HL Deb 10 December 1998 vol 595 cc1051-66

4.28 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman)

My Lords, with the leave of the House, I would like to repeat a Statement made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows:

"Madam Speaker, today I present to the House our White Paper on tobacco. It is entitled Smoking Kills; and that is a fact. It has been known for years. That is why a lot of adults gave up smoking. But the number of adults who smoke has stopped falling. Worse still, the number of children who smoke is going up, with more girls than boys taking up the deadly habit.

"And it is a deadly habit. Out of 1,000 20 year-olds who smoke regularly, one will be murdered, six will die in road accidents, 250 will die in middle age from smoking and a further 250 will be killed by smoking later in life.

"Smoking causes 84 per cent. of deaths from lung cancer and 83 per cent. of deaths from other lung diseases like bronchitis.

"Smoking does not just cause lung cancer, it causes cancer of the mouth, the larynx, oesophagus, bladder, kidney, stomach and pancreas. Smoking causes one in seven of deaths from heart disease. Smoking is very high among people who are severely mentally ill.

"Smoking is now the principal avoidable cause of premature deaths in Britain. It hits the worst off people hardest of all. Smoking is one of the principal causes of the health gap which leads to poorer people being ill more often and dying sooner. Smoking harms people who do not smoke. Smoking harms babies in the womb.

"These are all good reasons why this Government are so determined to turn things round. We cannot possibly achieve the reductions everyone wants to see in deaths and illness from cancer and heart disease unless we tackle smoking.

"Unless we reduce smoking we cannot reduce the inequalities in health which bear down most on the worst off. We want to help existing smokers quit the habit and help children and young people not to get addicted in the first place.

"We face an uphill struggle because the tobacco companies are committed to doing everything they can to promote the sale of cigarettes. That is because they have to keep recruiting new smokers to make up for the 120,000 of their own loyal customers they kill off every year.

"Most smokers take up the habit when they are children or young people. Few people start smoking once they are grown up. For years, the tobacco industry has poured millions into highly sophisticated advertising campaigns. People of all ages, including children, have been exposed to clever and eye-catching advertising material.

"All that will now change. Tobacco advertising is going to end and it is going to end soon.

"This White Paper spells out the measures which will be targeted on children to protect them from being exposed to tobacco promotions. It will require a sustained effort over a long period. Some benefits will not show up for decades, but unless we act now they will never show up.

"We will also be trying to help the seven out of every 10 smokers who want to quit the habit. All this calls for a concerted plan of action and that is what the White Paper outlines.

"From 1989 up to the last general election the previous government had helped block all European efforts to ban tobacco advertising and sponsorship. We changed that. We put Britain's full weight into getting a European directive through. We succeeded.

"As a result a Europe-wide anti-smoking framework is in place. We now propose to end tobacco advertising on billboards and the printed media in this Parliamentary session. Most tobacco sponsorship will end by the year 2003. Formula 1 motor racing, as a global event, may qualify for exemption to the year 2006 if, and only if, tobacco sponsorship funding and advertising are already being reduced.

"The European directive is intended to keep to a minimum tobacco advertising in shops and this will be fully applied in Britain through the law.

"The tobacco advertising ban will be backed up by an anti-smoking campaign. Over the next three years we will be putting £50 million into an anti-smoking campaign. We want to make sure that children and young people no longer fall into the trap of seeing smoking as cool and a passport to adulthood.

"We have negotiated with representatives of the hospitality industry a code of conduct for reducing smoking in public places.

"It is illegal to sell cigarettes to children under 16. This law is very frequently broken. We are taking action to increase compliance with this law by shopkeepers and to promote more effective action by trading standards officers.

"Some individual shopkeepers and others knowingly and repeatedly flout this law. To deal with repeated offenders we propose to introduce a new criminal offence and we are looking at the practicalities of such a measure.

"Following discussions with my officials the National Association of Cigarette Machine Operators are issuing new rules on the siting and operation of cigarette vending machines to make them inaccessible to children.

"We have also been encouraging the companies who sell age restricted goods such as alcohol, cigarettes and fireworks to develop an industries-wide `proof of age' card. This package should make a real impact on the illegal sales of tobacco to children: the tobacco advertising ban, the £50 million anti-smoking campaign, the crack down on sales to children, a new criminal offence for repeated sales to children, new restrictions on vending machines, and the proof of age card.

"Then there are the people who are smoking already. Every 10 years more than 1 million British people get killed by smoking. Most of the millions who will be killed by tobacco over the next few decades are already adult smokers. Most smokers say they want to stop, and these are the people that we particularly want to help.

"If they keep on smoking there is a 50–50 risk that they will eventually be killed by their habit. Yet if they stop smoking before they get ill then they will avoid most of that extra risk of death. So it is really worthwhile for people to quit smoking.

"As part of our effort to help those seven out of 10 adult smokers who want to quit we are investing up to £60 million in the first ever comprehensive NHS service to help them give up their addiction. This will involve all health professionals—midwives, health visitors, doctors, nurses, pharmacists and dentists, all taking every appropriate opportunity to counsel patients to give up smoking.

"This effort will be particularly targeted on smokers living in those deprived areas which have been chosen as health action zones. We will encourage the use of nicotine replacement therapy (NRT) again especially targeted on health action zones where free NRT products will be available for the worst off. Health improvement programmes in every part of the country will be expected to address the need to reduce smoking in the worst off areas.

"As part of the drive to reduce tobacco consumption, the new Government have raised tobacco duties by just over 5 per cent. in December last year and again this year.

"These and other measures set out in the White Paper amount to a formidable plan of action to stop children from taking up smoking and to help existing smokers to quit. To achieve this we will need to counter the efforts of the tobacco companies. There is evidence to show that for most of the last 20 years they have been planning to counter the loss of sales which might follow an advertising ban.

"That time has now arrived so we can be assured that they will be well prepared. As I speak, I am certain that executives in the tobacco industry will be planning their strategy to keep up tobacco sales. We have got to get ahead of the game. That is all the more reason why everyone who cares about the health of the nation should work together to support this strategy and I am confident that everyone who cares about the health of the nation will do so".

My Lords, that concludes the Statement.

4.36 p.m.

Earl Howe

My Lords, as ever, I am grateful to the Minister for repeating the Statement. I wish to say at the outset that there is much in it that we can welcome. I shall comment on those sections of the Statement which are less palatable to us on this side of the Chamber. The overriding thrust of the White Paper, and in particular the emphasis on the need to reduce the prevalence of smoking among the young, is one with which we can readily identify and endorse.

Smoking is the single most important cause of premature death in this country, accounting for, as I believe the Minister said, 120,000 deaths every year. The avoidance of smoking would eliminate one-third of the cancer deaths in Britain and one-sixth of deaths from other causes. However, the recent trends in smoking prevalence are of particular concern. Looking at the graph of the number of adult smokers, one can see that the downward curve, seen since 1972, was reversed in 1996.

Among young people the trend has been upwards for a much longer period. That is extremely worrying. We know that almost all smokers start to smoke as children or young adults. We also know that the health warnings, while they are known about and understood. are simply ignored as irrelevant by most young smokers. At the same time, it is clear that a variety of factors influence the take-up of smoking in younger age groups: for example, parental attitude, peer pressure and, not least, the price of cigarettes. Therefore, we understand the Government's view that only a concerted and sustained government campaign is likely to stand any chance of shifting attitudes and behaviour among smokers, and especially among young people.

Let us look at the ingredients of the campaign and specifically at the proposed ban on tobacco advertising and sponsorship. I have always been sceptical about a compulsory ban. I say that for a number of practical reasons. The first is, paradoxically, that a ban may turn out to be counter-productive. If different brands are prevented from competing with one another through advertising, then they are likely to try to compete in the other obvious way; that is, through price.

We know that cigarette consumption is extremely price-sensitive. It has been shown to decrease by 0.5 per cent. for every 1 per cent. increase in the retail price. That effect, not surprisingly, is greater in the low income groups. There must therefore be a real concern that more intense price competition will start to occur and will actually drive up the number of cigarettes consumed.

The second feature about advertising which will be lost with a ban is that one important way of encouraging smokers to switch from strong brands to less harmful ones—that is to say, the low tar varieties—will disappear. That seems perverse. Aside from saying that they want smokers to give up the habit altogether, what is the Government's answer to that point?

I worry too that it will be all too easy for the tobacco companies to drive a coach and horses through the legislation. I do not know how many of your Lordships have travelled on the London Underground in recent days. There is a prominent advertisement in many stations for a certain brand of cognac. It depicts a glamorous and sophisticated-looking young lady holding a smoking cigarette. If the tobacco companies are looking for a way of glamorising the activity of smoking, they need look no further than that. But it is not as such a cigarette advertisement.

While I have no evidence to suggest any involvement by the tobacco companies in that poster, how do the Government feel it will be possible to stop tobacco companies taking advantage of that type of opportunity in the future by, as it were, piggy-backing on other products? For all those reasons we strongly question the wisdom of a compulsory ban on tobacco advertising and would have preferred to see an extension of the voluntary approach. However, I have a specific question for the Minister on that aspect of the White Paper and it relates to the withdrawal of tobacco sponsorship. Tobacco sponsorship will need somehow to be replaced if a number of sports are to continue in their present form. What proposals do the Government have to assist those sports in obtaining alternative sponsorship?

We welcome the emphasis placed on encouraging smokers who want to quit the habit. Nicotine patches are an obvious way to do that. However, there is an interesting aspect to the Government's proposals. The Minister said that free NRT (nicotine replacement therapy) products will be available for the worst off. I have no quarrel with the idea of promoting NRT products. But what does the proposal say about the Government's publicly stated and oft repeated policy towards the health service? If they make a nicotine patch prescription available free to those on a low income and do not make it available to anyone else, does not that amount to the introduction, for the first time, of a means test for prescriptions? How much further down that road do the Government intend to travel?

Looking at the issue from a broader perspective, do the Government agree that this is a classic example of how community pharmacists can play a part in preventive help, advice and treatment? Research indicates that a smoker has a one in 100 chance of a successful cessation of smoking using willpower alone. Quitting with informal support increases that to one in 20; using NRT doubles the chances of success but if professional counselling is given as well—for example, from a pharmacist—in conjunction with NRT, that can increase the success rates to better than one in four. To my mind that is a powerful argument for looking to the local pharmacy as an important means of delivering the Government's targets.

Perhaps I can turn briefly to smoking in the workplace. Can the Minister be a little more specific about what the Government intend under the code of practice? If its force under the Health and Safety at Work Act is to be as robust as the White Paper suggests, it would appear that businesses will ignore it at their peril. Will the code require companies to create smoking areas in the workplace if smoking is to be allowed there at all? If there is to be any suggestion of compulsion for employers to alter their workplace premises, can the Minister confirm that that would be the subject of primary legislation to give the opportunity for a full and proper debate on the matter? Will all workplaces be affected by this legislation?

We welcome the voluntary proof-of-age scheme and the plans to enforce the ban on cigarette sales to the under-16s more toughly. We are also glad that the Government have stepped back from imposing an outright ban on smoking in public places, including restaurants and pubs. As was argued very effectively in your Lordships' House on 21st October, a voluntary approach is likely to prove fairer to industry and allow more readily informed choice by consumers.

Finally, it would be helpful to understand what targets the Government have in mind to judge the success of these measures. Can the Minister say what percentage drop in cigarette consumption over whatever period of time she chooses to take, is envisaged as a result of the measures announced today?

4.45 p.m.

Lord Clement-Jones

My Lords, I too thank the Minister for making the Statement today and warmly welcome a great many aspects of it. On these Benches we wholly accept the medical evidence which shows that there is an increased risk of disease not only through smoking, but also through passive smoking. That was demonstrated by the report of the Scientific Committee on Tobacco and Health which reported earlier this year and also the recently published WHO multi-centre research into the effects of environmental tobacco smoke which your Lordships may recall was the second largest study ever carried out on the subject. That shows quite clearly that there is a risk equivalent to the death of several hundred lung cancer deaths a year in the UK as a result.

As the Minister pointed out, significantly associated with passive smoking is sudden infant death syndrome, heart disease in adults and respiratory illnesses and asthma in children. We particularly welcome the proactive stance of the Government towards the European directive and of course that is in sharp contrast to that of the previous government.

However, there are some areas of concern in the Statement and in the White Paper. One of the areas your Lordships may recall which the BMA raised in recent weeks is the whole question of regulation of nicotine content. It is clearly vital to reduce the nicotine content of cigarettes. They must be manufactured to be less addictive. On these Benches we support the BMA's call for an overhaul of the regulatory framework in that respect. We must also deal with misleading labels and additives.

We need the Government's commitment in relation to raising the price, in particular the duty, on cigarettes. We are not quite clear from the wording of the White Paper whether it is an unequivocal commitment to raise the price year by year or simply a general statement of intent.

As regards the methods of marketing in the third world, clearly they must be regulated. We note the Government's strong support for an international framework convention by the WHO and welcome that. But we note also that the Statement said that it was likely to be brought forward to the World Health Assembly in 2003. Is there any way in which we can bring that forward earlier? Clearly international action in so many of these areas is the only way forward.

We welcome the commitment completely to phase out sponsorship and advertising. But when is the legislation going to come forward as regards the advertising ban? As regards sponsorship, why do we have to wait for the period that the Government stated for that to be phased out? Furthermore, on these Benches we do not accept the Government's case on Formula One motor racing. I have been associated with Formula One motor racing for many years. Indeed, my father-in-law ran a Formula One racing team. I still believe that the arguments put forward by Mr. Bernie Ecclestone earlier this year are totally bogus to justify the postponement of a ban on sponsorship on Formula One. We believe this should be treated in a way which is no different from any other form of sponsorship.

We also note the code of practice proposed for the workplace, to be introduced on a voluntary basis. Although the Government clearly trailed their coats in terms of a ban on smoking in the workplace, no doubt many people have been surprised by the eventual conclusions. We believe, unlike the noble Earl, Lord Howe, that the ban should have real teeth and that if it does not work on a voluntary basis enforced by the Health and Safety Executive then eventually a complete ban on smoking in the workplace may be necessary. For pubs, restaurants and so on, we agree with the voluntary approach and we made that quite clear in the previous debate on the subject in October. We believe that we should effectively outlaw smoke and not the smoker but, as part of that, we insist on the ability to segregate and to have adequate ventilation. We believe that the voluntary code should make that quite clear.

We commend the Government's approach, in public health terms, of setting very clear targets for smoking cessation. This is absolutely vital, as Sir Donald Acheson made quite clear in his recent report, to combat health inequalities. This must be reflected through health improvement programmes, health promotion and so on, but it must he put explicitly in the national priorities guidance. We do wonder whether some of those targets themselves are quite strong enough, in view of the recent take-up rise in smoking by the young. We believe that the target of a decrease from 13 per cent. to 9 per cent. over 12 years is rather too modest. One can argue about those targets over a period of time but they must be reflected in health improvement programmes.

It is particularly vital that pregnant women should be discouraged from smoking because, as we know and as Sir Donald made quite clear, smoking leads to low birth weight in children, a failure to thrive in early childhood and also to glue ear. Clearly we need education through the midwifery health visiting services, as recommended by the Scientific Committee on Tobacco and Health. We welcome the Government's statement of intention in that regard, but again the White Paper is not absolutely specific. What are the specific intentions of the Government as regards making that information available through the midwifery and health visiting services? We need strong campaigns directed at young people, as both the Minister and the noble Earl, Lord Howe, mentioned. It is particularly worrying that one-third of teenagers now smoke, and we know there has been an increase in the numbers of young women who smoke We welcome initiatives like the Respect Roadshow which ran in May but we ask what will be done on a continuing basis. It is important that any such campaigns are properly evaluated. For example, how far is the Department of Health exploring the possibilities of peer group education, where young people can communicate with each other about the problems associated with smoking, in a way similar to drug-education campaigns?

We welcome the additional expenditure announced by the Minister today. Currently, only something like £6.5 million is spent on education as regards smoking, compared with the costs of smoking-related diseases for the NHS, which is estimated to be between £1.4 billion and £1.7 billion, so the rise from £6.5 billion to £50 billion is, in our view, a significant increase.

What about the duties of retailers? We welcome the Government's plan to ensure that they are fully aware—

Lord Williams of Elvel

My Lords, perhaps I may draw the noble Lord's attention to the Companion, which says that these Statements should not be the occasion for a mini-debate?

Noble Lords

Hear, hear!

Lord Clement-Jones

My Lords, I fully intend to ask further questions. I thank the noble Lord for his intervention, and I will be concluding very shortly. Do the Government plan to ensure that they are continuously aware of their legal responsibilities? As a member of the Parents Against Tobacco Campaign in the late 1980s and early 1990s, I welcome the local authority enforcement protocol which has been mentioned and I look forward to seeing the proposals for criminal law when they come forward.

As regards the making available of nicotine replacement therapy on prescription, will this be universally available? It is not clear from the Statement. We on these Benches believe that this is a good day for Britain's health and the health service and a bad day for the tobacco companies. We therefore welcome the Statement on that basis.

4.56 p.m.

Baroness Hayman

My Lords, I am grateful for the broad welcome that has been given to the Statement by the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones. This is a comprehensive package of measures intended to try to reduce smoking in this country, and it is important to stress the comprehensive nature of the package.

The noble Earl, Lord Howe, asked about the effects of banning advertising in itself on rates of smoking. He asked whether this was not in fact price-sensitive. He also referred to the possibility of unintended consequences. There has been a great deal of evidence on this and an important study was undertaken by the Department of Health, looking at the effect of the banning of advertising in four countries: Norway, Finland, Canada and New Zealand. The conclusion was that in each case the banning of advertising was followed by a fall in smoking on a scale that cannot reasonably be attributed to any other factors. Even the small percentage falls which have followed advertising bans, given the large number of people who are affected, are extremely important. That is why we believe that an advertising ban is extremely important.

In answer to the noble Earl, we also believe that the terms of the directive are very wide. They do not deal only with billboard advertising for smoking or newspaper advertisements for smoking. The concept of brand stretching is included in the directive, as are all the promotional activities of the tobacco companies that go on, such as the giving out of free cigarettes at nightclubs, among many other promotional activities. So there is a very broad range of activities which we believe are usefully covered by the ban and that ban will be brought in as soon as possible. Obviously it is important that we consult on the regulations, and that is what is being done within this parliamentary Session, but we want to make progress and we want it to be effective as soon as possible.

As for the targets, the noble Lord, Lord Clement-Jones, suggested that they were not stretching enough. We believe, given the current increase in the numbers of young people who are smoking, that it is extremely challenging to make the kinds of rates of reduction that we hope to see by the year 2005. We are also challenging ourselves to make sure that the rates of reduction lie across all social classes. The evidence of the Acheson Report showed the difficulties involved in achieving those rates, and we do not want to see the health gap increasing in this area.

Turning to the issue of nicotine replacement therapy, perhaps I can clarify the position there. It is not that we are making this available on prescription for some people and not for others. This therapy is not available on prescription at the moment: it is available for sale over-the-counter from pharmacists. For those targeted groups where the problems are greatest, as part of a smoking cessation plan—and the evidence is very clearly that the greatest effect is when nicotine replacement therapy is given as part of an overall supportive plan to help people give up smoking—particularly in health action zones and among the poorer people, we hope it will be possible to give at least a week's supply, a starter supply, of nicotine replacement therapy.

I should point out of course that once you have got over the hump of the first week or two, the costs of the nicotine replacement therapy are in fact less than the average smoker is spending on smoking, and so we start seeing people being able to pay for their own therapy. I agree with the noble Earl, Lord Howe, that pharmacists can be particularly helpful in this area and we welcome the involvement that they have pledged themselves to make in giving advice and support, as well as selling nicotine replacement therapy products.

As regards the workplace, I can tell the House that it is intended that the Health and Safety Commission should consult on a new approved code of practice on smoking in the workplace. It will toughen up existing measures and be designed to improve the protection and welfare of all employees by defining the kind of smoking policies that employers need to operate to comply with existing health and safety legislation. Inspectors would then be able to quote the code in court cases alleging breaches of the Health and Safety at Work etc. Act 1974. Both in the areas of workplace smoking and public place smoking, we believe that the best way forward is to build on what is already there. We hope to see results and to monitor them, but we shall be willing to consider further action if we do not see the results that we wish.

I turn now to the international concerns. On the issue of tar content, the European Commission is considering further legislative proposals covering tar, nicotine and carbon monoxide, as well as tobacco labelling and health warnings. We welcome those steps and will work closely with the Commission and other member states to achieve practical improvements on current directives in these subjects. In terms of broader international action, which I believe the noble Lord, Lord Clement-Jones, mentioned, the new director general of WHO has made smoking one of its top priorities. The framework convention proposal will provide an overall structure of objectives, with more detailed action set out in various protocols. The aim would be to commit all signatory states to develop policies along the same broad lines, but not bind them to particular activities until they are ready to commit themselves to the relevant protocol. We have been asked to play a leading role in developing the convention to see how we can help other countries.

Perhaps I may now turn to the question of sports sponsorship. The international experience is that, given enough time to adapt, sports and other tobacco-sponsored activities can find alternative sources of sponsorship. Perhaps I may tell the noble Earl that we certainly want to help sports find exactly those sorts of alternatives because we are anti-tobacco advertising, not anti-sport. Indeed, my honourable friend the Minister for Sport has called together a group of experts to advise and help sports, which are facing difficulties in adapting, to find the new sponsors that they need.

The noble Lord, Lord Clement-Jones, drew attention to the particular needs of pregnant women. He is absolutely right: this is one of the areas where we have set ourselves targets for reductions. We believe that it is an especially important time when parents and parents to be are focused on their health needs. It is also a particularly useful time to intervene and we shall be working with the relevant professionals to ascertain what is the most effective form of activity in certain areas.

I believe that I have covered most of the points raised, but I shall review what has been said when I read the Hansard report tomorrow. I shall write to noble Lords if I have not covered all the matters raised.

5.3 p.m.

The Earl of Lauderdale

My Lords, after the 10 minutes used up by the Liberal spokesman, I have one quick question for the Minister. Can she say whether the Government's anti-smoking campaign includes positive encouragement to smoke herbal tobacco? If you smoke herbal once, you never want to smoke again! That is how I gave up the habit more than 50 years ago.

Baroness Hayman

My Lords, the noble Earl has made a fascinating contribution and one which I believe deserves serious attention. I shall ensure that my right honourable friend the Minister for Public Health takes note of his suggestion.

Lord Janner of Braunstone

My Lords, does my noble friend the Minister recognise how important this White Paper is and how greatly it will be welcomed by most people, even the majority of smokers? Having said that, does my noble friend agree that those adults who exercise their freedom to smoke should also respect the wishes of non-smokers not to be adversely affected by it; not to have to work in an environment of smoke; and not to have to eat and drink in places where the air is polluted by smoke? If my noble friend does agree, does she not consider that this House could set an example? To the best of my knowledge, the only place in this House where you can eat smoke free is in the staff dining room. Therefore, should there not be a smoke-free area in all eating places in this House? If not, can my noble friend say why not?

Baroness Hayman

My Lords, I think I made it quite clear that we want to build on the progress which has already been made in many sectors of the hospitality industry to make improvements and give real choice to consumers. As my noble friend rightly points out, there are different sorts of freedoms here. For example, there is the freedom, which no-one is challenging, for individuals to continue smoking if they so wish. There is also the freedom of people who want to eat and drink in a smoke-free area. We want to encourage the industry to make progress in providing separate facilities.

As my noble friend will be well aware, I answer for the Government in this Chamber, not for the Chairman of Committees or for the committees of the House which are in charge of issues relating to smoking within your Lordships' House. I understand that a working group is currently undertaking a review of smoking policy in this House. As a Member of the House rather than a member of the Government, I suspect that I would tend towards my noble friend's views on the matter.

Lord Mackie of Benshie

My Lords, will the Minister tell the House what the Government think of smoking as portrayed on television and, in particular, smoking in televised plays? This must be the most dangerous practice for young people to see on the screen, or in a televised play, where sometimes people smoke continually. I believe that that sort of thing does as much damage to the young as anything else. Has the Minister any idea as to how the Government could control the situation?

Baroness Hayman

My Lords, the noble Lord, Lord Mackie of Benshie, is correct to pin-point the number of different factors that can influence the climate which encourages young people to take up smoking. Indeed, it is multifarious. We need to attack the climate in which smoking is considered the norm—certainly the climate in which it is considered in some way attractive, romantic or indeed the "grown up" thing to do. There are responsibilities in the matter for all parts of society. For example, there are some areas in which sports men and women have been particularly helpful in joining in campaigns to provide young people with role models, which are anti-smoking rather than pro-smoking. I believe that other parts of the entertainment industry should rightfully look to their own policies in this area.

Lord Gisborough

My Lords, I fully support the Minister in her efforts to reduce smoking. However, when one compares the 120,000 deaths a year caused by smoking with the billions of pounds, millions of cattle and the destruction of the farming industry for the sake of 10 deaths per year, one wonders whether the £50 million designated will be enough.

I have four questions for the Minister. First, can she tell us what sort of loss she anticipates the Exchequer will suffer if cigarette smoking is reduced? After all, that is a very important part of the tax take. Against that, can she tell us what sort of savings she expects might be made in the National Health Service by fewer people becoming ill through smoking? Secondly, as the Minister knows, the European Commission actually subsidises a number of countries to grow tobacco. Can she say what pressure the Government will put on the Commission to stop subsidising people growing tobacco in Europe?

Thirdly, we have heard about peer pressure. Does the Minister agree that it is important that school teachers should not smoke and that young children should be put in the position where there is reverse peer pressure so that, from an early age, they learn that the pressure is on them not to smoke rather than to smoke? In that way they can follow by example.

Fourthly, I should just like to confirm what the noble Lord, Lord Janner, said. On Tuesday night I went into the Dining Room, which was full of cigarette smoke. I then went down to the Home Room, which was full of cigar smoke, and eventually ended up in the Barry Room. I understood that smoking was not allowed in our dining rooms; indeed, I believe that that is the rule. I feel that we ought to set an example rather than go the wrong way about it.

Baroness Hayman

My Lords, I am sure that the House authorities will look carefully at the comments made today about the difficulties caused for non-smokers by the present arrangements.

I accept very much the point made by the noble Lord, Lord Gisborough, and the noble Lord, Lord Clement-Jones, that some of the most successful educational programmes for young people are undertaken by young people. I suspect that lecturing by government Ministers is not the most potent weapon affecting the behaviour of teenage girls. We need to be very careful and ensure that our advertising campaigns are targeted so that they communicate effectively with young people.

Some quite novel and radical approaches have been tried in America which focused very much on conventional ways of showing the vested interests of those who persuade people to take up smoking. It has been very effective in reducing smoking among young people.

As to the common agricultural policy, we do not consider that financial support for tobacco production is an effective way of spending Community money. The Government strongly disapprove of the tobacco regime and would like to see its end for reasons of health, costs and control. We would like to see a progressive disengagement from the sector and we will press for an end to tobacco subsidies in the long term. We are actively promoting that policy within the EU.

As to the financial loss to the Exchequer, I should make it absolutely clear that the policies that we are putting forward today are the policies of the Government as a whole—including my right honourable friend, other health Ministers and the Chancellor of the Exchequer. Yes, if we are successful there will be a loss of tobacco revenue—and the sooner the better.

Lord Monson

My Lords, I welcome the decision not to use the criminal law to force pubs and restaurants to provide non-smoking areas, especially as market forces will achieve the same result without compulsion. Non-smoking adults in Britain now out-number those who smoke by more than two to one. It is in their own interests for catering establishments to provide non-smoking areas. If they fail to do so, they will be increasingly boycotted by non-smokers.

I have three questions for the noble Baroness. In the light of her response to the noble Lord, Lord Gisborough, I think she probably agrees that young people throughout history have enjoyed doing whatever is forbidden by the elder generation. As suggested in the Sunday Telegraph a few days ago, the right deterrent is not to tell young people that tobacco is dangerous—because danger has a certain glamorous aspect in the eyes of young people—but to try to convince them that the smell of tobacco makes them repellent to members of the opposite sex.

Does the noble Baroness agree that constant price rises, in real terms, encourage smuggling and are unfair on the elderly poor, who derive comfort from cigarettes? It does not affect most of us, but it affects them particularly badly.

Finally, as everybody has to die sometime, what is the precise definition of "premature death"? Is it one year, two years, three years, or whatever, before someone might otherwise be expected to die?

Baroness Hayman

My Lords, I will certainly write to the noble Lord, Lord Monson, with the precise definition of "premature death". The figures that I gave in the Statement are quite clear: of 1,000 young people who are smoking at age 20, 250 of them will die in middle age of smoking-related diseases. A further 250 will die prematurely in later life. We are not just talking of people losing a year of life at the end of their life, we are talking of large numbers of people dying in their middle years because of smoking-related diseases.

I accept in one sense what the noble Lord said about the importance of stressing in the messages why young people should not take up smoking—not only in the health messages but in the messages about the things that matter to them. The insidious message in the past about weight loss and smoking is perhaps one of the reasons that more young women than young men have taken up smoking. We have to target very carefully the advertising and educational campaigns.

It is also possible for us, who have listened to the health messages for more than 20 years, to over-estimate how well they have been translated to the 13, 14 and 15 year-olds of today. They have not been hearing these messages for 20 years in the same way that we have done. We have to make sure that they understand the health-related dangers very clearly. I am not sure that we have done so in the past.

Smuggling is a real and serious issue. We need to ensure that we take action against it. That is why it was announced that we are allocating the considerable sum of £35 million to the Customs and Excise over the next three years to implement the recommendations made in the Government review into alcohol and tobacco fraud. It is important that we ensure that we tackle effectively the smuggling going on at the moment, which for many reasons is dangerous and which is causing a loss of revenue to the Exchequer.

Lord Rea

My Lords, I speak for all members of all the health professions in welcoming this comprehensive White Paper. I notice that my noble friend the Minister has a very nasty cough. I am sure that in her case it has not been caused by the effects of smoking, either personal or environmental. I am sure that there is not much environmental smoke in the Department of Health.

I welcome my noble friend's remarks about how the £50 million to be allocated to an anti-smoking campaign will be spent. We should have learnt by now that big bill-board posters do not work. Certainly that was the case in campaigns to inform young people about drugs. If anything, drug-taking increased during those campaigns.

My first question relates to nicotine replacement therapy. Why not put it on prescription? People with low incomes will then be exempt from the charge and it would surely be far less bother to do that on a nation-wide scale than to allocate it to specified vulnerable groups. My noble friend may not have the figures available<—perhaps she could write to me—but how much would it cost to put nicotine replacement on prescription?

The issue of health warnings on cigarette packets has not been mentioned. The present size of such warnings has been shown to be virtually useless. Have the Government any plans to increase the size of the health warnings so that they actually cover the whole of the side of a packet of cigarettes?

The noble Lord, Lord Clement-Jones, made the point about nicotine content as well as tar content being properly labelled on cigarettes. At the moment low-tar is a big con. People who smoke low-tar cigarettes are getting enough nicotine to keep their habit going.

Baroness Hayman

My Lords, my noble friend is correct. One of the problems about the supposed advantage of switching to lower tar brands is that it has been shown that people actually inhale more deeply of the lower tar brands. Therefore, the supposed advantage is not there. I shall write to my noble friend with the figures that he asked for.

We are anxious to target nicotine replacement therapy on the areas where it will have most effect. That is why we are starting off with action in smoking cessation services. As I said earlier, there is clear evidence that, while NRT can double the success rate of people trying to give up smoking, it is most effective when it is part of an overall programme to support people. We are trying to do that within the most deprived areas—the areas that have been designated health action zones. We have also made it clear in the national priorities guidance for the NHS and local authorities that smoking cessation had to be a priority from April 1999. We hope to see action plans to tackle that coming through in their health improvement programmes. We will be looking at the success of what we are doing in terms of the NRT given in the health action zones and seeing what further services we want to build on top of that.

I take my noble friend's point about not simply using exhortation and assuming that that will be the most effective motivator for young people not to take up smoking. I can certainly confirm that, as he was my general practitioner for about 20 years, my own cough has nothing to do with a smoking related disease.

The Viscount of Oxfuird

My Lords, does the noble Baroness agree that, ironically, the only effective way of resolving the smuggling issue, which is costing this country £1 billion a year, is to seek European-wide harmonisation of tax; namely, excise duty?

Baroness Hayman

My Lords, the UK was disappointed at the failure of the Commission to make any substantial proposals in its second biannual review of minimum rates of excise duty. The Government advocate upward price convergence through high minimum duty rates across the EU. But just because we failed to get member states to agree on that should not stand in the way of taking UK action when it relates to overriding health objectives in this country.

Lord Williams of Elvel

My Lords, can my noble friend say whether there is any evidence that cigarette smoking is more dangerous than cigar or pipe smoking? There is a good deal of debate about cigarette smoking but none about cigar or pipe smoking.

Baroness Hayman

My Lords, my understanding is that all smoking, with perhaps the exception of herbal cigarettes to which the noble Earl referred earlier, is damaging to health. Obviously, the main bulk of smoking is cigarette smoking. That is certainly the area in which most young people are taking up smoking. I shall certainly write to my noble friend with specific details about the relative risks of cigar, pipe and cigarette smoking.

Lord Mackie of Benshie

My Lords, perhaps I may—

Lord Hunt of Kings Heath

My Lords, we have reached 20 minutes. We must move on.

Lord Mackie of Benshie

My Lords, perhaps I may—

Lord Hunt of Kings Heath

My Lords, the Companion is quite clear. We have reached 20 minutes. We must move on.

Lord Mackie of Benshie

My Lords, I wish to talk about a procedural point. The noble Lord, Lord Williams of Elvel, raised a point with my noble friend when he was speaking. I think that the point needs clearing up. My understanding is that the Front Bench speakers may speak for a reasonable time and comment on policy if they so wish. I think that the noble Lord, Lord Williams of Elvel, was wrong on this point and I should like the opinion of the House on it.

Lord Hunt of Kings Heath

My Lords, perhaps I may read from the Companion: Ministerial statements are made for the information of the House, and although brief comments and questions for clarification from all quarters of the House are allowed, such statements should not be made the occasion for an immediate debate. Discussion on a statement should not exceed 20 minutes from the end of the Minister's initial reply to the Opposition spokesmen who are themselves expected to be brief.",

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