Good morning, everyone. I remind members and others that all pagers and mobile phones should be switched off. This is the Finance Committee's fifth meeting of 2005. Our first agenda item is consideration of the financial memorandum to the Smoking, Health and Social Care (Scotland) Bill, which the Minister for Health and Community Care, Andy Kerr, introduced on 16 December 2004.
Good morning, everyone. I thank the committee for inviting the Scottish Licensed Trade Association to give evidence. We contend that the research that the Executive conducted into the health and financial impacts of the proposed smoking ban is inadequate, to an extent irrelevant and definitely incomplete. Our research clearly shows that few total smoking bans are in place worldwide from which to draw conclusions. The Irish ban, which is the closest to home, has not been in place long enough for full evaluation. Health and economic benefits could be maximised by adopting a controlled and structured approach to curbing smoking and many countries have taken that course of action.
Can Gordon Greenhill make COSLA's opening statement?
I am happy to do that, but I will not use Eric Jackson's words.
I thank the committee for inviting the Scottish NHS Confederation. Our members fully support the bill's aim of reducing smoking and firmly believe that the provisions will reduce smoking. The health benefits that will flow from that will be most welcome. The provisions will make a significant difference to Scotland's health over time. Our evidence concentrates purely on those aspects of the bill that will have a direct financial impact on boards; we do not comment on the areas that will not.
Thank you for your opening statements. I invite questions from members.
I begin by asking the witnesses from the Scottish Licensed Trade Association how they quantify the research that they did. We would expect you to disagree with the official figures, which we got from the research that was carried out by the University of Aberdeen, but why do you disagree with them so much? How do you justify your comment that its report is "incomplete, irrelevant and rushed"?
We say that the research is incomplete and, to a certain extent, irrelevant because there are few countries in the world in which outright smoking bans have been implemented. There are only three—Ireland, New Zealand and Norway—and the bans in those countries are all recent. No research has been conducted into whether a phased approach to a smoking ban—as opposed to an outright ban—has greater benefits for health and less financial impact.
You produce statistics from the Moffat centre for travel and tourism business development at Glasgow Caledonian University, which suggest that your turnover will decline by £105 million, that
The research by the Centre for Economics and Business Research Ltd was conducted by examining the information that is available from the situation in Ireland. It concludes that turnover in Ireland is down by more than 7 per cent in value and 10 per cent in volume and that the number of jobs has reduced by 6 per cent. It took those figures, assigned them to the Scottish situation and worked out the numbers. The figures are quite scary and they are of considerable concern to our membership.
The Aberdeen research considered only one study and that was from California, where there is not a total ban. That study examined hotels and restaurants but not pubs, which is one of the reasons why we think that it is fundamentally flawed. There is a sectoral difference, but the study took only an aggregate look at the situation. We do not believe that one study from California should be the basis for such an important piece of legislation.
On the one hand, you say that the Irish example has not been in place long enough for us to make any real judgments, but on the other you outline facts and figures that appear to be produced from what we have seen already from the Irish legislation. You seem to want the best of both sides from the Irish experiment.
We have been put in that position by the timing of the bill. We are saying that we should wait for at least a year to see what the Irish experience throws up, because it is the closest experience to home on which we can work. We had to go with something because of the timing of the situation that we are in.
I welcome Councillor Eric Jackson and Alan McKeown to the meeting; Gordon Greenhill was able to give an opening statement on behalf of COSLA.
We can imagine that when people leave pubs and stand outside—especially pubs in tenements—noise will emanate upwards, particularly late at night. From the publican's point of view, it is difficult to control patrons and the level of noise when people go out into the street with alcohol. Also, there may be bans on drinking alcohol in the street. We can imagine that where there are a lot of nightclubs together in a street in the middle of a town, there could be more people out in the street than in the nightclubs.
One of the big differences between Scotland and Ireland is that we have so many more tenement properties. In such premises, there are no facilities to the rear of the pub because of the noise that would be caused to neighbours. In streets where there are rows of pubs, such as in the east end of Glasgow, there would be difficulties on busy soccer nights, with everybody spilling out of the pubs to smoke. We can imagine issues arising that do not apply in Ireland because of the different type of property structures there.
Many pubs have people on the door—I will not call them bouncers—to control access and egress, and obviously bar staff have control inside the pub. Will the ban mean that pubs will have to have somebody standing at the door or in the vicinity to ensure that there is some regulation of noise and other nuisance?
Where does the responsibility end? Do we allow doormen to intervene in situations that arise outside public houses? Where does the police's responsibility come in? Trying to control people outside premises is a major difficulty and it is obvious that that will be a major problem with the ban.
Recently, Belhaven Brewery Company, which I work for, sent a team of people to Ireland to look at the situation there. They found that drinks were being poured from glass containers into plastic containers and then taken outside to be consumed. In Scotland, we have a different situation; in certain cities it is against the byelaws to drink alcohol outside, but in other cities that is permitted. When the regulations come out, there needs to be some clarification of where responsibility starts and stops on the issue.
The litter issue is addressed in our submission. At the moment, litter is a particular problem outside shopping centres and large office complexes and we expect similar problems to arise when the ban comes in. Local authorities have different views about the implications and the cost, and we are working through that. We assume that there will be a need for additional fixed litter appliances outside pubs.
We have the estimated costs from a couple of councils. Glasgow City Council estimates that the cost will be about £144,000 for three years, which includes the purchase of fixed litter bins with ash-trays and the cost of additional street cleaning. If such cleaning is to be done outwith normal hours, there will be an additional cost. South Ayrshire Council estimates the cost at £81,000. We can aggregate those costs up throughout Scotland and we expect that they will be significant. It is fair to say that local government will be expected to be responsible, but we hope that people who use pubs will take some personal responsibility and that licensed and other premises will provide some signage to assist us.
As well as litter issues, there are environmental health issues and possibly police issues. Would you like to say anything about those?
To consider the matter in the round, we need to examine the implications of the bill and the review of licensing. Gordon Greenhill can give us some more detail on that.
There are two elements. First, it is an offence to drop litter and the Scottish Executive has adequately funded local authorities under the quality of life and cleaner, safer funding streams to put in place environmental wardens and agencies to enforce the legislation on litter. We have embraced that approach in Edinburgh, but the funding for it is temporary. If we wish it to continue, the funding will have to be made permanent. If people who go outside offices and the like to smoke drop litter, they will be issued with a fixed penalty; it is as simple as that. After people have been fined, they do not drop litter again.
You have offered a rose-tinted view of life in cities. The idea that people standing outside a pub at night drinking will have conversations that are not above the ambient noise level is bizarre. You said that if people drop litter they are issued with fixed-penalty notices. If that provision applied to every piece of litter in Edinburgh, the coffers of the City of Edinburgh Council would be rather large, which they are not.
Are you referring to the cost to the licensed trade?
I am referring to the general costs—the cost of clearing up litter and perhaps needing extra police to deal with people outside pubs. Even if we take a phased approach, we will eventually reach the same end point. Are you suggesting that people's behaviour will change if the policy is implemented over five years rather than one?
That is exactly the argument that we are making. We believe that if, over a period of years, we maintain choice for consumers but restrict tobacco in the way in which Paul Waterson suggested in his opening statement, consumers will continue to come to pubs. There will be choice for them, but gradually, through education and watching more floor space being given over to no-smoking areas, they will come to realise that smoking is an antisocial habit and get used to the idea of a smoking ban. The phased approach will bring the health benefits that the bill seeks.
You argue that there is a lack of evidence to support the Government's approach. Do you have evidence for the success of a phased approach?
At the smoking conference in Edinburgh, which was organised by the Scottish Executive, there were presentations from around the world, notably from Australia and America, on phased approaches and how well they have worked. Norway has been working towards a total ban for 10 years. We heard speakers give different viewpoints, but the consensus view at the conference was that giving people choice works and that we must give people time to come to terms with a smoking ban. Smoking is an addiction and people cannot stop just because politicians change the rules.
Do you share the view that enforcement costs could be reasonable and manageable? Who should meet those costs?
It would be totally unfair for licence holders simply to be told that they are responsible for everything that happens outside their pubs. We have put proposals on the table that do not include a ban and would allow us to retain control of our customers inside the premises. That is the way in which we should proceed. There may be noise problems even if five or six people are having a normal conversation outside a pub that is based in a tenement. It would be wrong for us to dismiss that issue—there will be significant problems. A large proportion of pubs are located in tenement properties.
We must take into account the fact that, at the moment, 60 per cent of the people who use pubs are smokers. That is not a small proportion.
Understandably, much of your evidence has focused on the economic disbenefits of an outright smoking ban. Have you undertaken any work to analyse the opportunities that may exist for the trade in respect of people who at the moment are not encouraged to enter pub environments because of the presence of smoke? Is there a significant imbalance between those kinds of pubs and clubs that could accommodate an outright ban and the many others in areas that you have identified where there is a tradition of what have been called working men's pubs? What would be the impact of a ban on such pubs? Casual customers who would go into a city centre pub would not necessarily go into "The Wee Man" somewhere in the east end of Glasgow.
The health professionals keep telling us that this is a tremendous opportunity for us to attract a new range of customers. However, last week a non-smoking pub in Elgin, which had the whole market to itself, closed within a month or so of opening because there was no business there. There will be a major problem in rural areas, where I am sure the pubs will close. Such pubs are very concerned, because they do not have the opportunity to reinvest in the environments that they offer. There is no doubt that the people who go to traditional working men's pubs will be forced out of the pub and will smoke at home. All our members are agreed on that point. Admittedly, the evidence is anecdotal, but many people say that they will not go to the pub if there is a smoking ban. That will lead to an increase in home drinking, with its associated problems. The pubs in some sectors are very vulnerable. We know that in Ireland the turnover of some pubs that are totally land-locked and have no facility for smokers is down by 50 or 60 per cent. Such pubs are especially hard hit.
The issue of who should be responsible for paying for the extra work that the bill will create was raised. Our position is that, because this is a new burden on local authorities, it should be funded. It is for members to decide where the money should come from, but there is a cost to the extra work that is involved and we would expect to be reimbursed for it.
In its submission, COSLA notes that at the moment there is a difficulty in recruiting environmental health officers. The bill represents a substantial change in direction and there are passionate views on different sides of the argument. If the bill is implemented, whom will we recruit to enforce it, given that there are already difficulties with recruitment of EHOs?
We have already raised that issue with the Executive. We mentioned the possibility of introducing a fast-track system, of the sort that has been developed for social workers. Clearly, we need to start the recruitment process now, so that we can build up the number of people whom we employ and expect to need. In part, that involves building up the profile of the job.
I am sorry to say that my identity card is still not recognised—I can get through doors in Parliament, but my card is not recognised in the Finance Committee.
Yes—those costs are built into all the submissions that we received from our member councils. The work that EHOs do at the moment contains an element of that kind of work; they consider noise control and check establishments that sell food, so a lot of their work is done out of hours.
Will somebody expand on the view that it is the landlord's responsibility to clean up litter and cigarette ends in the area outwith his property? Is that legally enforceable?
I am not sure that that is a financial question. We need to be careful not to get into the policy.
I ask about the cost implications of cleaning up.
Let us get COSLA's view on the SLTA's evidence that the cost of enforcing the ban could be £6 million per annum. Perhaps Alan McKeown will respond to that.
The £6 million is our estimated cost in view of the fact that the bill has been published before detailed regulations have been drafted. We have tried to direct our authorities through areas such as training and recruitment costs, which includes the cost of paying for staff and introducing new systems, associated legal costs, additional out-of-hours and street-cleaning costs, the security cost for staff; the cost of providing assertiveness training or training in dealing with aggressive customers for staff; and mobile phone and other communications costs.
The general view of the Finance Committee in respect of much legislation is that we want—before bills are passed—to see precisely what will happen and how the proposals will be implemented so that cost calculations can be checked. You are flagging up clearly that there are a number of areas of uncertainty because you do not know the enforcement mechanisms and you cannot make an exact guess.
That is fair—we have to deal with such conflicts in the process. However, we have been able to build up a detailed picture of costs. Almost all our authorities have replied to us in some detail. There is a bit of fog around the exact numbers that they have given us and we acknowledge that that represents a slight failing in our figures, but no one could be exact in their figures right now. The figures that we have produced in our evidence are fairly close to what will be required; I do not anticipate their being hugely different one way or the other. Some of the costs could be met centrally—we could do some training and recruitment and provide information centrally. We are trying to see what best value we can get for our money.
I read with great interest the submission from the Scottish Licensed Trade Association. The amount of income and profit that will be lost if a ban is imposed is staggering. You say in your evidence that if people stop smoking, it will impact on the reduction of costs in health treatment. Recent reports have shown that alcohol is as big a danger to health as tobacco. Therefore, would it not be a good thing if sales of alcohol were vastly reduced in this country?
I do not think that the question is relevant to the debate, but the argument about smoking in public places potentially shifts the consumption of alcohol from public places to domestic settings. The question of why people consume alcohol is different to the question of why they use tobacco.
That argument is not borne out by the amount of profit that you will lose. There is nothing to suggest that people will go home to drink.
There is, in fact. The Centre for Economics and Business Research Ltd study touches on that and contains figures on switching of alcohol consumption from on-premise to off-premise. The statistics from Ireland show that there has so far been about a 10 per cent swing; those statistics are incorporated in the report.
Drinking at home introduces serious problems as far as alcohol abuse is concerned. As soon as drinking is forced into a domestic setting in a jurisdiction that has a big off-sales industry, there are real problems with alcohol abuse. If we force people to drink outside the controlled environment of the pub, we will simply add to alcohol abuse problems.
I am keen to ask about the overall adequacy of the financial memorandum. I ask COSLA and the SLTA whether the full financial scenario has been properly modelled. Have we captured all the positive and negative impacts on the public purse? When they answer, I ask the witnesses to consider evidence that we heard last year from the Allander series of lectures: Nicholas Crafts of the London School of Economics told us that if Scotland could bring its life expectancy up to the UK level, that would increase our gross domestic product by 21.3 per cent. He quoted W D Nordhaus of Yale University in coming to that conclusion. That 21.3 per cent represents £16 billion. If we moved towards that, what impact would that have on your business and the public purse vis-à-vis the public sector and local government in particular?
At the national conference on smoking that was held in September, speakers from around the world gave us an account of how the provision of choice and a phased or ratcheted approach to tobacco restrictions have worked adequately. In answering John Swinburne's question about longevity, I do not think that any research has been conducted into whether the Scottish Executive proposals would be more effective than the proposals that we make today.
Okay, I understand that. Equally, is there any worldwide example of another jurisdiction's being involved in the gradualist approach that you advocate?
Yes. Australia is a good example. Although there have been significant tobacco restrictions there, there has been no impact on the economy. People who do not want to smoke can go to a non-smoking bar and people who want to smoke can go to a smoking bar. Our argument is based on allowing people the right to make lifestyle choices, which we believe is a fundamental right of anyone in this country.
I understand that people have that right. Are you saying that the Australian migration has been public-purse neutral?
That is what came over at the conference.
I agree with that. I will let Alan McKeown speak to the financial memorandum but, on the general point, there will be costs and there will be savings. Our experience is that, given that people are living longer, we are involved actively in looking after them when they become frail and need our support later in their lives. The fact that people are living longer means that they are living more healthily until they need our help. My view is that the proposals could be cost neutral.
What actions could you take at local authority level to load the dice in favour of more savings being made, rather than more costs being incurred?
It is difficult to estimate the broader impact of a ban on the use of tobacco in wholly enclosed public spaces on life expectancy and the national health service, although that would be an interesting exercise and we should perhaps consider doing it. The cost of meeting the policy objective of maintaining the position whereby people are living longer and more healthily in the community falls invariably on local authorities. People's needs become more complex as they get older; therefore some of the care packages become more expensive. However, that debate is for another day. Research on the broader impact would be fascinating, if someone were to commission it.
I want to follow up that point, which relates to some of my concerns about the methodology and costings of policing the ban. As I understand it, the Association of Chief Police Officers in Scotland has said that the police do not wish to be involved in policing the ban, therefore the burden will fall on local authorities. You say in your submission that there is a shortage of environmental health officers and that their age profile is increasing. Trying to police the ban will be a massive job for you, especially if the police are not involved. Clubs and private places will also be covered by the bill. Can you tackle the scale of work that will be involved?
All those questions are valid. The majority of the enforcement will be carried out by enforcement officers. People do not need an honours degree in environmental health to issue a fixed penalty notice, but training and management elements have to be put in place. The environmental wardens, whom many councils employ, enforce the litter legislation adequately at present. We are not criminalising smoking—if people pay their fixed penalty, the criminal offence will be discharged. Matters will become slightly complicated if cases progress to the next stage and a report is presented to the procurator fiscal, which is where training will be needed. The evidence is that the majority of people pay fixed penalties and cases do not proceed to the next stage. I am confident that throughout Scotland more than enough people can be trained up to the level that will be necessary to enforce the eventual legislation.
What is the reaction of the Scottish Licensed Trade Association witnesses?
The fixed penalty might be the end of the matter for the person who is smoking, but the licensed trader involved in running the premises could lose his licence. Andy Kerr stated in our journal last week that we would not be responsible for enforcement, so there seems to be confusion. Will it be worth our while to have legislation that will be so difficult to enforce? Will that be good law, given that it will be difficult to enforce at 1 o'clock in the morning, 12 o'clock at night or throughout the afternoon? There will be a massive cost to having inspectors police a business that runs 24 hours a day. We do not think that it is worth while; our proposals are far more practical, workable and enforceable.
I want to wind up this discussion with a couple of questions. Stuart Ross came before the committee to give evidence on Stewart Maxwell's bill, which was the Prohibition of Smoking in Regulated Areas (Scotland) Bill. One of the debates that we got into was about the relative advantages of a partial ban, which involved structural issues for many licensed premises, compared with a total ban. I know that you would prefer a phased-in ban. Will you give a sense of the relative advantages and disadvantages of the two options from your perspective?
Yes. When Stewart Maxwell lodged his bill we said that we would have been happy to support the proposals if they had related to where and when food was served. There were technical issues in respect of segregation of properties, which caused us considerable concern. Obviously segregation could take place and a total ban could follow. We debated the issues that were specific to the Maxwell bill at the time. As Paul Waterson said in his opening remarks, we have not changed our position. We met the then Deputy Minister for Health and Community Care as far back as May last year, when we proposed the phased approach. Throughout the four-month consultation period we have heard nothing from any other country to make us change our minds and say that we are not on the right tack. I believe that there are health and financial benefits in going down the route that we suggest and we have done our best to put those benefits down on paper. Some of the issues are complex, but we have made a full written submission that we have backed up with research which, although we commissioned it, is independent in the conclusions that it reaches.
What is COSLA's view of the enforcement of a partial ban—having smoking and non-smoking areas in pubs—compared to a total ban, as is proposed in the bill?
It is acknowledged that the Maxwell bill was almost unenforceable and difficult to put in place. I envisaged that if it became law we would spend most of our time in the courts defining premises. It is for health professionals to determine the overall effect of a phasing-in approach. The bill that is before us is simple—it will be good law because it is enforceable. Parliament must decide whether it wants phased implementation.
May I comment?
I was going to ask you a specific question on your estimate of £5 million funding for smoking cessation programmes and the suggestion that that might need to be supplemented. Will you give us more information on that?
Yes. First, I apologise to the committee, because that figure should be the £7 million that the Executive includes in the financial memorandum. May I make a couple of points about what we heard earlier?
Yes.
We have not consulted our members specifically on a phased approach, but I say without doubt that they support a one-step move.
The Executive confirmed an investment of £7 million in the breath of fresh air for Scotland strategy. Although the strategy is welcome and important, it came out before we started talking seriously about a ban, so it does not take into account the impact that the ban might have. Obviously, our hope is that the ban will have a considerable impact and that people will actively seek out the NHS's support to give up smoking. In some ways we want smoking cessation services to be flooded by people looking for support and help, but we must ensure that there are sufficient resources to back that up. The ban must not be seen as an end in itself but as a lead in the wider strategy to reduce smoking considerably throughout Scotland.
It is worth remembering that many of the public places to which the ban will apply are also workplaces, so people who work there and who are not smokers will be protected from smoke to which they would otherwise be exposed. That will have significant health benefits for them.
I thank all the witnesses. As I said at the beginning, the substantive policy issues that are involved are not really for the committee; we are specifically interested in the financial matters. It has been agreed across the board that there has been a lack of definition of some issues on enforcement and other matters. We may wish to continue correspondence with the witnesses to establish the facts. I thank the witnesses for giving oral evidence today.
I come from an area where there is an extreme shortage of dentists. In fact, no dentist in Dumfries and Galloway—private or NHS—has a list open. I am concerned about the costs that you identify in your submission and the burdens that will fall on boards where there are shortages of NHS dentists. The expectation might be that additional incentives may have to be given to dentists to do checks. What might happen in areas where there are no dentists to do them in the first place?
There are varying estimates of the total shortfall of dentists around Scotland. One of the most recent figures is in a report by NHS Education for Scotland, which estimates—in its workforce planning for dentistry—that Scotland is lacking approximately 215 dentists in total throughout the country. We contacted our members in areas where we know there is a particular issue and we managed to get an estimate for the Grampian area based on work that was conducted there about 18 months ago. It was estimated that NHS Grampian is about 40 dentists short; that situation is likely to be replicated in other parts of the country. The picture is changing. More dentists are leaving NHS dentistry, but not necessarily all the NHS patients are going with them.
Are you able to say how many Scots are not registered with a dentist?
I do not have that figure.
I do not have the figure here, but I know that the Health Committee published a report last week that contains such figures. The figure is quite high; I think that it is slightly more than half of Scots, but the figures are slightly different when they are broken down into adults and children. That information is in the research report that the Health Committee published last week. We could certainly find the figures and provide them to the Finance Committee.
There is also a capacity issue. There are not enough dentists and we cannot create dentists out of nowhere. A free check-up might be desirable, but there is not much point in the patient having one and being told, "You've got a mouth full of caries", if nobody can do anything about it and the patient cannot get treatment.
NHS Education for Scotland calculated that as a result of the entry into the system of newly qualified dentists and better workforce planning, which will make more appropriate use of the entire dental workforce, including dental assistants and hygienists, it should be possible to make up the shortfall by 2008, which is not terribly far away. However we must ask how many of the new dentists who enter the system will be NHS dentists. There is a shortfall in the numbers of qualified professionals, but it is not so drastic that it cannot be addressed, according to NHS Education for Scotland. The key issue is how we persuade dentists to remain in the NHS and carry on treating NHS patients. That is the crux of the matter.
Do you have any idea how many extra dentist hours per year will be needed to fulfil the requirements of the bill?
The short answer is no, and I do not think that the boards know the answer to that yet, either.
How can we estimate the costs of the policy, if we do not know how many additional dentist hours will be required?
We cannot.
That is the point. When we consulted our members about the implications of the bill and the accuracy of the financial memorandum, they simply could not give us an answer, because they have not yet mapped out the areas in which there is overprovision or underprovision. In most cases there is underprovision, but until there is a clear picture of the situation our members will find it very difficult to calculate the number of hours of NHS dentistry that they will need to provide to make up the shortfall.
Is there a suggestion that somewhere in the country dentists are sitting around doing nothing?
No.
A substantial number of extra dentist hours will be required, but we do not know how many. How can we be sure that the bill's requirements will be met by the new dentists who will come into the system?
Dentists are not sitting around doing nothing, but some dentists do not treat NHS patients—that is the context of the shortfall and underprovision and the reason why people have to go private. The issue is how we encourage those dentists to treat NHS patients.
Let us leave aside the suspension of credibility that is needed if we are to believe that dentists who have discovered that they can make a lot of money from treating private patients will suddenly come back to the public sector. Even if such dentists were to come back to the public sector, all the patients who were being treated privately and presumably quite liked that system would try to find another private dentist. The pressure and the demand on the system would be exactly the same. If we simply move people from one sector to the other without increasing the total number of dentists, we will not solve the problem. Somebody will still not get treatment.
According to NHS Education for Scotland, total capacity will increase over the next four years, not only because of an increase in the total number of dentists in practice but as a result of better planning for the entire dental workforce. Such planning is going on in other parts of the NHS workforce, in which people are working differently and not doing certain jobs when they would be better employed doing something else. For example, dentists might be undertaking jobs that a dental assistant could do. We hope that the workforce planning that is being undertaken will eliminate such situations over the next four years. That is another element of what is happening.
The other corollary of the issue that Elaine Murray raised is that, in the short and medium term, dentists who perform free dental examinations will detect a lot of work that needs to be done on people's teeth. Has an estimate been made of the amount of work that the examinations will identify?
Not to my knowledge.
I presume that a dental examination takes 10 or 15 minutes, but if someone needs treatment after their examination they will need a significantly longer course of treatment. We do not know how much work the free examinations will generate, because we do not know how many examinations will take place.
NHS National Services Scotland might have a clearer idea of the number of examinations that will be needed. Eye and dental examinations are a slightly different issue from the one that you raise, although there are obvious connections. The issues are financially slightly separate, in that there is a centrally held general dental services budget from which boards draw down costs, whereas increases in the number of dentists and in dental provision must be funded by the boards themselves.
Would it be too cynical to suggest that the cost could be estimated quite well? We know how many dentists there will be and we know that they can work only so many hours per week, so we know what the cost would be. The more problematic issue might be whether the hours that are worked will deliver the number of dental checks and the amount of treatment that will be required. The costs will be fixed, anyway.
The costs will be to the NHS and will depend on the number of hours that dentists give to the NHS. We cannot predict the costs, because we do not know the number of hours.
The Finance Committee's problem is that it must consider a financial memorandum that is based on a number of imponderables.
I apologise for returning to the provisions on the prohibition of smoking in public places, but I have a significant number of questions that I did not ask earlier because I thought that we would get a second pass.
I am sure that the estimate is low. A number of academic researchers have used that figure in relation to direct links between smoking and ill health. Of course, smoking is a contributory factor in many conditions but is not the primary cause. The ultimate cost of smoking to the NHS is probably unquantifiable. Equally, the ultimate saving to the NHS of reducing smoking is probably unquantifiable. It is impossible to say how many people will not start smoking because they are not in a pub in which smoking is allowed and will therefore not contract a smoking-related illness later in life. We hope that that will be the case with many people, but we cannot put a figure on it.
I accept all that you say. However, I am contrasting the suggested saving of £200 million, which could be higher, with the £5.7 million to £15.7 million estimated gross savings in the financial memorandum.
We expect the legislation to act as such a trigger, because we know that a majority of smokers would like to give up. Our concern about the financial memorandum relates to the support for them to do that. When we consulted our members on the previous bill, one of the major points that was made related to the cultural aspects of smoking. If a piece of legislation can change some of those cultural aspects and ensure that the cultural norm is that people do not smoke when they are out for a drink, that will have a beneficial effect. However, quantifying all that is difficult.
I want to try to consolidate that and get some hard numbers and hard methodology around it. Do you have any plans to talk to the health services in Ireland and other countries in which a smoking ban has been implemented to find out whether there are lessons to be learned that might result in better and more cost-effective provision of health services?
Do you mean health services specifically related to smoking or health services generally?
I wondered whether you had tried to find out what other health services had done to take advantage of smoking bans, whether their efforts had worked and what they would do differently if they had a second chance, which is, in effect, what we have got. Do you have any plans to do that?
We have no such specific plans at the moment. However, we would be happy to support the Executive in any work that it wants to do in that regard. The lessons that might be learned are hugely important.
It can be useful to consider other people's experiences. Listening to your answer, I was thinking that it might be more helpful to talk to the New York police department than to the New York health department, as its policy of zero tolerance for fare dodging and littering on the subway had a disproportionate impact on the murder rate. The causal link between certain initiatives and their results can be somewhat oblique, but the signal can, nevertheless, be powerful. That shows that it is possible to make step changes over time, if we learn from other jurisdictions.
Given the work that has been done by people such as Michael Marmot, who has clearly defined issues relating to health causation, I am surprised that it is not possible to make rather better estimates of impacts on health. For example, it should be possible to work out statistically the issues relating to smoking-connected illnesses that affect people's capacity to work for what should be the normal period of their working life. We do not know what the ban would deliver in reducing the number of people who are inclined to smoke, but it should be possible to produce a range of estimates of, for example, the impact that a 5 per cent, 10 per cent or 15 per cent reduction in the number of people who smoke would have on working hours over a period. That is the kind of figure that Jim Mather and others are looking for.
The only firm figure that we have in relation to free dental checks is the figure of £500,000 for establishing administrative back-up. I am concerned about that, because we should not go down that road until we know the financial consequences. The move is progressive, but it is quite a big one to make without our knowing what the cost will be. I am sure that it is within the committee's remit to ask for more information on what the cost will be and on whether the human resources are available for delivery.
I am not sure that that is a financial question in relation to the memorandum. I think that you are quite clearly straying into policy areas. I will let our witnesses talk about the financial issues that arise from that question, but I think that we need to be a bit cautious with regard to the policy aspects.
The figure of £500,000 relates to the predicted increase in administrative costs as a result of the new provisions, such as the cost of administering the new list. According to our members, it is difficult to say whether that estimate is accurate but it is probably not unreasonable. If the costs fall within that scope, they could probably be fairly easily found within existing allocations. The service development element could stretch what is available within allocations at the moment.
I think that we have concluded our questions. I thank Hilary Robertson and Susan Aitken for attending.
Pharmacy.
Okay.
Compensation for hepatitis C sufferers.
I am not sure that that relates to finance in this particular—
Is it not money that they are going to get?
I am sure that our suggestions will be helpful to the clerks.
Basically, we are interested in a bit of everything.
It is basically pharmacy, dentistry and smoking. In relation to smoking in particular, are members interested in the enforcement issues or the broader health issues?
Others may be interested in the health aspects, but I am interested in enforcement.
The key financial issues are about enforcement, so perhaps we can focus on that.