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Lord Colwyn: My Lords, at this stage of a debate there tends to be some repetition, particularly of statistical evidence. However, I welcome the Bill and the changes that have been made in the other place. The other place has been discussing dentistry this afternoon. Normally, when speaking on a health Bill I can steer it round towards dentistry. The Minister will be delighted to hear that that has not proved possible this evening.
Although most smoke-related deaths are caused by passive smoking at home, about 500 each year are due to exposure at work. This exposure is particularly high in the hospitality industry and is likely to affect bar workers and, indeed, musicians. Perhaps I have been lucky, having played my trumpet for more than 40 years in smoke-filled bars, clubs, hotels, and marquees withoutas yeta smoke-related problem. I commend the work of the Roy Castle foundation on this particular issue. Roy died from lung cancer at an early age, and passive smoking was thought to have been the major cause of his disease.
Although I dislike any nanny-state regulations and the restriction of freedom of choice, I did think that the provision of smoking areas and smoke extraction could go a long way to lessening the risk. It was a regular subject for discussion during my time as chairman of the Refreshment Department, and the committee tried to accommodate the wishes of all members. I am sure that the matter is still being discussed regularly. However, my medical training and the statistical evidence has convinced me that the introduction of smoke-free policies will improve public health, or generate long-term health
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improvements and reductions in health social inequality. These benefits must override the issues relating to freedom of choice.
I am proud to have been present for one of Sir Richard Doll's early lectures on the association of lung cancer and smoking many years ago and, like the Minister, I pay tribute to his work on this subject. At one time, I thought that a ban in public places would increase smoking at home, but the evidence now shows that where smoke-free workplaces and enclosed public places are accepted, there tends to be less smoking at home. That is clearly the case following the ban in Ireland. The legislation could lead to a million people quitting smoking. Thousands of lives will be saved and the economy will benefit by about £4 billion.
I shall now stress some of the points made by the noble Baroness, Lady Murphy. For many years I have thought that there should be changes in working practices in community pharmacies to allow pharmacists to make best use of their skills and experience for the benefit of the public. I was attached to Boots via the Industry and Parliamentary Trust when it widened its policy to build consultation areas into its pharmaceutical outlets for direct patient advice. Doctors should not have to spend time on minor illnesses and infections when practice nurses and pharmacists are equipped by their qualifications to deal with this important aspect of primary care.
The Bill deals with many of the issues of concern relating to supervision and responsibility in a pharmacy. Pharmacists will be allowed more freedom to begin to provide some of the other services set out in the newly negotiated community pharmacy contract. A responsible pharmacist will have professional accountability for all processes in the pharmacy and will be able to carry out other duties, such as visiting patients and meeting local GPs, when pharmacy activities can be delegated to appropriately trained pharmacy technicians. That is to be welcomed.
When I first read the Bill, I was concerned that it might affect the regulations currently applied to the way drugs and medicines are stored and dispensed by groups of general practitioners who effectively run small pharmacies within their practices. This issue is not covered by the many pages of briefing notes that I have received, so I assume that there will be no change in the current situation. But will the Minister specifically confirm that the Bill will not affect this vital and essential service, and that suitably trained doctors' dispensers will continue to dispense without the supervision of a pharmacist? That is particularly important in rural areas, where pharmacies can be many miles from the doctor's surgery. I ask for confirmation as I am aware that the relationships between community pharmacies and doctors' dispensing outlets are not always ones of mutual agreement, yet they are essential for the efficient management of many practices.
I also welcome the provisions in the Bill relating to healthcare-associated infections. This is a major problem that is not under control, and I am concerned that the final version of the code of practice will be
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unnecessarily delayed by the decision that it should not be published until the Bill receives Royal Assent. The latest figures for MRSA reveal that the NHS will not achieve its goal of cutting rates by 50 per cent within the next two years. The number of deaths linked to MRSA has risen by 22 per cent. Research has shown that up to 100,000 patients admitted to hospital each year were unknown carriers of MRSA. I should have thought that identification of those carriers should be fairly straightforward and an absolute priority.
The need for the code to be relevant to all health care, and its relationship to hospital design, staff-patient ratios, bed occupancy, isolation facilities, and a clean air environment, must be addressed urgently. Finally, a brief comment on the supervision of management and the use of controlled drugs, as that directly affects my own work when I have to order drugs, store them, carry them with me, and prescribe and use them in different situations. I hope that the Minister can confirm that this legislation will not affect the right of healthcare professionals to prescribe these drugs.
I welcome the response to the Shipman inquiry and the fact that routine monitoring and inspection of controlled drugs in community pharmacies is likely to become a role undertaken by the pharmacy inspectorate of the Royal Pharmaceutical Society.
being able to enter premises. Pharmacy bodies have been negotiating on the inspection of controlled drugs in England, but not in Wales or Scotland. Given the preparations for the transfer of this role to the Royal Pharmaceutical Society inspectorate, I know that they are keen to receive clarification on this issue.
While welcoming the Bill, I am concerned about the sheer volume of detailed provisions that will be enacted through regulations that will have little scope for amendment once made. I hope that the Minister will be able to set out as much detail as possible in the Bill.
Lord Walton of Detchant: My Lords, I am a fervent believer in the rights of the individual and in personal freedom. That leaves me free to indulge in a habit, if I so wish, such as smoking, if I am alone, but it does not give me the right to indulge in a habit such as smoking in the presence of other individuals who thereby could be seriously harmed. That is one of the core principles underlying the Bill as amended. I am very glad to see the noble Lord, Lord Naseby, back in his place because the attitude of the medical profession has undergone a sea change over the past 50 or 60 years on this issue.
Many years ago, when I was a medical student, the professors of anatomy and physiology recommended that we should all smoke, particularly in the dissecting
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room, as it would help to dispel the odours. More than 60 years ago, when I was in the Army as second in command of an army hospital ship in the Royal Army Medical Corps, I used to buy a 50-can of Senior Service every other day and I got through it in two days. It cost one shilling and eight pence and I smoked 25 cigarettes a day. Then, when Sir Richard Doll produced his first paper, with Bradford Hill and others, I began to see that there were some risks in smoking. However, the evidence at that time suggested that pipe smoking was less dangerous than cigarette smoking, so I moved on to a pipe. In another 10 years' time, the risks associated with pipe smoking of tobaccoindeed all tobacco consumptionbecame increasingly clear and I gave up nearly 40 years ago. For a time I had that feeling, like Lady Macbeth:
I give that personal history because, since that time, the evidence on direct, personal smoking has accumulated steadily and progressively, not only in relation to cancer of the lung or cardiovascular disease, but also in relation to many other cancers. I can quote to my noble friend Lord Skidelsky, although I shall not tonight, the massive volume of statistical evidence that has clearly underlined the facts relating to this matter.
Some 20 years ago, I chaired a conference at Green College, where I followed Sir Richard Doll as the warden, on the effects of passive smoking. We took a lot of evidence from skilled individuals, such as statisticians, doctors, scientists, and from members of the public. We came to the conclusion that there was anecdotal evidence suggesting that perhaps passive smoking might be harmful. In the past 20 years, the statistics have steadily accumulated and the evidence is now absolutely cast-iron. There is a very large body of scientific literature that makes that point clear. As my noble friend Lady Howarth said, the BMA published evidence last March showing that second-hand smoke is likely to be responsible for the deaths of more than two employed people every working daymore than 600 deaths a yearand at least one employee in the hospitality industry dies each week54 deaths a yearfrom passive exposure to tobacco smoke.
I appreciate what was in the Government's manifesto, but I congratulate the Members of another place on their good sense in introducing the amendments to change the Bill from what had originally been in the manifesto to enact a total ban on smoking in public places, including private members' clubs. I would be delighted if the Bamburgh Castle Golf Club, of which I am president, enacted a ban on smoking. The noble Lord, Lord Geddes, who is not in his place, won a competition there a few years ago. I believe that will be very important because everyone, including those working in private clubs and pubs that do not serve food, has the human right to work without being exposed to poisonous and life-threatening substances. For that reason, the provision relating to private members' clubs is very important.
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On the points made by the noble Lord, Lord Naseby, on ventilation, I commend to him the parliamentary brief from the British Medical Association with a series of very precise references to scientific research studies in Europe, which demonstrate that,
I agree with her entirely. The Royal College of Physicians estimates that some 12,000 deaths per year occur from passive smoking, but the great majority of those occur in the home. The figures for the workplace are very much smaller, at 500 to 600. Most of the deaths are caused by passive smoking at home, but exposure is particularly high for some workers in the hospitality industry. Preventing passive smoking at home, particularly for children, is, therefore, a public health priority. Home exposure is prevented only by encouraging parents and carers to quit smoking completely by making homes completely smoke-free. I agree entirely with what the noble Lord, Lord Colwyn, said. There is a widespread misconception that banning smoking in public places will lead to an increase in tobacco consumption in the home. In fact, the reverse is the case. There is now growing evidence that where smoke-free workplaces and smoke-free enclosed public places are the norm, parents report that they are more likely to try to prevent smoking in the home. In Ireland there has been a significant increase in the percentage of smokers who ban smoking in their own homes. I firmly and warmly support Clause 1 of the Bill as amended in the other place. I believe it will make a massive contribution to public health.
I shall comment briefly on Parts 2 and 3. The Royal College of Nursing welcomes the action that is now proposed to tackle healthcare-associated infection. But they have some specific concerns, which the Minister may be able to allay, relating to the scope of the code of practice, the timetable for introducing the final code of practice and the need to ensure that the code for acute settings is not just transferred to the primary and independent care settings without consultation on its impact. That is particularly important in relation to care homes, as other noble Lords have said. Others have pointed out the concern expressed by the Royal College of Nursing about the definition of healthcare-associated infection. They much prefer the definition of the Health Protection Agency and not the one in the Bill. I hope that the Minister will be able to comment on that.
I turn to Part 3 and the anxieties expressed by the Royal Pharmaceutical Society of Great Britain, which wants assurances that it will be an active participant in the drafting of the regulations which, as the noble Lord, Lord Colwyn, said, are likely to come thick and
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fast once the Bill has become law. The legislation should clearly define those activities that can be undertaken only when the responsible pharmacist is present and should include clear lines of accountability, provisions for the responsible pharmacist to be contactable when absent and in a position to return without undue delay, and provisions for the responsible pharmacist to justify any absence from the pharmacy.
being able to enter premises. Given the preparations for the transfer of that role to the RPSGB inspectorate, it believes that the role of the Royal Pharmaceutical Society in inspecting pharmacies should be stated on the face of the Bill, over and above the role of the constable.
Those are the points that I wished to make at Second Reading. I hope that your Lordships will give warm support to the Bill in general, but will be prepared to look at some of the points that I have raised when it comes to Committee stage, in particular the strong support that we have heard from all sides of the House for the ban on smoking in enclosed public spaces.
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