Immigration: Tuberculosis Testing
Lord Ribeiro Excerpts(12 years ago)
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Earl Attlee
My Lords, sadly, about 30% of the world’s population have latent TB. We would not test people from other European states even if they have a TB problem.
Lord Ribeiro
My Lords, TB and HIV co-exist. The NHS is required to test all new healthcare workers for tuberculosis and blood-born viruses, including HIV. In relation to overseas recruitment, it is recommended that the tests are performed in the country of origin before applying for employment. Can the Minister confirm that compliance with this guidance is being maintained and is it possible to move towards the situation that currently pertains in Australia, New Zealand and Canada?
Earl Attlee
My Lords, eventually for all the 82 high- risk countries, you will not be able to get a visa to the UK unless you are clear of TB. To clarify further my answer to the noble Lord, Lord Morris, arrivals from the other European states are not tested for TB because of course they do not need to be tested. They can come and go as they please.
Smoke-free Private Vehicles Bill [HL]
Lord Ribeiro Excerpts(12 years, 5 months ago)
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Lord Ribeiro
My Lords, I declare an interest as a past president of the Royal College of Surgeons of England and as a patron. As a doctor and a surgeon, I have seen and treated the long-term effects of smoking in adults and wish to prevent similar harm occurring in children.
I am grateful that so many noble Lords have stayed over on a Friday to take part in this Second Reading debate. We are supported by experts in the health field and others who bring a personal perspective on the effects of second-hand smoke, and I look forward to hearing their contributions.
I was encouraged by my noble friend Lord Howe’s response to my question on 19 June on the damage which smoking does to our children. He welcomed this Private Member’s Bill, which he hoped would lead to wider debate. He acknowledged the harm that second-hand smoke can have on people’s health and recognised the need to eradicate smoking when children are present. Where we differ is on the means to achieve that objective.
I acknowledge the excellent work that the Department of Health has done in undertaking an awareness and behaviour campaign over the past two months, with anti-smoking advertisements on television and the provision of advice to smokers who wish to stop. There were nearly 500,000 visits to the Smokefree website, compared to 100,000 last year, and 60,000 smokers requested Smokefree kits in response to the adverts. I encourage noble Lords to watch them. They are indeed powerful, and I am happy to forward the link to them.
However, awareness and behaviour change needs to be coupled with legislation. In responding to a question in the Welsh Assembly on 26 June this week on outlawing smoking in cars with children present, the First Minister said,
“if we find that people are continuing to smoke in cars, legislation will be required”.
He reported that one in five of 11-to-16 year-old children in Wales were being exposed to second-hand smoke when they travelled last year.
Simon Clark, the director of FOREST—Freedom Organisation for the Right to Enjoy Smoking Tobacco—is quoted as saying,
“it’s important to encourage parents not to smoke in a car where small children are present”—
but that he believes that a ban would be a step too far. This is a libertarian view that some hold, but for an organisation that promotes smoking to recognise the harm that smoking does to our children in a confined space is an acknowledgement from an unexpected sector, which I welcome.
The Bill is not an attempt to ban smoking for responsible adults in the privacy of their cars. It is intended to raise awareness of the risks of smoking in cars where children are present and to drive home the message that we as adults are responsible for the safety and protection of our children. I hope to convince your Lordships of the need for the Bill and will provide scientific evidence to support my case.
Last week a group of Peers heard evidence from Sharon Gould, a mother who smoked when her son Ben was quite small. She knew about the dangers of smoking when pregnant and stopped immediately she was diagnosed, but the stress of her mother’s terminal illness made her start again. She described to us how she never smoked in the same room as Ben and would not dream of taking him into a smoky pub, but felt happy to smoke in her car with Ben in the back because the window was open. She had no idea that smoke was concentrating in the back of the car.
Therein lies the problem. We can see a room full of smoke—we were used to seeing that in pubs when they had smoking, though they do not any more—and we would recognise the dangers that that would have for our children. Somehow, though, driving in a car with the window open is OK. Why? Because the smoke appears to be going out. In fact, that is not the case. The evidence for second-hand smoke entering the back of cars where children sit is high. Do not forget that these children are strapped in for their own safety and cannot move away from the smoke.
The evidence is compelling. Professor Fong of the University of Waterloo in Ontario, Canada, was able to prove that just one cigarette smoked in a car can provide levels of second-hand smoke many times higher than those in a smoke-filled pub or bar, and that commonly used methods to reduce second-hand smoke in cars—air conditioning and keeping the windows open—fail to reduce levels safely. Cigarettes release small, suspended particles, or particulate matter, less than 2.5 microns in diameter. These are inhaled deeply into the lungs. Particulate matter 2.5, which I will henceforth refer to as PM 2.5, is used as a measure of air quality internationally and was used by Professor Fong to assess the level of PM 2.5 in cars. A monitor was placed behind the driver’s chair with a probe between the front seats at the level of the child’s head. Recordings were made in five separate conditions: the engine of the car off, windows closed, no air conditioning; driving with windows closed, with no air conditioning; driving with the air conditioning on; driving with the driver’s window half open; and driving with all the windows open. Measurements were taken during a 30-minute drive while smoking one cigarette. Results in the two most common driving conditions—with the windows closed and air conditioning on, and the windows half open—showed levels two and a half times greater than a smoky bar when driving with the air conditioning on, and two-thirds the level when the window was half open—still a significant enough level to cause harm.
Children, particularly young children, are still developing physically and biologically. Compared with adults, children have smaller lungs and breathe more quickly. They absorb more pollutants because of their size. They have less well developed immune systems, making them prone to respiratory and ear infections. They are more vulnerable to cellular mutations. As a result, they are more susceptible to the harmful effects of second-hand smoke. A child’s immune system compared to an adult is considerably underdeveloped and lacks the necessary defences to deal with the damaging effects of second-hand smoke.
The medical evidence that second-hand smoke harms children is equally compelling, with over 300,000 primary care consultations a year, 120,000 new cases of middle ear infections a year, 22,000 new cases of wheezing and asthma a year, 9,500 hospital admissions a year and 40 sudden deaths a year. This is a huge drain on NHS resources, costing the taxpayer more than £23 million each year.
The impact of the smoking ban in public places has been dramatic. A sample of 41 pubs in Scotland saw smoke levels, as measured by PM 2.5, fall by 86% within two months of the legislation coming into force. Using salivary cotinine, a specific marker of tobacco smoke exposure, there was an 89% reduction in cotinine concentration in a cohort of 126 non-smoking bar workers one year after the legislation. The same study using personal PM 2.5 monitors during working shifts recorded an 86% reduction in exposure to PM 2.5, demonstrating the serious effects of smoking in the period before legislation. In the confined space of a car, levels of exposure are considerably higher than in a bar or pub, and for the children who are strapped in there is no escape from the toxic fumes.
The Bill is intended to reduce exposure to second-hand smoke, which is one of the six internationally recognised strands in the Government’s tobacco control plan, by adding legislation to the behavioural change which they seek. A survey of nearly 700 boys and girls between the ages of 11 and 15 by the NHS Information Centre in 2010 found that one in five children had been exposed to second-hand smoke in cars. This was similar to the finding in Wales. A survey by the British Lung Foundation in 2011 of over 1,000 children between the ages of eight and 15 found that only 31% of them asked adults to stop smoking, while 34% were too embarrassed or frightened to ask. Adults can look after themselves; children cannot.
This is, in effect, a public health Bill. It seeks to protect children from the effects of second-hand smoking, in the same way that legislation exists to protect children through the appropriate use of car seats for those under the age of 14. The 2006 legislation, which reformed the car seats law, made it the responsibility of the driver to ensure that children were correctly restrained. I believe it should also be the responsibility of the driver to ensure that children are protected from second-hand smoke. As Sharon Gould explained, it is often mothers who are faced with the day-to-day problems of caring for their children or finding carers for them if they work. Mothers who smoke put their children’s health, both in the short and long term, at risk. The Bill seeks not to punish mothers, carers or anyone who smokes in the presence of children but to educate and inform them of the risks.
Internationally, legislation has been in force since 2006. Laws banning smoking in cars carrying children exist in three countries—South Africa, Mauritius and Bahrain—and involve six of the eight states or territories in Australia, nine of the 13 in Canada and four of the 50 states in the United States, although nine municipalities there impose a ban. It is time to apply similar legislation to England and to follow the Welsh Assembly’s example by not ruling out legislation if behavioural change does not reduce the incidence of smoking in cars.
The Bill seeks to amend the Health Act 2006 by banning smoking in cars where children are present and to provide further education and awareness of the dangers of smoking through the provision of smoke-free awareness courses in place of a fine for first offenders. We have the evidence to support this Bill and I ask your Lordships and my noble friend the Minister to consider it in the interests of our children and grandchildren, if not ourselves. I beg to move.
Lord Ribeiro
I thank my noble friend Lord Attlee for his reassuring comments—in particular, for saying that the Government are not persuaded “at this time”. I brought the Bill forward to raise awareness of this matter and to say that it should be introduced in conjunction with attempts to change behaviour. The Welsh Assembly has set a time limit of three years. I would hope that we would be able to make a decision within a shorter period.
I also thank noble Lords who have spoken in the debate. I know that two were unable to do so because the previous Bill went through much quicker than expected. I was particularly heartened to hear the noble Lord, Lord Collins of Highbury, speak, because he has personal experience as a smoker. It is very important to get that perspective because the feeling is that those who smoke have no concern for young children in cars. That is certainly not the case, as came through very clearly in many of the contributions. Noble Lords have given a general, wide view of the impact of smoking on children as well as, often, on themselves.
I accept the reservations expressed by my noble friend Lord Colwyn about the other toxic elements that children are exposed to, but the car is a very special place because children within a car are confined and unable to get away from the smoke.
The noble Lord, Lord Crisp, put his finger on it when he said that it was a matter of judgment. Have we identified the problem? Yes, we have. Are there downsides? Yes, there are. The question is: who is likely to benefit from such legislation? If you look at the issue in libertarian terms and try to make a decision about whether this is about the rights and freedoms of individuals to do what they want to do in their private space, then I think it is also necessary to consider the rights of the child in that private space and ask who is responsible for that child. Frankly, I am prepared to let my individual liberties go for the benefit of young children. This is something that the Government will need to take away and think about.
On the issue of powers and the police, I was careful to talk to two former chief commissioners of police in this House to find out their views. Their view was that this is a visual matter: you look to see whether somebody is using a mobile phone or whether someone who appears underage is smoking, and then you verify. Therefore, this is not an issue that we should get too worried about.
I agree with the noble Lord, Lord Collins, about the issue of age. I put in 18 because medically that is the age at which you move from being a child to an adult. However, I am perfectly aware that you can drive a car at 17. There may be a loophole here if the law stipulates 18 and a 17 year-old boy or girl driver is pulled over for an offence. There might even be a strange situation where a 17 year-old is driving and an 18 year-old in the car with him is smoking. In that case, the 17 year-old is the person who should have the authority to tell their passenger to stop smoking. This is something that we must come back to and look at.
This has been an excellent debate. I am glad that the Bill has got this far and hope that we will be able to take it further. I beg to move that the Bill be given a Second Reading.