THURSDAY 18 NOVEMBER 1999

PROFESSOR LIAM DONALDSON, DR DAWN MILNER, MR TIM BAXTER AND MR PAUL LINCOLN

  160. Do you not think that in view of the fact that you accept the link then the Government's stance is a bit weak in terms of practice and in the use of voluntary agreements in so much of this area?
  (Professor Donaldson) The fact that they have gone for a voluntary agreement rather than banning smoking in public places entirely, do you mean?

  161. Do you not think that something rather tougher is needed? For example, I always take the example of restaurants where I know Government takes the view that it is a nanny state to say that people cannot smoke in restaurants but the evidence is that the only effective way to deal with it is by that sort of rule.
  (Professor Donaldson) You will have seen within the Tobacco White Paper the approach on this. It is a voluntary agreement that the Government chose to use but it is not with the tobacco industry, it is with restaurateurs and owners of public places and things of that sort. I think Mr Baxter was there when the policy was actually formulated. As I understand it if that does not work then tougher measures will be looked at.
  (Mr Baxter) I actually arrived after the policy was formulated. Certainly there is a mixed experience worldwide about bans, they seem to work well in some places and not others. The Government took the view that they wanted to try to reach beneficial ends by more voluntary means, so there is the Public Places Charter which is actually the Licensed Hospitality Trades Charter but we have strongly supported it. We look forward to a lot more action in that area from the industry. Certainly the Government reserves its position to introduce tougher measures if no progress is made. I should also mention the Approved Code of Practice on Smoking in the Workplace which the Health and Safety Commission have consulted on and that consultation is finished. If the Commission introduced that particular measure that would have a very marked effect. Most public places are somebody's workplace. The ACOP would make sure that those employers who do not take smoking in the workplace seriously do actually take it seriously because it is a very powerful clarification and support of the law. Coming back to the Chief Medical Officer's point that the Government is not necessarily going to be satisfied with voluntary measures, the results have to be obtained.

  162. I just wonder how long they will go on before they actually are tougher in terms of the legislation. I know from a paper that came through to me this morning that at least in the House of Commons they are increasing the restrictions on tobacco use in eating places in the House of Commons. They are prepared to introduce a nanny state, they think that is all right as far as MPs are concerned but I think it is taking too long and they are too tolerant as far as the trade in general is concerned.
  (Mr Baxter) I think it is fair to say that these are issues to pursue with ministers when you hear their evidence.

  Mr Gunnell: One or two of them have heard me on about it before.

  163. The scientific committee has stressed very clearly that it is necessary to protect non-smokers in the workplace. I assume that in the Department of Health non-smokers working in the Department of Health are so protected and can work in a smoke-free atmosphere?
  (Professor Donaldson) Yes. I should say that I previously, prior to my taking up appointment last year, was in charge of one of the eight regional offices of the NHS, which is part of the Department of Health, and in that building in Durham there was no smoking right down to the end of the car park, so people were not allowed to smoke outside the door because it set a bad example, they were not allowed to go into the car park and smoke. In the Department of Health buildings at the moment they are smoke-free apart from a smoking room that is set aside for smokers. My own view is that that is not part of a modern policy but I have only been there a year and I am chipping away at it.

  164. In respect of modern policy, contrary to what my colleague Mr Gunnell says, it is not possible to guarantee a smoke-free environment for people who work in the Palace of Westminster. Would you give some advice to the Palace authorities?
  (Professor Donaldson) I believe I would not hesitate in saying that MPs should set an example, given the number of deaths that occur in this country, and the House of Commons and the Palace of Westminster should be declared smoke-free premises and we should trumpet that as loudly as we can.

  Chairman: I will bring in the persecuted minority, Mr Burns.

  165. Could I just ask, how have you responded to the tobacco companies' claims that there is no proof of a link between environmental tobacco smoke and long-term illness?
  (Mr Baxter) I think we fundamentally disagree and rely on the scientific evidence.

  166. With all the extra money that has been announced, both by the Chancellor in a variety of Budgets and pre-Budget statements and also the commitments in the White Paper, do you know or do you anticipate that there will be more money spent from those sources on cessation programmes and on public health campaigns in addition to what is already anticipated to be spent?
  (Mr Baxter) I think the answer is that obviously the money should go on tackling the big killers, cancer and CHD. That does not necessarily mean that it will go all or part on smoking cessation and those will continue to be funded, but my understanding of the position is that it will be for tackling those killers within the NHS. Smoking is a very important part of that but it is not the only one. That is my understanding.

  167. Going back to Mrs Wise's earlier point about patches and all the other things available to try and encourage people to get off smoking, would there not be a drive within the Department to seek, if there is some extra money coming in from these sources, to divert more for, say, more than one week of patches or whatever it is across the whole country from April next year on the grounds that preventive medicine or preventive means are as effective as other means of dealing with the problem? I know it is a question of balance but is there a role here for more money?
  (Professor Donaldson) That is our philosophy and, indeed, in reducing the cancer mortality in the population experts have said that the balance would be three-fifths prevention, one-fifth pre-symptomatic screening and one-fifth treatment. That would be how the action would have to flow. So that is definitely our philosophy. We have had money put behind these programmes, as you know. We are just starting to spend it and I think we will be reviewing it and urging ministers to review it as we go along.

  168. Would the Department have liked to see in the Queen's Speech yesterday a really comprehensive bill banning smoking entirely?
  (Professor Donaldson) I think most of the evidence and opinion suggests that complete prohibition of things does not work, is not an effective strategy, and I think that is the view on tobacco as well.

  169. Following on from that, anyone who smokes, they pick up a packet of cigarettes and it says on the packet that this is likely to kill you or cause a fatal illness, etc. I am talking about adults now, not children. There we have grown adults picking up this packet, it tells you that if you smoke whatever is inside it it is likely to kill you. Does the Department not think that is sufficient?
  (Professor Donaldson) Evidence shows that warnings do make a contribution to stopping people smoking. They do not account for a big percentage of behaviour change. They are less likely to be effective in what the World Bank calls high income countries where levels of knowledge about the health effects are already high. They are probably less effective in children and more effective in adults. They do have an effect. The other piece of evidence suggests that you should change them regularly and refresh the message so that people do not become bored and switch off from it. It does have an important part to play. I think stronger messages mean changing the message and trying to fit it more to people's opinion. For example, I understand—I do not know whether it has been formally evaluated yet—the Health Education Authority advertising campaign recently which drew attention to the effects which smoking has on the ageing of women's skin was highly effective with young women and very alarming to them. It may be that in addition to messages about cancer and heart disease and so on, we can target some of the messages more closely to what people worry about in the short term if you like.

  170. I am just a bit puzzled about that. We are going off to America and as far as I am concerned whilst there might be some good things there is an awful lot of trash but we are going to learn at first hand about litigation and all of that. If you drink a bottle of whisky perhaps you feel good about it but you do not pick up a bottle of whisky and it says "this is likely to damage your health", etc., etc. Anyone in their right mind must realise that taking smoke—we can talk about derivatives and all the rest of it—is not going to improve your health. Here we have the most graphic warning imaginable, a packet of cigarettes, there it is, it is going to kill you and it still is not enough which is probably why I asked my first question, if the Department has it in mind to ban smoking completely.
  (Professor Donaldson) I do not think that is the plan, no. I do not think prohibition would work. Within the range of measures that have been shown over the years to be effective, even some of them which are confronting for the first time the tobacco companies, those are now in place.

  171. Does the Department give any money to ASH at all?
  (Professor Donaldson) Yes. I do not know whether we can give you the precise amount off the top of our heads but we can certainly send it to the Committee.
  (Mr Baxter) Section 64 grants. You can ask Mr Bates next week actually.

  172. The final question: is the Department doing much work on the relationship between someone suffering a stroke and the effects of smoking? It is always cancer and heart disease that is mentioned all the time but I have not heard stroke mentioned, unless I missed it.
  (Professor Donaldson) There is an association with stroke. Broadly there are six or seven cancers which have been associated with smoking, lung cancer being the most prominent. Coronary heart disease, chronic bronchitis and emphysema are the other main diseases. Smoking does increase the risk of stroke but it is not as powerful a risk factor as it is with heart disease and cancer. It does increase risk. Other risk factors for a stroke include diet, excessive intake of alcohol and high blood pressure.

  173. Can I go through this business of refreshing the message which I think is very important because people just do not see it any more. I took your point about skin. When this Committee looked at advertising a while ago, a few years ago, it was suggested to us that male virility can be adversely affected. It did strike me at the time that could be a very powerful message indeed because young people always think they are going to die sometime and when they think of bronchitis they associate it with old men, not with themselves. Also with the cancers, there is a heavy emphasis on lung cancer, for reasons which I well understand, but oral cancer does strike me as having a bigger horror effect and yet I do not seem to see a mention of oral cancer although you are five times as likely to get oral cancer. I do not know what the likelihood is but five times could be the message. Do you think that there is enough imagination used in creating a more positive aversion, not just a cold warning which demands rationality, which they do not have, but actual aversion?
  (Professor Donaldson) Yes, I think it is a very important point. Cancer is used as an umbrella term but it does include all those sorts of cancers and it may be that certain groups should be targeted particularly with particular messages. But there is a field of study and if the Committee had time to call as a witness Professor Gerard Hastings from the University of Strathclyde, he is an expert in what is called social marketing of health and they research groups of the population, young people, people living in particular areas, and try to identify the precise reason why they are adopting a particularly unhealthy behaviour and the things that would help them to stop the things that scare them and then to target health education and advertising campaigns on a tailored basis according to segments of the population.

  174. Finally, can either Mr Lincoln or Professor Donaldson point us in the direction of any surveys which may have been done amongst young people, teenagers, who do not smoke, to find out why they do not? Has there been any work?
  (Mr Lincoln) Yes, there have been lots of surveys along those lines. We would be happy to send you that information. We would also be happy to send you information about the effectiveness of different mass communication strategies as well. All the sorts of dimensions that you have mentioned have to different degrees been explored in other parts of the world and so on, and we are constantly looking at others' work.

  175. Does anyone have any further questions? Do any of the witnesses wish to add anything at all that we have not touched on?
  (Mr Baxter) Just to say I have copies of the draft Directive which has been discussed today and if that would help the Committee I could leave copies with you.

  176. That would be very good.
  (Professor Donaldson) Chairman, I am sure you are already taking evidence from the Home Office but the question of smuggling has not come up. We have not actually put in any evidence on that but we do regard it as an important issue.

  Chairman: Dr Milner, gentleman, may I thank you for your helpful evidence. We are most grateful for your co-operation. Thank you very much.