06 August 2004
Former smokers are supposed to take up the anti-smoking cause with an evangelist's zeal. Not so John Reid, apparently.
Although the health secretary is a firm supporter of NHS smoking cessation programmes, he feels they will succeed in poorer households only when the wider issue of social exclusion has been addressed.
Hence his comment that smoking may be the only pleasure available to a single mother on a sink estate, which raised the hackles of anti-smoking campaigners.
Their suspicions were roused further last week when he was portrayed as (at best) dithering on the one public health measure that could significantly reduce smoking – banning the habit in enclosed public places.
Reid's stance on the ban is simple. He believes in treating the public as adults – giving them information on the dangers of smoking together with help to give up. While this might smack of good, old-fashioned libertarianism, Reid's political instincts tell him that supporting a ban would leave him open to accusations of creating a nanny state. This led to a reported meeting with leisure industry bosses in June, where Reid is said to have encouraged them to introduce a voluntary ban.
The health secretary's manoeuvrings have brought him into conflict with England's most senior doctor, chief medical officer Sir Liam Donaldson, who last week launched a barrage on the tobacco industry.
In his annual report, Donaldson says that there is no economic argument against imposing a smoking ban in public places, such as bars and restaurants.
Speaking of Reid, the chief medical officer says: 'I do disagree with his reluctance to introduce legislation on smoking. But, to be fair, he says his mind remains open. I think his concern is how we get there, not whether we get there.'
Reid's mind is being kept open because he cannot be seen to prejudge a consultation exercise on the smoking ban and many other public health issues, which was completed at the end of June.
This will inform a white paper, Choosing health, to be published in the autumn, and only then will he come down on one side of the fence. Legislation is expected in the next Parliament.
Yet the arguments in favour of a ban are becoming compelling. This week, a Hansard Society survey of 15,000 people found 84% in favour of prohibiting smoking in public.
Donaldson claims the country would be £2.3bn–£2.7bn better off, before counting the benefits to the health service. He adds that the hospitality sector would not suffer.
'In other parts of the world where legislation to create smoke-free public places and workplaces has been introduced, profits in the hospitality and leisure industries rise,' he says. 'The only remaining reason not to do it in the face of majority public opinion in favour is on the grounds of defending the smoker's rights. But as one young woman bar worker in San Francisco put it to me rather pithily: “Your freedom ends where my nose starts”.'
The CMO's views are backed by the British Medical Association, which has called for the introduction of a ban since 1988.
'I have seen smoke-free pubs and restaurants in Ireland thronging with crowds of people. Business is booming in smoke-free Ireland and lives are being saved,' says Peter Maguire, deputy chair of the BMA's board of science.
'The government really has no excuse. It's time for ministers to show leadership and follow the examples of Ireland, Norway and New York and go smoke-free.'
But first, the NHS must get its own house in order. Health service premises were supposed to be 'virtually smoke-free' by the end of 1993, a target that was never achieved. Donaldson wants them to be completely smoke-free by the end of the year.
NHS Confederation chief executive Gill Morgan says the NHS should lead the way in creating smoke-free workplaces.
'There are genuine challenges in implementing this policy within the next five months. Such a ban must not disrupt the treatment of patients, specifically some mental health users,' she says, 'and it is important NHS organisations are able to consult with their staff over the introduction of the ban. This would create a very tight timetable for action.'
It seems that it is now a question of when, not if, a public smoking ban will be introduced. As a former holder of Scotland's Champion Smoker title, this may not come easily to Reid and he is still hoping for a voluntary ban. But if this is not possible, he will need to take a deep breath and call time on second-hand smoke.