Orders of the Day — Health Bill

House of Commons, 29 November 2005.

Patricia Hewitt (Labour, Leicester West)

I beg to move, That the Bill be now read a Second time.

I am proud to introduce a Bill that is a landmark in the protection of public health and the improvement of our health services. It does three key things. It gives us power to ban smoking in enclosed public places and workplaces, it strengthens our hand in the battle against methicillin-resistant Staphylococcus aureus and other hospital infections, and it contains a series of measures that will strengthen control of dangerous drugs, improve pharmaceutical and ophthalmic services and help to deal with fraud in the national health service.

I realise that the House may be particularly interested in the provisions on smoking, but I want to make a few brief points about other aspects of the Bill first to ensure that they are given due attention. The first commandment of the medical profession is "Do no harm". Unfortunately, as we all know, there are occasions when patients are harmed, not healed, by their hospitals. It is not surprising that MRSA and other health care-associated infections are of great concern to members of the public, particularly if someone in the family or neighbourhood has suffered from them. Part 2 of the Bill—clauses 13 to 15—gives us stronger powers to reduce MRSA and other infections to the absolute minimum.

We were the first Government to require surveillance for MRSA, and we are already using the information to help drive down infection rates. We set a target of no later than 2008 for the halving of MRSA infections. Indeed, some of our specialist hospitals such as Guy's and St. Thomas's, which treat some of the most complex cases in the country, and in early 2004 had among the highest MRSA rates, had already nearly halved their infection rates a year later.

The Bill builds on the work that we are already doing; it provides for a legally binding code of practice on health care-associated infections, which will apply to any relevant NHS body. The code will be based on existing best practice, and a draft on which we consulted earlier this year was well received. It will be backed up by new duties for the Healthcare Commission to ensure that it is observed, including the power to serve an improvement notice.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The Secretary of State referred to the statutory code and the consultation held on it. Last year's National Audit Office report on hospital-acquired infections found that half of all NHS managers are struggling to reconcile meeting Government waiting time targets with managing hospital infections. That issue came through again in the response to the consultation on the code. The NHS wants to know what priority the Government will attach to the code, compared with other health priorities—so can the Secretary of State make that clear today?

Patricia Hewitt (Labour, Leicester West)

The hon. Gentleman raises an important point. It is not acceptable to try to achieve infection targets at the expense of waiting list and other targets, nor is it acceptable to try to achieve waiting list targets by compromising on patient safety and infection rates. Throughout the country there are hospitals that are both improving the number of patients whom they treat, thus getting waiting lists and waiting times down, and getting a grip on infection control, thus bringing MRSA and other infection rates down. The answer is that hospitals need to do both.

Andrew Lansley (Conservative, South Cambridgeshire)

I fear that the Secretary of State has not answered the perfectly reasonable question asked by the hon. Member for Sutton and Cheam (Mr. Burstow). The essence of the question, which we have asked Ministers time and again, is this: will the Secretary of State give a simple guarantee that when, after a suitable risk assessment, infection control teams in a hospital recommend that beds or wards should be closed for infection control purposes, they will not be overruled in pursuit of waiting time targets?

Patricia Hewitt (Labour, Leicester West)

That would be a matter for the Healthcare Commission to consider, under the new code and under the Bill.

As we increase even further the capacity and the number of hospital beds available to the NHS, as we are doing, it will be possible to reduce occupancy rates in acute wards, which will help. It is not essential, but it will certainly help, as hospitals get their MRSA rates under control.

Andrew Lansley (Conservative, South Cambridgeshire)

rose—

Patricia Hewitt (Labour, Leicester West)

I shall give way one more time to the hon. Gentleman on this point.

Andrew Lansley (Conservative, South Cambridgeshire)

The Secretary of State does not have to give way to me, so I am grateful to her for doing so again—but does she not recall that two weeks ago I presented to the House data that showed that although in 2000 the NHS started with 186,000 beds, with a target of 7,000 additional beds, the number went down by 4,000? On present indications, we estimate that this year, as a result of NHS deficits, the number is likely to reduce by another 2,500, so there will be fewer than 180,000 beds. The number of beds is going down, and bed occupancy rates are persistently far higher than the Government said they would be when they responded to the National Audit Office five years ago.

Patricia Hewitt (Labour, Leicester West)

The hon. Gentleman is doing exactly what he did in that debate two weeks ago, and ignoring the fact that with modern medical techniques and technology, far more operations can be done on a day- case basis. He is also confusing acute beds with beds available for mental health patients, for whom far more treatment is being carried out within the community.

Andrew Lansley (Conservative, South Cambridgeshire)

indicated dissent.

Patricia Hewitt (Labour, Leicester West)

I make again the point that I have made before: thanks to our investment and unprecedented funding for the NHS, which the Conservative party failed to make available, and thanks to our reforms, we are bringing waiting lists down, and as more capacity becomes available to the NHS both in NHS hospitals and in independent sector treatment centres, as is happening now, it will be possible to get the waiting lists down even further, with lower bed occupancy rates, which in turn will help to build on the good results already being achieved with infections. The other point to consider on this particular issue is that, if a hospital is still failing to abide by the new code and to reduce its infections, even after an intervention by the Healthcare Commission, I—or in the case of the foundation trusts, the regulator—have the power to intervene.

Mark Pritchard (Conservative, The Wrekin)

Does the Secretary of State agree that the Government can have all the codes that they want to try and tackle ESBL—extended-spectrum-lactamases; VRSA—vancomycin-resistant Staphylococcus aureus; MRSA and all the superbugs, but if primary care workers are unable to obtain flu jabs this winter, patients will be put at direct risk? In my constituency, primary care workers are unable to have flu jabs, putting my constituents at risk.

Patricia Hewitt (Labour, Leicester West)

As I have already told the House, more people are being vaccinated against winter flu than ever before in our country—even more than last year, when we achieved a level twice that achieved under the Conservatives.

Stephen Dorrell (Conservative, Charnwood)

The Secretary of State has been talking about the code of practice that will be introduced to enforce better standards in NHS hospitals. When we come to consider the enforcement of those standards within hospitals, will the Secretary of State explain why she is not planning to extend the sanctions regime that applies to private sector hospitals to their NHS counterparts?

Patricia Hewitt (Labour, Leicester West)

The right hon. Gentleman raises an important point. As for private hospitals and the independent sector generally, the same standards will apply, using the same code provisions but under the existing legal powers of the Care Standards Act 2000. The obvious reason why we have a somewhat different enforcement regime is that we have direct management controls—or through a monitor, direct regulatory controls—on NHS and foundation trust hospitals that do not exist in respect of the private sector.

The new code that we are introducing, backed up by the new powers of the Healthcare Commission, will help to ensure that our NHS, which is treating more patients faster than ever before, will also provide the highest possible standards and quality of care.

I want to refer briefly to parts 3, 4, and 5 of the Bill, which deal with drugs, pharmaceutical and ophthalmic services and various other matters. We are strengthening the management of controlled drugs in response to some of the shortcomings identified in the Shipman inquiry's fourth report. Those provisions, which are UK-wide, will require every health care body to appoint an accountable officer who will have to take personal responsibility for the use of controlled drugs within that organisation.

We are also taking steps to continue improving pharmaceutical and other services. Community pharmacists are already playing a much wider role than they used to within the NHS—for instance, providing screening services and reviewing medicine use for people with long-term conditions. We know from our recent consultation on community health and social care services that the public welcome the work of community pharmacists and would like to see it increased. The Bill, by freeing pharmacists from the requirement personally to dispense every item, will allow them to expand the other services that they offer without in anyway compromising patient safety.

Howard Stoate (Labour, Dartford)

I thank my right hon. Friend for her remarks on community pharmacies. I am sure that they will be greatly appreciated by the many thousands of community pharmacists who work so hard to provide front-line health care services. Will my right hon. Friend ensure that, when she relaxes the requirements for pharmacists to be on the premises at all times as they are now, at least one pharmacist will be available so that we avoid the situation in which one pharmacist has, in theory, to manage more than one premises at the same time? I am concerned that that could compromise standards.

Patricia Hewitt (Labour, Leicester West)

My hon. Friend makes an important point, which we will look into carefully when we draw up the detailed regulations to give effect to the provision. In order to ensure that patient safety is in no way compromised, a responsible pharmacist will have to be in charge of every pharmacy. However, because he or she may not have to dispense every item, it will be possible to make much better use of the range of skills within the pharmacy team.

We are also reforming the entry requirements governing the provision of pharmacy services by implementing in England the final elements of the balanced package of reforms that we published in response to the Office of Fair Trading report two years ago. Similarly, in modernising ophthalmic services, we are relaxing the current restrictions on who can provide them.

Helen Jones (Labour, Warrington North)

As someone who has been using opticians since the age of seven, may I ask my right hon. Friend about the logic behind devolving general ophthalmic services to PCTs? Will she give an assurance that PCTs will not be able to restrict the number of opticians who provide sight tests?

Patricia Hewitt (Labour, Leicester West)

My hon. Friend raises an important point. We want to give PCTs the ability to secure the best services for people in their area, and that is exactly what we are doing by devolving responsibility for dental services—[Interruption.] Yes, they will be able to respond to some of the very real problems that we are addressing. On ophthalmic services, PCTs will be able to use a wider range of providers to obtain the services that people need. The changes will simplify entry requirements for the provision of NHS services and help to support better service provision.

Andy Reed (Labour, Loughborough)

I accept that PCTs are often well placed to drive up the level of provision in their area, but does my right hon. Friend understand the concerns of optometrists in my constituency, such as David Austen, who provides an excellent service but is fearful that quality may be reduced if the PCT is driven by the need to make economies? The changes should be about driving up standards, not reducing them to a level playing field.

Patricia Hewitt (Labour, Leicester West)

My hon. Friend's final point is right. These changes will help to continue improving the quality of care that opticians are able to provide. My hon. Friend the Minister with responsibility for ophthalmic services has recently met the opticians to reassure them on that point, because it has been raised not only by the constituents of my hon. Friend the Member for Loughborough (Mr. Reed) but by many others.

Patricia Hewitt (Labour, Leicester West)

I wish to make some more progress, because I know that there are many other issues that hon. Members will wish to—

Michael Martin (Speaker, Glasgow North East)

Order. The Secretary of State said that she does not intend to give way.

Patricia Hewitt (Labour, Leicester West)

The Bill will also strengthen the powers of the NHS Counter Fraud and Security Management Service, which has—

Henry Bellingham (Conservative, North West Norfolk)

Will the Secretary of State give way?

Patricia Hewitt (Labour, Leicester West)

No. The hon. Gentleman is very persistent, but I have already said that I will not give way, because I wish to make some progress and there are many other issues on which I anticipate hon. Members will wish to make interventions.

The counter fraud service has performed a highly important job since we established it in 1998. By the end of the last financial year, it had produced a financial benefit to the NHS of £675 million, which is a 13:1 return on its total budget since 1999. The service is an important part of ensuring that we get value for money for every additional £1 of taxpayers' money that we put into the NHS.

I come to my final point before I turn to smoking. In part 5 of the Bill, we respond to an important report published in 2003 by the Public Administration Committee, which was called "Government by Appointment", by establishing a new non-departmental public body, the appointments commission, to replace the current NHS Appointments Commission. In the Committee's estimation, the NHS Appointments Commission was working well and the Committee recommended that other Departments should be able to use its services. The Bill provides the legal framework to do that and reaffirms our commitment to an independent appointments process.

Andrew Turner (Conservative, Isle of Wight)

I am grateful to the Secretary of State for giving way before she discusses smoking. In her responses to interventions by Labour Members, she did not appear to give an assurance that she would not allow PCTs to restrict patients' choice of ophthalmic practitioner. Will she assure the House that she will carry out a full review of general ophthalmic services, in consultation with the profession, so that people in England receive the same quality of treatment as is available in Wales and Scotland?

Patricia Hewitt (Labour, Leicester West)

The measures in the Bill are designed to increase the choice that is available to patients in England. The Bill will enable primary care trusts to contract with a wider range of providers, and indeed, as you would expect, Mr. Speaker, we have been discussing this very closely with the opticians, with the profession, and we shall continue to do so as we bring forward regulations on this matter.

Patricia Hewitt (Labour, Leicester West)

I am not going to take further interventions because I wish to turn to another very important matter—part 1 of the Bill, on smoke-free places. The provisions that we are introducing in part 1, which extend to England and Wales, fulfil the commitment that we made last year, in the "Choosing Health" White Paper, to legislate to shift the balance significantly in favour of smoke-free environments.

Desmond Turner (Labour, Brighton, Kemptown)

I am sure that my right hon. Friend is aware that many of us see a fatal flaw and contradiction in the Bill—[Interruption.]—in part 1, which is otherwise admirable in its intent. I am sure that everyone on the Labour Benches would wish to protect workers from being exposed to smoke in their workplaces, and probably all of us in the House would support that aim. Part 1 is fatally undermined, however, by providing exemptions for private clubs for instance, or pubs that do not serve food, where people still have to work and where, in practice, it is impossible to separate those working there from the smoke. My right hon. Friend must be aware that there will be serious moves to amend that part of the Bill.

Patricia Hewitt (Labour, Leicester West)

My hon. Friend has raised early in this debate what the exemptions should be, but I would refer him first to the manifesto on which he and I were both elected earlier this year—[Interruption.] Perhaps I may just finish this sentence, which is rather an important one, if I may say so, for all my hon. and right hon. Friends. We were all re-elected this year on a manifesto that promised we would legislate to ensure that

"all enclosed public places and work places other than licensed premises will be smoke-free . . . that all restaurants will be smoke-free, all pubs and bars preparing and serving food will be smoke-free".

The Bill delivers on that promise by introducing a complete ban on smoking in enclosed public spaces and workplaces, but allowing for limited exemptions about which I shall say something more in a moment.

Patricia Hewitt (Labour, Leicester West)

I give way first to my hon. Friend the Member for Livingston (Mr. Devine).

Jim Devine (Labour, Livingston)

My right hon. Friend will be aware that I was not actually elected on the manifesto, coming in, as I did, in October, and she will be aware that many of us in this place would like us to follow the lead of the Scottish Parliament and the Dail in banning smoking totally in all public places. But I wonder whether she is aware of the British Medical Association report that was produced in October, which compared the respiratory function of bar staff in Northern Ireland and in the Republic, before and after the introduction of the smoking ban. It showed that the respiratory function of bar staff in the south had increased substantially, and the conclusion was that the smoke-free law—

Michael Martin (Speaker, Glasgow North East)

Order. Perhaps we can leave that for a speech. Interventions should be short.

Patricia Hewitt (Labour, Leicester West)

Thank you, Mr. Speaker. My hon. Friend the Member for Livingston makes an important point, to which I shall return not only this afternoon but in Committee.

Patricia Hewitt (Labour, Leicester West)

I shall make a little more progress at this point and then I will take further interventions.

Today, only 51 per cent. of the work force enjoy a totally smoke-free environment. The Bill, even with the limited exemptions that we are proposing, will give 99 per cent. of the work force complete protection from smoking. That is an enormous step forward for public health and for the health and well-being of our people.

Patricia Hewitt (Labour, Leicester West)

I shall give way in a moment. Smoking is already—thank goodness—far less common than it used to be. Many of us can remember when it was the norm for people to spoke in cinemas, on trains and buses and in most factories and offices. Today, smoking is banned on almost all public transport and in many other public places. Thirty years ago, about half of men and almost half of women smoked; today, only one in four people do so. That number is continuing to fall, in part thanks to the excellent smoking cessation services provided on the NHS.

Steve Webb (Liberal Democrat, Northavon)

Can the Secretary of State clarify a simple factual question: did she try to persuade the Cabinet to go for a total ban?

Andrew MacKinlay (Labour, Thurrock)

Hand on heart.

Patricia Hewitt (Labour, Leicester West)

My hand is always on my heart. We had a debate in the Government on how best to implement our manifesto promise, just as we will have a debate this afternoon and in Committee, but I stress that Labour Members are completely committed to legislating for public health and for a smoking ban to strengthen the provision of smoke-free places.

Philip Davies (Conservative, Shipley)

Will the Secretary of State give way?

Patricia Hewitt (Labour, Leicester West)

I will give way to the hon. Gentleman, and I hope that he will tell us whether he proposes to vote for the Bill or against it.

Philip Davies (Conservative, Shipley)

I thank the Secretary of State for giving way, but I would prefer to put points to her. I do not smoke. I do not like going into smoky places, so I choose not to. Does she not agree that, if I own a pub, I should be free to decide whether or not people are allowed to smoke on my premises based on the feedback that I get from my customers and my employees? This should not be a matter for more nanny-state interference.

Patricia Hewitt (Labour, Leicester West)

I take that as a statement that the hon. Gentleman and, no doubt, many of his hon. Friends will vote against the Bill, because they do not accept that the Government have a responsibility to act in this respect.

Patricia Hewitt (Labour, Leicester West)

I will take further interventions in a moment, but I want to make a little progress because there is an extremely important point of principle, which divides Labour Members from the Conservative party. Fewer people now smoke and more people demand smoke-free public places and workplaces.

Patricia Hewitt (Labour, Leicester West)

I have just said that I will make a little more progress before I take further interventions.

I have no doubt at all that, even without legislation, in the fullness of time, we would eventually see a self-imposed ban on smoking spread to virtually all public places and workplaces. The reason why that is not good enough is that it would take too long. Smoking kills and so does second-hand smoke. Even if the Opposition cannot make up their mind, the Government have a duty to legislate. The public consultation that we conducted made it plain that the public agree. They want the Government to speed up the change that is already happening. They want the Government to do more to protect people from second-hand smoke.

Patrick McLoughlin (Conservative, West Derbyshire)

I do not know whether the Secretary of State managed to hear Mr. Tony Benn—a former Member of Parliament for Chesterfield, whom I am sure she knows well—on the radio on Saturday morning. He said that he found it rather odd that, at this stage of their life, the Government were allowing 24-hour drinking, with all the damage that alcohol can do to people, yet they somehow believe that smoking should be banned.

Patricia Hewitt (Labour, Leicester West)

There will not be 24-hour drinking as a result of very sensible changes in the licensing laws, which, of course, Opposition Members have called for and which will enable responsible adults to drink rather more without the current restrictions—[Interruption.] We will enable responsible adults to drink without the restrictions that are currently imposed by out-of-date licensing laws, but we will give the police much tougher powers to deal with the minority who binge drink and then attack other people.

Helen Jones (Labour, Warrington North)

I accept that the Bill is a great step forward. I feel a bit like a bag of ailments this afternoon—as well as being short-sighted, I am asthmatic. Breathing in second-hand smoke doubles the chances of an adult developing asthma and inhibits the action of the drugs that are used to control asthma. Can my right hon. Friend explain why someone who works in a pub that does not serve food should be exposed to that risk, when someone who works in a different establishment is not exposed to it?

Patricia Hewitt (Labour, Leicester West)

I will return to that very point in a moment. It is precisely the damaging effects of second-hand smoke that have led us to conclude—in striking contrast to the Conservative party—that we need to legislate on the matter.

Ann Keen (Labour, Brentford and Isleworth)

The Government are putting forward a strong public health message. Will the Secretary of State examine the line of the Royal National Institute of the Blind on the effect of smoke on sight, especially on macular degeneration of the retina? Will she consider putting warnings on cigarette packets that smoking can cause blindness?

Patricia Hewitt (Labour, Leicester West)

My hon. Friend raises an important point. We will shortly be consulting on strengthening the general health warnings on cigarette packets by putting pictures on them to illustrate the damage that smoking does to people's health.

David Taylor (Labour, North West Leicestershire)

My right hon. Friend will know that I admire what she tried to do at earlier stages of the Bill's life. Does she agree that we must set against the drift downwards of the prevalence of smoking in the general population—she accurately described that as about one in four people—the fact that two groups buck the trend? One such group is in working-class communities. Work done by SmokeFree Liverpool, which is an immensely effective organisation, shows that in the most deprived wards, as much as half the population smokes. From her observations and statistical analysis, my right hon. Friend will have noted that the number of younger women who are starting to take up smoking is increasing significantly. What does she believe can be done in that regard?

Patricia Hewitt (Labour, Leicester West)

My hon. Friend makes an extremely important point. The prevalence of smoking in England and other parts of the country is going down among all groups, including working-class men. Indeed, the evidence on young women is not as clear cut as he suggests. Smoking rates are going down. They are going down even faster among better-off groups. Of course, we need to do more on smoking cessation programmes, in particular, alongside the Bill.

The Bill is an enormous step forward for public health. It will help to reduce the number of people smoking by a further 500,000 to 750,000 over time. It will help to reduce the number of deaths of people in the work force that are associated with second-hand smoke, which is estimated at some 500 to 600 a year.

In framing the legislation—this was the point of many debates and the public consultation that took place before the publication of the "Choosing Health" White Paper and, indeed, the election—we are striking a balance between two extremes: on the one hand, an over-prescriptive state; and on the other, which is represented by Conservative Members, an irresponsibly laissez-faire Government. We are responding to the clear wish of the public to be protected from other people's smoking in public places, especially restaurants, on the one hand, and on the other hand allowing people who want to have a cigarette with a drink to do so.

Chris Bryant (Labour, Rhondda)

I am grateful to the Secretary of State for moving forward with the Bill, not least because in the Rhondda more people now contract chronic obstructive pulmonary disease from smoking than they did from the mines. She will know that the Welsh Assembly has made it clear that it will not introduce exemptions along the lines of those proposed in clause 3. Will she go a little further and consider time limiting any exemptions that might be in the Bill for just two or three years?

Patricia Hewitt (Labour, Leicester West)

My hon. Friend makes an interesting point. I have made various changes in response to the consultation that we have had since May this year. For example, my hon. Friends will recall that the proposed implementation date for licensed premises was originally the end of 2008. I have brought implementation forward to the summer of 2007, when all the provisions relating to smoke-free places will take effect.

Patricia Hewitt (Labour, Leicester West)

I want to finish this point.

I have also made it clear that we intend to monitor the impact of the ban, with the exceptions, from day one and to complete that review within three years. As I said, the Bill provides for a complete ban, but exceptions can be made by regulation. If, in the light of that review and monitoring, the Government and Parliament decide that they no longer want some or all of those exceptions, it will not require further primary legislation. It would be a simple thing to change.

Natascha Engel (Labour, North East Derbyshire)

On the exemptions, my constituency, like many other former mining constituencies, has a large and lively network of miners' welfare clubs. They are not strictly speaking membership clubs. Do they fall under the exemptions?

Patricia Hewitt (Labour, Leicester West)

I am confident that those clubs, which many of us have in our constituencies, will be covered by our proposed exemption for membership clubs. However, I stress that the membership clubs that will be exempted will have to comply with the much narrower definition of a genuine membership club contained in the Licensing Act 2003.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Will the Secretary of State explain how she came to the balance that she has struck and, in particular, why she appears not to have taken into account her regulatory impact assessment? It compares a comprehensive ban with a partial ban and shows that more than 200 additional people a year will die from second-hand smoking if we stick with a partial ban. Will not more people die if we do not go for a comprehensive measure?

Patricia Hewitt (Labour, Leicester West)

Some 95 per cent. of deaths that are related to second-hand smoking occur as a result of smoking in the home. That is where the real problem lies. It is why we have to continue to invest in the smoking cessation programmes and, more generally, to raise awareness so that adults who choose to smoke do not do so either in their homes, where their children might be present, or, indeed, in their cars. Unfortunately, about a third of parents who smoke do so in the car when their children are with them.

Iris Robinson (DUP, Strangford)

Is the Secretary of State aware that according to Macmillan Cancer Relief, which is to be applauded for the excellent way in which it supports patients and families in the community, approximately 37,000 people in the UK are diagnosed with lung cancer each year? Surely that figure alone should mean that she considers completely lifting all exemptions so that there are none across the UK. There should be a total ban. Nothing else will do.

Patricia Hewitt (Labour, Leicester West)

Macmillan Cancer Relief does excellent work. It is precisely because of the damage that smoking and second-hand smoking do to people's health that we are taking this enormous step. I remind the hon. Lady that 99 per cent. of the work force will be guaranteed a completely smoke-free environment as a result of the Bill, along with the ban on smoking in virtually every enclosed public space.

Patricia Hewitt (Labour, Leicester West)

I intend to make a little more progress before I give way.

On exemptions, clause 2 gives the National Assembly for Wales and, in the case of England, the Secretary of State the power to make exemptions, some of which I hope will be uncontroversial. They include private dwellings, along with premises that are clearly private space, such as bedrooms in a hotel or a bed and breakfast, and other places, such as care homes and prisons, that are a person's full-time place of residence for an extended period, although not necessarily as a matter of choice. We are respecting people's private lives and their freedom of choice.

Louise Ellman (Labour, Liverpool, Riverside)

Is the Secretary of State aware that the Under-Secretary of State for Northern Ireland, my hon. Friend the Member for St. Helens, South (Mr. Woodward), informed Smoke-Free Liverpool that the main reason that he wanted a total ban on smoking in Northern Ireland was that he did not want two classes of workers—people exposed to smoke and people not exposed to smoke? If that is good enough for Northern Ireland, why is it not good enough for workers and employees in this country?

Patricia Hewitt (Labour, Leicester West)

Inherent to devolution and the constitutional settlement is the fact that different decisions will be made in different parts of the United Kingdom. Although the Northern Ireland Assembly is suspended, we are proceeding in Northern Ireland in the spirit of devolution. Just as different provisions are made on the NHS in Wales and in Scotland which we do not choose to follow, so we are making our own decision to strike the right balance on licensed premises.

Betty Williams (Labour, Conwy)

The Secretary of State clearly acknowledges the position of Northern Ireland, Scotland and Wales, but does she think that it is fair that workers and the public in England should be treated differently from Wales, Northern Ireland and Scotland? Will she take into consideration the content of the Smoking in Public Places (Wales) Bill, which my hon. Friend the Member for Cardiff, North (Julie Morgan) presented in the last parliamentary Session?

Patricia Hewitt (Labour, Leicester West)

As my hon. Friend is well aware, health is a devolved matter, so there are different approaches to NHS policy in Wales, Scotland and England. Not surprisingly, there are different approaches not to a general ban, but to the specific issue of whether there should be an exemption for licensed premises.

Eric Forth (Conservative, Bromley and Chislehurst)

On a point of order, Mr. Deputy Speaker. The Secretary of State, no doubt inadvertently, implied that a decision made by a Northern Ireland Minister was a result of devolved government. Will you confirm that the Northern Ireland Assembly and devolution are not functioning, so that cannot possibly be a devolved decision? Can you help the House, Mr. Deputy Speaker?

Alan Haselhurst (Deputy Speaker, Saffron Walden)

The right hon. Gentleman must not draw me into the argument. I am sure that there are right hon. and hon. Members who can help themselves in this matter.

Patricia Hewitt (Labour, Leicester West)

I am most grateful, Mr. Deputy Speaker. Indeed, I said that the Northern Ireland Assembly was suspended but that we were proceeding in the spirit of devolution.

In making our judgment about licensed premises, we have taken into account the fact that England already has the lowest smoking rates in the United Kingdom. Our smoking rates have fallen faster and to a lower level than in Wales, Scotland and Northern Ireland. We have also taken account of the tension in public attitudes. I referred earlier to the extensive public consultation that we conducted before publishing the "Choosing Health" White Paper. It demonstrated enormous support for a ban on smoking in restaurants and pubs where meals are served. People clearly want to be able to enjoy their meal without someone blowing smoke over their food and into their face. Similarly, people want an extensive ban in most enclosed public spaces, but when they are asked about membership clubs and pubs that do not serve food, most of those who do not smoke—the majority—believe that smokers, even though they are a minority, should none the less have some freedom of choice. They clearly view membership clubs as private clubs run by members for members. Such clubs have always been treated differently from other licensed premises because they are non-profit-making organisations.

Patricia Hewitt (Labour, Leicester West)

May I make this point before accepting further interventions? Those clubs are non-profit-making organisations in which the members make the decisions, just as people make their own decisions in their own homes. It is therefore right to exempt membership clubs, just as it is right to allow people who continue to smoke to do so while they have a drink, provided that they are in licensed premises that do not serve food. This is a difficult judgment to make. It is one on which there has been much argument. I shall give way to the hon. Member for South Cambridgeshire (Mr. Lansley), then I will take further interventions.

Andrew Lansley (Conservative, South Cambridgeshire)

I am grateful to the Secretary of State for giving way. Given that we are debating a public health measure and that the public may take the view that we should not interfere with smokers' right to continue smoking among smokers, where is the public health evidence that the impact of second-hand smoke differs according to whether one is in premises where food is consumed, as distinct from other premises? What is the evidence relating food to second-hand smoke?

Patricia Hewitt (Labour, Leicester West)

I regret that the hon. Gentleman did not tell us whether he supports the measure or not. It would appear that the Opposition cannot make up their mind whether there should be legislation. I have made it clear that in legislating on this matter, which is a matter that directly affects people's own choices about how they behave, we have made the judgment that the right balance to strike is between banning smoking in virtually every enclosed public space and work space, and exempting the membership clubs and the licensed premises that do not serve food, in order to protect freedom of choice for that minority of people whom nobody is forcing to go into a pub that allows smoking, but some of whom none the less continue to do so.

Joan Walley (Labour, Stoke-on-Trent North)

In respect of the consultation that my right hon. Friend carried out, what account has she taken of health inequalities?

Patricia Hewitt (Labour, Leicester West)

The issue of health inequalities and reducing health inequalities is central to our purpose as a Government, whether it is in health policy and the work that we are doing to improve the national health service, or a series of other aspects.

The point I want to make in relation to the narrow but important proposed exemptions is that bar staff everywhere will have protection against smoking, which does not currently exist. There is at present no law at all in that regard. We will consult on the regulations in this and other areas, and ensure that even in the membership clubs and non-food pubs that decide to allow smoking, smoking will still be prohibited, at least in the area around the bar.

Andrew MacKinlay (Labour, Thurrock)

What constitutes that?

Patricia Hewitt (Labour, Leicester West)

I hear my hon. Friend from a sedentary position. He anticipates the point that I was about to make. We will consult in particular on whether the best way to achieve that is to designate an area that does not include the bar to be a smoking area or smoking room—a discrete, separate smoking room or smoking area that does not include the bar.

Patricia Hewitt (Labour, Leicester West)

I give way to the hon. Gentleman.

Pat McFadden (Labour, Wolverhampton South East)

rose—

John Grogan (Labour, Selby)

rose—

Alan Haselhurst (Deputy Speaker, Saffron Walden)

Order. It would be helpful if the right hon. Lady could make it absolutely clear to whom she is giving way, when there is a forest of hon. Members rising.

Stephen Hesford (Labour, Wirral West)

On a point of order, Mr. Deputy Speaker.

Alan Haselhurst (Deputy Speaker, Saffron Walden)

Order. Would the hon. Gentleman wait a second? My second guess was that the Secretary of State was giving way to Mr. McFadden, but I shall take a point of order from Mr. Hesford.

Stephen Hesford (Labour, Wirral West)

I am obliged, Mr. Deputy Speaker. Should it not be an ASH of interventions, rather than a FOREST?

Alan Haselhurst (Deputy Speaker, Saffron Walden)

I am sure the House appreciated that. I call Mr. Pat McFadden.

Pat McFadden (Labour, Wolverhampton South East)

Thank you, Mr. Deputy Speaker. Will my right hon. Friend clarify what she said a short time ago about the exemptions and a review? Is she saying that if the proposals go through the House in their present form, the Government will give the House an opportunity to review the exemptions in—I think she said—three years, and that those who favour a full ban will have an opportunity to revisit the issue then?

Patricia Hewitt (Labour, Leicester West)

I am grateful to my hon. Friend for raising an extremely important point. As I have said, the Bill provides for a full ban with the power to make exemptions, which will be made by statutory instrument and which will be subject to the affirmative resolution procedure. If after the review, which we propose to complete within three years, the Government and Parliament decide that they do not want to retain some or all of those exemptions, the matter will simply involve the repeal of the relevant regulation and not further primary legislation.

Bob Laxton (Labour, Derby North)

What consideration has been given to making an exemption for what I term "inherently dangerous workplaces"? For example, Acordis Acetate Products has a large chemical site on the edge of my constituency, where there has been no smoking for 40 years because of the inherent danger. It has always provided smoking rooms, so there has been no mix between smokers and non-smokers. If an exemption is not made, employees, who cannot leave the huge site for a quick smoke, may, against all instructions and contracts of employment, smoke on site, and if they were to smoke in the wrong place, the repercussions for public safety would be serious. Has any consideration been given to granting exemptions for such sites?

Patricia Hewitt (Labour, Leicester West)

As far as I know, that particular point has not been put to us—we have considered the specific issue of oilrigs, where workers cannot leave the site. I undertake to consider my hon. Friend's point more closely, but at this stage my response is that we expect workers in such factories, as in other workplaces, to go off the site to smoke, if that is what is required by safety regulations.

As I have said, we shall seek to protect all staff, even in the limited number of premises that allow smoking, through the consultation on smoking areas. We are following the example of virtually everywhere else that has considered how to legislate on smoking in public: California, New York, Norway, Sweden, Australia and many others either have moved or are moving towards a full ban, and they all began by exempting licensed premises and, in some cases, the hospitality industry, before removing those exemptions as public support for the ban grew.

Laurence Robertson (Conservative, Tewkesbury)

On a point of order, Mr. Deputy Speaker. The Secretary of State keeps referring to the fact that licensed premises will be exempt. Is she aware that these days almost every pub serves food, so—

Alan Haselhurst (Deputy Speaker, Saffron Walden)

Order. The hon. Gentleman has been here long enough to know that that is not a point of order for the Chair. The Secretary of State is being very generous in taking interventions. Equally, she is taking a generous amount of time and, hopefully, other hon. Members will be able to contribute in due course.

Patricia Hewitt (Labour, Leicester West)

I am drawing my remarks to a close.

It is important to remember that the Government cannot force people to be healthy. The clear message from the public consultation and the central proposition in "Choosing Health" is that people want the Government to help them become healthy and stay healthy, but they do not want the Government to dictate to them. The huge public health challenges that we face as a nation, such as smoking, drinking and obesity, concern people's lifestyles. We must move with public opinion, because we need to help people make different, healthier decisions for themselves, rather than trying to impose such decisions.

Lynne Jones (Labour, Birmingham, Selly Oak)

Will the Secretary of State give way?

Patricia Hewitt (Labour, Leicester West)

I want to bring my remarks to a conclusion because I am keen that as many hon. Members as possible should contribute to the debate.

This part of the Bill has already aroused considerable debate. Yet the changes that we propose will transform our public places. They will provide a modest degree of choice to those who continue to wish to smoke outside their own home, far better protection for all employees, and far greater choice for workers in the hospitality industry who want to work in a smoke-free environment. The provisions will help us to reduce the number of smokers by a further 0.5 million or more and save up to £100 million a year for the national health service. The measures that I mentioned earlier will help to protect patients from MRSA and other health care infections and modernise the provision of pharmacy and ophthalmic services. I am confident—

Lynne Jones (Labour, Birmingham, Selly Oak)

On a point of order, Mr. Deputy Speaker. Some time ago, before she took a large number of interventions, the Secretary of State was moving on to discuss exemptions in respect of care homes, prisons and other establishments, but she has not continued with the relevant passages of her speech—

Alan Haselhurst (Deputy Speaker, Saffron Walden)

Order. I have to say to the hon. Lady, as I said to the hon. Member for Tewkesbury (Mr. Robertson), that that is not a matter for the Chair. I certainly cannot determine the content and shape of the Secretary of State's speech.

Patricia Hewitt (Labour, Leicester West)

I am most grateful to you, Mr. Deputy Speaker. I did indeed say that we would legislate for prisons and for care homes, and that I trusted that those exemptions would not be controversial. If they are controversial, I am sure that they will be discussed in more detail, not only this evening but in Committee.

Lynne Jones (Labour, Birmingham, Selly Oak)

Will the Secretary of State give way?

Patricia Hewitt (Labour, Leicester West)

I really want to bring my speech to an end.

The Bill is a landmark in the protection of people's health and of public health in our country. It will continue to improve our national health service. I am confident that all my right hon. and hon. Friends, whatever their views on the specific matter of exemptions, will join me in supporting it—unlike the Conservatives, who had 18 years in which they could have acted on this scourge to public health but chose to do nothing.

I commend the Bill to the House.

Andrew Lansley (Conservative, South Cambridgeshire)

I am sure that the House is grateful to the Secretary of State for giving way so frequently, although I hope to be considerably briefer to allow time for the many Back Benchers who wish to speak.

We are not, I am afraid, presented with a landmark Bill in public health. It was our intention, had we been elected in May, to introduce a public health Bill that would have achieved landmark changes in public health. It would have reorganised public health to enable public health directors to use dedicated resources across the public and private sectors, ending the fragmentation of recent years. It would have addressed the whole range of public health issues, including sexually transmitted infections, where the Government have failed lamentably. I have discovered in the past few days that there is to be no advertising of positive sexual health messages to young people this year, in circumstances where sexually transmitted infections are at epidemic levels. A Government who abolished the Health Education Authority and have presided over the highest rate of rising obesity in western Europe have allowed sexually transmitted infections to reach epidemic levels, as compared with a Conservative Government who acted on the problems relating to HIV and AIDS in the 1980s and secured a much lower incidence of HIV. This country now has the fastest rising levels of HIV since 1997.

The Bill is not a landmark measure in public health even as regards smoking. The reduction in the prevalence of smoking was faster in the 1980s than it has been since 1997.

Ian Gibson (Labour, Norwich North)

Why does the hon. Gentleman believe that it has taken more than 50 years since the epic work of Sir Richard Doll, who sadly died this year, to do something about the problem? The Conservative party was in office for a large part of that time and did nothing about smoking, although the evidence for second-hand smoking and smoking among doctors existed since the work of Richard Doll. Has that failure anything to do with the dirty tricks campaign of the tobacco industry, which tries to defend the evil weed in the United States?

Andrew Lansley (Conservative, South Cambridgeshire)

I hope that the hon. Gentleman will have the opportunity to speak later when he can explain what he means by that last comment. I am not an apologist for the tobacco industry. I was simply pointing out that the reduction in the prevalence of smoking was faster in the 1980s. He knows that—I attended the conference that he chaired on the battle against cancer. There has been a long-term reduction in, for example, lung cancer mortality but there are worrying indications. It was wisely noted earlier that difficulties remain with the prevalence of smoking in elements of the population. That is especially true of working-class communities and young women. Smoking by young people has barely reduced in the past five years. He knows from the statistics that were presented to his conference of the all-party parliamentary group on cancer last Thursday that not only has the incidence of lung cancer mortality in young women risen, but overall mortality rates for women are not reducing compared with the substantial reductions in men.

Pat McFadden (Labour, Wolverhampton South East)

The hon. Gentleman mentioned the proposals that a public health Bill would have contained if the Conservative party had won the election. Would such a Bill have provided for a full ban on smoking?

Andrew Lansley (Conservative, South Cambridgeshire)

Before the election, we made it clear in a document that was published in February that we believe that individuals are primarily responsible for their health. Indeed, the Secretary of State made more or less the same point. We therefore want to proceed when possible through voluntary measures and self-regulatory solutions rather than legislative ones.

If I am to disappoint Labour Members, I will disappoint some of my colleagues, too. As we made clear before the election, we would have included provisions in a public health Bill to enforce a reduction in smoking in circumstances in which a self-regulatory solution had not been effective in three years. We did not propose a comprehensive ban. We proposed that, first, wherever non-smokers had access—including licensed premises as well as workplaces—they should not be exposed to second-hand smoke. That is different from private houses and private clubs. Secondly, wherever children had access, they should not be exposed to second-hand smoke. Thirdly—again reflecting a point similar to one that the Secretary of State made—workers in the hospitality industry, such as people who work behind a bar, should not be exposed to second-hand smoke.

Although not a comprehensive ban, our proposals bore a close resemblance to those that the Secretary of State reportedly pressed on her Cabinet colleagues before the publication of the Bill but was prevented from implementing. The proposals that we are discussing are not those that the Secretary of State wanted to introduce.

Bob Spink (Conservative, Castle Point)

My hon. Friend makes some excellent points. On self-regulation and choice, does he agree that, for the Bill to be more effective, we need clarity on the position of private members' clubs, especially those that serve food, and the way in which they can hold annual ballots on smoke-free places in those clubs?

Andrew Lansley (Conservative, South Cambridgeshire)

I accept my hon. Friend's contention that we need clarity. That applies to many provisions. The detail of many aspects of the Bill will be filled in later. That is an all-too-depressing characteristic of measures that the Government have presented in recent years.

Chris Bryant (Labour, Rhondda)

Will the hon. Gentleman give way?

Andrew Lansley (Conservative, South Cambridgeshire)

No, I want to answer the point of my hon. Friend the Member for Castle Point (Bob Spink) about private members' clubs. The Secretary of State appeared to accept that we were making substantial progress with self-regulatory solutions but claimed that it was not fast enough. She is not proposing to give the industry any additional time to achieve that. For the industry, the flexibility that is inherent in self-regulatory solutions is important commercially.

Whatever may be said about the desirability of limiting the liberty of smokers, private members' clubs should be treated as an extension of a private home in the sense that a club has members who can make decisions about what happens in their club. It seems burdensome for legislation to interfere in that and to prevent members from taking such decisions.

Chris Bryant (Labour, Rhondda)

As far as I can understand the hon. Gentleman's argument, he is saying that, if the Conservative party had been elected, it was hoping that the market would provide, over the next few years, substantial numbers of clubs and bars where people would be able to go without having to suffer passive smoking. Can he name three bars, apart from those in the House, or pubs anywhere in the country that have gone non-smoking already?

Andrew Lansley (Conservative, South Cambridgeshire)

Yes, there is one in Cambridge, which Greene King owns. There is also a large Wetherspoon pub. Unfortunately, it took the Regal cinema in Cambridge and turned the premises into the largest bar area in the country. As it is Wetherspoon, that is non-smoking. I think that I can find the hon. Gentleman at least three such pubs.

To correct the hon. Gentleman—having done so, I must move on to what is in the Bill rather than what might have been in Conservative legislation—I did not say that the market would deliver these things. I said that there would be a self-regulatory solution. I appreciate that there are market pressures, but such pressures can take a long time to have an impact. We were aiming for a self-regulatory solution. He should accept—although Ministers appear not to have accepted it—that, throughout the hospitality industry and in the British Beer and Pub Association and elsewhere, substantial measures have already been put in place to try to deliver smoke-free solutions for customers. The way in which the Government propose to interfere with what might otherwise have been achieved on that basis is excessive.

I am a shadow Secretary of State for Health, and in my view there is no acceptable outcome other than that we deliver much reduced smoking and smoke-free environments for everybody who wants them. There should be smoke-free environments for children, but there is no reference in the Bill to children. There is nothing that says that, wherever children are present, second-hand smoke should not be permitted, although the evidence of the Scientific Committee on Tobacco and Health points to the impact of second-hand smoke on respiratory disease, on asthma and on sudden infant death syndrome.

Andrew MacKinlay (Labour, Thurrock)

Will the hon. Gentleman give way?

Andrew Lansley (Conservative, South Cambridgeshire)

No. I shall carry on because I want to get the evidence on the record. Curiously, the Secretary of State did not get the evidence on the record. I remind my right hon. and hon. Friends that it is not acceptable for us not to make progress. That was at the heart of what we were proposing at the election. We must make progress towards smoke-free environments because the evidence of health effects is increasingly strong.

The Scientific Committee on Tobacco and Health set out the evidence straightforwardly. The increase in the risk of lung cancer among non-smoking partners of smokers is about 24 per cent. for women. For non-smoking men who are partners of smokers, there is about a 37 per cent. increase in risk. For those who have workplace exposure, there is an 11 per cent. increase. It estimates a 25 per cent. increase in risk of coronary heart disease resulting from exposure to second-hand smoke. Insufficient attention has been drawn to this, but what has become most interesting most recently is the significant increase in the risk of coronary heart disease associated with small increases in exposure to second-hand smoke. I shall read the relevant extract from the committee's report:

"The increased risk associated with exposure to SHS"—

for coronary heart disease, it is about 25 per cent.—

"is . . . a substantial fraction of the risk from active smoking, although uptake of smoke by non-smokers is typically only about 1 per cent. of that by active smokers. Thus it appears that substantial risk arises from quite modest exposure to SHS."

That is the most important extract from the updated advice of the scientific committee. There is not a linear relationship between dose and risk; if anything, there is a non-linear relationship that shows substantial risks associated with modest exposure.

Laurence Robertson (Conservative, Tewkesbury)

Did my hon. Friend discuss secondary smoking with the previous Health Secretary, who said that if smoking were banned in most pubs—as it will be, because most pubs serve food—people would be likely to stay at home to have a drink and smoke? That is exactly where their children are. People have a choice whether to go into a pub, but children do not have a choice about breathing in smoke at home.

Andrew Lansley (Conservative, South Cambridgeshire)

I am grateful to my hon. Friend for that intervention. The essence of our proposals would have made it possible for non-smokers to be in a smoke-free environment. They would also have made it possible for smokers to continue to be in smoke-filled environments—[Interruption.] The Under-Secretary of State for Health, the hon. Member for Don Valley (Caroline Flint) asks how from a sedentary position. It is actually rather similar to what her right hon. Friend the Secretary of State was proposing, that is, if a public house can segregate smokers in smoking rooms, it would be able to allow smoking. If it could not, smoking would not be allowed. A public house is open to the public, but it would not be allowed to invite people in if they were likely to be exposed to second-hand smoke against their wishes.

Greg Hands (Conservative, Hammersmith and Fulham)

I want to return to my hon. Friend's earlier point about children. Tomorrow, in the House, I shall launch children's cancer awareness month for CLIC Sargent, and that is an important issue. However, I want to raise exemptions on behalf of a company in my constituency. Does my hon. Friend agree that there should be an exemption under clause 3 for certain workplaces involved in the tobacco trade? A business in my constituency, Hunters and Frankau, is a specialist importer of cigars, but under the Bill, it will not be able to test its products on its premises. The business is located in one of Britain's most deprived wards. [Interruption.] Labour Members may well talk among themselves, but there was a majority for the governing party of only three votes in that ward. That company also imports products from some of the world's most deprived countries, including Cuba. Is it not therefore unreasonable that it should be banned from testing its products on site?

Andrew Lansley (Conservative, South Cambridgeshire)

I am grateful to my hon. Friend for his intervention, and I hope to be at the launch of children's cancer awareness month tomorrow. I am also aware of his point about specialist tobacconists. I understand that they have made those points to the Government, but have had no clear answer. I hope that we shall be able to explore the matter further.

I shall come to the other issues in the Bill shortly, but I want to stay with smoking for a moment. I have talked about all the risks involved, but what has been the response to these points? Curiously, no one has mentioned the fact that the Government had plenty of advice on how they should respond to these issues. The chief medical officer's annual report in 2002 made it perfectly clear that he recommended a comprehensive ban on smoking in enclosed public places. He believed that that would lead to a 4 per cent. reduction in prevalence, from 27 per cent. to 23 per cent., which would represent a substantially greater impact on prevalence than anything that the Government anticipate from their own proposals.

How are other people responding to the risks? The Scottish Parliament—whether I agree with it or not—says that, from April next year, it wants a comprehensive ban on smoking in enclosed public places. As the hon. Member for Rhondda (Chris Bryant) pointed out, the Welsh Assembly wants to use the Bill to deliver a comprehensive ban. Speaking about Northern Ireland, the Under-Secretary of State for Northern Ireland, the hon. Member for St. Helens, South (Mr. Woodward) has said that

"no-one has a right to subject colleagues and workmates to the dangers and hazards of second-hand smoke and passive smoking. No-one has a right to subject members of the public who do not smoke to those same dangers in enclosed public spaces."

Responsibility on this matter is not devolved but held here in Westminster, and that Minister has decided that the only proper course of action would be a comprehensive ban.

Eric Forth (Conservative, Bromley and Chislehurst)

In exactly that context, does my hon. Friend know whether there will be a total ban on smoking in prisons in Wales and Northern Ireland in order to protect the health of prison warders?

Andrew Lansley (Conservative, South Cambridgeshire)

I am happy to confess to my right hon. Friend that I do not know, and perhaps the House does not yet know. I stand to be corrected if the necessary regulations have come forward in relation to Northern Ireland to make that clear. The issue arises in relation not only to prisons but to some care homes and mental health institutions.

Angela Watkinson (Conservative, Upminster)

The workplace argument does not apply to older people who have retired. Does my hon. Friend concede that large numbers of older people have a habit of decades, dating back to the days when the health risks were not known and tobacco advertising presented the habit as glamorous and sophisticated, and are often beyond smoking cessation programmes? Are they to be confined to their homes? Should not restaurateurs and publicans have a choice, so that if they wish to have smoking premises, those who wish to smoke can opt to go to them, and those who do not wish to smoke can go to non-smoking premises?

Andrew Lansley (Conservative, South Cambridgeshire)

I understand my hon. Friend's point, which is important, and it is one of the reasons why exemptions would be needed for people who, to all intents and purposes, are at home, such as people in long-term care. There are limits to liberty, however, and the limit to the liberty to smoke is that one should not impose second-hand smoke and its risks and dangers on others. However sympathetic we might be about the addiction to or habit of smoking among older people, we should not allow that to turn into a risk to the health of others through second-hand smoke.

Adam Afriyie (Conservative, Windsor)

As a member of the Science and Technology Committee, I am much interested in the evidence and in what we are trying to achieve. Does my hon. Friend agree that it is most important to achieve air quality standards and that the debate is not so much about smoking and passive smoking as about air quality standards in public and other places?

Andrew Lansley (Conservative, South Cambridgeshire)

I understand my hon. Friend's point and we might not have explored fully all the engineering solutions that might help to reduce exposure to toxins emitted through tobacco smoke. Indeed, the aetiology of the increased risk might not be entirely clear. Rather than the nicotine content, which is what is typically measured, other toxins might get into the system and change metabolic responses. We need to be clear about that. It might be intensely difficult, however, to remove the carcinogenic material from tobacco smoke that affects other people.

Lynne Jones (Labour, Birmingham, Selly Oak)

On prisons, care homes and other places where people might reside involuntarily, the Bill provides for an exemption of such facilities from the ban. I accept that a total ban might not be in the best interests of prison officers, carers or residents, but does the hon. Gentleman accept that people who are in prisons or care homes, who might have mental health problems or learning difficulties, are among the most disadvantaged, and might also smoke heavily due to the regime that they are under and the boredom factor? What proposals has he to deal with those health inequalities?

Andrew Lansley (Conservative, South Cambridgeshire)

I am grateful to the hon. Lady, and she got the chance to make the point that she would have made to the Secretary of State. She will know that the Bill allows for the possibility of such exemptions, although, as on many other matters, it does not say what kind of exemptions the Government propose in respect of care homes, prisons or mental health institutions. Clearly, in many such instances, it will be necessary to construct a regime that protects staff as best one can while avoiding harm to inmates. If one were simply to introduce a smoking ban in mental health institutions tomorrow, for example, serious risk would be posed to some of the care and clinical plans for some of the people inside them.

Jacqui Lait (Conservative, Beckenham)

My point is supplementary to what my hon. Friend said about mental health institutions. As he suggested, the damage to the health of people in such institutions would be great. Does he know whether the Government have made any provision for increased spending on mental health to try to repair that damage?

Andrew Lansley (Conservative, South Cambridgeshire)

I do not know of any specific allocation by the Government. I only know that, in South Cambridgeshire, a significant reduction in mental health resources is expected, and I imagine that that is reflected elsewhere. If my hon. Friend will forgive me, however, I will not proceed down that path.

The debate in which we have engaged during the past few minutes illustrates the difficulty. Even if the Government proposed a comprehensive smoking ban, it would be necessary to explore in detail how it would be applied in specific circumstances. I do not pretend that that would be easy, but we should at least be clear about the objective, which is to enable people to live in smoke-free environments and, wherever possible, to create such environments in order to reduce the prevalence of smoking.

Where does the issue of food come into the debate? I asked the Secretary of State that question, but I am afraid she did not reply. When the Scientific Committee on Tobacco and Health published its otherwise admirable report to the Government and the chief medical officer—it appeared alongside the public health White Paper in November last year—it was clearly deficient in not mentioning the instrumental relationship, in health terms, between the consumption of food and exposure to second-hand smoke. That must surely have motivated the Government's conclusion that second-hand smoke was dangerous where food was being prepared, but where no food—or only shelf staples and pre-packaged food—was being consumed, it was not dangerous at all.

What will be the consequences of the structure that the Government propose for future regulations? In September, the British Medical Journal published the report of a survey conducted in Telford and Wrekin. I do not think that my hon. Friend the Member for The Wrekin (Mark Pritchard) is here. I should have told him that I was going to mention this—I apologise. The survey covered pubs, and all licensed premises, in the borough. Those who conducted it tried to work out what proportion of premises would be exempt, and concluded—on the basis of what they found in Telford and Wrekin—that two thirds of English pubs in deprived areas would be exempt, whereas only a quarter would be exempt in affluent areas. Action on Smoking and Health has made not dissimilar observations; if anything, it has slightly underestimated the proportion of pubs in deprived areas that will continue to be exempt. The survey of all licensed premises, including members' clubs, found that two fifths of establishments in affluent areas and four fifths in deprived areas would be exempt.

Can the Government really imagine that their proposals will result in anything other than a worsening of health inequalities? I am not arguing that the prevalence of smoking would not be somewhat reduced, but we should not exaggerate that. Last year's report to the chief medical officer on smoking in workplaces revealed that there was no smoking in 50 per cent. of workplaces, in 36 per cent. smoking took place only in designated areas and in 5 per cent. people worked alone rather than with others, so only 9 per cent. of people at work would be exposed to second-hand smoke if they did not wish to be. However, the Government's proposal to discriminate between premises on the basis of whether food is prepared and served clearly drives to the issue of health inequalities. It means that health inequalities will widen, when inequalities in health and mortality expectations between the most affluent and the most deprived areas have widened already.

Steve Webb (Liberal Democrat, Northavon)

I follow the hon. Gentleman's logic about health inequalities being exacerbated by the Government's approach, but does that not also apply to his own desire to keep the exemption for private members' clubs? Are they not too concentrated in less privileged places?

Andrew Lansley (Conservative, South Cambridgeshire)

Yes, I am not disputing that. There is a balance to be struck between continuing to give smokers the right to choose and protecting everybody else from smoke. I have never pretended otherwise. However, I do not understand where the distinction in relation to food has come from. It will entrench smoking in many clubs and pubs in deprived areas, with no expectation of that ever changing. The Secretary of State said that things would improve over time, but what pressures will there be? When we enact legislation we introduce hard and fast distinctions, and I suspect that this will be one of those.

Andrew MacKinlay (Labour, Thurrock)

I would like to clear up some confusion in my understanding of the positions of those on both Front Benches with regard to private clubs. As I understand it, both the Opposition spokesman and the Secretary of State are saying that even in private clubs, people will not be able to smoke at the bar because of the duty of care to employees. But what about another point, which the hon. Member for South Cambridgeshire (Mr. Lansley) has already raised? What about the duty of care to children in clubs in working-class places? If there is a duty of care to one category of people—staff—surely there is a duty of care to children in private clubs. I thought that the hon. Gentleman was with me on that subject.

Andrew Lansley (Conservative, South Cambridgeshire)

Actually, I am with the hon. Gentleman. I said that we had three objectives, the first of which was that non-smokers should not be exposed to second-hand smoke. The second applies wherever children are present, so if a private members' club wants to admit children, it should have to choose whether to do that or whether to allow second-hand smoke. It should not be able to do both. I want to speak about other aspects of the Bill as well as smoking, so I shall finish talking about this issue now.

The Government know perfectly well not only that there is no evidence to support their supposition, but that 90 per cent. of the 57,000 responses to the consultation opposed their partial ban and wanted something more comprehensive, in many cases, or something more voluntary, in other cases. People on both sides of the argument regard the Government's proposal as the worst outcome. Astonishingly, when appearing before the Health Committee last week, even the chief medical officer made it clear that in terms of health inequalities this is the worst outcome—worse than no ban at all.

David Taylor (Labour, North West Leicestershire)

rose—

Andrew Lansley (Conservative, South Cambridgeshire)

This is the last time that I will give way on the subject of smoking.

David Taylor (Labour, North West Leicestershire)

Will the hon. Gentleman clarify something for the House and extend his earlier comments? It is true that more than 90 per cent. of the 57,000 responses were hostile to the proposed exemption—but he should have gone on to say that those people supported a simple, comprehensive, workable and enforceable ban.

Andrew Lansley (Conservative, South Cambridgeshire)

I thought that I did go on to say that most people said that, although some who opposed the Government's proposal wanted a more voluntary approach. However, that is not the point. The point is that people on both sides of the argument do not see any merit in the Government's proposals.

It is for that reason, and considering the range of views in the House, that my right hon. and hon. Friends have agreed to have a free vote on this issue. This is a genuine issue of judgment, which Members of Parliament are perfectly capable of dealing with, and it is not proper to use whipping to try to constrain people to exercise their judgment contrary to their conscience. The official Opposition will have a free vote, and I hope that the Secretary of State will take the opportunity to say that she has thought hard and concluded that there should be a free vote on the Government side as well. [Interruption.] Apparently not.

I now come to the other measures in the Bill. On infection control—a curious theme appears to be emerging—the chief medical officer told Ministers in October 2004 that they should act, through legislation, to provide additional statutory backing. It was not that the Government did not already have the powers, as the Health and Social Care (Community Health and Standards) Act 2003 more or less gives Ministers the power to set standards and it is possible to proceed in a similar way with respect to standards in the codes of practice. In 2004, however, the CMO said that we needed additional focus then, but Ministers did nothing about it that year. I cannot blame the Secretary of State for that as she did not hold her present position then, but action could have been taken earlier.

Many things might have been done earlier. The story of MRSA and infection control over the past few years has been one of continuous failure to take the urgent action that is required. I shall provide just one example. The Secretary of State is fond of making a comparison between food hygiene legislation and the responsibilities that should be met in the NHS. The CMO, in "Winning Ways", published in December 2003, said:

"The new Inspector of Microbiology and the National Patient Safety Agency will work jointly to ensure that the techniques of 'root cause analysis' and the methodology of Hazard Analysis and Critical Control Point . . . are developed for healthcare associated infection and applied in every local NHS organisation."

That is a direct transfer of experience from food hygiene legislation into infection control. I have searched for any evidence to demonstrate that the inspector of microbiology at the NPSA has acted on that or that it is being applied in any local NHS organisation, but I simply have not found it.

When the Secretary of State arrived in office after the election, she discovered that there was a big difference between food hygiene legislation and what went on in the NHS. Anyone could have told her that and anyone could have told her that things could have been done about it. We know that some measures will make a difference: hand hygiene, isolation facilities, clear lines of management accountability, pre-admission screening before operations, post-discharge surveillance after operations, accurate reporting of infection data by clinical departments, optimum bed occupancy—the Secretary of State appeared not to know that the number of beds in the NHS was reducing—24/7 access to high standards of cleaning and expert infection control teams. We know that all those things work, but we also know that, in too many cases, those measures are not being taken.

The Government say that they will bring in a code of practice, so let us look at the draft code to see whether any of those actions that will make a difference are reflected in it. There is no requirement for one board member to have responsibility for infection control and cleanliness. There is no requirement for the standards of cleaning to be in line with the model cleaning contract. There is no requirement for access to 24/7 cleaning on wards. There is no quantitative measure for the availability of isolation facilities. There is no specific requirement for the number of infection control nurses. There is no specific requirement for pre-admission screening before operations. There is no reference at all to post-discharge surveillance. There is no requirement to reduce excessive bed occupancy rates, although we know that there is a strong correlation between that factor and infection rates. There is no requirement for the comprehensive recording and reporting of infections in the terms recommended by the National Audit Office report of more than five years ago.

Although it has many other elements that are laudable in themselves, the code is not actually about outcomes or enforcing actions that we know will have effect. It is actually about processes and policies. Time and again, we have seen what the Government approach to infection control amounts to—a tick box to say that the policies are in place or that the appropriate processes are being undertaken, but too little emphasis on the actions that will make a difference. Patients have a right to know that action that has been demonstrated to work is being actively pursued within the NHS.

We need to know—I note that the Secretary of State refused to answer a question on this matter—that targets and financial pressures will not lead to the compromising of patient safety. We must be sure that the NHS is putting infection control at the forefront of its priorities because all the evidence now shows that that is at the forefront of the public's priorities. If it is to deliver, the draft code must be made stronger. The Government's draft code will not survive. At the moment, the Government propose not to supply us with the final code of practice, which would facilitate debate as the Bill passes through Parliament, but to delay it until after the Bill has been passed. That, frankly, is unacceptable to the House.

Philip Hollobone (Conservative, Kettering)

I am grateful to my hon. Friend for raising the issue of hospital-acquired infections. Does he agree that while many of us are worried about the uncleanliness of many of our local hospitals, it is a particular concern for vulnerable elderly patients, many of whom are now sadly frightened of going into hospital because of the infections they may pick up there?

Andrew Lansley (Conservative, South Cambridgeshire)

I understand exactly the point that my hon. Friend makes and he is right. At the heart of what we need to achieve is an assurance that action will be taken by the NHS that delivers vastly improved infection control procedures across the board, so that our constituents are reassured. I have visited Kettering district general hospital and I know that it is a very good hospital, but—as my hon. Friend knows—the public need reassurance.

I shall give my hon. Friend an example of the kind of measures that need to be taken. We have pressed on the Government for a long time the need for more comprehensive recording of data on infections by clinical department. That is not only because that is the basis on which action should be taken inside a hospital, but because it provides more meaningful measures for those outside the hospital. For example, when I visited the Lister hospital in Stevenage, there was much local concern about the level of MRSA infections. When I talked to staff, it became clear that the hospital's problem was associated with the fact that as well as being a district general hospital it was also a regional centre of excellence for kidney dialysis. It had problems with access to operating theatre time and the extent to which patients on dialysis had to be catheterised, which led to infections. Those distinctions were not known and understood by the local public, because the one figure published by the Government showed that the hospital had a lot of MRSA. The public need to know what is really going on. Information is at the heart of the issue, but the Government continue to resist the National Audit Office's proper call for data to be published by clinical department.

Jim Devine (Labour, Livingston)

In Scotland, over a 15-year period when the Conservatives were in power, compulsory competitive tendering and cuts in cleaning services led to the loss of 15,000 jobs. MRSA increased as the number of domestics in hospitals was reduced. At least this Government have faced up to a problem that the Conservatives denied was happening.

Andrew Lansley (Conservative, South Cambridgeshire)

The hon. Gentleman should ask the Department of Health and the Secretary of State about that. The Department published a report that showed that there was no correlation between the contracting-out of cleaning services and the levels of infection. NHS hospitals with contracted-out cleaning are as likely to have high levels of infection as those with in-house cleaning. However, there is a correlation between the quality of cleaning and rates of infection, and that is why I mentioned the model cleaning contract. The code of practice should directly reflect the standards in the model cleaning contract.

The Government propose to legislate to transfer the responsibility and budgets for general ophthalmic services to PCTs, which raises three issues. First, why are the Government pre-empting the review of general ophthalmic services that is expected to report shortly? Would it not be more sensible to legislate after the review? It will be difficult, in the circumstances, for people to take seriously the Government's approach to the review. Secondly, the Secretary of State made the comparison with dental services, but that is exactly what people working in ophthalmic services are afraid of. How many letters of complaint have MPs had in recent years, before the publication of the Bill, about the quality of local ophthalmic services compared with the number of letters about quality of and access to dental services? Those figures tell the story. As with the 2003 legislation, the Government propose to legislate for a transfer of responsibility to primary care trusts. The National Audit Office made it clear that PCTs did not have the expertise to conduct the commissioning of dental services and still less, probably, do they have the expertise to conduct the commissioning of ophthalmic services.

What will PCTs do? Under current circumstances, in which—in the last financial year—91 PCTs broke their statutory duty to break even, they will be given an additional budget that they will use to try to offset their overall financial problems. People working in ophthalmic services are rightly worried that the consequence will be a reduction in quality and a reduction in access. From a Government who say that they are about choice, what will we have? A reduction in choice for patients, because it will no longer be true that those who are registered with the General Ophthalmic Council will automatically be able to supply services locally to NHS patients; that may be restricted by primary care trusts in ways that we cannot at the moment even anticipate.

Finally, the Secretary of State transferred from the Department of Trade and Industry, where she was previously responsible for competition policy, the issues relating to community pharmacies after the consequences of the review of control of entry regulations. I told her before, in that respect, that one needed to have regard to the health issues associated with maintaining community pharmacies—and I say it again. We should not underestimate the difficulties that might accrue if, in the course of this legislation, we were significantly to shift the balance of advantage towards the large stores with their new pharmacies, which are able to provide a service with relatively limited amounts of professional pharmacy cover. The pharmacists are concerned—and I share their concern—that we strike the right balance in the span of control of pharmacists and the responsibility that they take for the provision of services.

At my count, the Bill has nine issues. Perhaps I have not done justice to any of them, but we will do them all justice later in the Bill's passage. Most of it is a shell, into which regulations are intended to pour decisions. During its passage, we in Parliament should make a few decisions about what goes into it and what happens to our constituents. I hope that we shall do that in a substantive way in respect of smoking by striking out the Government's partial ban, and I leave it to my colleagues and those across the House, perhaps on a free vote, to determine what goes in its place.

I hope that we will get to hard outcomes and clear measures for reducing the impact of health care-associated infections. I hope that we will maintain choice in ophthalmic services, that we will give certainty to pharmacists and protect the profession, and that the Bill, while making progress, will be amended substantially during its passage. On the basis that I hope and expect that the House will amend the Bill, it is not my intention to ask my colleagues to divide against the Bill tonight.

Alan Haselhurst (Deputy Speaker, Saffron Walden)

Order. I remind the House that Mr. Speaker has placed a 10-minute limit on Back-Bench speeches, which operates from now.

Kevin Barron (Labour, Rother Valley)

I shall first declare an interest—I am a lay member of the General Medical Council. I have been very conscious in recent years of the events surrounding the deeds of Dr. Harold Shipman, so I want to start by commenting on the measures in the Bill that go some way to redress some of the issues that were found when the Shipman inquiry reported in July 2004 about the regulation of controlled drugs in the community.

The case of Harold Shipman was a very dark chapter in the history of doctors in this country. The fact that he was able to obtain such large quantities of controlled drugs, and the failure of the system to detect his inappropriate use of those drugs over many years, had to be not just found, but corrected if we are to ensure that, hopefully, it never happens again. Dame Janet Smith identified serious weaknesses in the system of regulation of controlled drugs and highlighted the need to introduce a number of changes to strengthen the system, while accepting—as I think we all must—that no system can be totally immune from fraud.

I congratulate the Government on clause 16, which relates to the appointment of accountable officers and provides details of their responsibilities. I understand that those new senior executive posts were proposed in Dame Janet's fourth report, although the report uses the term "proper officer" rather than "accountable officer". Under clause 16, accountable officers will have overall responsibility for the management and use of controlled drugs in such organisations, as well as the arrangements for the audit, inspection and training of staff who work with controlled drugs, thereby ensuring better patient safety than in the past.

Howard Stoate (Labour, Dartford)

Dame Janet concluded that the control of such drugs should be passed to the Royal Pharmaceutical Society, yet clause 18 refers to a constable or other officer being responsible. Do you think that that point needs clarification? Does my right hon. Friend agree that that needs to be brought out properly before the Bill is passed?

Alan Haselhurst (Deputy Speaker, Saffron Walden)

Order. There were two things wrong with that intervention: first, the hon. Gentleman used the second person when he should not have done so; and secondly, most of his remarks were not addressed to the Chair.

Kevin Barron (Labour, Rother Valley)

I will leave clause 18 to my hon. Friend the Minister, who may talk about that issue. I am more concerned about the fact that health trusts other than strategic health authorities will have someone specifically responsible for such drugs. That is the most important thing, no matter who in the system does it.

I am concerned that the hon. Member for South Cambridgeshire (Mr. Lansley) talked about the weakness of the codes that are likely to come into being to protect us from health-care acquired infections. I may be wrong, but I thought that he said that the draft code was not good enough, but that he had not seen it. That seems a bit of a jump that should be addressed. I understand that the Bill will give the Secretary of State the power to provide a statutory code of practice and to place a duty on NHS bodies to comply with that code, as well as the power for the Healthcare Commission to issue improvement notices to non-compliant bodies. I spoke to Healthcare Commission representatives at a meeting yesterday and they want the Bill to ensure that that can happen. They also want the existing intervention powers of the Secretary of State and Monitor—the Independent Regulator of NHS Foundation Trusts—to be used to take enforcement action.

Andrew Lansley (Conservative, South Cambridgeshire)

rose—

Kevin Barron (Labour, Rother Valley)

I will certainly give way to the hon. Gentleman, but I would have thought that he was reasonably happy with that aspect of the Bill. Given that that seems to be the only health policy on which the Conservative party fought the last general election, I would have thought that Conservative Members were cock-a-hoop about the fact that what they said that they would do with health care within about 12 to 18 months of winning a general election has been done.

Andrew Lansley (Conservative, South Cambridgeshire)

For the purposes of accuracy, I did not say that I had not seen the code of practice on health care-associated infections, but simply that the Government consulted in July on a draft that struck me as deficient and that they are not proposing to show us a new code, following the consultation, until after the Bill has completed its passage.

Kevin Barron (Labour, Rother Valley)

I misheard the hon. Gentleman.

I want to move on to the aspect of the Bill that is more contentious. I am very conscious of the fact that I am the Chairman of the Select Committee on Health, which is investigating smoking in public places. The Select Committee has not yet reported to the House, so I want to limit my remarks to the three evidence sessions on 20 October and 17 and 24 November, which are marked on today's Order Paper as relevant to the debate on Second Reading.

The Government's intention to exempt drink-only pubs and membership clubs has inevitably caused frustration and anger, not just among the health community but in large sections of the leisure industry that did not want to ban smoking in the first place, but would now prefer a comprehensive ban as that would create a level playing field for them. They do not want to have to consider whether or not they should get out of food and into drink only, given that some sort of ban will be introduced under the Bill.

During a number of evidence sessions, I talked about my apprenticeship as a young man drinking in South Yorkshire pubs. They were largely full of smoke and men and there was little food beyond a packet of crisps. I hope that that culture has changed in many of those public houses, which I sometimes frequent, and that food and families can be seen in them. They are a lot better than they were in years gone by. I would hate to think that we were going to reverse that change in the culture of drinking in our public houses by introducing a Bill that was not specific.

Iris Robinson (DUP, Strangford)

Does the right hon. Gentleman agree that it is more than likely that pubs serving grub will eventually give up food and that massive redundancies will therefore take place in the catering trade?

Kevin Barron (Labour, Rother Valley)

I am not too sure whether that is the lesson of the Irish Republic. None the less, there is a danger, and no one knows what will happen on day one if exemptions are granted in the way that the Government propose.

The Health Committee has obviously considered enforcement. Under the Government's proposals, enforcement will be more difficult to achieve, more open to misinterpretation and more costly than under a comprehensive ban. The Health Committee went to Ireland for two days, and one thing that jumped out at us when we talked to people there is that the ban was enforced by people who used the pubs, not by people who work in them or own them, or by people whose duty it is to visit pubs occasionally to ensure that they are run properly. The people who went into the pubs had the opportunity to complain if their pubs were not meeting the requirements set down by their legislation.

Of course, another issue that has been touched on several times in the debate is health inequalities. Exempt pubs and clubs are more likely to be found in areas where health inequalities already exist. The current proposals are likely to work against meeting the Government's targets. My right hon. Friend the Secretary of State, who is not in her place, said in her opening address that health inequality targets are central to Government policy. Some of the information received by the Health Committee would suggest that the proposed exemptions will not help to reduce health inequalities.

Most Members have received correspondence from the Local Government Association, whose research shows that in Newcastle 47 per cent. of pubs and clubs would be exempt; in Northamptonshire, 54 per cent. would be exempt; and in Corby, the figure is as high as 85 per cent. Not every pub in my constituency has changed the culture in the way that I explained earlier, and quite a large number of pubs and clubs that are on the wrong end of health inequalities will suffer if the proposal is introduced unchanged.

Julie Morgan (Labour, Cardiff North)

Does my right hon. Friend agree that by exempting bars that do not serve food, young people will be particularly at risk? Certainly, in many city-centre pubs in Cardiff, young people tend to stand in big groups, drinking without food. Would not such an exemption be very dangerous?

Kevin Barron (Labour, Rother Valley)

It is likely to be very dangerous, but I do not want to go into all the issues about drinking. I see that the clock is ticking away and I do not know whether I have any added time for interventions this afternoon, so I will move on very quickly to what I want to say.

Listening to the Government's arguments, one of the conclusions that I reach—it may be that no one else, including the Health Committee, reaches this conclusion—is that the Government do not want to introduce a complete ban because they believe that it is unpopular. I think that they are wrong. I beg to differ with them. I will briefly look at two issues. First, hon. Members will know that the Office for National Statistics conducts an annual smoking-related behaviour and attitude survey. In the autumn of 2003, 20 per cent. of people believed that no smoking should be allowed anywhere and 51 per cent. believed that there should be mainly no smoking, but that there should be separate areas where smoking could take place. In the autumn of 2004, those figures had changed to 31 per cent. and 47 per cent. respectively. The fact that the second figure had dropped a bit is understandable.

Action on Smoking and Health got YouGov to do the same survey in August 2005. First, people were asked the straight question that the ONS asks in its surveys. It found that 41 per cent. of people believed that no smoking should be allowed anywhere in places they visit when they go out, while 39 per cent. of people believed that there should be separate smoking areas. YouGov then told people about the science of secondary smoking before asking the question again, and found that the proportion of people who said that they would ban smoking in all public places rose to 52 per cent. The evidence shows what has happened in other parts of the world where a ban has been brought in, so I would like to think that we could act a bit more strongly.

Stephen Williams (Liberal Democrat, Bristol West)

Will the right hon. Gentleman give way?

Kevin Barron (Labour, Rother Valley)

No, I will not give way again.

The Health Committee and I did an experiment with "You and Yours", the well-known and popular Radio 4 programme. I went on the programme the other week and did a half-hour phone-in. A mixture of people phoned in and all the evidence from the letters and e-mails that the programme received was collated. Some 60 per cent. of listeners—626 people—said that there should be a complete ban.

All I want to say is that what can happen in the rest of the UK should happen in England as well. It is inequitable and I find it—

Alan Haselhurst (Deputy Speaker, Saffron Walden)

Order. The right hon. Gentleman has had his allocation.

Steve Webb (Liberal Democrat, Northavon)

It is a pleasure to follow the Chair of the Select Committee, the right hon. Member for Rother Valley (Mr. Barron), who made a thoughtful and well-informed speech. His and his colleagues' evidence sessions have informed our debate, so it is a shame that the Secretary of State had a higher priority than listening to what he had to say.

I congratulate the Secretary of State and the Government on consulting extensively and listening to what they heard. We cannot deny that the Government consulted the right hon. Member for Airdrie and Shotts (John Reid) and listened to him. They have done what he asked them to do, so they were consulting and listening. They did not listen to what 90 per cent. of the public wanted, but the right hon. Gentleman is obviously the person who counts.

The priority for Liberal Democrats is the freedom of people to work in a smoke-free environment. As far as I am concerned, this is an issue about the health and safety of employees in England. The health and safety of employees of England is just as important as that of employees in Scotland, Wales, and north and southern Ireland.

I can cite examples of what has happened around the world. I want to take you, Mr. Deputy Speaker—albeit not literally—to the land of the free. No fewer than 300 cities and seven states in the United States have a total ban. Since a ban was introduced in California in 1998, the respiratory health of bartenders has significantly improved. That shows the point of the exercise and where we are coming from. After a six-month trial in Montana, there was a 40 per cent. drop in hospital admissions due to heart attacks. People who are sceptical about the evidence should look at what is actually happening on the ground.

There are those who say, "You may be worried about the welfare of workers, but it is their choice because they can choose to work in a smoky bar or somewhere else." However, if asbestos was found in the roof of a bar, people would not say, "You don't have to work there—go somewhere else." We would say, "It's bad for your health, so we'll do something about it." The onus should be on the workplace to be good for the health of the people who work there and not to harm it.

Laurence Robertson (Conservative, Tewkesbury)

I am listening carefully to the hon. Gentleman, as I do to all his speeches. However, if we were to follow his point to its logical conclusion, we could not allow people to work down coal mines. I am not aware that the Government are going to introduce a ban on that.

Steve Webb (Liberal Democrat, Northavon)

Yes, the hon. Gentleman and his colleagues went a long way towards achieving that. I draw a distinction between avoidable and unavoidable risk. Being exposed to second-hand smoke is not an inherent part of working behind a bar, so we can, and should, do something about that.

I want to say a word or two about the two major exemptions. As several hon. Members have eloquently said about the exemption for food, there is no logical basis for saying that whether food is served has anything to do with whether second-hand smoke is bad for people. As far as I understand it, people may smoke if pork scratchings are served, but if pork chops are served, they may not. If pork sandwiches are served, it might depend on where they were cooked, whether they were hot or cold, and whether they were brought on to the premises. Nothing in the exemption has anything to do with the welfare of people working in pubs. It is entirely irrational.

Allowing people in so-called wet pubs—I have never quite followed that phrase—to be exposed to second-hand smoke seems to be in conflict with a recent campaign of which I have become aware. The campaign is an attempt to raise awareness of something called the "invisible killer". There will be adverts to

"highlight the fact that 'Secondhand smoke is a killer'".

One of the main advocates of the campaign says:

"smokers and non-smokers don't appreciate the full dangers of secondhand smoke. Tobacco smoke contains around 4,000 different chemicals, including . . . 50 known cancer-causing substances, such as arsenic, formaldehyde and ammonia".

The campaign is, of course, the Department of Health's. The person who gave that evidence was the Under-Secretary of State for Health, the hon. Member for Don Valley (Caroline Flint), who will wind up the debate. The NHS campaign was launched on the Department's website this autumn. How can the Department cite all these terrible things about second-hand smoke, which are true, yet say that it is all right for people who work in pubs that do not serve food to breathe it in? I do not understand how the Minister can simultaneously hold those two opinions.

I want to warn the House about the rise of death burger. Many of us who went to university will remember the burger vans that used to ply people on the high streets and what their products used to do to our health. If people can smoke in pubs provided that no food is served there, there will be an explosion—if that is the right word—of death burgers. Burger vans will park outside pubs, and people who want to smoke and eat will go out of the pub to buy a burger and quite possibly bring it back into the pub to eat it. As the burger would not have been provided on the premises, that would be no problem. Such people would get a triple whammy. They could go out to drink, nip outside for a burger and go back into the pub and smoke. The Department of Health is approving that behaviour, so I think that we are missing the point.

It is not only the exemption for food that is irrational, but the link between that exemption and the alcohol policy. It is clear that pubs that serve only a bit of food and do not make much money from that will stop serving food altogether. We will see more of what is inaccurately called vertical drinking—I have never quite understood why it is called that. There will be more pubs in which people will stand and drink, rather than sit and eat. All the concerns about alcohol abuse will increase.

Howard Stoate (Labour, Dartford)

May I assist the hon. Gentleman? He says that it is difficult to define food and to determine whether a particular type of food constitutes cooked food. I met one of my constituency's publicans at a public meeting last night who made the interesting point that beer, by definition, is a food. Does that not rather confuse the situation under the Bill because any pub that sells beer will technically be selling food?

Steve Webb (Liberal Democrat, Northavon)

I had not considered that point, but I am glad that the hon. Gentleman is keeping in close contact with his local publicans, as ever.

I have a further worry, which I have not really thought through, about the exemption's link with alcohol policy. Given the extension of licensing hours—we do not necessarily need to be talking about 24-hour licensing—the situation for bar staff will get worse. If licensing hours are longer, they will be exposed to second-hand smoke for longer. The case for doing something about that, which is the case against an exemption, thus becomes more pressing.

Andrew Murrison (Conservative, Westbury)

I think that we understand the hon. Gentleman's position on smoking tobacco. I hope that he will comment on his party's position on smoking cannabis. There appears to be some confusion about why he is focusing on smoking tobacco, but ignoring cannabis.

Steve Webb (Liberal Democrat, Northavon)

The hon. Gentleman's comment gives rise to the interesting point that enforcement will be difficult if what is being smoked effectively has to be inspected. Some environmental health officers argue that if we stick strictly to addressing tobacco products, people could always claim that they were smoking something else, which would mean that an investigation of what was being smoked would be required. A broader definition of smoking could thus make enforcement action easier.

The exemption for private members' clubs also makes no sense. As the hon. Member for South Cambridgeshire (Mr. Lansley) accepted, that exemption will increase health inequalities. Again, we must ask why the health and welfare of people working in private members' clubs is less important than that of other people. What can the Minister say about the danger of "The Rose and Crown" becoming a private members' club, which would allow people to circumvent the ban by becoming members of "The Rose and Crown"? It would not be beyond the wit of a landlord to circumvent the ban by setting up a membership scheme. How can a ban that is full of exemptions that allow it to be circumvented so easily be worth the paper that it is printed on?

Martin Horwood (Liberal Democrat, Cheltenham)

There is an instance of that in my constituency, where one pub is considering redesignating itself as a membership club. Does my hon. Friend agree that one of the perverse results of such a potentially powerful ban is that establishments will market themselves as smoker friendly, thereby undermining much of the health promotion activity in recent years?

Steve Webb (Liberal Democrat, Northavon)

My hon. Friend helpfully illustrates my point. The ban will be easy to circumvent and therefore possibly ineffective.

The issue of unfair competition may appeal to Conservative Members. With a partial ban, which the hon. Member for South Cambridgeshire seems to support, a private membership club can have smoking, but that may not be possible for the pub down the road. If they are the only two establishments in a town, the private membership club has an unfair advantage over the pub, which is covered by different and broader legislation. That is unfair competition. It is neither logical nor fair.

Colin Challen (Labour, Morley and Rothwell)

There is another problem with the partial ban. A disabled person—registered or not; it does not matter—who has a debilitating respiratory disease may feel entitled to use measures in the Disability Discrimination Act 1995 and take a case against a landlord or licensee who enables smokers to use their premises. The disabled person may feel discriminated against by not being able to use those premises because it could further damage their health. Does the hon. Gentleman agree with that assessment?

Steve Webb (Liberal Democrat, Northavon)

That possibility has been raised in the context of employment rights. Provided that there continue to be smoking pubs, a disabled person who might otherwise be able to work in a smoke-free environment will be effectively debarred from applying for a job in those pubs. The implications for people who have those sorts of disabilities need to be considered.

We touched on health inequalities. There is a danger that we think of the problem as a north-south issue, but even in relatively prosperous areas it is clear that the inequalities in health will be exacerbated by the Bill. My director of public health in south Gloucestershire—a relatively prosperous area—tabulated the pubs that do and do not serve food across the authority. The director found that all the pubs in the most prosperous fifth serve food, but 41 per cent. of the so-called wet pubs are in the poorest fifth of the area. So the partial ban will increase inequalities within areas and between areas, not just across the country as a whole.

Stephen Williams (Liberal Democrat, Bristol West)

I draw my hon. Friend's attention to the initiative undertaken recently by Smoke Free Bristol. The city is next to south Gloucestershire. It found that only 12 per cent. of people in the Henleaze ward in my constituency smoke. However, just a quarter of a mile away in the Southmead ward in the constituency of the hon. Member for Bristol, North-West (Dr. Naysmith), smoking is at nearly 50 per cent. Those health inequalities, in a relatively small area, will be perpetuated and expanded if the Bill goes through.

Steve Webb (Liberal Democrat, Northavon)

My hon. Friend is right. For the Government to say that tackling health inequalities is a key priority and then to put in place a measure that will make them worse does not stack up. When they launched the embarrassing statistics in the summer that showed that health inequalities had risen under them, the answer was, "We have these things called spearhead primary care trusts, which deal particularly with deprived areas." When the spearhead PCTs responded to the consultation, they said:

"Many spearhead PCTs suggest that the proposed legislation will make it harder for them to meet their targets on health inequalities".

In reflecting on the comment on conflicting targets, we have one bit of the Government setting targets for relatively deprived areas to reduce inequality while another bit of the same Department is making it harder for them to reduce inequality.

We have heard, and the Health Select Committee was advised in its oral evidence, that enforcement is more difficult with a partial ban. Presumably, I will have to go up to the bar and ask the barmaid whether she sells pre-packaged ambient shelf-stable snacks before I can decide whether to light up. That is the criterion. It is absurd to have separate categories. We heard about Ireland, and if the other customers do the enforcement, they need to be clear about the legislation. If a place serves food at lunchtime but not in the evening, a customer who uses it in the evening is supposed to know that to determine whether he can smoke.

Stephen Williams (Liberal Democrat, Bristol West)

I notice that the Minister is trying to be helpful by saying, from a sedentary position, that signs will help people in such circumstances. May I relate my experience as a director of the Watershed Media Centre in Bristol? We tried to ban smoking from a large part of the café bar by, at one time, placing signs on every table. As there is a mix of where people can and cannot smoke, people use the element of doubt to ignore the signs and carry on smoking. Signs are not always the right answer.

Steve Webb (Liberal Democrat, Northavon)

My hon. Friend is right. Essentially, we are partly talking about a cultural shift towards smoke-free workplaces. That message will be hampered by the phased introduction of the Bill and by different rules for different establishments. The picture will be confusing and will not make a clear statement about the rights of the people who work in such environments.

On phasing, there will be confusion if certain establishments have a ban first, if others follow on later and if some are not covered by the legislation. The Secretary of State said that she expects a total ban and that we will get there eventually. We heard that the chief medical officer used the phrase to the Select Committee about states around Europe and beyond falling like dominoes towards a total ban. The Secretary of State said that the people who introduced total bans often did so in stages, but in many cases they realised that it was unworkable to do it partially and got on with it. Why do we have to repeat their mistakes?

The Chairman of the Select Committee, the right hon. Member for Rother Valley, put his finger on it when he said that the Government have not introduced a total ban because they are afraid. They are afraid to lead public opinion and want to follow it. We need a courageous visionary Government, who are willing to take the lead and set an example. I imagine that the full ban will come into effect and, two or three years later, no one will conceive of turning the clock back.

Tim Farron (Liberal Democrat, Westmorland and Lonsdale)

Does my hon. Friend acknowledge the research by groups such as Action on Smoking and Health which recognises that four in five smokers wish that they did not smoke? We are talking largely about liberty and freedom. Many people think that an addiction is an encumbrance on their freedom and would welcome the opportunity to go to work or to a social setting where smoking is not rammed down their throat and temptation is removed.

Steve Webb (Liberal Democrat, Northavon)

My hon. Friend makes an interesting point about the liberty argument, which our party considered. We are primarily concerned with the liberty of those who work in such environments, but where addiction is involved, we may, in many cases, going with the grain. Individuals who want to give up but who have found it difficult might appreciate such a measure. It is not patronising or nannying. It could assist people to do something that they want to do. Perhaps the most appropriate day to introduce the ban is 1 January, although midnight might create operational problems if everyone had to stub out their cigarettes halfway through the evening. Noon on 1 January might be a better time because it would assist those who want to make a new year's resolution to follow the grain of that decision.

I asked the Secretary of State what she had said to the Cabinet and did not get the straightest of answers. However, we are reliably informed that she pressed for a total ban. If she wants that, then I agree with her. However, it means that her argument that the Labour manifesto said that there would be only a fudgy ban falls down. If she pressed to go beyond that, how did she justify going beyond the terms of the manifesto? She did so because it was right and the best policy to adopt. On smoking, the Westminster Government have got it right, but only for Northern Ireland, where there is a total ban. How, therefore, can they adopt a different approach for England? I can see nothing about the situation in Northern Ireland that would warrant its workers having a different level of protection from those in England.

The Bill deals with other important subjects. On health care-acquired infections, a group of people who had been bereaved by MRSA held a lobby yesterday. That group—MRSA Action UK—presented a petition to Downing street. I think hon. Members on both sides of the House joined them. I laid a wreath with them at Westminster abbey in commemoration of their friends, relatives and loved ones who had died.

One thing that the group is calling for is mandatory national reporting of all health care-acquired infections, which we do not have. The estimate is that only 6 per cent. of all infections have to be reported. That relates to bloodstream MRSA only—not all cases of MRSA have to be reported. I hope that the Minister explains why there is not more mandatory national reporting. The scale of the problem is immense and although we heard reassuring words from the Secretary of State about the progress that is being made, across Europe we have one of the worst rates of Staphylococcus aureus infection. It is about 40 per cent. in the UK—one of the highest in Europe—and the right hon. Lady's reassurances were complacent on that front. Having met relatives of those who have died from MRSA, I urge her to listen carefully to what they say and to take much more serious steps.

I echo the question of the Public Accounts Committee—how can the 80 per cent. or so of infections not covered by the Department's mandatory surveillance programme be measured and managed? If they have not even been reported, how does the Department of Health know what is going on?

We have already heard about things that can be done to tackle infection and about infection control. As for bed occupancy rates, my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) pressed the Secretary of State on what trusts will do if they have two conflicting targets. The answer was "Meet both". I accept that that is the ideal solution, but what if one target conflicts with the other? As the hon. Member for South Cambridgeshire rightly said, what if there is pressure to close a ward because of infection, but that decision is overruled by the trust managers? There is nothing in the Bill to prevent such conflicts, so the Government must make it clear that infection control is a priority.

The right hon. Member for Rother Valley, the Chair of the Health Select Committee, spoke about the Shipman inquiry, and said that the Bill will improve current practices, which we welcome.

The Bill includes some worrying provisions on ophthalmology. All I can say is that if dentistry is the precedent, heaven help us. If access to ophthalmology services is cash-limited and restricted, as Opposition Members have said, many of our constituents will be concerned. The Bill was originally to be called the Health Improvement and Protection Bill. The Government dropped the words "Health Improvement" and "Protection", because this is a missed opportunity to do far more of both.

Frank Dobson (Labour, Holborn and St Pancras)

I should like to make one or two simple points.

Smoking in enclosed spaces kills people. It kills smokers themselves, and it kills non-smokers who inhale second-hand smoke. It is obviously a good idea to try to stop people smoking in enclosed public spaces if possible. There is no longer any "if" about it, however, as we know that it can be done. Smoking in enclosed public spaces has been banned in Ireland, where the sanction has proved both workable and enforceable. It has stopped people inhaling second-hand smoke, and it has helped smokers to give up. Fewer cigarettes are being sold in Ireland, and fewer people are smoking. The ban in the Irish Republic has been so successful that our Government are to introduce a total ban in Northern Ireland. Having checked with the Clerks, I believe that that will require a vote in the House before it can be brought into effect. The Scottish Parliament is introducing a similar ban in Scotland, and the Welsh Assembly intends to use the measure to do the same thing.

Stephen Williams (Liberal Democrat, Bristol West)

Will the right hon. Gentleman give way?

Frank Dobson (Labour, Holborn and St Pancras)

No, I would like to make progress, as other hon. Members would like to make a contribution.

The Government want only a partial ban in England. Smoking is to be banned where food is sold, but it will not be banned where food is not sold. Pubs, clubs and bars serving booze but not food are mainly located in poor neighbourhoods, and serve working-class people, so the partial ban will be good for the health of middle-class people but bad for the health of working-class people, who are ill more often and die sooner than the middle classes. The partial ban introduced by the Labour Government will widen the health gap between the social groups. No one has mentioned the fact that the partial ban will concentrate smokers and smoke in pubs where smoking is permitted, because smokers will move to them from places where smoking is banned. The partial ban will therefore make the situation worse for people in those pubs. It is hard to believe that a Labour Government are knowingly widening the health gap.

Smoking is one of the major causes of the health gap. Headlines in two Sunday papers said "Glasgow is Britain's smoking capital" and "Glasgow people have the shortest lifespan". There is a clear connection between smoking and early mortality, as has been pointed out by the chief medical officer in his advice to the Government and in his public statements. Professor Sir Liam Donaldson believes that there should be an outright ban, but the Government have decided to ignore his professional advice. It is his job to try to promote good health, but the Government have ignored his advice, just as they have ignored the advice of the distinguished doctor, Professor Dame Carol Black, president of the Royal College of Physicians, who also gave evidence on the matter.

The Government proposals are half-baked and half-hearted, without any merit at all. Most members of the catering trade take the same view, and they would rather have no ban or a full ban, because half a ban is a great deal of trouble for them. The environmental health officers responsible for enforcing the measure believe that a half-ban is unworkable and difficult to enforce. Under the measure, smoking in bar "areas" will be prohibited. What is the bar area? I represent an enormous number of lawyers, and I am sure that they have spotted that wording in the Bill. Some establishments that do not serve food consist only of a bar. Hon. Members may not visit such places, but they exist, so I think that the lawyers will do well. If anyone thinks that they can make a distinction between one part of a room that does not have any smoke and another part that does, they should have tried flying Iberia when the airline banned smoking on one side of the aisle, but permitted it on the other. That ban did not work very well.

May I tell my hon. Friend the Minister, who has the task of defending the Government's policy, that Professor Alex Markham, the chief executive of Cancer Research UK said yesterday that the Government had a huge number of achievements in tackling cancer to their credit. They have quite a few achievements in promoting the reduction of smoking and helping people to stop smoking, thus reducing the incidence of cancer and improving recovery rates. We should not be distracted and throw that credit away by coming up with this half-cocked measure.

We have had many debates in the House in the past few years about weapons of mass destruction. The worldwide weapon of mass destruction is the cigarette, which has killed more people than all the weapons, bombs, mines and bullets since the second world war, far exceeding anything that we have managed to do by trying to blow one another up or to shoot one another. In our country alone, it kills more than 100,000 people every year, but we are giving up an opportunity to make progress.

Finally, last year, I had the singular pleasure of speaking on the same platform in Edinburgh as Sir Richard Doll who, in his 90s, made a fine speech about his initial work to identify the link between smoking and cancer. I made the people present, who were from across Europe, stand in honour of a man who had saved millions of lives. We seldom meet people who save millions of lives, but he has left us an enormous legacy—a better legacy than most politicians are likely to leave, I might add. It would not be a bad addition to his legacy to persuade the Government to introduce an outright ban instead of a partial ban that will not do any good. It will not be enforceable. That partial ban should be avoided by a Labour Government who, as the Secretary of State has said, are dedicated to reducing social and health inequalities, because it will serve to do nothing but increase them.

Stephen Dorrell (Conservative, Charnwood)

I agreed with two things that the right hon. Member for Holborn and St. Pancras (Frank Dobson) said. The first is that we all owe a great debt to Sir Richard Doll, and I am sure that the right hon. Gentleman spoke for the whole House in what he said on that subject. Secondly, the Government's policy on the subject of statutory smoking bans is, in the right hon. Gentleman's opinion and in mine, half-baked and unenforceable. The difference between us is that, unlike the right hon. Gentleman and the hon. Member for Northavon (Steve Webb), who both draw from that the conclusion that we should proceed to an outright ban, I shall speak against the principle of statutory smoking bans.

I do so, as the House is aware, as a former Secretary of State for Health. It would have been an unpopular argument for a Secretary of State for Health in office to advance. I also do it from a personal point of view, as a lifelong non-smoker and somebody who has a deep dislike of smoky atmospheres—so much so that when I go into a pub that has a smoky atmosphere, I go out again, because I do not like it. That is my freedom as an individual, and it is that freedom which lies at the base of my remarks.

As Secretary of State, I of course received advice from the chief medical officer, and successive chief medical officers have argued in favour of statutory action against smoking. I also met many, many clinical staff who were emotionally committed to the principle that it was part of the Government's job to tilt the system more heavily against smokers. However, we should not proceed on the basis of the Government's half-baked proposal, and still less in the direction that the right hon. Member for Holborn and St. Pancras and the hon. Member for Northavon advocate. I shall set out briefly why.

At root, my reason is that, like my hon. Friend the Member for Witney (Mr. Cameron), I have always described myself as a liberal Conservative. By that I mean, among other things, that I think it is part of our job in this place to defend private space against the well-meaning aspirations of a well-meaning state. I have no doubt that the clinicians who argue for statutory smoking bans do so for the very best of motives. I accord to the Secretary of State and to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who argued from the Opposition Front Bench for a different form of compromise, the best of intentions, but sometimes we in this place should defend private space, particularly the private space of unfashionable minorities, among whom we should now number smokers.

Against that background, I shall go through the arguments that are used to justify the proposals for smoking bans. First—this is the weakest argument of all, which, with respect to him, was advanced by an hon. Member from the Liberal Benches—there are those who say, "It will help me give up smoking". It is not a safe guide for public policy to legislate to encourage somebody to do something that they want to do for their own private benefit. Of course, as a private citizen, one to another, I would encourage people to give up smoking. As a result of the work of Sir Richard Doll and his successors, we all acknowledge that smoking causes cancer and therefore premature death. We should not be mealy-mouthed about that, but we should not use the power vested in us as legislators to impose on people a private benefit that they may wish for themselves, but which they apparently cannot deliver for themselves without legislative backing. That is no basis for public policy.

Tim Farron (Liberal Democrat, Westmorland and Lonsdale)

Is not the right hon. Gentleman guilty of not giving due balance to the right of the non-smoker and of classifying a space as private when, in fact, it is public? We are speaking about balancing liberties. As a liberal Conservative, surely he recognises that some liberties encroach upon the liberties of others and should therefore be curtailed.

Stephen Dorrell (Conservative, Charnwood)

I shall come on, if I may, to that argument. I was trying to respond specifically to the argument that "a ban on smoking will help me give it up", which I do not think is a guide to policy.

Kevin Barron (Labour, Rother Valley)

When the right hon. Gentleman was Secretary of State for Health, he did not spend anywhere near the amount of money that the present Government have spent on smoking cessation. Ireland had a smoking prevalence of one in three before the ban. After 18 months of the ban, the smoking prevalence is one in four. Does the right hon. Gentleman agree that there is a lot to be gained from taking such action—not banning smoking, but banning it in places such as pubs and clubs?

Stephen Dorrell (Conservative, Charnwood)

I shall make two points in reply to that. First, during our years in government, tobacco consumption fell, and I think I am right in saying that it is starting to rise now, particularly among teenage girls. Secondly, the argument that if we deliver a reduced level of smoking, we deliver a public health gain is transparently true; that is not in dispute. The question is whether that is a basis for legislative action. That is the second argument that I shall come to.

Frank Dobson (Labour, Holborn and St Pancras)

rose—

Stephen Dorrell (Conservative, Charnwood)

I shall give way once more, then I shall make progress.

Frank Dobson (Labour, Holborn and St Pancras)

In his liberal Conservatism, the right hon. Gentleman—who usually talks more sense than he is talking now—predicates his entire argument on the idea that smokers can come to a voluntary decision. They are smokers because they are addicts, and we owe it to addicts to help them break their addiction.

Stephen Dorrell (Conservative, Charnwood)

I do not agree with that argument. There are very few people, if any, who are clinically unable to give up smoking. I entirely accept that it is difficult, but the right hon. Gentleman needs to be careful of that argument. He is in danger of saying that the people of whom he spoke, in low-income and disadvantaged groups, are unable to make on their own behalf decisions which, from the level of tobacco consumption, one can see that better off people have made. That is not true and it is a patronising argument for us even tacitly to endorse.

The next argument is closely allied to the argument that a ban will help people give up smoking. It is the argument behind public health targets related to tobacco consumption. As Secretary of State for Health, I was always uneasy about public health targets that could be delivered not as a result of Government action, not as a result of collective action, but only as a result of private decisions by private citizens. It is not a proper basis for public policy to introduce a measure that I find objectionable for the reasons that I am describing, in order to deliver some public health objective about reducing tobacco consumption, which can be delivered only by private citizens making a private choice about their own private behaviour. The job of the public health Minister is to use resources in a way that is targeted at health need, but always to understand that private citizens should be free to make their own decisions about the way they lead their lives.

The third argument that is advanced is that we should introduce a smoking ban in order to create a more pleasant environment for people like me who do not like going into smoky pubs—again, not a good guide for public policy, and not a reason for compulsion, though a very strong reason for individual publicans and restaurateurs to introduce no-smoking policies in their establishments, which attract people like me and presumably do not attract those who want to go in and be able to smoke.

On the final argument, it was interesting that the hon. Member for Northavon rested his argument in favour of a smoking ban almost exclusively on the grounds of a safer working environment. All around the country, employers and employees have for a generation been agreeing no-smoking policies in their establishments, without the assistance of the Government. I applaud that. In my own business we operate a no-smoking policy because that is the decision that the individuals on the sites have collectively reached. I do not believe that a ban should be imposed from here, because individual employers and employees should be free to decide the matter for themselves.

In addition to the public health driver that explicitly informs smoking bans, there is a strong whiff of political correctness—we know the scientific facts and what is good for the people who send us here. Our righteousness is reinforced when we present that argument, because we can quote scientific evidence to support our assertions of what is good for people. We then make the fatal leap—this is where I part company from the prevailing majority—that because we know how people could better lead their lives from a health point of view, we should use our available powers to lead them to do things that they would not choose to do for themselves.

The Prime Minister is fond of talking about respect, and he is dead right when he says that we should learn better to respect each other. We should understand, for example, that two adult citizens in a free society—this is almost the definition of a free society—can look at the same set of facts, come to two diametrically opposite conclusions and both be right. We will have learned the real meaning of respect when we respect the conclusions that other people reach when they are presented with the same facts as us, but reach opposite conclusions.

Joan Walley (Labour, Stoke-on-Trent North)

I have the greatest respect for medical officers, and when the right hon. Member for Charnwood (Mr. Dorrell) was responsible for the health service, a substantial body of medical opinion called for bans such as those in the Bill. I congratulate the Government on going so far with what will hopefully be a landmark Bill on smoking. After 18 years of Tory Government, we should now make as much progress as possible.

The Bill could have gone much further than a partial ban on smoking. As I said in an intervention, my greatest concern is what the Bill will do for health inequalities. That concern is shared by not only Sir Liam Donaldson in his evidence to the Health Committee, but many other distinguished people. The Under-Secretary of State for Health, my hon. Friend the Member for Don Valley (Caroline Flint), who has responsibility for public health, must satisfy herself that the Government are dealing with health inequalities.

My primary care trust, which is a spearhead trust, is getting extra money to deal with health inequalities—the increase is some 9.4 per cent. this year and 8.4 per cent. next year. We do not want legislation that makes the matter worse, and the more that I look at the evidence and the situation on the ground—I speak as an ex-smoker—the more I believe that the Government should use the time between now and Royal Assent to make sure that they are doing everything that they can to reduce health inequalities. The issue concerns changing behaviour, because nothing can be done by legislation alone. It involves hearts and minds as well as legislation, and properly trained enforcement officers will be important, too.

I was interested in the contribution by my right hon. Friend the Member for Rother Valley (Mr. Barron), who is Chairman of the Health Committee. On 24 November, the Committee took evidence from the Chartered Institute of Environmental Health, of which I am vice-president. In its comments, the CIEH makes it clear that it strongly opposes the proposed exemptions for pubs and clubs that do not serve food. The CIEH position is that all workers should be afforded an equal level of protection.

I have this to say to hon. Members who have already spoken: we are not discussing private places; we are discussing public places. There is no justification for exempting premises where workers are exposed to the greatest risk. The CIEH believes that its members will face the serious ethical issue whether it is professionally acceptable to participate in the enforcement of a law that unjustifiably fails to protect whole categories of vulnerable people and may be open to subsequent challenges under human rights legislation. I urge my hon. Friend the Minister to speak to those who will enforce the legislation.

I know that time is limited and that many other hon. Members want to speak. In the short time remaining, I shall refer to the issues that concern my local spearhead PCT. Smoking is the single most important cause of illness and death in Stoke-on-Trent, where it kills more than 450 people each year. Are we sure that it is right to leave the most vulnerable workers at risk from the dangers posed by breathing other people's tobacco smoke?

Exposure to second-hand tobacco smoke has been linked to lung cancer and heart disease since the 1980s, when many people started to campaign to bring about a ban on smoking. In my constituency, 64 per cent. of licensed premises do not serve food and will therefore be exempt from the smoke-free legislation. In the most deprived wards, however, 84 per cent. of pubs will be exempt, leaving both workers and the community at risk and contributing to the social acceptability and normalisation of smoking within those communities. Moreover, the PCT in Stoke-on-Trent and I believe that two out of every three smokers who want to quit are hindered by the environments in which they socialise.

Hon. Members have already covered many aspects of the debate. I shall briefly refer to the views of Charles Pantin, a consultant physician at the University hospital of north Staffordshire. He has written to me setting out the medical evidence on the risks to health from second-hand smoke, including the links to heart disease, asthma, reduced lung function, chest discomfort and all other associated illnesses.

This is a momentous opportunity for the Government to make a positive impact on smoke-free workplaces. We must make sure that we are doing everything that we can to help those who want to quit to do so and to prevent people from starting to smoke. This two-tier legislation does not send a simple, concise message. The Bill should contain a comprehensive, simple law to end smoking in the workplace. I urge the Minister to examine carefully the concerns raised by those hon. Members who want to see more being done to reduce health inequalities.

Eric Forth (Conservative, Bromley and Chislehurst)

My two least favourite words in the political lexicon are "modernisation" and "prohibition". When I looked through the Bill, I found that although the first of those is, happily, not present, the second one, sadly, is—right up front. I also found that "regulations" occurs 18 times, "offence" occurs 20 times, and "enforcement" occurs 10 times. In schedule 1, "penalty" occurs 19 times, "offence" six times and "enforcement" three times. What have we come to, that we are being asked to take this approach in order to do what many people see as the right way forward?

I very much agree with the approach taken by my right hon. Friend the Member for Charnwood (Mr. Dorrell), who succinctly set out the case that is in danger of going by default in this debate: in a mature, informed society, we should surely leave individuals as much opportunity as possible to exercise their choice and discretion. That should be informed, of course. There is a duty on the Government of the day, and on us, to do what we can to inform people about the risks that they may be taking in terms of their health and safety.

Stephen Hesford (Labour, Wirral West)

Does the right hon. Gentleman agree that the logic of his position is that he would legalise class A drugs?

Eric Forth (Conservative, Bromley and Chislehurst)

The policy on drugs has been such an overwhelming failure until now that it is time that we had the courage to look at the issue properly, instead of being afraid of it and cringing from it. That is for another day, however. I shall happily engage in a debate on that subject with the hon. Gentleman, but not here.

I would certainly want to push as far as I could the freedom of adult, informed individuals to decide what they do with their bodies, and indeed with and between each other. That is my preference. I always recoil when I have presented to me proposed legislation that seeks to impose on a large number of people the wishes of experts or politicians, because that is not why I came into politics or why I am here.

Another irony is that all of us, in all political parties, pay lip service to local community decision making. I agree with that. However, when we are faced with it as a reality, we tend to recoil from it and resort to centralised decision making and imposition. My solution is that we should encourage workplace decision making of the kind that my right hon. Friend the Member for Charnwood mentioned. I see no reason why proprietors and work forces in offices, factories, restaurants and pubs should not be able to get together to make their own decisions about whether their premises should allow smoking, ban smoking or allow different things in different parts of the premises.

Last night, I went to St. Stephen's tavern, right next door to us here in Westminster, to assess the effectiveness of the removal of smoke from the atmosphere. I even lit up a cigarette and puffed at it energetically to see what would happen. Everyone present in the room agreed that although people were smoking, there was no trace of cigarette smoke at all. I can see one or two hon. Friends who were also there. Instead of instinctively saying, as so many politicians do, "We're going to try to use the force of the law to make you good people out there do what we think is right for you", why cannot we challenge people to take a sensible approach to the vexed subject of smoking? Why cannot we challenge proprietors to ensure that their premises are smoke-free by using the technology that is now freely available and was demonstrated to some of us last night? Why not allow that element of choice to prevail?

As my right hon. Friend the Member for Charnwood said, we can use our power as consumers to try to persuade people to do what we think is right. In other words, if we find smoke offensive, we can decide not to use bars, pubs, restaurants or other premises where it is present. If sufficient of us were prepared to do that, their proprietors would have to make a decision on whether to deem them smoke-free or partly smoke-free.I see no reason why we, as consumers, as well as proprietors and members of the work force, cannot make rational choices in the workplace and in the community. That is preferable to having us here reaching for the law—as we so often instinctively, and wrongly, do—and seeking to impose our view on our citizenry and voters.

I shall reluctantly support the Bill on Second Reading in the hope that we can water it down in Committee or on Report to move it towards a more truly liberal approach than the rather heavy-handed approach that it takes at the moment. I am not terribly optimistic, but I shall do my best to move it in that direction.

Bob Laxton (Labour, Derby North)

Unlike the right hon. Member for Bromley and Chislehurst (Mr. Forth), who could by no stretch of the imagination be described as a zealot about anything, I admit to being a bit of a zealot when it comes to smoking. Indeed, I have been a virulent anti-smoker for many years. If someone put my name into Google or looked me up in "Who's Who", they would see that I once described smoking as a dirty, filthy, stinking, antisocial, expensive, bourgeois habit. [Interruption.] That is my weird sense of humour. We all know that these days smoking is generally a working-class habit.

I approach the subject with an almost missionary fervour. About 10 years ago, when the issue of not smoking was not particularly fashionable, I was leader of Derby city council, where we brought in an anti-smoking policy. We stopped all smoking in the work force and required people who indulged in this dirty, filthy, stinking, antisocial and expensive habit to go to little nicotine-ridden rooms where they could have a quick drag in clouds of smoke. We did that because there was a huge conflict between smokers and non-smokers in open office areas.

We introduced that policy in June 1995. In November 1995, we went further and wrote it into people's contract of employment and stated it in all job adverts. Applicants were advised that we had a clear non-smoking policy and that, if they wanted to smoke in the workplace, they need not bother to apply for a job at Derby city council. I came in for some heavy criticism. I was told, "You're denying the city council the chance of employing the very best employees around." I replied, "I think that people who smoke are stupid, and why would Derby city council want to employ stupid people?"

Eric Joyce (Labour, Falkirk)

If someone wanted to work in a pub that allowed smoking, would my hon. Friend use exactly the same argument and therefore argue for allowing smoking in pubs?

Bob Laxton (Labour, Derby North)

Yes, there is an argument for that.

By now, anyone would have concluded that, as a virulent anti-smoker, I would be very much in favour of a total ban across the piece. I took that view until about six months ago, but I have finessed it a little because of some of the impositions that have been put on the statute book. I do not want to drag up banning hunting with dogs, but we have seen that people are circumventing that legislation and operating illegally, or with dubious legality.

I have changed my position and, if there is a Division tonight, I shall support the Government. The Bill gets us 90 or 95 per cent.—some would say 99 per cent.—of the way to achieving our aim. In talking to heavy smokers, I have found that some accept that smoking is bad for their health, colleagues and families, including their children, but have no intention of kicking the dirty, filthy, stinking, antisocial and expensive habit. Those people will smoke, come what may.

Martin Horwood (Liberal Democrat, Cheltenham)

Will the hon. Gentleman give way?

Bob Laxton (Labour, Derby North)

No, I shall not take interventions.

The Bill gives people such as me an element of choice, which I do not currently have. Most pubs allow smoking in part of their establishment. Perhaps they do not allow it in the restaurant or perhaps they have a no-smoking area, but most restrictions are ineffective in practice.

Greg Knight (Conservative, East Yorkshire)

Will the hon. Gentleman give way?

Bob Laxton (Labour, Derby North)

No.

Greg Knight (Conservative, East Yorkshire)

To me?

Bob Laxton (Labour, Derby North)

No, not even to the previous Conservative Member for Derby, North, whom I was pleased to defeat at the time.

The non-smoking facilities in many public houses are inadequate. Under the new arrangements, I shall have a choice. I will be able to go to a wide variety of establishments if—as I do—I wish to socialise in a non-smoking environment. Those who want to smoke, insist on smoking and demand the right to smoke will be able to go to establishments that are full of cigarette smoke where they can indulge their dirty, filthy, stinking, antisocial and expensive activity. The Bill provides an element of choice that hitherto did not exist.

Some Conservative Members suggested that public houses would decide to junk food and become drinking-only establishments so that they could get the punters in, chuffing away fast and furiously. I do not believe that that will happen. If we consider how social activity and public houses have changed in modern Britain, we realise that most establishments need to sell food to stay in business. In my locality—I guess that it is not very different elsewhere—all country pubs, pubs on the fringes of cities and those near city centres sell food. If they did not, they would not survive. If they decided to get rid of food to attract people who wanted to indulge in the dirty, filthy, stinking, antisocial and expensive habit, they would go out of business. Market forces mean that there will be public houses full of smoke and—thank God—public houses that have a clean environment, where people such as me can go and breathe reasonably fresh air and, perhaps for the first time, enjoy the wonderful aroma from the head of a good pint of Marston's Pedigree.

The Government have got it just about right. That is why I shall support the Bill.

George Young (Conservative, North West Hampshire)

It is a pleasure to follow the hon. Member for Derby, North (Mr. Laxton), who runs a serious risk of serving on the Committee because, until he spoke, the score was: Secretary of State 0, Labour rebels 3. I hope that the Committee of Selection reflects the variety of opinion on the Back Benches when it chooses a Committee to consider the detail of the Bill.

Before I deal with part 1, I should like briefly to mention clause 34 on ophthalmic services. The Macular Disease Society is based in Andover in my constituency and it and the Royal National Institute of the Blind have raised some issues that are best considered in Committee about the services that are optional and those that the primary care trust must provide. However, as smoking at least doubles a person's chance of losing sight in later life, that brings me to part 1 and the wisdom of my party's allowing us a free vote. I take a substantially different view from that of my right hon. Friends the Members for Charnwood (Mr. Dorrell) and for Bromley and Chislehurst (Mr. Forth).

My right hon. Friend the Member for Charnwood prefaced his remarks with a definition of what an individual was entitled to do in a private space. I agree with him. However, the Bill does not deal with what an individual does in a private space. Clause 2 makes clear the spaces that we are discussing.

We have made great progress in reducing the number of avoidable premature deaths that are caused by smoking. The Bill offers an opportunity to build on those achievements. However, there is a risk of a missed opportunity because of the political compromise on which it is built. That is an unsound foundation for a credible public health policy. If, as the Secretary of State implied at the weekend, it is right to introduce a total ban in three years, it is right to do it now. It would be absurd to have two bites at the cherry and two different regimes. It is worth reminding hon. Members, especially Labour Members, of the Prime Minister's words at the Labour party conference:

"Every time I've ever introduced a reform in government, I wish in retrospect I had gone further."

That applies to this measure.

When I was first elected, the House of Commons sold its own cigarettes, with the green portcullis on the pack. My first modest engagement against the tobacco industry was with the then Catering Committee. I asked it to withdraw the product on the ground that it gave parliamentary validation to an activity that killed thousands of our constituents. I failed, but it agreed to reduce the cigarettes from high to low tar. The product was subsequently rightly removed from the shelves.

Parliament has not hesitated to use legislation to combat smoking. The ban on television advertisements dates back to the 1960s. More recently, we have introduced legislation to ban advertising except at the point of sale. I welcome that. We have also used voluntary agreements but they have been less satisfactory because the industry has been reluctant voluntarily to concede anything that would do it serious harm.

The Bill is a legacy from the previous Secretary of State for Health, the right hon. Member for Airdrie and Shotts (John Reid). He was not quite as bad as the chain-smoking health Minister in "Yes, Minister", but he did the Department's reputation no good in proposing the compromise a year ago. I recall telling him in the House at the time that it would not work. However, due to secondary lobbying, his influence is pervasive and visible in the Bill. From next March, his constituents will enjoy enclosed public spaces that are free from tobacco smoke, and the risk of lung cancer will fall by 24 per cent. for those helped by that measure in Scotland. However, he has used his influence in Cabinet to ensure that my constituents in Hampshire will not share that advantage. It is not so much the West Lothian question as the West Virginian question.

It is hard to find a subject on which the Cabinet agrees nowadays. The disagreement on smoking was the best advertised since that on prescription charges 50 years ago. At business questions a few weeks ago, I asked the Leader of the House for a free vote on the matter for Labour Members, but the request was dismissed.

Conservative Members have a free vote. I understand the libertarian argument that my right hon. Friends the Members for Charnwood and for Bromley and Chislehurst presented but a person's freedom to smoke ends where my nose begins. I remind my right hon. and hon. Friends that it became compulsory for motor cyclists to wear crash helmets and car passengers to wear seatbelts under a Conservative Government. When I was a health Minister some 25 years ago, I remember advocating the application of fluoride to water supplies in the interests of dental health. Despite the comments of my right hon. Friend the Member for Charnwood, his Government did exactly the things in the interests of public health that he claims that they should not have done. Our party has, in some circumstances and in the broader public interest, curtailed the liberty of the individual to harm himself and others. It is an extraordinary Bill. Indeed, one wonders whether it is a Bill or a Green Paper. Clause 3(2) refers to

"Examples of descriptions of premises which may be specified".

I have never come across a Bill with language of that type, being wholly unspecific as to what it is that will be exempt.

Members have asked whether there are already smoke-free pubs. There are some—12 in Hampshire are already smoke-free. Presumably, that is because it makes financial sense. I say that to reassure those in the trade who are worried that the consequences of going smoke-free will be injurious to their profits.

It is worth reminding the House that, in 2001, the Prime Minister promised in the Labour party manifesto that we would have a more democratic second Chamber. He then voted for a wholly appointed second Chamber. I hope that the Government Whips extend to all Labour Members the latitude enjoyed by the Prime Minister on the occasion when they get to vote for a total ban.

I recall negotiating with what was then the Tobacco Advisory Committee in the 1970s, trying to get the health warning not only on the pack of cigarettes but on individual cigarettes. I was told that that was not possible as the ink has carcinogenic properties. My negotiations with the committee taught me one thing, which was that the industry can live with tax increases, health warnings and a larger budget for those with responsibility for health education. It really feared that smoking would be branded as an antisocial unhygienic and unacceptable activity. A ban on smoking in public places would do just that. The industry would do all that it could to qualify that statement, hence its reliance on the ventilation argument and its enthusiasm to have as many exemptions as possible. It will do anything to give legitimacy to the activity by permitting it.

The industry wants confusion among the public as to where it is and is not legal to smoke. It wants different regimes in different parts of the United Kingdom. That is because the argument would be blunted and the waters would be muddied. The industry most fears a clear statement from Parliament that smoking is an unacceptable activity in an enclosed public space. It is that statement—not an impracticable, illogical compromise—that I hope the Bill will embody when it leaves the House.

Louise Ellman (Labour, Liverpool, Riverside)

I praise the Government for the positive and strong efforts that they have made in addressing the problems of smoking. I shall make a simple plea, and that is to say to the Government that they should grasp the nettle, go further than the proposals set out in the Bill and follow the lead from Smoke-Free Liverpool, which proposes a comprehensive ban on smoking in enclosed workplaces, including all licensed premises.

Smoke-Free Liverpool brings together the city council on a cross-party basis, the primary care trusts, John Moores university, the Roy Castle foundation, the chambers of commerce and the trades council. It has brought those organisations together to introduce a private Bill, currently in the other place, that proposes a comprehensive ban on smoking in enclosed workplaces in Liverpool. The Bill has had its Second Reading in the other place and awaits detailed scrutiny. It is important. It is an initiative that comes from Liverpool. It shows realistically what can be done.

The impact of Smoke-Free Liverpool has been profound, even in the short time in which it has been in existence. It has been working closely in the community and there has been a 25 per cent. increase in the number of people who want to stop smoking approaching smoking cessation services. There has been work across the communities and work with young people. There has been significant correspondence and discussion with the chief medical officer. Indeed, Sir Liam Donaldson wrote to Smoke-Free Liverpool on 7 November and stated:

"Finally, I have made it clear that I am totally opposed to the various hybrid proposals that were discussed and my view was made known to members of the relevant Cabinet Sub-Committee."

He supports the major thrust of the proposals coming from Smoke-Free Liverpool. In his letter, Sir Liam drew attention to the significant change in public opinion on this issue over the past two or three years. It is clear that public opinion is changing. Following the Government's own consultation, it was found that 90 per cent. and more of the 57,000 respondents opposed the exemption for pubs not serving food. Did that include the 11,700 postcards and 8,500 e-mails which were sent as a consequence of that consultation from Smoke-Free Liverpool? There appears to be no reference to those replies in the official report on the consultation. It is significant that that should have happened.

There have been references to the situation in other parts of the world, including the United States. Scotland has decided to impose a complete ban from next March. Wales has decided to do so when it receives the necessary powers, and they will not be long in coming. The Republic of Ireland has already taken its decision. Northern Ireland Ministers have already proposed similar action there. The Under-Secretary of State wrote to Smoke-Free Liverpool on 26 October and stated that the main reason for his making the proposal was that

"a key factor in my decision was the evidence that partial controls would create a two-tier workforce whereby some employees would be protected from second-hand smoke while others would not."

An obvious question has to be asked. If it is right for employees in Northern Ireland—which is not at present under a devolved assembly—to be protected from second-hand smoke, why should that same protection be denied to employees in England? That does not make sense. The statement made by the Minister was clear and unequivocal.

The issue is about smoking in general. It is also about health and equality, given that that is a major thrust of Government policy. It is particularly about the impact of second-hand smoke and the effect of that on those who are not smokers. Employees must be a prime category in that consideration.

One reason why Smoke-Free Liverpool emerged was that Liverpool has had, regrettably, the title of the lung cancer centre of the United Kingdom. Indeed, the Roy Castle foundation had its headquarters in Liverpool for that very reason. That is a sad fact, given the prevalence of smoking in Liverpool. We see that 34 per cent. of the population are smokers. If we look more closely at the work done by Smoke-Free Liverpool, we see that that figure increases to 50 per cent. in some of the most deprived areas in the city.

There is the Government's evidence and the reasons for their current recommendations. They state that throughout the country, presumably, between 10 and 30 per cent. of pubs will be exempt from the ban. That is because they do not serve food. In Liverpool, that figure is 59 per cent. In Liverpool, an area suffering great ill health, six out of 10 pubs do not serve food and a third of pubs currently serving food say that they would stop doing so if the proposals in the Bill came into force. The impact of that would be to increase health inequality.

The report to the Department of Health from the Scientific Committee on Tobacco and Health underlines the significance of second-hand smoke. The increased risk of heart disease goes up by 25 per cent. The increased risk of lung cancer goes up by 24 per cent. Even low levels of second-hand smoking increases the risk of adults developing asthma by up to five-fold. That is clear, and it should not be accepted. All those risks will be exacerbated for bar workers, who will be subject to second-hand smoking in a concentrated form. That concern should be foremost in our deliberations.

Eric Joyce (Labour, Falkirk)

My hon. Friend mentioned in passing the question of displacement, but she did not give it sufficient attention. If we are to measure the effect on health of a complete ban on smoking, we must also take into account the effect that such a ban would have on displacing smoking into the home. Some people will be discouraged from going to pubs and clubs and will therefore smoke and drink more at home. Should not that be taken into account when we consider the effects of this legislation?

The rest of the debate is in Hansard.