NHS: Seven-day Working
Lord Hunt of Kings Heath Excerpts(12 years, 5 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath (Lab)
My Lords, I, too, am grateful to the noble Lord, Lord Ribeiro, for instituting this debate. It is clear that all noble Lords who have spoken are broadly in favour of moving to what we are calling a seven-day week for the NHS. However, there is a range of views about whether it is deliverable. I hope that the noble Earl will be able to address some of the substantive points that have been put to him.
The argument for seven-day working to its full extent is of course persuasive. Noble Lords have talked about the high mortality rate at weekends, the variable staffing levels, the absence of senior decision-makers and a lack of consistent specialist services, such as diagnostics. It is also clear that capital is not used by the NHS to the extent that one would desire if very expensive machines are left idle for quite a part of the week.
However, there are three major questions about whether this is workable which I will put to the noble Earl. First, is the rest of the health and social care system able to match the seven-day working of the health service? It seems that the major pressure problem facing the NHS is frail, older people who probably should not have been admitted, but have been because either nursing homes or social care provision was not sufficient. Once they are admitted to hospital, it often becomes difficult to enable them to be discharged quickly because of an absence of community infrastructure. If we are going to have full seven-day working within acute hospitals, it is essential that GPs and social and community services also embrace seven-day working.
I do not know to what extent the Bruce Keogh work has really reflected that. It will have to be tackled. We cannot carry on any longer with GPs who are inaccessible and unable to do what is necessary to help people who have been discharged into the community. The same goes for social services, which still seem to shut down over bank holidays and the Christmas period. This simply is not going to work unless the whole of the system is working to the same tune.
Secondly, there are mixed views on resources. My noble friend Lord Parekh thought that the cost of this could be contained. I must say that I rather share the view of my noble friend Lord Warner and the noble Lord, Lord Ribeiro, that this is in fact going to be massively expensive. The noble Lord, Lord Ribeiro, talked about the necessary massive expansion of consultants. That must be true because we do not want seven-day working that involves staffing up at the weekends and reducing staffing during the week. I suspect that mortality rates would go up during the week because you would not have the necessary cover. I am afraid that some of the plans of acute hospitals are indeed to squeeze staffing during the week. That is a crazy way to go about it. I am very concerned that, in time, we will see a rise in mortality rates during the week. I do not think that this has been fully considered by those who say that we can do this simply by a better ordering of the way in which things are done. I refer the noble Earl to the Institute of Fiscal Studies report published today, about the resource challenges facing the NHS, and ask him how this is to be afforded.
Finally, does the noble Earl think that, as a result, the noble Lord, Lord Ribeiro, will be even more engaged in dealing with reconfiguration issues? Does the noble Earl agree that the implications of this are that we have to have radical reconfiguration of services? Will Ministers support that? Equally, will they tell Monitor and the competition authorities to back off from instituting competition procedures if this reconfiguration is necessary to make this work?
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I congratulate my noble friend Lord Ribeiro on securing a debate on this important issue. I know that as a former consultant surgeon and former president of the Royal College of Surgeons this is a subject in which he takes a great deal of interest. I also take this opportunity to pay tribute to the work done on seven-day services by NHS England, the NHS Services Seven Days a Week forum, the Academy of Royal Medical Colleges and the Royal College of Surgeons, among others.
The historical five-day service model offered in many NHS hospitals no longer meets justifiable patient and public expectations of a safe, efficient, effective and responsive service. I very much echo the comments of the noble Lord, Lord Parekh, in that context. Over the past 10 years, a growing body of national and international evidence has emerged that links poor outcomes, including a higher risk of death, to patients admitted to hospital at the weekend, around the world. It is impractical and inefficient to continue to operate a five-day approach when our illnesses and conditions do not limit themselves to office hours. Patients are entitled to receive the same standard of care regardless of the day of the week.
As the largest and most comprehensive health service in the world, the NHS is well positioned to solve the issue of poorer outcomes and reduced levels of service provision at the weekend. That is why NHS England has set out a vision for the NHS which is of a service more closely organised around the lives of the public it serves. To develop this vision, NHS England established the NHS Services Seven Days a Week forum in February last year to consider how NHS services can be improved to provide a more responsive and patient-centred service across the seven-day week.
The forum’s work has been met with nothing but positive feedback and support from the public and patients, the Academy of Medical Royal Colleges and the British Medical Association, among other organisations. The immediate focus for improvement activity will be addressing the need for high-quality urgent and emergency care services, seven days a week. NHS England is also looking to make similar improvements across primary and community health services and social care, and the forum will report in autumn this year, setting out proposals for the creation of a fully integrated service. NHS England’s ambition is for seven-day services to be fully implemented in England by the end of 2016-17.
I recognise that we cannot talk about the idea of seven-day services without giving full consideration to questions of staffing and finance; many noble Lords have raised those issues. NHS providers and their commissioners already face difficult choices when deciding where to invest their resources in order to maximise the outcomes for patients and value for taxpayers. Early indications are that seven-day services have the potential to be part of the solution. However, more information is needed. NHS England is therefore conducting research which will provide a helpful indication of the likely costs providers and commissioners face when considering how to redesign their services to provide comprehensive seven-day care. In addition, to answer my noble friend Lady Brinton, NHS England intends to commission financial and system modelling and analysis of the implications of its strategy for achieving seven-day service provision in the NHS.
My noble friend Lord Ribeiro rightly highlighted the workforce implications of having a consistent, high-quality service seven days a week. The department, alongside NHS England, Health Education England, NHS Employers and a number of strategic partners, is considering that very issue. Its analysis is considering issues such as junior doctors feeling unsupported during weekend working and the resulting need to ensure that education contracts include appropriate seven-day senior supervision; and numbers of diagnostic and scientific staff, with NHS England intending to undertake a thorough assessment of the different roles needed in diagnostic and scientific services to support an extended service.
Of course, many commissioners and providers will need support to address the challenges presented by seven-day services. To that end, NHS Improving Quality has just introduced a new, large-scale transformation change programme, set up in collaboration with all healthcare commissioners and providers, to support the spread of seven-day services over a three-year period.
I realise that the move towards seven-day care will not be easy, but there are encouraging examples of pioneering NHS organisations that have moved to make healthcare services more accessible seven days a week to avoid compromising safety and patient experience. For example, Sheffield Teaching Hospitals NHS Foundation Trust has adopted seven-day service provision, improving patient flow of frail and older people through the emergency pathway. Bed occupancy for emergency care for older patients has now reduced by more than 60 beds. Other examples in my brief include Salisbury District Hospital and the Lancashire Intermediate Support Team, both of which have produced impressive results.
We know that across the country, more hospitals, primary and community care organisations and social care services are working together to break the link between poorer outcomes for patients and the reduced level of service provision at the weekend. We also know that patients and the public want us to act now to make seven-day services a reality in all parts of our NHS.
A number of noble Lords, including my noble friend Lord Ribeiro and the noble Lords, Lord Parekh and Lord Hunt of Kings Heath, raised the issue of cost. Interestingly, there is already evidence that seven-day services can be implemented in a way that does not increase the overall cost of healthcare. The average cost of implementation at trusts pioneering the service was 1.5% to 2% of their total income. Costs vary according to local service models, but research shows that they can be reduced by reconfiguring services and by trusts working collaboratively. Seven-day services at the front end—that is to say, A&E departments—could also pay for themselves by reducing admissions and lengths of stay.
Seven-day services would not work under a one size fits all model—a point made by my noble friend Lord Ribeiro. Local solutions need to be found and pioneering NHS providers and commissioners are already working to develop them.
In answer to the noble Baroness, Lady Masham, on the issue of safety at weekends, we expect all NHS services to be able to meet patients’ needs as they arise. To do this, trusts should adopt the clinical standards developed by the seven-day services forum to drive up clinical outcomes and improve patient experience at weekends.
My noble friend Lady Manzoor referred to the CQC. The CQC and the Chief Inspector of Hospitals are considering how implementation of the clinical standards could best be assessed by the CQC and how this might be reflected in its forthcoming ratings and the judgments it makes when it inspects.
As I said, workforce is a major issue. The noble Baroness, Lady Masham, was right to raise that point. There are over 12,200 more clinical staff in the NHS than there were before the election, thanks to the money we have invested in the service and to the reforms we have carried out. Nevertheless, there is an issue about motivating staff to work at weekends, as the noble Baroness rightly said. We understand that contractual levers and incentives are required to drive change. NHS England and a number of key strategic partners are already looking into this. However, in many cases seven-day services have reportedly already had a positive impact on individuals’ work-life balance, offering greater certainty in planning ahead and flexibility in time off. In addition, the medical royal colleges are all in support of seven-day services. Building seven-day service provision into recruitment, job planning and appraisal processes will help create a sense of common purpose to underpin organisational delivery.
A number of noble Lords, including my noble friends Lord Ribeiro and Lady Barker, referred to the role of GPs. To address that important role in the mix of services the NHS provides, we recently announced the setting up of a £50 million fund to support innovative GP practices in improving services, and in particular access for their patients, including seven-day week access and evening opening hours and the testing of a variety of services including Skype, e-mail and phone consultations.
However, as the noble Lord, Lord Hunt of Kings Heath, emphasised—as did my noble friend Lady Barker—community services and social care are absolutely integral to this as well, particularly when it comes to the care of the frail elderly. Social care and the NHS are priorities for the Government and we know that there is interdependency between the two systems. However, providing more resources is not enough on its own. We have provided more resources from the Department of Health but we need to do more. NHS England is currently working with the Local Government Association to create a health and social care system that is truly seamless so that people receive the right care at the right time and in the right place. The Seven Days a Week forum will report on that work in the autumn, setting out proposals for a fully integrated service.
The Better Care Fund is a key enabler for change, as my noble friend Lady Manzoor pointed out. As part of the process for accessing funding, clinical commissioning groups and local authorities will have to demonstrate, as part of agreed local plans, that they are addressing a number of national conditions, including seven-day services in health and social care.
The noble Lord, Lord Warner, asked whether the Government would expect A&E departments to have weekend consultant cover. We recognise that the consultant contract is a key enabler of seven-day services. In October last year the Government mandated NHS Employers to enter into formal negotiations with the BMA to deliver joint proposals for consultant contract reform, including changes that will support seven-day services.
My noble friend Lord Bridgeman focused on the working time directive. He may know that we asked the president of the Royal College of Surgeons, Professor Norman Williams, to chair an independent task force to look at the implementation of the working time directive, and the impact of the directive on the delivery of patient care and the training of the next generation of doctors. The independent review will provide its report during March 2014. Professor Williams is working with stakeholders from the Royal College of Surgeons, NHS organisations, the BMA, National Voices and others, and we ourselves are working with the task force to ensure that it has appropriate legal and analytical support.
There is a compelling case for healthcare services to be accessible seven days a week. To echo the noble Lord, Lord Parekh, if we were starting the NHS from scratch I very much doubt whether we would design a part-time system. We would surely create a seven-day service to better meet patients’ needs. Seven-day service provision is about equitable access, care and treatment, regardless of the day of the week. It is a cause for some pride that the NHS will be the global pioneer in providing equality of access to consistent, high-quality healthcare seven days a week.
Lord Hunt of Kings Heath
My Lords, before the noble Earl sits down, I was remiss in not declaring my interests at the start as chair of a foundation trust, president of GS1 and a consultant trainer with Cumberlege Connections. I know that we all know that, but I have to do it every time.
NHS Property Services Ltd
Lord Hunt of Kings Heath Excerpts(12 years, 5 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath (Lab)
My Lords, I refer noble Lords to my interests in the register; I should have done that yesterday on another health Question, for which I apologise to the House. Can the Minister confirm that the chairman of this organisation resigned early, that capital money was raided to cover a revenue shortfall and that, only months after the organisation formally started, an investigation has been mounted by the National Audit Office? Given that the shares in this company are owned by Ministers, will Ministers take responsibility and can the noble Earl confirm that this was forecast in the NHS risk register, which the Government have not yet published?
NHS: Cancer Treatment
Lord Hunt of Kings Heath Excerpts(12 years, 5 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
My Lords, I am with the noble Baroness all the way in wishing to see your Lordships live a healthy and long life but, as regards the population generally, I hope that I have made clear the Government’s determination to see that all citizens of this country receive treatment according to their ability to benefit from it.
Lord Hunt of Kings Heath (Lab)
My Lords, I am sure we are all with the noble Baroness in those sentiments. Can I refer the noble Earl back to the research that my noble friend referred to? The report seems to show that survival rates for cancer patients over the age of 75 are very poor in this country compared with other European countries. The noble Earl has said that he will ensure that action is taken through the mandate to NHS England. Should he not give instructions to clinical commissioning groups to start commissioning cancer services with no age discrimination?
Earl Howe
My Lords, commissioning is an important ingredient in this, but there is a range of actions that we can take and have taken. We know that low levels of awareness and late diagnosis are particular problems for older patients, so it is welcome news that Public Health England is to run a national campaign to raise awareness of breast cancer in women over the age of 70. We are also raising the screening age for breast cancer to include women aged 71 to 73, and the extension of the NHS bowel cancer screening programme to men and women aged 74 is now complete.
Children and Families Bill
Lord Hunt of Kings Heath Excerpts(12 years, 5 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath (Lab)
My Lords, I shall speak also to my Amendments 61 and 57BB. I very much welcome Her Majesty’s Government’s change of heart as far as standardised packaging is concerned, and I certainly welcome the appointment of Sir Cyril Chantler to review the evidence. Sir Cyril is known to many of your Lordships and has made a significant contribution to the NHS. We can have complete confidence in his work.
My two amendments are designed to press the noble Earl on the comments he made in his final remarks and to encourage him to give the House an absolute assurance that should Sir Cyril Chantler conclude that the evidence is clear that standardised packaging is effective in reducing the risk of harm to children, the Government will speedily move to lay the regulations specified in his Amendment 57B. The noble Earl will know that at the moment line 3 of his amendment merely says,
“The Secretary of State may make regulations”.
I would have preferred to see the word “must”. To an extent, the noble Earl has already explained why it is to be “may”, but are there any circumstances where, on the assumption that Sir Cyril has concluded positively, the Government would not proceed to legislate?
Amendment 57BB concerns the proposal that it be an offence for any person who drives a vehicle to fail to prevent smoking in the vehicle where a child or children are present. I do this on the basis that the past 15 years have seen an impressive reduction in the amount of smoking in this country. Indeed, since the previous Government’s 1998 Smoking Kills action plan, smoking rates among children, who are, of course, the focus of this Bill, have fallen by more than half following a period of little progress lasting 20 years. I have little doubt that the ban on advertising was pivotal, but the fall was also due to a series of other concerned measures which included an increase in the age of sale, picture warnings on packs and an above-inflation increase in tobacco duty to reduce affordability.
I believe that we should continue the momentum and protect future generations from the dangers of smoking. That is why I welcome the Government’s agreement to legislate on standardised packages and the proposals that the Minister has outlined today in relation to proxy purchasing and the restriction of the sale of e-cigarettes to under 18 year-olds. However, the Government could do more by accepting my amendments and support the principle of a ban on the use of cigarettes when children are present in cars.
Children’s lungs are smaller and they have faster breathing rates, which makes them particularly vulnerable to second-hand smoke, especially within the close confines of a car. Members of the public are protected by smoke-free legislation when in public transport and work vehicles. However, large numbers of children remain exposed to high concentrations of second-hand smoke when confined in family cars. Indeed, around one child in five reports being regularly exposed to second-hand smoke in cars, with catastrophic health consequences. Figures released by the British Lung Foundation show that around 185,000 children between the ages of 11 and 15 in England are exposed to potentially toxic concentrations of second-hand smoke in their family car every day or on most days.
We know that children exposed to second-hand smoke have a raised risk of lower respiratory infections, wheeze, asthma, middle ear infections and meningitis. Every year, exposure to second-hand smoke leads to an estimated 165,000 additional cases of these conditions among children. Many of those cases are serious, leading to an estimated 8,500 hospital admissions.
I was very surprised by research identified by the British Lung Foundation, which shows that a single cigarette smoked in a moving car with the window half open exposes a child in the centre of the back seat to around two-thirds as much second-hand smoke as in an average smoke-filled pub of days gone by. Levels increase to 11 times those of a smoky pub when the cigarette is smoked in a stationary car with the windows closed.
Some noble Lords will argue—as I heard the FOREST spokesman arguing this morning—that a car is a private space and that we should not legislate for what happens in such a space. However, there are more important principles than that, one of which is the need for child protection. Unlike most adults, children lack the freedom to decide when and how to travel, and they lack the authority most adults have to ask people not to smoke in their company. In those circumstances it is right for Parliament to step in to protect children.
I know that the Government argue that the most effective way to reduce smoking in cars carrying children is not through legislation. In his letter to us the noble Earl talked of two successful campaigns aimed at encouraging people to change their behaviour, and said that the evaluations are encouraging. From what I see—and they do not appear to be very robust evaluations—I am not aware that the scientific evidence of behavioural change has been published. Can he give an assurance that the evaluations spanned several months and not just immediately after the campaign? Can he also confirm that they took into account what was reported by children and not just adults? There is sometimes a discrepancy between what adults say they do and their behaviour as reported by children. Can he also confirm that the research includes actual measurement of behavioural change? I do not believe that marketing measures such as website visits effectively demonstrate behaviour change. Can the noble Earl also say why, if the Government are so keen on evaluation, Ministers forced NICE to abandon a project to give public health guidance for commissioners and providers on the development and implementation of policies on smoke-free homes, private cars and other vehicles?
The noble Earl will argue that this is best done through education. I understand that argument and I certainly accept that education programmes can achieve much. However, my contention is that we are now close to—
Lord Stoddart of Swindon (Ind Lab)
I have listened to the noble Lord very carefully and I cannot understand—perhaps he can explain it to me—why on earth he has joined the question of plain packaging with smoking in cars. They are two completely different issues. Is it expected that those of us who are concerned with both amendments now have to speak in one debate rather than two, on two particularly difficult and important matters?
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 Cormack (Con)
I am grateful to the noble Lord. Surely, my noble friend Lord Forsyth highlighted a very important point. He talked about small flats; there are small flats where there may be several children and only one living room. What is the logic of the noble Lord’s argument in that case? Personally, I do not think we should invade private space; that is my position and I may seek to defend it later. There is no logical difference between a single child in a car and four children in the living room of a small flat.
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?
Lord Hunt of Kings Heath
My Lords, I do not have evidence on the length of the average car journey, though clearly short and long distances may be travelled during which smoking may take place. I suspect that we can argue that until the cows come home. However, I come back to the core argument that in a confined space, such as a car, a child is likely to be more damaged through inhaling second-hand smoke than they are in a person’s home. That is the reason for making a distinction between legislation affecting an individual vehicle and legislation affecting a person’s home.
Lord Scott of Foscote (CB)
I wonder whether the noble Lord can help me. Does “private vehicle” in the amendment include a motor boat? One drives a motor boat.
Lord Hunt of Kings Heath
No, my Lords, I do not think that that is covered in my amendment—although, of course, it is open to the noble and learned Lord to propose an amendment to increase the scope of the measure. I would give such an amendment all due consideration.
I refer noble Lords to an inquiry into smoking in private vehicles by the All-Party Parliamentary Group on Smoking and Health, carried out in 2011, which concluded that the evidence from smoke-free public places was that legislation would be necessary to reduce exposure to cigarette smoke in cars. That is the basic case I am making. At this stage, I am asking noble Lords to support the principle of a ban. If my amendment were accepted, I would be very happy to work on a cross-party basis to consult on the type of offence that should be put in place. I have not gone as far as the noble Lord, Lord Ribeiro, and his colleagues in terms of specifying the offence because I think that needs further consideration and discussion.
We would not be alone in legislating to protect children from the damage of smoking in cars. Seven other countries already do so, including four US states, 10 of the 13 Canadian provinces and all but one jurisdiction in Australia. As far as the public are concerned, a YouGov poll in 2011 found that 78% of adults in Great Britain agree that smoking should be banned in cars carrying children younger than 18 years of age. Just as significantly, perhaps, a British Lung Foundation survey in 2011 found that 86% of children want action to be taken to protect them from cigarette smoke in cars. I think that we should listen to the voice of children in this respect. I hope that noble Lords will support the amendment that I shall propose later.
In concluding, I should have pointed out to noble Lords my health interests in the register, including being chairman of a foundation trust, a consultant and trainer with Cumberlege Connections and president of GS1.
Lord Ribeiro (Con)
My Lords, the amendment of the noble Lord, Lord Hunt of Kings Heath, is compelling but fails to acknowledge the impact of second-hand smoke on children in confined spaces or in the home, as we heard in an earlier debate. For this to happen, the public, particularly parents, have to be educated about the harm that second-hand smoke can do to young children’s lungs. The noble Lord identified some of those problems. That is why I believe that education and behavioural change are important.
As a doctor, I recognise the damage that second-hand smoke can cause, and in particular the long-lasting effect it can have on the lungs of young children. Just this Sunday, I was present at the birth of my first grandson out of six grandchildren.
Lord Cormack
My Lords, that was really a speech rather than an intervention. There is all the difference in the world between the physical or sexual exploitation of a child and smoking. Smoking is not an illegal activity. Some of us may wish that it were, but it is not. It would be wholly impractical, as the noble Lord, Lord Patel, made plain in his remarks, for us to outlaw smoking. That is a road down which we cannot go. Therefore, to invade the private space of individuals who are committing a perfectly legal act seems to me a step too far. That is why we should look at other means. I have mentioned taxation and increased insurance premiums; there are many routes down which we could go to make it more and more difficult for adults to smoke in the presence of children.
Most importantly, it is up to experienced people such as the noble Baroness and my noble friend Lord Ribeiro to ensure that there is a well informed education campaign so that no one is in any doubt that smoking is a harmful activity and that inhaling passive smoke is dangerous and injurious to health. I am with the noble Baroness and my noble friend on that all the way, but the invasion of personal space—prosecuting people for what is a legal activity—seems a step too far. That is why, while I welcome and applaud the amendment introduced by my noble friend Lord Howe—if there were a Division, although I am sure that there will not be, I would enthusiastically go into the Lobby to support him—I cannot support something that I believe is a step too far in the invasion of personal space, which would also be monumentally difficult to enforce. We have to bear in mind the responsibilities of the police, whose job it would be to stop the cars and ask the questions.
Lord Hunt of Kings Heath
Does not the noble Lord accept that, although there may be difficulties of enforcement, the very fact of passing a law combined with the kind of educational programme that he supports is likely to have a positive effect?
Lord Cormack
No, frankly, I do not. I respect the noble Lord—he knows that—and we agree on many issues, but we will have to disagree on this one. I think it would make the job of the police even more difficult than it is at the moment and endanger what popularity they have with many law-abiding citizens. It is a burden that we should not place on them.
I repeat: let us do everything we can to educate; let us do everything we can to deter; let us have the plain packaging; let us listen very carefully to what Sir Cyril says in his report; but let us not take the ultimate step that the noble Lord advocates.
Lord Storey (LD)
My Lords, I want to speak to Amendments 57B and 62. First, on Amendment 57B, the Government are to be congratulated. The package that they propose—if I dare to use the term “package”—of proxy purchase, e-cigarettes and looking at the whole question of standardised packaging of cigarettes and tobacco products is to be welcomed. I think it will result in thousands of people being saved from getting respiratory and lung diseases; it will save literally thousands of lives. I congratulate the Minister and the Government. I want also to thank those cross-party noble Lords who put down the original amendment, because they initiated this debate.
On Amendment 62, I said in Committee and say again: some noble Lords have mentioned their grandchildren. Can you imagine carrying your grandson or granddaughter in a carry-cot, putting that child into a metal box—a car—and allowing somebody to pump cigarette fumes into that metal box? You would not do that at all; you would not allow that to happen. Whatever our concerns are about personal space or civil liberties or whatever it is, this is about the rights of a child; the rights of a baby. A baby cannot say, “Well, actually, I don’t mind”; a child cannot say, “Actually, I don’t mind”. In fact, research—certainly from talking to children—shows that they do mind. As we have heard, we can see when we look at the figures that children are particularly vulnerable to second-hand smoke. Why? Because they have small lungs, because they have faster breathing, and because they have a less developed immune system. That makes them more susceptible to respiratory problems: asthma, bronchitis and lung malfunction. Knowing that, and that passive smoking results in more than 165,000 new episodes of all sorts of diseases associated with lungs and respiration—and I am talking about children here—are we serious about allowing children and babies to be strapped in a car where that happens? Surely not; all the other arguments pale into insignificance.
We seem to cite lots of surveys here. Interestingly, in 2010 a survey that directly asked 11 year-olds and 15 year-olds found that one in five reported being exposed to second-hand smoke in cars.
A number of people have said, “How are we going to make this happen? The police are very busy; can we really make it happen?”. I have two answers to that. Do noble Lords remember when seat-belt legislation was suggested? People got up and said, “Oh no, this is an attack on my civil liberties; oh no, we will solve the problem by advertising”. It was the “clunk click” advertisement, was it not? Oh—perhaps we had better move on from that. With the “clunk click” advertisements, in fact, something like 24% of people started to belt up in cars. Legislation was then brought in and we found that 97% of people then put on a seat belt. We do that automatically; we do not think about it, or sit in our cars saying, “This is an infringement of our liberties; we shouldn’t be doing this”; we do it. Why do we do it? Because it saves lives: it saves our lives and the lives of other people who are travelling in the car.
Interestingly, a study conducted in Scotland—we talk about Scotland a lot in this Chamber, thank goodness—suggested that air quality inside a smoker’s car was comparable to industrial smog in cities such as Beijing or Moscow, even when the driver has the window open. Are we seriously suggesting that children and young people should be subjected to air quality which is akin to that in Beijing or Moscow? Of course, we are not. Research by Aberdeen University found that 7% of 11 year-olds experience smoking in cars. That is why I am pleased that one of my colleagues in Scotland, the Liberal Democrat MSP, Jim Hume, is introducing a Private Member’s Bill looking at safeguarding children by banning smoking in cars. That is now going out to public consultation.
I end by making two further brief points. It is easy to find all sorts of reasons why you cannot do something. We could ask, “What about cars that are convertible? What about yachts? What about this? What about that?”. However, if you believe in something and think that it is right, you get on and do it. My only regret regarding the amendment is that it was initially an all-party amendment. When I listen to the news, I hear that it is a Labour initiative. I am sorry that it has been politicised and has become a party-political issue; I hoped that it would not be.
Lord Hunt of Kings Heath
The noble Lord has made an impassioned speech. My understanding was that the original cross-party amendment had been degrouped and would be taken only late at night. I therefore brought forward this amendment to enable the House to make a decision. I agree with him about the cross-party nature of the debate.
Lord Storey
I respect what the noble Lord says and thank him for it.
The Minister is a listening Minister. I hope that he will reflect on what has been said and accept the amendment because it is important to take the whole House with him on issues such as this. I hope that he will look again at continuing the advertising campaign but, perhaps more importantly, that he will consider a review of this issue so that we can go forward on it together.
Earl Howe
My Lords, this has been a fascinating and very helpful debate and I am very pleased with the support that I have heard for the government amendments on standardised packaging. I would like, if I may, to commend noble Lords for their continued work in supporting tobacco control. We all want to drive down rates of smoking in this country and, in particular, to stop young people from taking up smoking in the first place. Let me address the points on standardised packaging first.
The noble Baroness, Lady Finlay, the noble Lord, Lord Faulkner, and my noble friends Lady Tyler and Lord McColl tabled a revised amendment following discussion in Grand Committee, and I see that they reflected the comments that I made in redrafting it. I particularly welcome their support for the Government’s amendments and can reassure them that our amendments would achieve all of the things that they seek to do.
My noble friend Lord Naseby raised a number of legal issues. I would like to reassure him that we have given very careful consideration to the legal situation. We believe that the government amendment gives us sufficient room to proceed with the regulations, should we choose to do so, and introduce standardised packaging, if that is what is decided. He queried the fact that the amendment is drafted in such a way that the devolved Administrations and Assemblies have to give consent, but it is the Secretary of State and not Parliament who gives consent in England. We do of course want Parliament to have a say, which is why we have introduced Amendment 63B to make the regulations subject to the affirmative procedure.
The noble Lord, Lord Stoddart—whose robust state of health I very much welcome—indicated that there has been no proper consultation on standardised packaging. In fact, in 2012 the Government ran a full public consultation and received almost 2,500 substantive responses and well over half a million postcard and petition responses. The consultation asked 15 specific questions and invited comments on the consultation stage impact assessment, which was also published. So it was a very thorough exercise.
The noble Lord, Lord Stoddart, suggested that this was the thin end of the wedge, if I can put it that way, and might herald similar measures in relation to junk food. I think we need to remember that tobacco is a uniquely harmful consumer good. Tobacco kills one in two long-term smokers. There is no safe level of smoking. That is why we have a range of specific legislation and an international treaty around tobacco control.
My noble friend Lord Naseby referred to illicit tobacco. We received a wide range of responses to the question in the consultation on illicit tobacco. They are summarised in the consultation report. In 2000, around 21% of the UK cigarette market was illicit. The latest estimate from HMRC, for 2012-13, is that this has dropped to around 9%. It is too high, I concede, but we are heading in a positive direction.
The noble Baroness, Lady Howarth, asked about the timetable for the regulations. I emphasise here that I do not want to pre-empt any decision that the Government may make on whether to proceed with standardised tobacco packaging, and I know that the noble Baroness understands that; but equally for that reason, it would be premature to set out a detailed timetable. What I can confirm is that the regulations would be subject to the affirmative procedure to ensure an appropriate opportunity for parliamentary scrutiny in both Houses. She may like to be aware that before being laid in Parliament, any draft regulation that seeks to regulate tobacco packaging would need to be notified to the European Commission and member states. There is a process that goes with that, which would mean that we would not be able to lay regulations instantly after taking a positive decision. I am happy, however, to reiterate the Government’s commitment to make a decision quickly when we receive Sir Cyril Chantler’s independent report. Tabling these amendments is, I hope, evidence of our commitment to act without delay if we decide to go ahead. But the Government, as I am sure she appreciates, must rightly consider the wider issues raised by this policy, and I can assure her that we will do so.
I can understand the intention of the noble Lord, Lord Hunt, in tabling both of his amendments, Amendments 57BA and 61, which seek to compel Ministers to introduce standardised packaging. However, I am sure that he will not be surprised to hear me say that we cannot accept provisions that tie our hands in this way. One of the amendments imposes an arbitrary timetable for government action, and both pre-empt Ministers’ proper and careful decision-making, involving consideration of all the relevant issues. Litigation by the tobacco industry is always a risk when introducing tobacco control legislation. Indeed, the World Health Organisation says that one of the six main forms of tobacco industry interference in public health is the intimidation of Governments with litigation or the threat of litigation. Government must have time and space to give proper consideration to the wider issues raised by standardised packaging of tobacco, and demonstrate that it has done so. Doing so will also reduce the risk of successful litigation. I do appreciate the desire to go faster but we must follow the proper decision-making process to enable us to arrive at the right policy decision. It is right that we should wait for Sir Cyril’s report. Once we do, I say again, we will make a decision quickly.
The noble Lord, Lord Hunt, asked me to put on the record that we will definitely introduce the regulations should the case be made and should we be persuaded of the case that Sir Cyril presents. I hope that I have been clear about that. I will repeat the comments made by my honourable friend the Minister for Public Health when she announced the review:
“The Government will introduce standardised tobacco packaging if, following the review and consideration of the wider issues raised by this policy, we are satisfied that there are sufficient grounds to proceed, including public health benefit”.—[Official Report, 28/11/13; col. WS 96.]
I thank the noble Lord, Lord Faulkner, the noble Baroness, Lady Finlay, and my noble friends Lady Tyler and Lord McColl for having made clear their intention not to press their amendment on standardised packaging. I hope that the noble Baroness, Lady Hughes, and the noble Lord, Lord Hunt, will do the same with theirs.
I turn to smoking in cars. Since we considered the issue at the previous stage of the Bill, I have met a number of noble Lords who support the idea of legislating to stop smoking in cars with children present. I have also listened very carefully to the debate as it has proceeded this afternoon. One thing is clear from those meetings and the debate—we all want to eradicate smoking in cars carrying children. None of us wants to see children continuing to be exposed to harmful second-hand smoke, whether in the home or the family car. However, although we agree on the destination, I have to acknowledge that there are differing views on the most effective route. As your Lordships will know, the Government believe that encouraging positive and lasting behaviour change by making smokers aware of the significant health risks of second-hand smoke will be more effective than resorting to the use of legislation—which is of course a blunt instrument—to tackle the problem. I believe very clearly that we should consider resorting to the use of legislation only if our work to promote positive changes in behaviour is shown not to have had the desired effect.
When we debated this issue in Grand Committee, a good deal of time was spent considering the practicalities of enforcing an offence of smoking in cars carrying children. I do not propose to rehearse those arguments in detail again today. Nevertheless, I want to encourage your Lordships to reflect on just how difficult it would be to enforce such a provision. My noble friend Lord Cormack referred to this. In my view, there would be substantial challenges in enforcing any such legislation, particularly with respect to vehicles travelling at speed. Currently, local authorities enforce smoke-free legislation, but they do not have the powers or the means to require moving vehicles to pull over. We would need therefore to set up a complex and probably resource-intensive enforcement regime, which would need to involve the police. These remaining questions of how to achieve effective enforcement undermine the credibility of the measures that have been proposed. If it were known that there was little chance of enforcement action, I have to ask whether individuals would comply with the law.
Lord Hunt of Kings Heath
I am most grateful to the noble Earl. Would he accept that my amendment has been drafted in a way that allows your Lordships to vote on the principle but then allows for work to be done, hopefully cross-party, and for the Government to bring in regulations, during which some of these matters could be talked out thoroughly?
Earl Howe
I have noted the way the noble Lord’s amendment has been drafted. However, we need to be very careful before accepting it, for the reasons that I am explaining now. One of the points made about enforcement was that we could make a useful comparison with seat-belt legislation. I understand why that comparison has been made but it needs to be borne in mind that we are not comparing like with like. Seat-belt legislation is a road safety measure which is properly enforced by the police; smoking in cars is a public health matter and the police have no public health role or functions. That is part of the reason that the issue is so complex. Before launching into the kind of amendment that the noble Lord, Lord Hunt, invites us to accept, we need to take stock of these questions. There is no point in putting something on the statute book if it is impractical to implement.
“Protection of Children’s health: offence of smoking in a private vehicle
The Secretary of State may bring forward regulations making it an offence for any person who drives a private vehicle to fail to prevent smoking in the vehicle when a child or children are present.”
Health: Confidential Patient Information
Lord Hunt of Kings Heath Excerpts(12 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath
To ask Her Majesty’s Government what assessment they have made of the likely impact of proposed European Union legislation on their plans to sell confidential patient information to drug and insurance companies.
Lord Hunt of Kings Heath (Lab)
My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I refer noble Lords to my interests in the register.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, while we have concerns about the EU proposals, there has been no cause to conduct an assessment of the sort suggested at this stage. The Government do not sell confidential patient information to companies. Drug and insurance companies can receive patient confidential information only where they have a legal gateway, either consent of the patient or some form of statutory authority. In these circumstances the cost of providing information may be recovered, but it is not sold.
Lord Hunt of Kings Heath
My Lords, clearly there is great advantage in using patient research in large-scale research projects. However, can the noble Earl assure the House that patient confidentiality can be assured? Also, is it right that projects such as the UK Biobank could be put in jeopardy were the proposed European legislation to be enacted in its current draft form?
Earl Howe
My Lords, under the 2012 Act, the Health and Social Care Information Centre cannot release data that could be used to identify an individual without a legal basis to do so. As a result, there are strict controls about how such information is released. As regards the UK Biobank, the noble Lord is right to be concerned because the proposed text from the so-called LIBE committee would rule out the work of the UK Biobank, in that it would need explicit and time-limited consent for any research project that it undertook, instead of being able to support a range of research purposes, as it now can, using its existing consenting mechanism. So there is cause for concern if this text is adopted, but that is not yet clear.
Health: Dementia
Lord Hunt of Kings Heath Excerpts(12 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath (Lab)
First, I refer noble Lords to my health interests as chair of a foundation trust, president of GSI and consultant and trainer with Cumberlege Connections. I, too, would like very much to thank the noble Baroness, Lady Gardner of Parkes, for allowing us to debate this important issue tonight. I also echo the tribute paid by my noble friend Lord Jones to the Alzheimer’s Society, both for the work that it does and for the very helpful briefing that I have received tonight.
If we come back to the question put by the noble Baroness, Lady Gardner, she is surely right about the important focus on improving information to the public, and trying to get over some of the stigma problems to which she referred. She referred to cancer—and I remember when, in the 1950s, people would not actually use the word “cancer”. It was almost hidden away. Clearly, there are issues with dementia, which we must tackle with enthusiasm. My noble friend Lady Turner spoke eloquently of the terrible impact that dementia can have on loved ones.
On a more optimistic note, both the noble Baroness, Lady Greengross, and the noble Lord, Lord Jones, said that much can be done. However, the problem is that often people do not know that that is the case. A major problem is the lack of information in many cases when a diagnosis is made. That, of course, assumes that a diagnosis is made. My understanding is that diagnosis rates are currently only 48% in the UK, and vary widely across the country. This suggests that more than half of people with dementia do not receive a formal diagnosis and therefore do not get access to vital treatment and support. How does the noble Earl think that we might improve diagnosis rates? Will he also consider the Alzheimer’s Society’s priorities for improving post-diagnostic support, to which my noble friend Lord Jones referred? That society’s priorities are that health and care professionals should provide post-diagnosis information packs, that information must be accessible and useful to people with dementia and not just available digitally—a very important point—and that commissioners must also consider the needs of carers of people with dementia in their local plans.
When a diagnosis is made of any condition, not just dementia, why is the information provided by societies such as the Alzheimer’s Society not automatically given to patients? It has long been a puzzle to me why the health service in particular finds it so difficult to give out this information. Any help the noble Earl can give in that regard would be appreciated.
Will the noble Earl say a little more about research? A number of noble Lords have referred to this. Research into dementia has improved but there is a long way to go compared with research into other diseases. I hope that the noble Earl will be prepared to comment on his own department’s policies on this issue and on the influence of the Medical Research Council in this area.
My noble friend Lady Turner said that people with dementia are best looked after at home. That must surely be right. However, the noble Earl will know that at the moment many patients with dementia are in National Health Service acute hospitals. Some people use the wretched term “bed blocking”, which I think is very unfortunate. However, there is no doubt that one of the problems for accident and emergency departments is the difficulty of discharging patients with dementia once they get to hospital, and, of course, those patients often suffer from co-morbidities. Has the noble Earl looked at the report of the Royal College of Physicians which suggests that, rather than having specialised hospital consultants, we need general physicians who can treat patients with co-morbidities? This is very relevant to people with dementia. Will he write to me on that issue if he cannot comment on it today?
The noble Baroness, Lady Gardner of Parkes, referred to nursing. I very much agree with her that in retrospect the phasing out of state enrolled nurses was an absolute disaster. I am afraid that it was done at the behest of the nursing profession. It is not satisfactory that we now have only one tier of registered nurse. I will not go back to the issue of healthcare assistant regulation, although rumours reach one of a Bill that will allow us to debate that again at some point in the near future. However, the substantive point the noble Baroness made was that we need to look at nurse training and, I think, healthcare assistant training, in this area.
We can tackle this issue only in a wider context. My noble friend Lord Jones said that the Question posed by the noble Baroness is a strategic one. I very much agree with that. The noble Baroness, Lady Greengross, talked of the need, in the case of an individual with dementia, for a navigator and co-ordinator. My argument would be that we need the equivalent at the national level also. We have the national dementia strategy for England but my understanding is that it is due to end in April 2014. I ask the noble Earl whether he thinks that the Government would be prepared to run with another national strategy.
This is a terrible illness. It impacts on 850,000 people at the moment; I believe that that figure is estimated to increase to 1 million or so by 2021. The need for national leadership and a national strategy is overwhelming. The noble Earl might not be able to commit to that tonight but I hope that he will take the message from noble Lords here, which is that this is a terrible illness, much can be done to help people with dementia if we have co-ordinated action, much more research ought to be done, and we need greater co-ordination at local level.
I hope that the noble Earl will pick up the suggestion of the noble Baroness, Lady Greengross, that local co-ordinators and navigators of care would be extremely helpful. Perhaps he will also pick up the point raised by my noble friend Lord Jones about the role of business and industry in supporting local societies. He gave a brilliant example of how that can pull people together and provide real support for organisations such as the Alzheimer’s Society at local level.
Health: Flour Fortification
Lord Hunt of Kings Heath Excerpts(12 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
I am sure the noble Lord would agree that we have to take a decision based on the most up-to-date data. The data that we had prior to this were 10 years old and it is important to take a decision in the context of the nutritional state of health of the population. On his first question, all I can say is that the risk to which I referred was considered as part of SACN’s overall assessment and we will draw on that in reaching our decisions on the fortification of flour and give it the appropriate weight that it deserves.
Lord Hunt of Kings Heath (Lab)
My Lords, on the issue of up-to-date information, as the noble Lord, Lord Rooker, has said, we now have the Wolfson study, which actually leads that organisation to recommend that all countries should introduce folic acid fortification. The Government already have the recommendation of the Scientific Advisory Committee on Nutrition for mandatory fortification. Yes, it says it should be accompanied by actions to restrict voluntary fortification of food with folic acid for the reasons to which noble Lords have already referred. Why on earth are the Government delaying action on this?
Earl Howe
My Lords, I can only repeat what I said before, which was that taking this step would be a major step by any standards. We must base it on a proper assessment of the risks and benefits. We have some excellent advice from SACN and we need to evaluate that advice fully before taking a decision.
Public Health Responsibility Deal
Lord Hunt of Kings Heath Excerpts(12 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath (Lab)
My Lords, I hope that the noble Earl will encourage his own noble colleagues to look at themselves in the mirror in the light of that unwarranted attack on my own Benches. Perhaps I can just refer the noble Earl to the report of the National Obesity Forum yesterday, which suggested that, on one of the worst-case scenarios, more than half of the population of this country will be obese by 2050. Does he not think that the volunteer approach may no longer be appropriate? Do the Government not have to take a greater lead on this?
Earl Howe
My Lords, there are certainly no grounds for complacency on obesity levels throughout the nation. However, the current data do not support the claim by the National Obesity Forum. In 2007, the Foresight team projected that, based on data from 1993-2004, more than half the population could be obese by 2050 if no action is taken. An analysis based on recent data suggests a flatter trend than the one projected by the Foresight team. I do not agree that we should belittle the responsibility deal. It has many worthwhile achievements to its credit and they are being added to month by month.
Health: Birth Defects
Lord Hunt of Kings Heath Excerpts(12 years, 7 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
My Lords, I recognise the opinion that is shared among many members of the medical community on this. However, the advice we received from SACN, our expert adviser, clearly showed that there are risks and benefits associated with this proposal. It is not an open-and-shut case. Among the things that we have had to consider are the practical implications of implementing SACN’s advice, which is no small matter.
Lord Hunt of Kings Heath (Lab)
My Lords, does the noble Earl not recognise that in fact the scientific committee he referred to has looked at the issue that he raised and has upheld its previous recommendation that the Government should go ahead? Some 50 countries have already done that; the scientific advice is clear; why on earth are the Government not getting on with it?
Earl Howe
My Lords, as I said, SACN’s recommendations highlighted both the risks and the benefits of this proposal—and I certainly acknowledge that there would be benefits. However, there are also implications. For example, SACN recommended that mandatory fortification should proceed only if accompanied by:
“Action to restrict voluntary fortification of foods with folic acid; measures for careful monitoring of emerging evidence on any adverse effects of long-term exposure to intakes of folic acid … and guidance on supplement use for particular population groups”.
We have to take those recommendations into account before taking any long-term decision.
Smoking: E-cigarettes
Lord Hunt of Kings Heath Excerpts(12 years, 7 months ago)
Grand CommitteeRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath (Lab)
My Lords, first, I apologise to the Committee for being a little late for the start of the debate. I welcome this debate and I congratulate the noble Viscount, Lord Astor, on allowing us to discuss a very interesting subject. I am sure that we are all looking forward to the noble Earl’s response to the many questions that have been put to him.
With more than 100,000 people dying from smoking-related diseases across Britain every year, it is clear that we need to do all we can to support people to give up smoking and discourage young people from taking it up in the first place. One thing I am convinced about is that e-cigarettes have the potential to provide a significant boost to public health. I understand that the National Institute for Health and Care Excellence supports the use of nicotine-containing products such as e-cigarettes to aid smokers in cutting down on tobacco. As we have heard, an estimated 400,000 people across the UK have already switched from smoking to e-cigarettes.
I noted the comments of the noble Viscount, Lord Ridley, on the risks of regulation, and I agree with him that it is important that regulation does not stifle innovation. On the other hand, as with any new and fast-emerging product, some additional safeguards may be needed to cover any gaps in our existing consumer regulations. I want to ask the noble Earl, Lord Howe, about this. Does he consider that the medicinal regulation of e-cigarettes would put a lot of the current e-cigarette companies out of business? The noble Earl is of course very well acquainted with the work of the MHRA, issues to do with the regulation of medicines and, indeed, herbal medicines, which may be relevant in this context. I wonder if any work has been done to estimate the cost of regulation for these products.
For instance, I imagine that a dossier has to be produced with scientific evidence to show the efficacy and safety of these products. I wonder whether the noble Lord has an estimate of the cost of this, and whether that would inhibit many of the small companies in this market from being able to carry on in business when this is introduced. I support regulation that is light-touch and permissive rather than restrictive.
As the noble Viscount has said, the regulation of e-cigarettes has been debated as part of the EU trilogue negotiations on the tobacco products directive. Can the noble Earl inform the Committee of the progress of those negotiations? I understand that they are scheduled to end in the coming weeks, and an update would be appreciated, as would some sense of the timeline between agreement within Europe and the implementation of this proposed directive.
As the noble Lord, Lord Borwick, has commented, e-cigarettes have clearly been very successful in encouraging smokers to quit and to use e-cigarettes instead. He posed the question of whether there are circumstances in which e-cigarettes could be a passport to tobacco smoking. I think he talked about teenagers in particular, implying that some of the marketing approaches of the e-cigarette manufacturers might provide a cool image to young people, who would take up e-cigarettes and then be tempted to go on to tobacco products. I do not know whether the noble Lord, Lord Borwick, saw the complaints made about an advert for e-cigarettes screened by ITV on 3 December during “I’m a Celebrity”, which appeared to show a woman talking about oral sex, while at the end of the advert it was revealed to be a reference to e-cigarettes. The question I put to the noble Earl is: how do we ensure that e-cigarette manufacturers are not able to advertise in such a way as to make e-cigarettes attractive to young people who would not ordinarily have come to smoking, so that they act as a passport to tobacco smoking?
If the noble Earl can reassure us that regulation can be light-touch, that the process of being regulated as a medicinal product will not be overbearing, and that there can be appropriate controls on advertising, then we should welcome the impact of e-cigarettes, because the evidence is clear that they have helped a lot of people come off tobacco smoking. Surely, in the end, that is to be welcomed.