NHS: General Practitioners

Lord Forsyth of Drumlean Excerpts

Wednesday 26th February 2014 Lords Chamber

[Earl Howe]

I do agree with the noble Lord’s final comment in particular. We know that GPs are hard pressed. GP consultation rates have risen by 40% since 1995. We therefore need to take several steps to address that. One is in the medium to longer term: we need more GPs, and we have tasked Health Education England to ensure that at least 50% of medical students move to the GP specialty. In the immediate term, there are the measures that I mentioned relating to the GP contract and the £50 million fund, both of which are designed to make the use of GPs’ time a lot more productive than it is at present.

[Lord Forsyth of Drumlean (Con)]

Can my noble friend tell me whether the previous Labour Government’s negotiation of the GP contract, which resulted in GPs being less available but being considerably better paid, may have something to do with the difficulties that we are now experiencing?

[Earl Howe]

My Lords, the resources that have been devoted to GP practice and primary care have gone up by a third in real terms since 2002. A lot of that was due to the revised GP contract. Unfortunately, that contract also allowed GP practices to opt out of out-of-hours care which, over time, has meant that patients have found it more difficult to access their GPs at evenings and weekends.

Children and Families Bill

Lord Forsyth of Drumlean Excerpts

Wednesday 29th January 2014 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, a number of amendments have been grouped together. Some deal with standardised packaging, others with the issue of smoking in cars. My answer to the noble Lord is that we will deal with both issues in one debate. The House always has to trade off having separate debates on individual amendments or pulling them together. I, for one, think it is better that we have a wider debate; but of course the noble Lord is entitled to speak on both issues. I hope that he will do so because he always has interesting insights—although I do not always agree with him on this particular one.

In finishing, I want to come back—and anticipating the noble Earl’s response—to the issues around awareness campaigns. As I said, of course they can achieve much, but sometimes legislation also needs to be brought into the picture.

[Lord Forsyth of Drumlean (Con)]

The noble Lord said earlier in his speech that the principle of not legislating into private space and private family activity was one that should be breached on certain occasions. Could he explain why he is stopping at cars and not at living rooms in small flats, for example?

[Lord Hunt of Kings Heath]

My Lords, they are two different issues. I certainly do not propose that we legislate in relation to people’s homes. The differences lie, first, in the scale of the health issue. As I have already indicated, the amount of second-hand smoke that a young person is likely to inhale in a car generally will be very much higher than in a person’s home. Secondly, by and large there are usually rooms in a person’s home that are not used for smoking, so there is more of an element of choice. I accept that this is a continuum, but I assure the noble Lord that it is not my intention to propose a ban on smoking in people’s homes. There are specific circumstances that make the banning of smoking in cars while children are present a particular health issue.

[Lord Hunt of Kings Heath]

My Lords, I do not accept that. Clearly, in relation to a child travelling in a car we are going to debate where the balance lies: whether a car should be regarded as a private entity in which the state ought not to intervene, or whether noble Lords consider that a child’s health becomes the paramount concern.

A private car is rather different from a home; the health damage to a young person inhaling smoke in a car generally will be much greater than in a person’s home. I do not want to repeat the point that I have already made to the noble Lord, Lord Forsyth, although I may be tempting him to intervene again. However, within a home there are likely to be opportunities for young people to avoid the smoke-filled parts of that home.

[Lord Forsyth of Drumlean]

I do not want to prolong the noble Lord’s speech; I am not making a debating point, but am genuinely interested in his logic. A child in a car—which I accept is a very confined space—will probably be in a car for a short journey. If children are in a living room, they are there all evening. Perhaps I should declare an interest; my late mother used to smoke 60 cigarettes a day. That is one of the reasons why I would never touch a cigarette. Surely, if a child is in a small living room in which continuous smoking is going on, that seems to me, without any evidence, to be as great a health hazard as being in a car. I am not advocating invading private space, but where is the evidence that supports what the noble Lord is saying—namely, that it is a much worse hazard being in a car, probably on a short journey, than being in a living room where smoking goes on all day?

--- Later in debate ---

[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.