Smokers: Surgical Treatment Policy (Hansard, 15 June 1993)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, every citizen, whether a smoker or not, has the right to NHS care and treatment on the basis of clinical need. In deciding what form of treatment is appropriate for individual patients, clinicians will need to exercise their professional judgment in the light of resources available.

§ Lord McColl of Dulwich
My Lords, while thanking my noble friend for that reply, does she agree that, if a surgeon deems that it would be unwise to operate on a patient because of his smoking habit, which would preclude a successful outcome to such treatment, that would be a perfectly reasonable course of action?

§ Baroness Cumberlege
My Lords, yes.

§ Lord Mason of Barnsley
My Lords, is the Minister aware that her words were ill-conceived when she indicated that doctors can play God? Does she not agree that that encourages doctors to prescribe punishment, especially when they turn away a smoker? What about the cases of a pregnant prostitute, a homosexual suffering from AIDS or a drink-driver who may have suffered an accident on the roads? I agree that doctors have to use their clinical judgment. But if someone needs treatment, the National Health Service is there to provide that service, irrespective of that person's habits or lifestyle. I hope that the Minister will therefore reinforce that point. There is a right to clinical judgment, but the Minister must not allow her attitudes and vision to be impaired by the anti-smoking lobby.

§ Baroness Cumberlege
My Lords, the Government's position is absolutely clear. The General Medical Council has also made it clear that treatment should be available to all parts of the community. The Government fully endorse that view. Clinicians have always had to make difficult judgments in setting clinical priorities. Smoking is only one of a number of factors, such as age, weight and family history, which clinicians have to take into account when deciding whether or not to operate or treat a patient. It is not the role of doctors to act as agents for punishment for any sort of lifestyle. We do 1420 not encourage that. We want them to exercise their clinical judgment, for which they are trained and educated.

§ Lord Ewing of Kirkford
My Lords, will the noble Baroness draw to the attention of her noble and learned friend Lord Fraser of Carmyllie the contradictory situation that prevails in the Tayside Health Board? Its consultants are indicating that they may refuse to treat patients who smoke while, at the same time, it has substantial investments in tobacco companies. Will the noble Baroness examine the position in regional health authorities and health boards in general to ascertain whether or not they have investments in tobacco companies?

§ Baroness Cumberlege
My Lords, I am too intrepid to cross the Border. It is a matter that I shall discuss with my noble and learned friend Lord Fraser of Carmyllie.

§ Lord Molloy
My Lords, will the noble Baroness and her department be good enough to look into a statement issued by the National Health Service that smoking-related illnesses cost the NHS £400 million every year? Surely that should tempt the Government to ban the advertising of cigarettes and pipe tobacco.

§ Baroness Cumberlege
My Lords, the Government have made it absolutely clear, not least in their evidence to the Select Committee, that they accept that effective controls on tobacco advertising are a key element of the strategy aimed at reducing the harm from smoking. That is why we have developed stringent voluntary agreements with the tobacco industries.

§ Lord Ennals
My Lords, does the Minister agree that, in view of the large costs to the National Health Service of treating self-induced conditions, while it would be utterly wrong for the health service to deny treatment to those people who have need for it, some warning should be given that they would be given low priority on the waiting list? They are people who positively induce, by their own decision, a condition for which they may eventually need treatment.

§ Baroness Cumberlege
My Lords, it is a matter of risk and benefit: the risks of treating a patient and the benefit of the treatment once it is given. That is a decision for clinicians and we would leave it to clinical judgment.

§ Lord Walton of Detchant
My Lords, would the noble Baroness agree that smoking-related illnesses are one of the greatest scourges of the present day? Would she also agree that there is good evidence, not only that they are an important cause of lung cancer, heart disease and stroke, but that smoking is the principal cause of peripheral arterial disease? Is it not the case that many individuals operated upon for peripheral arterial disease and coronary by-pass surgery who continue to smoke, find that the arteries gradually become occluded as a result of their continuing habit? Is it therefore surprising that, while a doctor's continuing duty of care must be paramount 1421 in the medical profession, some surgeons prefer to operate upon those who are non-smokers or who agree to give up smoking?

§ Baroness Cumberlege
My Lords, I had a distinguished father-in-law who lived by the axiom, "moderation in all things— and not too much of that". It is an axiom that I adopt in most of my life, but not in smoking. Smoking is a devastating cause of death. In 1,000 young people who smoke regularly, on average one will be murdered, six will be killed on the roads and 250 will be killed before their time by tobacco-related diseases. It is quite right that those of us responsible for promoting the health of the nation should take on the issue, as we are, through voluntary agreement and negotiation with the tobacco industry.

§ Lord Stoddart of Swindon
My Lords, will the noble Baroness confirm that, although smoking may or may not cost the National Health Service some £400 million a year, smokers contribute £8 billion a year in additional taxation? Does she agree that there are many other lifestyles which contribute to a person's illness; for example, obesity, drink and all kinds of other life-time habits? I shall not list them all. But I sincerely hope that the noble Baroness will make it absolutely clear once again that every patient, no matter what his lifestyle, has equal access to proper health care and proper health treatment. That is the issue, and that is the issue I want her to clarify completely now.

§ Baroness Cumberlege
My Lords, I thought that the position was clear. It is up to clinicians to decide whom to treat and on whom to operate, relying on certain factors which they take into consideration such as age, weight and family history. There is no ambivalence on this subject. It is up to clinicians to make their own decisions in the light of their clinical judgment.

§ Lord Dean of Beswick
My Lords, the noble Baroness must be aware that the Question asks whether the Government have a policy on this issue. She ought to know that some of us are quite relieved that the Government do not have a policy on this issue —and no other government in the future should have a policy for deciding who will be treated and who will not be treated. Such decisions should be left with the clinicians on the basis of the cases that they see. Many of the other questions today have been hypothetical, but I hope that the situation will continue as it was and that decisions will be left at the sharp end, with doctors dealing with medical problems individually and not in batches.

§ Baroness Cumberlege
My Lords, that is the policy. But of course the Government also try to prevent people from smoking because we know that it is the biggest cause of preventable death in this country. We always return to the fact that it is up to clinicians to exercise their clinical judgment.

§ Lord Kinnaird
My Lords, after Question Time, if any noble Lord should have a few minutes to spare, I would he delighted to offer him a cigarette.

§ Lord Williams of Mostyn
My Lords, will the Minister assist on this point? If stringent voluntary arrangements by way of restriction on cigarette advertising are good, why are obligatory restrictions bad?

§ Baroness Cumberlege
My Lords, we know that voluntary agreements work. This country has a better record in terms of reducing the consumption of tobacco than any other European country bar the Netherlands. When we look at those countries which have banned tobacco advertising we see that their success in preventing the consumption of tobacco smoke is less good than ours. We know it works and we will continue with it.