tobacco. They are summarised in the consultation report. In 2000, around 21% of the UK cigarette market was illicit. The latest estimate from HMRC, for 2012-13, is that this has dropped to around 9%. It is too high, I concede, but we are heading in a positive direction.

The noble Baroness, Lady Howarth, asked about the timetable for the regulations. I emphasise here that I do not want to pre-empt any decision that the Government may make on whether to proceed with standardised tobacco packaging, and I know that the noble Baroness understands that; but equally for that reason, it would be premature to set out a detailed timetable. What I can confirm is that the regulations would be subject to the affirmative procedure to ensure an appropriate opportunity for parliamentary scrutiny in both Houses. She may like to be aware that before being laid in Parliament, any draft regulation that seeks to regulate tobacco packaging would need to be notified to the European Commission and member states. There is a process that goes with that, which would mean that we would not be able to lay regulations instantly after taking a positive decision. I am happy, however, to reiterate the Government’s commitment to make a decision quickly when we receive Sir Cyril Chantler’s independent report. Tabling these amendments is, I hope, evidence of our commitment to act without delay if we decide to go ahead. But the Government, as I am sure she appreciates, must rightly consider the wider issues raised by this policy, and I can assure her that we will do so.

I can understand the intention of the noble Lord, Lord Hunt, in tabling both of his amendments, Amendments 57BA and 61, which seek to compel Ministers to introduce standardised packaging. However, I am sure that he will not be surprised to hear me say that we cannot accept provisions that tie our hands in this way. One of the amendments imposes an arbitrary timetable for government action, and both pre-empt Ministers’ proper and careful decision-making, involving consideration of all the relevant issues. Litigation by the tobacco industry is always a risk when introducing tobacco control legislation. Indeed, the World Health Organisation says that one of the six main forms of tobacco industry interference in public health is the intimidation of Governments with litigation or the threat of litigation. Government must have time and space to give proper consideration to the wider issues raised by standardised packaging of tobacco, and demonstrate that it has done so. Doing so will also reduce the risk of successful litigation. I do appreciate the desire to go faster but we must follow the proper decision-making process to enable us to arrive at the right policy decision. It is right that we should wait for Sir Cyril’s report. Once we do, I say again, we will make a decision quickly.

The noble Lord, Lord Hunt, asked me to put on the record that we will definitely introduce the regulations should the case be made and should we be persuaded of the case that Sir Cyril presents. I hope that I have been clear about that. I will repeat the comments made by my honourable friend the Minister for Public Health when she announced the review:

“The Government will introduce standardised tobacco packaging if, following the review and consideration of the wider issues raised by this policy, we are satisfied that there are sufficient grounds to proceed, including public health benefit”.—[Official Report, 28/11/13; col. WS 96.]

I thank the noble Lord, Lord Faulkner, the noble Baroness, Lady Finlay, and my noble friends Lady Tyler and Lord McColl for having made clear their intention not to press their amendment on standardised packaging. I hope that the noble Baroness, Lady Hughes, and the noble Lord, Lord Hunt, will do the same with theirs.

I turn to smoking in cars. Since we considered the issue at the previous stage of the Bill, I have met a number of noble Lords who support the idea of legislating to stop smoking in cars with children present. I have also listened very carefully to the debate as it has proceeded this afternoon. One thing is clear from those meetings and the debate—we all want to eradicate smoking in cars carrying children. None of us wants to see children continuing to be exposed to harmful second-hand smoke, whether in the home or the family car. However, although we agree on the destination, I have to acknowledge that there are differing views on the most effective route. As your Lordships will know, the Government believe that encouraging positive and lasting behaviour change by making smokers aware of the significant health risks of second-hand smoke will be more effective than resorting to the use of legislation—which is of course a blunt instrument—to tackle the problem. I believe very clearly that we should consider resorting to the use of legislation only if our work to promote positive changes in behaviour is shown not to have had the desired effect.

When we debated this issue in Grand Committee, a good deal of time was spent considering the practicalities of enforcing an offence of smoking in cars carrying children. I do not propose to rehearse those arguments in detail again today. Nevertheless, I want to encourage your Lordships to reflect on just how difficult it would be to enforce such a provision. My noble friend Lord Cormack referred to this. In my view, there would be substantial challenges in enforcing any such legislation, particularly with respect to vehicles travelling at speed. Currently, local authorities enforce smoke-free legislation, but they do not have the powers or the means to require moving vehicles to pull over. We would need therefore to set up a complex and probably resource-intensive enforcement regime, which would need to involve the police. These remaining questions of how to achieve effective enforcement undermine the credibility of the measures that have been proposed. If it were known that there was little chance of enforcement action, I have to ask whether individuals would comply with the law.

--- Later in debate ---

[Earl Howe]

I am coming in a minute to talk about consultation, which is one of the questions that my noble friend Lord Ribeiro asked, and I hope I can at least utter some words of comfort to the noble Lord, Lord Faulkner, as regards his question.

I will focus for a moment on why the Government prefer to achieve behaviour change without recourse to imposing the law. We believe that our approach is making a distinct impact, both in terms of raising awareness and, more importantly, changing behaviour. There is a very simple point to be made here, which was made by my noble friend Lady Tyler. I cannot believe that any parent would want, knowingly, to expose their child or children to harm. I am convinced that smoking in family cars and the home is much more likely to be due to a simple lack of understanding among smokers about how damaging to health second-hand smoke can be. Our social marketing campaigns remind us that more than 80% of cigarette smoke is invisible. Our campaigns have used the strap-line:

“If you could see what’s really there you wouldn’t smoke”.

That is why we are focusing our efforts on raising awareness of the harm caused and on encouraging smokers to modify their smoking behaviour.

The noble Baroness, Lady Masham, referred to pregnant women and whether we would regulate to protect them. I understand of course how vulnerable the child is when still in the womb, and the noble Baroness rightly raised the issue of how harmful second-hand smoke can be, especially for people with respiratory conditions such as asthma.

[Baroness Hughes of Stretford]

Does the Minister not agree that the impact of the legislation prohibiting smoking in public places, to protect the public and people working in common areas, had a much greater and more immediate impact than all the public awareness work that was done before then?

[Earl Howe]

I am the first to say that legislation passed by the previous Administration has had a marked and profound effect and has been widely welcomed. However, we are now dealing with something that we know can be influenced by public marketing campaigns. I shall mention how effective those have been in a moment.

With regard to pregnant women, there is a need to encourage everybody to be aware of the risks to health from second-hand smoke. We are achieving high levels of awareness as well as changing attitudes and behaviours. Almost three-quarters of those surveyed said that our campaigns had made them realise that smoking out of an open door or window was not enough to protect children from second-hand smoke. More than a third of those who saw the adverts reported that they had taken action to reduce their children’s exposure to second-hand smoke after seeing them. Those results emerged from the evaluation of last year’s campaign and the campaign that we ran in 2012.

I have to say that I am slightly surprised to hear how strongly the Opposition feel about creating legislation to end smoking in cars, because that is at odds with the position that they took on this issue when in government. The 2010 tobacco control strategy included commitments on smoking in cars that align entirely with my Government’s current approach. That strategy said:

“By increasing the level of awareness of the harms of secondhand smoke, particularly to children, we will encourage people to voluntarily make their homes and private cars completely smokefree”.

That is the stance that the party opposite took when in government and, to pay a little tribute to them, we have followed their lead. Your Lordships will recognise that there is a long way to go. Achieving behaviour change in public health takes time but we are heading in the right direction and the key is maintaining the momentum we are generating.

That is why I am pleased to announce that the Government will run another smoke-free homes and cars campaign this year, as explained in my letter to noble Lords earlier this week. We are finalising the details with colleagues in Public Health England, but our intention is that the campaign will take place in the spring. In addition to a mix of TV and digital advertising, we will work with local and commercial partners to spread the message through their networks. The campaign will be designed to maximise the potential of social media in making our messages clear and accessible to as many people as possible. I hope that that serves to reassure your Lordships that the Government are working hard to make progress in this important area. Our approach is to change smoking behaviour in both the home and family car.

In addition to the campaign activity, we will look at what more we might do to speed up the pace of change. Some local authorities are taking forward excellent work with their local communities to promote not only smoke-free homes and cars but also smoke-free environments such as playgrounds. Working with Public Health England, we will encourage more of this good practice to denormalise smoking, particularly in settings where children are present. I have asked Public Health England to look at what more we can do to spread this good practice.

This year’s smoke-free homes and cars campaign will be the Government’s third successive one, as I mentioned. At its conclusion, we will undertake a complete analysis of the progress that we have made through the campaigns. At that point the Government will give careful consideration to whether our action has had a meaningful impact in reducing smoking in cars carrying children. If health Ministers are not satisfied with the progress made, we will give serious consideration to what more can be done. I can tell my noble friend Lord Ribeiro that we will, if need be, conduct a public consultation so that we can understand how others feel about this issue, and to enable us to consider further the practicality and likely effectiveness of other measures to tackle smoking in cars carrying children, including legislative measures. I do not rule out legislation if our current course does not deliver the desired effect.

The Government take this matter extremely seriously, particularly the issue of reducing the uptake of smoking by young people. We have tabled the amendment today on standardised packaging. We intend to make proxy purchasing of tobacco an offence and prohibit the sale of electronic cigarettes to people under 18. If the Government are not satisfied with progress after this year’s smoke-free homes and cars campaign, we will give serious consideration to what more could be done, including a public consultation. I hope that that indicates our seriousness of purpose.

On the amendments that have been tabled by the Opposition I repeat what I said in Grand Committee. If we cannot credibly enforce the law, the law loses credibility. I appreciate the strength of feeling on this matter. I can assure noble Lords that we will continue to work with all interested parties to protect children from second-hand smoke. I hope that in the light of the assurances that I have given that the noble Lord will not press his amendment on that topic.

Health: Children and Young People

Baroness Hughes of Stretford Excerpts

Monday 6th February 2012 Lords Chamber

Asked By

[Baroness Hughes of Stretford]

To ask Her Majesty’s Government what assessment they have made of the NHS Confederation report Children and Young People’s Health—Where Next? on the impact of the Health and Social Care Bill on children’s health.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, last month my right honourable friend Andrew Lansley launched the development of a health outcomes strategy for children and young people. An independent children and young people’s health outcomes forum will inform the development of this strategy and will consider the findings of this report alongside the wider views of children, young people, their families and the professionals who support them. It will report back to government by the summer.

[Baroness Hughes of Stretford]

I thank the Minister for his Answer. However, as this report makes clear, under government proposals up to six different commissioning bodies will have responsibility for commissioning child health or child public health services. Will the Minister tell the House how the Government will prevent the fragmentation of those services to ensure that children do not fall through the gaps, and whether the Government will therefore now consider placing a specific duty on all those commissioning bodies to improve outcomes and reduce inequalities in children’s and young people’s health?

[Earl Howe]

My Lords, the outcomes framework that I have just referred to should assist in the latter regard. I think the noble Baroness would agree that the system we have at the moment is not sufficiently joined-up, and in that sense does not adequately serve the needs of children. The approach we have taken to the proposed NHS reforms is to promote the importance of the integration of care and service provision for everyone, including children. We believe that strong partnerships at a local level, supported by professionals and local leaders, are the way forward, not top-down direction. The health and well-being board provides the forum for repositioning the joint strategic needs assessment into a truly joined-up strategy for local people.

Health: Cancer

Baroness Hughes of Stretford Excerpts

Wednesday 2nd March 2011 Lords Chamber

[Earl Howe]

My Lords, the strategy we have laid out is an ambitious one. It aims to save an additional 5,000 lives every year by 2014-15. That programme is supported by over £750 million of additional money over the next four years. It sets out actions to prevent cancer incidence and to improve the quality and efficiency of cancer services and of patients’ experiences of care. We are giving ourselves a little time, but we are under no illusions, and this is an agenda to be pursued very energetically. We are putting considerable additional money—from memory, it is £150 million—into radiotherapy services, but we also feel that there is an important issue around the use of existing radiotherapy equipment, which is often not utilised as effectively as it could be.

[Baroness Hughes of Stretford]

My Lords, would the noble Earl agree that the regional networks of specialist cancer services, established through the co-operation of clinicians themselves, have been instrumental in improving outcomes for patients? If so, how does he think that essentially collaborative model fits with the rigid and mandatory price competition that the Government now want to introduce into the NHS?

[Earl Howe]

My Lords, the Government are not introducing price competition, it has never been our intention to do so, and the Bill that will come before the House will make it absolutely and abundantly clear that price competition is out of range. As regards the cancer networks, the noble Baroness is absolutely right. Over the past 10 years, these have played a crucial role in improving the quality of cancer treatment and the patient experience of care. The outcomes strategy that we have published explicitly states that next year there will be funding for cancer networks to support commissioning.