World Health Organization: Pandemics

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Tuesday 9th March 2021 Lords Chamber

[Lord Judd (Lab) [V]]

My Lords, has the pandemic not brought home almost more powerfully than ever before the total interdependence of the global community? Therefore, are the international institutions such as the WHO and other specialised UN agencies the only way that we can have a sane future for society as a whole? We cannot forge that on our own as an island. We played a distinguished part in the role of developing organisations such as the WHO in the past. Can the noble Lord reassure us that it is not just a matter of saying that we have priorities and commitments but of ensuring that the whole culture of government looks towards strengthening international institutions such as the WHO?

[Lord Bethell (Con)]

I completely agree with the noble Lord. A multilateral approach is at the heart of our response to the pandemic, and I agree that we are not safe here in the UK until the whole world has addressed the question of the pandemic.

NHS Long-term Plan

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Monday 1st July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. The core of the work my noble friend Lady Harding is doing is to analyse recruitment and retention patterns in the health service, obviously not just among core clinicians but across the whole system, to identify best practice for improving the workplace environment to recruit and retain. I am not sure whether she has done specific work on the difference between direct entry and graduate entry but I will be happy to find out for my noble friend.

[Lord Judd (Lab)]

My Lords, with longevity still at record levels, is the Minister satisfied that in the plan for the future new doctors coming into the service get sufficient support in their training on dealing with the dying and their families, or is it often just left to them to pick it up in their professional work? The same sorts of issues arise in mental health. If you are treating mental health, of course there is often a great deal of stress within families. How far do these plans take into account family support, at the same time as the treatment of those with mental illness?

[Baroness Blackwood of North Oxford]

The noble Lord raises two hugely significant issues, which probably deserve a full debate. On clinicians and NHS systems being prepared to respond most effectively to those facing terminal illness, and their families, we have improved but there is much more to do—not just for the health service but for us all as a society. We need to become more open and comfortable with discussing that; some work has been done but more is needed. On mental health services providing support for families as well as individuals, we are still some way from where we would like to be but it is recognised as something that needs to be done.

Healthcare (International Arrangements) Bill

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Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

[Baroness Brinton (LD)]

My Lords, both the noble Lord, Lord Ribeiro, and the noble Baroness, Lady Chisholm of Owlpen, are missing the point of these amendments. While this is only an enabling Bill, it increases the scope of reciprocal health agreements with countries outside the EEA and Switzerland to include trade agreements. The noble Lords, Lord Lansley, and Lord O’Shaughnessy, at earlier stages of the Bill, raised exactly this point about setting up trade agreements. We are extremely concerned, for all the reasons given by the noble Baroness, Lady Thornton; this is the sort of large change that requires considerable consultation with the public prior to Green Papers, White Papers and bringing it through the House. We should not try to rush it through as one of the Brexit Bills, which it is, regardless of what happens over the next few days. This is one of the Bills that we were told must be passed by 29 March. Increasing the scope of the Bill means that we are moving into another area that the country, let alone this House, has not had a chance to consider.

I do not believe that reducing the scope would prevent some of the agreements already made; in fact, as the Minister has said when summing up previously, a number are already available. What it does is protect the NHS from being a bargaining tool, particularly—although not only—with the United States. Until the country has a chance to have that debate, it is important that we reduce the scope.

I endorse entirely the comments made by the noble Baronesses, Lady Thornton, and Lady Jolly, the noble and learned Lord, Lord Judge, and the noble Lords, Lord Marks and Lord Foulkes. Our task is solely to replicate the arrangements that may become out of date on 1 April; it is important that we remain focused on that.

[Lord Judd (Lab)]

My Lords, I too find this amendment imperative. The Bill as it stands has some exciting prospects, which are worth looking at, but if we are to go down that road we must recognise that the implications are highly complex and potentially demanding economically. It is quite unthinkable that we should move along that road without primary legislation that has been properly considered by a wide cross-section of Britain, including the professions. It is extraordinary to bring in exciting, challenging ideas of this kind on the back of a Bill concerned with making sure that the excellent arrangements that exist within the European Union are protected.

The most imperative words that we have heard in the remarks so far—apart from the, as usual, exemplary speech by my noble friend Lady Thornton—came from the noble and learned Lord, Lord Judge, who, with all his experience, said that this is just wrong and that we cannot pass major legislation on this basis. That is exactly how I feel. To dilute our commitment to those in the European Union and, indeed, to people from the European Union living in this country—arrangements will be reciprocal—would be very unfortunate. I hope the House will warmly endorse the amendments.

[Lord Wilson of Dinton (CB)]

My Lords, I am glad to follow the last two speakers; they have eloquently made the case for supporting the noble Baroness’s amendment, as I do. This is not about supporting Brexit or wanting to remain; it is about the tension that exists between the Executive and Parliament, and the duty of this House, and of Parliament, to scrutinise the proposals of the Government to ensure that good government, as far as possible, is provided in this country.

I am very glad that the Minister has tabled the amendments that will follow later. However, I agree with the noble and learned Lord, Lord Judge: they are a step in the right direction, but that is not enough. The sweeping nature of the powers proposed in the Bill are in many ways offensive to the proper conduct of legislation. I accept that they are needed in the current situation in relation to the EU and Switzerland, but to go wider than that is wrong, I think. We have to insist on legislation being properly prepared, properly debated, properly scrutinised and properly consulted on. If, in the middle of the current turmoil, we let go of some basics of legislation, we will do ourselves harm and set a bad precedent. I shall support the noble Baroness’s amendments.

Hospices: Impact of NHS Pay Increases

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Monday 18th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I am sorry that that meeting has not taken place, and of course I am always glad to meet the noble Lord to discuss this issue. I am glad that the threat of a meeting has had the desired result, and clearly, I agree with him that we have to make sure that hospices are equally attractive places to work as is the NHS more broadly.

[Lord Judd (Lab)]

My Lords, I declare an interest as a vice-president of Hospice at Home in west Cumbria, where I live. This Question is very important. Does the Minister not agree that hospices work best when they work very closely with the health service? That is certainly the case in west Cumbria. We have become part of the co-operative provision of services and care to the community as a whole, but raising the necessary funds is a tremendous task. I hope that the Government will look very seriously at how hospices can be supported in ensuring that the nurses working for them with so much devotion are able to enjoy any improvements in the remuneration of nurses across the country.

[Lord O'Shaughnessy]

I can reassure the noble Lord that we are looking at that. Hospices work closely with local CCGs, which provide around 30% of their funding. We estimate that around 9,000 nurses work in hospices, and clearly we want to make sure that that number not only stays level but increases so that we can start to deliver the choice that we have committed to in palliative care for people.

Breast Cancer Screening

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Thursday 3rd May 2018 Lords Chamber

[Lord O'Shaughnessy]

I know that the whole House will join me in saying that the noble Baroness is definitely worth it. Indeed, I am pleased to hear that her care was successful and that she is with us today. It is a very interesting question about age discrimination. We have again to separate it from the clinical advice, which I am reassured, having spent time with those involved in putting it together, is based on a proper weighing of costs and benefits—of course, that is inevitably in aggregate because we are talking about whole populations. Clinicians have autonomy to do things differently. Indeed, the offer we have given to women aged over 72 is that they can refer themselves and they will have an appointment if they want one. I can provide that reassurance to the noble Baroness.

There is perhaps a separate issue. There are sometimes problems of age discrimination in society and in the national health system itself. Could that be an issue regarding why signs were missed? We know that in some instances, the National Health Service has not been very good at listening to women on some of the issues we have debated in this House and that my noble friend Baroness Cumberlege is looking at in her review. This is a very good point that needs to be investigated properly: are there cultural reasons why signs that might otherwise have been picked up during these nine years were not? I can reassure her that the inquiry will look at this.

[Lord Judd (Lab)]

My Lords, reverting to the point about the role of the GP, does the Minister agree that it raises wider questions about the operation of the health service? Surely, if we are taking a holistic approach to the well-being of patients and people, the GP has a vital role which increases in importance the more technology comes into play. There should be a proactive role for the GP in helping people to meet the challenges that arise from the inevitably rather more impersonal operation of more technological services. There is a significant issue. Frankly, I sometimes wonder what the role of the GP really is. In a lot of surgeries, it is a pretty meaningless term, because one goes not to a general practitioner but to a surgery. This issue needs attention as we consider the future of the health service.

[Lord O'Shaughnessy]

The noble Lord makes a good point, in the sense that technology is an enabler and supporter of clinical practice done by highly skilled professionals, not a replacement for it. That interaction between reliance on technology and the human face of the service is an issue that the inquiry should investigate.

End of Life Care

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Tuesday 14th March 2017 Lords Chamber

[Lord Judd (Lab)]

My Lords, it is always challenging to follow the noble Baroness. Her knowledge and expertise are well heard in this House, and are informed by a direct, personal engagement in the front line that is outstanding. We all pay tribute to her on both scores.

We are dealing with a gigantic cultural and social problem. Modern, high-tech society has many benefits that we spend a lot of time debating but it has many casualties, too. Life goes faster and faster, pressure on families is greater and greater, and it is more and more difficult for them to provide the care which might have been more readily available in a more steady age when life was less frenetic. This is a reality we must face.

However, we must also be very careful about loose press reporting. Sometimes the pressure on staff trying to deal with these issues is immense. Perhaps understandably, sometimes things that go a little bit wrong can be played out of all proportion. Anyone who has been through a situation of this kind within the family knows very well that things are not always perfect. People are human and sometimes cannot live up to their own standards because the pressures are too great. So we need a great deal of understanding about the pressures being borne, carried on behalf of society.

I just want to raise several points. First, I am a vice-president of Hospice at Home West Cumbria and was previously president. I cannot speak highly enough of the quality and commitment of the volunteers and staff alike, and what they do not only in their immediate work but in relating to the wider community in a really remarkable way, drawing it into a sense of responsibility for the hospice at home movement and feeling that it is their movement to sustain.

Are we yet doing enough in our training and preparation of doctors for their profession to ensure that the care of the elderly, vulnerable and dying is central to their concerns? All of them will face this issue, and some will specialise in it. It should be a central part of medical training and preparation to take into account the needs of the dying and the elderly, and how that can be covered. Demography demonstrates the high and growing proportion of our population that this will affect. It is sheer madness not to make this a priority in the profession at all levels.

Still there is too much evidence of postcode lottery in the provision of services but the sort of thing that worries me when talking about the work of Hospice at Home West Cumbria, for example, is that it can have remarkable results when the health service co-operates and they work together.

But does the health service, as a matter of course, take that expertise and insight into consideration in the preparation of its plans, not only nationally but locally, and join all that up as part of the whole process of developing its work?

At the moment it is alarming that one in three health and well-being boards does not consider the needs of dying people when assessing health and care needs in its local population. Almost six in 10 health and well-being boards do not include the needs of dying people in their key strategies. More than one in four—27%—of clinical commissioning groups do not have a strategy for addressing end-of-life care. More than seven in 10 do not have a strategy for children and young people with life-shortening conditions.

These are alarming statistics. A tremendous amount has to be done. The Government have stated their intentions but the road to hell can be paved with good intentions. What matters is what is actually done and what resources are actually arriving to give effect to the intentions that are expressed.

Health: Global Health

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Monday 26th October 2015 Lords Chamber

[Lord Prior of Brampton]

I completely agree with the noble Lord. According to the report, health spending is likely to increase by 8% per annum in Asia for the foreseeable future and by some 5% in the rest of the world. This is a huge opportunity. The NHS is arguably the best-value healthcare system in the world, and the many lessons we have learnt since 1948 will be valuable when we go overseas.

[Lord Judd (Lab)]

Does the noble Lord agree that as part of carrying forward the excellent report to which the noble Lord, Lord Crisp, has referred, it is essential to take into account the lessons learnt from the Ebola episode in Sierra Leone, and to ensure that the World Health Organization has adequate resources to give muscle to its work, and to co-ordinate the work of other departments and aspects of government that are essential in preparing for such epidemics?

[Lord Prior of Brampton]

The Ebola crisis was indeed a wake-up call. There is no doubt that the leading role we play in the WHO is hugely important, so I agree fully with the noble Lord. The work we are doing on antimicrobial resistance is another example of the very important role the WHO can play, as does our Chief Medical Officer, Sally Davies.

Palliative Care

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Thursday 22nd October 2015 Grand Committee

[Lord Judd (Lab)]

My Lords, I am glad to be able to thank the noble Lord for introducing this debate and giving us the opportunity of a pre-run to the Second Reading debate tomorrow. With all his experience, it has been great to hear from him. Having said that, I should give a word of explanation for why I will not be in the House tomorrow. Paradoxically, the reason is that after several years, tomorrow I will complete my service as president of Hospice at Home West Cumbria. Most unfortunately, our annual general meeting is to be held at exactly the same time as the debate, and of course not only am I expected to preside at that meeting, I want to do so.

What have I learnt from my years as president? They have been fascinating, cheering and, while very challenging, deeply reassuring. One thing I have learnt is that death, a safe and secure death, is very much the responsibility of us all; it cannot be delegated to anyone. We all have our part to play in creating an atmosphere of support for the feelings and morale of everyone concerned. That covers the staff, the volunteers, the supporters and the wider public. What is great about the Hospice at Home charity in West Cumbria is that the staff are all volunteers who work way beyond what could be expected from them in a contract. But I have also learnt that the volunteers are determined to be professionals. They want to maintain the voluntary spirit, but they want all the time to train and improve so that they can make the best possible contribution. Given the opportunity, members of the public love to feel a sense of responsibility. They want to feel that the hospice is their hospice: it belongs to them. The one point I wanted to get over is that this movement depends upon an awful lot of people.

It also depends upon a dynamic working relationship between the hospice and the health service. There has to be a great deal of flexibility and vision. I hope that a message can go out from the leadership of the health service that this is a good thing because it helps the health service to do its job properly. We have had very good experiences of this in West Cumbria and I want to commend it to the hospice movement throughout the country. It also helps to ensure that people really are striving for the best standards in palliative care. About the care, commitment and love there is no doubt, but some careful training and preparation is needed for palliative care, and one wants to make sure that it is happening all the time and that it is available to all the volunteers so that they can do their work properly. From that standpoint, I endorse what the noble Lord said about it being essentially a community affair. Both the community and the cared for can derive great joy and benefit from that spirit.

Children and Families Bill

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Wednesday 20th November 2013 Grand Committee

[Baroness Thornton (Lab)]

My Lords, the noble Earl and I have been discussing the regulation of tobacco products since 2008. At that time he was often sceptical about the efficacy of our proposals for the retail marketing of tobacco products. I particularly welcome these amendments because it is important that we keep this issue alive. Since 2010, my noble friend Lord Hunt and I, as well as others, have asked a series of questions about the enactment of the legislation concerning the display of tobacco products. I congratulate the noble Earl on making that happen successfully. It has been a success: it is now normal to walk into your corner shop and not see tobacco products side by side with comics and chocolates, which used to normalise tobacco for our young people.

It is important to be clear in what we are talking about. There are all the statistics in the world that people can talk about in terms of cancer, addiction and all those other things. However, we are talking about whether we are prepared to allow the over-powerful and wealthy tobacco companies to gain their next market for the profits they need to make from tobacco products. That is what this amendment is about. They can exist only if they continue to recruit young people to tobacco addiction so that they have their next generation of smokers, and that is what this is about. It is about reducing the number of young people who, by becoming addicted to tobacco and tobacco products, provide tobacco companies with their next generation of smokers. We know how hard it is to stop smoking once you have started, and I speak as an ex-smoker.

I hope that, over the years when the noble Earl has distinguished himself as the Minister in his job at the Department of Health, he has had access to all the information and research, and now has at his disposal all the facts about tobacco addiction and all the terrible diseases that this brings to everybody, so that he will be convinced that we need to take this forward. I hope he will tell the Committee either that the Government will support these amendments, or that they are not necessary because the Government intend to take plain packaging forward as quickly as possible.

[Lord Judd (Lab)]

My Lords, my noble friend just referred to how difficult it is to break the habit once you have formed it. I was a smoker in my youth. I progressed to a pipe, and on one occasion I was in some gathering with fellow young people when the bowl of my pipe dropped off into a pint of beer. I realised that this was a message from God and that one or other had to stop. I had little difficulty in choosing beer with which to continue. We all have these experiences. I am sure I am not alone in remembering with some guilt that, having joined the smoking culture—certainly the presentation of tobacco and cigarettes was an important part of the wooing of a person into the habit—I used to take tremendous pride in choosing the right cigarettes for my father on his birthday or at Christmas. That was very important, because he was a smoker and I was able to present him with a well wrapped packet of what he would like. Later in life, he suffered a severe stroke which left him speechless for the rest of his life, and I have always had an element of guilt about the fact that I no doubt contributed to that development in his health.

I do not understand why we prevaricate on these issues, as we are talking about a killer. Let us get this absolutely straight: it is a killer. We have no hesitation in saying that we must have rules about seat belts in cars because children get killed in accidents. We have special rules about children in cars because of how vulnerable they are. Why, if we take this seriously for seat belts and the rest, do we not take it equally seriously for tobacco?

My final point is that, as a society, we are agonising over the difficulties faced by our health service as it tries to grapple with the pressures on it. By enabling and encouraging young people to become part of the smoking community—by allowing them to drift into it or, indeed, by encouraging the deterioration in their health because of our failure to take rigorous action—we are deliberately adding to the problems of the health service. It seems to me that this is not only wrong but irresponsible. On the one hand to be grieving and agonising about the problems of the health service and the shortage of funds, and on the other hand to be aggravating it by our failure to act where we could act, seems to me irrational behaviour.

I commend noble Lords who have tabled these amendments, which certainly deserve support. I believe we shall be looked at very critically indeed in history for having prevaricated and pussyfooted for so long on such a crucial issue.

[Lord Wigley (PC)]

My Lords, I was going to make rather a longer speech the other night, but when I listened to the noble Baroness, Lady Finlay, present Amendment 263, most of the points in my speech were covered. However, I add my voice in support of what she said and of the other amendments before us today.

When I was 15, I remember being called home from school, as my father had had a very severe heart attack. He smoked between 40 and 60 cigarettes a day. I was there when the doctor told him, “You know what has caused this: it is your smoking”. I avoided smoking as a result—it brought the message home to me. When I used to travel in the car with him, invariably the little side window on the driver’s side would be slightly open, and most of the smoke would come back to me. We have legislation that protects people who have to work in vehicles from exposure to smoke—my goodness, we should be protecting children in a similar situation.

People say, “What next? You’ll be saying that people cannot smoke in their own homes”. The difference is that, in their own homes, children can go to another room—up to their bedroom or wherever—but when they are travelling in a car they cannot do anything like that. I very much hope that the Committee, and in due course, on Report, the House, will take on board an amendment along the lines of that moved by the noble Baroness, Lady Finlay. There is certainly widespread support on the Cross Benches for these amendments. If the Government do not move something themselves, I suspect the House will move on their behalf and that this will go forward into legislation.

Tobacco Advertising and Promotion (Display and Specialist Tobacconists) (England) (Amendment) Regulations 2011

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Monday 11th July 2011 Lords Chamber

[Lord Palmer]

My Lords, the noble Baroness, Lady Thornton, will know full well how I abhor the habit of smoking, albeit that I am a smoker. I must declare an interest as the convenor of the Lords and Commons Cigar and Pipe Smokers’ Club. We ought to be very careful about the hypocrisy of the last Administration. If smoking was completely outlawed, the entire British economy would literally collapse. As such, as much as I admire the noble Baroness, I regret this Motion—particularly in these hard pressed times, most especially for very small retailers.

[Lord Judd]

My Lords, I strongly support my noble friend and applaud the fact that she has brought this Motion before the House. People have spoken with great emotion about the rights of individuals. There is no proposal before us to ban people from smoking—perhaps there should be. It concerns me that we always dance round the brutal, central point about smoking: that it is known beyond doubt to be a killer. We are condoning a delay in discouraging young people and others from indulging in a habit that kills.

It is not just the smokers themselves but their families, the grief, the cost to future production as people fall ill and the heavy cost on the health service when we already know that the health service is stretched almost beyond all reason. In the arguments of those who are against my noble friend, I find it difficult that they seem to suggest that this is a private matter for the individual. It is not: it has social implications and the cost falls upon society as a whole. It is not just a cost upon the individual who decides to smoke. What evaluations have been made of the cost of this delay? What will be the cost to the health service? How many people will die prematurely who would not otherwise have died? What will the cost be of supporting families where people have died prematurely because of indulging the habit? This is an absolutely inexcusable delay.

In the last 24 hours, we again heard the Prime Minister make great speeches about how he will not brook delay in his decision to decentralise and make sure that people share in responsibility and participate in the kind of society of which he dreams. If he will not brook delay in that circumstance, why does he do so in allowing a practice to go on of encouraging people to take up a habit that is dangerous and results in death? We must face these central facts. If we condone what the Government propose, we condone more death, suffering, cost to the general public and burdens upon the health service. How on earth can that be justified?

[Baroness Morgan of Drefelin]

My Lords, I thank my noble friend Lady Thornton for tabling this Motion of regret. Like many around this House, I am particularly concerned about the issue of tobacco control and I value this opportunity to seek assurances from the Minister on a number of key questions. For the record, I declare my interest as chief executive of the research charity Breast Cancer Campaign and also trustee of Lung Cancer Campaign Carmarthenshire. I have a particular perspective—it is not necessarily an interest—as my father was diagnosed with lung cancer when he was 40 and I was a child. My noble friend Lord Judd talked about the impact on the family. We have not got time to talk about that but I appreciate that comment.

I look forward to hearing from the Minister a full explanation of the rationale for the delay in the implementation of the tobacco advertising and promotion regulations. My noble friend Lord Judd asked what the cost will be. I would particularly like to know who will benefit from this delay. In the Government’s analysis, who are the real beneficiaries?

The House has already heard very passionate words about the campaign by the National Federation of Retail Newsagents to delay implementation, about how it was funded by British American Tobacco and that this was not made clear and transparent. I personally feel very concerned about that—if we do not address it now, where will that lead? I very much hope that the Minister can give us the assurance that the noble Baroness, Lady Thornton, is seeking that the Government are still committed to the framework convention on tobacco control, which aims to protect a range of public health policies, and this policy as an example, from vested interests.

We should not think for a moment that our understanding of the impact of smoking on our health is fully understood. We are for ever learning more about the impact of smoking on health and, as our understanding of that impact deepens, so does the case for control. We already know that smoking is the single largest preventable cause of cancer, with smoking causing 28 per cent of all deaths from cancer. Worryingly, an estimated two-thirds of smokers started smoking before they were 18 and almost two-fifths started smoking regularly before the age of 16.

Until recently the link between smoking and breast cancer, a particular interest of mine, was poorly understood, but only a few months ago new evidence emerged demonstrating a clear link between smoking and breast cancer for the first time. While previous reviews had not demonstrated an association between active smoking and breast cancer risk, a cohort study published in the BMJ on 1 March has made a very clear association between active and passive smoking and an increased risk of breast cancer in post-menopausal women, the group of women most likely to develop breast cancer. Significantly higher breast cancer risk was observed in post-menopausal women who are active smokers, with links between the intensity and the duration of smoking—what some might describe as a dose response—as well as a link with the starting age of smoking.

Compared with women who had never smoked, breast cancer risk was increased by 16 per cent among current smokers. This is yet more evidence in favour of the need to control tobacco. Among former smokers, the time since quitting smoking was significantly inversely associated with breast cancer risk. It took 20 years for a former smoker’s risk to fully reduce. On the point made by the noble Lord, Lord Judd, about whether or not this is a private matter, passive smoking was also looked at in this research very effectively. The same study suggests an association between passive smoking and breast cancer and this is a really important new piece of understanding. Among women who have never smoked, those with the most extensive exposure to passive smoking had a significantly increased risk of breast cancer compared with those who had never been exposed to passive smoking. This is a very important development in our understanding.

While there is still much more to be done to understand the precise link between smoking, both active and passive, and breast cancer, one thing that is crystal clear to me is that women will not benefit from a delay in this measure. The noble Lord, Lord Borrie, makes a very good point about the need for balance in public health policy, but it is important that we recognise that, in that balance, the desire of smokers to quit, the need to prevent young people starting and the fact that our understanding of smoking and the impact on public health continues to unfold need to be factored in.

The case for the tobacco display regulations has already been made. I do not believe that the case for delaying these regulations has been made to the satisfaction of this House and I very much welcome this debate.

--- Later in debate ---

[Lord Stoddart of Swindon]

My Lords, I had better declare an interest, as did the noble Lord, Lord Palmer, in that I am an associate member of the Lords and Commons Cigar and Pipe Smokers’ Club. I am an associate member because I do not smoke, and I therefore cannot be a full member. Nevertheless, I have sympathy with the club’s aims, which are to give some support and protection to people who smoke.

Smoking is, as we have heard tonight, perfectly legal. In spite of all the attacks made on smokers, at least 21 per cent of the population still decides to smoke. In spite of all the measures that have been taken and all the high costs of cigarettes, a fifth of the population still wishes to smoke. Their rights deserve just as much consideration as in any other practice, whatever that may be. They are entitled to the same consideration and protection.

I am most surprised that these regulations from the coalition Government are before the House tonight, because I well remember during our discussion in Committee on the Health Bill in 2009 that the noble Earl, Lord Howe, was very doubtful about these measures of screening tobacco products from the public. It really is an imposition that retailers are prohibited from displaying a legal commodity. That undermines freedom. Make no mistake about it; if you allow people to sell a product and say that it is legal to sell it, why on earth then say that although they want to sell it and advertise it, they may not do so—they may not display to people that they can buy a certain product in their shop?

There is a lot of hypocrisy about smoking. If people believe, as the noble Lord, Lord Judd, and others do, that this is the most dangerous product in the world, they ought to come forward bravely and ban it. That is the answer. Why is it not banned? There are probably two reasons. The first is because of the £10 billion which the Treasury gets every year from the sale of tobacco. The Treasury loves to have that money; make no mistake about that. The other reason is that the cost of enforcing the ban would be so high that it would probably have to spend another £10 billion doing so.

[Lord Judd]

Of course it is powerful to argue that people like me should come out for a ban. We recognise that there is a balance between individual freedom and what is decided about society. That arises in the context of smoking. We are dealing with measures that delay the introduction of a scheme to discourage people from taking up the habit. We are dealing with a proactive situation that is encouraging people to smoke. There is a fundamental difference here.

[Lord Stoddart of Swindon]

There is absolutely no difference at all. The brewers and the distillers wish to promote their product. They want people to start drinking as soon as possible because they make big profits out of people drinking. The noble Lord, Lord Judd, waxed eloquent about the dangers of tobacco. I remind him about the even worse dangers of alcohol addiction. Why are we not doing the same about alcohol? If people smoke, they do not go home at night and beat their wives and children. People who drink too much alcohol do that. Indeed, they kill people outside pubs. Cirrhosis of the liver kills many people at a very young age. Why are we allowing drinks to be displayed? Why do we not tax alcohol in the way that tobacco is taxed?

There are lots of arguments against using this huge sledgehammer against tobacco retailers in particular. We know that a lot of pubs have closed because of the smoking ban in public places. How many retailers will go out of business because of this ban? I have been a small retailer myself, and not everyone realises that the very fact that cigarettes are on display and people go in and buy them helps retailers to sell other things as well. They are not just tobacco retailers, they retail a whole host of other things, and the fact that they are selling and displaying tobacco helps them to sell other products.

I really would like to speak for a long time about this—after all, so far the debate has been rather one-sided—but I realise that time is getting on, there is another Bill to be discussed and the Minister has yet to reply. I repeat that I am surprised that we have this legislation before us tonight, and I will allow the Minister to tell us all about it.

--- Later in debate ---

[Earl Howe]

The noble Lord asks a very interesting question. I have seen some papers in the department about that particular product. I am not in a position yet to give the noble Lord any definitive answer, but I would be glad to do so once the Government have reached a view on the matter. It is a very new development.

I mentioned just now that the majority of smokers say that they were smoking regularly by the age of 18—that is, before the age at which you can now lawfully purchase tobacco products. However, we also recognise that while nicotine keeps tobacco users physically dependent, a wide range of social and behavioural factors encourage young people to take up smoking and make it harder for tobacco users to quit. To promote health and well-being we will work to encourage communities across England to reshape social norms so that tobacco becomes less desirable, less acceptable and less accessible. We want all communities to see a tobacco-free world as the norm and we aim to stop the perpetuation of smoking from one generation to the next. To reduce smoking uptake by young people, we all need to influence the adult world in which they grow up. We must also remove the considerable social barriers that smokers face when they are trying to quit.

One focus of the Government’s tobacco control plan is that we must do as much as we can to stop the recruitment of new young smokers. We know that teenagers are susceptible to experimenting even when there is clear evidence of the dangers. The noble Lord, Lord Stoddart, expressed some surprise that the Government have decided to maintain the ban on tobacco displays. We looked at the evidence and there is evidence that the display of tobacco in shops can promote smoking. We believe that eye-catching displays encourage young people to try smoking. Displays also undermine attempts by adults to quit by tempting them to make impulse buys of tobacco. That is why we are implementing the legislation set out in the Health Act 2009, and related regulations, to end tobacco displays in shops. This will help to change perceptions of the social norms around smoking, especially by young people, who are often the target of tobacco promotion.

However, the Government are also committed to amending the display regulations to mitigate burdens on business. The growth review announced by my right honourable friend the Chancellor of the Exchequer in November last year aims to reduce the regulatory burden on business, particularly on small and medium-sized enterprises and micro-businesses. In line with this priority, as set out in my Written Ministerial Statement made to your Lordships’ House when the tobacco control plan was published on 9 March, we will both delay the implementation of the tobacco display legislation and make it more practical for shopkeepers. The amending regulations that we are discussing today implement the first step by changing the start dates so that the legislation will apply to large stores on 6 April next year and on 6 April 2015 to all other stores, including small shops.

Of course, delaying implementation will delay the expected public health benefits, but this is only one initiative within our tobacco control plan. The noble Lord, Lord Judd, and the noble Baroness, Lady Gale, picked up the point we made that we still aim to maintain the public health gains. The evidence shows that limiting displays can be expected to reduce the number of young people taking up smoking and help quit attempts by adults, but we do not expect an immediate, dramatic effect on rates of smoking prevalence. The effect will be long term as successive cohorts of young people grow up in a world of free of tobacco displays.

[Lord Judd]

Perhaps the Minister was intending to go on and make this point, in which case I apologise, but will he inform the House whether the cost of the delay has been estimated, and if so, what it is?

[Earl Howe]

My Lords, I had planned to carry on and cover that point. In broad terms, the impact of this is being recalibrated, and we will publish further figures in due course.

Experience across the world shows that success in reducing smoking prevalence requires a comprehensive approach; the tobacco control plan for England sets out our strategy for the next five years, and it therefore includes a range of initiatives that will help to reduce smoking uptake and in particular help us to achieve our national ambition to reduce rates of regular smoking among 15 year-olds in England to 12 per cent or less by the end of 2015, from 15 per cent in 2009.

The Government are taking the following actions to reduce smoking by young people. We will end tobacco sales from vending machines on 1 October this year. This will remove an easily accessible, and often unsupervised, source of cigarettes for under-age young people. The Government will review sources of tobacco for young people. The Department of Health has commissioned an academic review of the evidence about this. The report will be completed late this year and we will then be able to determine what further action might be needed to reduce under-age access to tobacco. We will encourage and support the effective enforcement of the law on under-age tobacco sales by local authorities, and encourage local authorities and their partners to play an active part in helping to change social norms around smoking, particularly through using behavioural insights. We will also explore whether the internet is being used to promote tobacco use to young people and, if so, to consider what more can be done on a global level. In addition, as part of a new tobacco marketing communication plan to be published later this year, we will explore ways in which to provide young people with information about risky behaviours that can affect their health, including tobacco use, and to help them to resist pressures to take up smoking. This work is likely to involve digital media, because of their popularity, and reach among young people.

I impress on the House that the regulations that we are debating tonight are only one part of a concerted effort to reduce smoking prevalence among young people. My Written Statement set out how the regulations will be further amended, and I want to reassure the House and other interested parties, in particular retailers with large stores, that the Government will publish draft amending regulations as soon as possible. These will set out how the legislation will work in detail. By moving forward in this way, we believe we have struck the right balance between improving public health and supporting businesses during these difficult economic times. This is in keeping with our deregulation agenda, while continuing to make long-term progress to protect public health.

The noble Baroness, Lady Morgan of Drefelin, asked me specifically who would benefit from the delay in implementation. Our decision to delay implementation will most benefit the micro and small businesses that are so vital to communities across this country, and the delay is entirely in line with the principle set out in the Government’s growth review.

We have also heard about how the tobacco industry has been involved, and has involved others, in lobbying against tobacco control legislation. While we want to be sure that all voices are heard in debates on new legislation and policies, there is an inevitable tension between policies that are intended to reduce smoking prevalence and the interests of those who profit from the promotion and sale of tobacco, including tobacco companies and, to a lesser extent, retailers that sell tobacco products. I am sure noble Lords will agree that we need transparency in lobbying.

The Department of Health works hard to develop workable, balanced tobacco control policies and invites views, not least through formal consultation exercises, from all those with an interest in, or who may be affected by, proposed policies, including retailers. However, as set out in the tobacco control plan, the Government take very seriously their obligations as a party to the World Health Organisation’s Framework Convention on Tobacco Control. The FCTC places treaty obligations on parties to protect the development of public health policy from the vested interests of the tobacco industry. To ensure transparency, in future all organisations with which the Department of Health liaises on tobacco control, including through responding to consultation exercises, will be asked to disclose any links with, or funding received from, the tobacco industry. We want all parties that engage with the Government to be honest and transparent when it comes to vested interests.