Tobacco and Primary Medical Services (Scotland) Bill: Stage 1
The next item of business is a debate on motion S3M-4807, in the name of Nicola Sturgeon, on stage 1 of the Tobacco and Primary Medical Services (Scotland) Bill.
I am pleased to open the debate on the general principles of the Tobacco and Primary Medical Services (Scotland) Bill.
Before I turn to the substance of my speech, I have a number of people to thank: the organisations and individuals who helped to shape the legislative proposals; Christine Grahame and the Health and Sport Committee for their careful and robust scrutiny of our proposals and the considered conclusions in the stage 1 report; the many witnesses who provided evidence to the committee; and colleagues on the Finance Committee and the Subordinate Legislation Committee for their considerations.
The bill will reform two areas of health legislation: it will update statutory controls on the sale and display of tobacco and smoking-related products, and it will amend and clarify the eligibility criteria for providers of primary medical services.
I do not need to remind members of the health risks that are associated with tobacco smoking. Suffice to say, the evidence of those risks is clear and irrefutable. Smoking kills and debilitates. Each day, 35 Scots die from smoking-related illnesses—lives are destroyed and families are devastated. Those are the tragic and completely avoidable consequences of illness and disease caused by tobacco.
Significant progress has been made in recent years in reducing the cultural acceptability of smoking, including through the bold and decisive action taken by the Parliament. Everyone in the Parliament should be proud that our actions have made Scotland a world leader in tobacco control. However, there can be no let up, because there is more to be done. Some 15,000 children and young people start to smoke each year in Scotland, and the potential impact on their health is frightening. A child who starts smoking at 15 or younger is three times more likely to die of cancer than someone who starts smoking in their mid-20s.
Of course, we will continue to help smokers to quit but, as Minister for Public Health and Sport, I believe that we have a duty to act decisively to prevent children and young people from starting to smoke in the first place, so that they and future generations of young Scots might avoid the devastating consequences that have robbed so many people of their loved ones.
The measures in the bill are firmly embedded in our vision for improved public health in Scotland. They form part of the comprehensive programme that was set out in the smoking prevention action plan that I launched in the Parliament in May last year. More specifically, they are aimed at reducing the attractiveness and availability of tobacco by banning the display of cigarettes and other tobacco products at points of sale; updating existing tobacco sales law, including the introduction of a ban on selling cigarettes from vending machines; introducing a new registration scheme for tobacco retailers; and creating a new system of fixed-penalty notices for breaches of the law.
I sensed when I launched the smoking prevention action plan that there was broad agreement within the Parliament for further action to reduce smoking among children and young people. I sense the same feeling now. We might differ, of course, on what form that action should take. I appreciate that there are different views both inside and outside the Parliament. For example, there are those who remain unconvinced about the justification for some of the measures in the bill, particularly the banning of displays and of selling cigarettes from vending machines. However, point-of-sale advertising—which undoubtedly is what displays are—is a powerful marketing tool. I believe that it is totally inappropriate for such a uniquely dangerous product to be promoted in such a way. Similarly, I can see no place in a modern Scotland for cigarette vending machines. The fundamental question is whether tobacco is an appropriate product to sell from a vending machine. The Scottish Government's view is that it is not.
I stress, however, that the decision to legislate on those and other matters in the bill was not taken lightly. We were conscious, from the full regulatory impact assessment that was undertaken, that the legislation would have an impact on business. More specifically, we were aware that the ban on displays would have cost implications for retailers and that the ban on cigarette sales from vending machines might jeopardise the future viability of the 15 companies involved in that sector.
I take it that the Minister for Public Health and Sport now accepts that the original figure that the Government published for the number of jobs that would be lost in the vending machine industry is wrong and that the number involved is significantly larger than Parliament was led to believe when the Government's memorandum was first published.
The financial memorandum was based on the best available evidence at the time. I assure the member that officials went out of their way to consult the companies involved. They tried on numerous occasions to contact the National Association of Cigarette Machine Operators, without a positive conclusion, and they had discussions with Sinclair Collis. However, only latterly did they manage to have discussions with NACMO, which led to the information that 60 jobs are involved. I assure the member that the provision of that information did not happen without effort on our part.
Of course, any job losses or costs to business are regrettable and not to be taken lightly, but that is also the case for the enormous personal and economic burdens that smoking inflicts on Scotland. As I said at the outset, tobacco kills and debilitates. We have a duty to the Scottish people to act decisively to prevent future generations from suffering the distress that it causes.
Does the minister believe that specialist retailers of cigars, pipes or tobacco products should be treated as a separate case? Some of those retailers are in key tourist areas, but constituents of mine are also affected.
I think that we have been clear about specialist retailers. There have been many meetings and discussions about such shops. Of course, there is the requirement for 50 per cent of their products to be tobacco products. Discussion has taken place around that, and it will continue.
Further, while wishing to do nothing to undermine our stated policy objectives for the bill, members have my assurance that we will continue to work closely with Scottish companies that are affected to minimise the impact of the legislation through providing, for example, longer lead-in times and diversification opportunities.
It is worth reminding members that forces are at work that perhaps have a vested interest in undermining our tobacco control efforts in order to recruit new smokers and to maintain the numbers of existing ones. For example, I have no doubt that some of the fears about shop closures resulting from the display ban have been by driven by those who seek to protect their own business interests—namely, the tobacco companies.
Will the minister give way?
I must move on. I have already given way to the member.
My only motive, on the other hand, as Minister for Public Health and Sport is to protect young Scots of today and future generations from the harmful effects of tobacco. I am therefore pleased that the majority of the Health and Sport Committee agreed with the Scottish Government on these matters and, indeed, with the tobacco provisions in general.
The Health and Sport Committee's stage 1 report highlights a number of matters on which I have been asked to report back to the committee before stage 2, and makes a number of recommendations on amendments for us to consider. I appreciate the rationale for all the points that are raised in the stage 1 report, including those that were flagged up by the Finance Committee and the Subordinate Legislation Committee. Essentially, I have an open mind about anything that might improve the bill, so I am happy to commit to considering carefully and sympathetically each of those points and to reporting back to the Health and Sport Committee with a considered view before stage 2.
However, there is one issue that it might be helpful for me to address more specifically in this debate. The Health and Sport Committee's report emphasises its desire to bring tobacco sales law more into line with that of alcohol, including by introducing new offences on proxy purchases and underage purchases. As I said in my evidence to the committee—and as I reaffirm today—I am happy to consider amending the bill in those respects. I understand that such significant changes would be within the scope of the bill, but I need to be satisfied that they would be otherwise compliant, including from the perspective of the European convention on human rights. We also want to complete the consultations that are under way with key interests, including children and young people.
I turn briefly to the primary medical services provisions in part 2 of the bill, the aims and objectives of which are clear. We wish to ensure that general practice in Scotland continues to be part of a mutual national health service. General practice is, of course, something special. It lies at the heart of the NHS and accounts for the majority of patient contacts. The patient's relationship with their general practitioner is very private and personal. General practice deals with the most important of life's events, so the care and treatment that patients receive from their GP largely determines their confidence in the NHS. Again, we will carefully consider the points that are raised in the committee's stage 1 report. The Cabinet Secretary for Health and Wellbeing is leading on that part of the bill, and when she closes this debate she will no doubt address any issues that members highlight.
I have great pleasure in moving,
That the Parliament agrees to the general principles of the Tobacco and Primary Medical Services (Scotland) Bill.
I rise to speak on behalf of the Health and Sport Committee, therefore my remarks will be somewhat constrained, but happily so—I can assure my deputy convener on that point.
The Tobacco and Primary Medical Services (Scotland) Bill is difficult, in that it is a bill of two halves that are not exactly related to each other. That gave the committee some slight difficulties, so I will rely on our committee members who are medical experts—who are, if I may say so, much more informed about such matters—to deal with the technicalities of part 2. As the Minister for Public Health and Sport described, the purpose of part 1 is to legislate on the sale and display of tobacco and tobacco-related products. Part 2 will reform the National Health Service (Scotland) Act 1978 in relation to GP practices.
Many of the conclusions in the committee's report were agreed unanimously, but many were agreed by majority—I was in a minority of one once. However, when we have our disagreements on the committee, they are dealt with amicably.
As the minister said, the bill will make it an offence to display tobacco and smoking-related products where they are offered for sale. Many committee members felt that such displays are the last vestiges of tobacco advertising. On the issue that Jeremy Purvis raised, I understand that specialist tobacconists and web displays will be exempt from the ban, but shops in which less than 50 per cent of sales are tobacco products are considered to be sub-specialists. My understanding is that the minister is looking into discussions with the few retailers who come into that category—we are all aware that businesses are under threat in the current climate.
The committee's report recognises that the evidence base for banning displays is at an early stage and international evidence is inconclusive. We will submit a bid for some exotic travels to try to determine whether better evidence is available. I hope that other conveners on the Conveners Group will look on that bid with affection—we have not travelled anywhere so far.
The committee accepts that the ban will result in a cost to business from reconfiguring space, but most committee members are not persuaded that the cost will be excessive. Indeed, the tobacco manufacturers might cover the cost. I understand that tobacco displays will need to be hidden by 2011 in large retail outlets and by 2013 in small outlets, so there will be a lead-in time. On balance, the majority of committee members considered that the display of cigarettes at the point of sale constitutes advertising.
The bill restates the existing offence of selling tobacco products to under-18s, but it will give retailers a defence to the offence—this might be described as a reasonableness test—that they believed that the customer was over 18 and were shown acceptable proof of identification. It was argued in oral evidence that the creation of such a defence would be a retrograde step, and the majority of the committee were in favour of removing it from the bill. I am not—I will continue to pursue the inclusion of a reasonableness defence. I was substantially outvoted, not for the first time.
Is the member comfortable with the fact that if the reasonableness defence is not removed from the bill, those who take part in test purchasing will have to appear in court?
I accept that there are issues to address, which will be developed in the course of the debate. At this point, I am constrained in what I can say.
Under the Licensing (Scotland) Act 2005, it is an offence for a person under the age of 18 to buy or attempt to buy alcohol for himself or herself. The committee believed that there needed to be a similar balance of responsibility between retailers and underage purchasers of tobacco, and called on the minister to consider whether the responsibility of minors with regard to the purchase of tobacco should be brought into line with the provisions on the purchase of alcohol.
Another major aim of the bill is the prohibition on the use of vending machines to sell tobacco products. The bill will create a new offence of having a vending machine for the sale of such products. The person who commits the offence will be the person who manages or controls the premises on which a vending machine is available for use.
The committee noted the argument that a ban on cigarette vending machines may have an economic impact on the licensed trade, as David McLetchie said, but recognised the opposing view that the impact may be marginal, which was among the minister's arguments. We know that she is holding discussions on the issue.
The committee remained to be convinced that the radio-controlled system proposed by the industry, which would be based on age verification by bar staff in licensed premises, would work in practice.
Did committee members not hold that view because they had been unable to see the system tested in practice? Would it not be sensible to see it tested in practice before making a judgment about it?
The decision about whether to have a demonstration was a committee decision. We took the view that, at the time, sufficient evidence was not available. The committee was not convinced. That was a majority view, which I know was not supported by the Conservatives.
The committee recognised that the proposals would inevitably have a cost for cigarette vending machine businesses, but noted the minister's assurances that she would hold discussions with the industry.
The provisions on a register of tobacco retailers are of particular interest to me. The bill will establish a national register of all tobacco retailers. A retailer who is the subject of three or more tobacco enforcements against specified premises could face a ban on selling tobacco in those premises for up to 12 months. There are issues to do with the operation of such a system, which we have raised with the minister. The committee welcomed the proposal and the minister's agreement that she would reflect on our discussion about operators of multiple premises and report back to us.
I will not discuss enforcement and fixed penalties so that I can move on to part 2, which seeks to amend legislation on the eligibility criteria for persons who contract or enter into arrangements with health boards for the provision of primary medical services. The bill intends to ensure that any person who contracts with a health board must, among other things, regularly perform or be
"engaged in the day to day provision of, primary medical services".
The current situation is that a commercial operator is eligible to bid for contracts to provide primary medical services. That will change to avoid a repeat of the situation that arose in 2007, when Serco bid for a vacant GP practice in Harthill that was tendered by NHS Lanarkshire.
Under the bill, boards will be able to make such arrangements only with medical practitioners, health care professionals, qualifying partnerships, limited liability partnerships and companies. The majority of the written evidence that we received was in favour of the change. The sentiment of supporters of the bill is encapsulated by the view expressed by NHS Tayside, which said that the bill will
"prevent the creation of ‘corporate GP contracts' by commercial companies which would permit them to take over vacant GP Practice."
There were sceptical voices. Community Pharmacy Scotland and the Confederation of British Industry were sceptical. Two members of the committee—Mary Scanlon and Helen Eadie—went to Canary Wharf and Tower Hamlets to see two practices that are run by commercial providers. I am sure that they will go into more detail about what they saw, but it is fair to say that they were impressed by the level of patient service. I think that it is fair to say that those ladies are not easily impressed.
The committee grappled with the extent to which GP practices, typically under the general medical services contract, can be differentiated from the commercial operations in some parts of England. The British Medical Association was keen to stress that doctors in Scotland were part of an "independent sector" and that that was preferable to a "commercial sector". [Laughter.] Mr McLetchie anticipates my point. The subtleties of that distinction were lost somewhat on some members of the committee.
What did the committee think of part 2 of the bill? It is fair to say that there was a range of views. A majority of members were in favour of the general principles, albeit that they wanted to re-examine matters at stage 2.
The bill is relatively unusual in that it is a comparatively small bill that covers two very different areas of health policy. The majority of committee members consider that there is merit, in principle, in both parts, although some committee members have concerns about various aspects of part 1 and some members—not always the same ones—have reservations about the rationale behind part 2. Those matters can be debated at stage 2. However, a majority of committee members agreed to recommend to the Parliament that the general principles of the bill be agreed to.
This Parliament has demonstrated its acute awareness of the unsatisfactory state of Scottish public health in respect to smoking. It introduced the smoking ban, which came on top of the United Kingdom's ban on advertising, and it introduced test purchasing. I understand that recent research shows that since the ban, the number of heart attacks in Scotland has gone down by almost 30 per cent. Our joint commitment to improving health is not in question, but it remains a fact that 12 per cent of boys—or perhaps slightly more—and certainly more girls still take up smoking by the age of 15. Indeed, approximately 80 per cent of smokers start smoking when they are under the age of 19 and, as the minister has indicated, they face correspondingly higher risks.
The bill proposes to end the display of tobacco in shops, to ban vending machines, to register tobacco outlets and to tackle enforcement. Three questions need to be asked about the display element, which I think the committee has asked. Is display a form of advertising? Is there evidence that banning display would have an effect? Are the actions proportionate?
The advertising ban that came in in 2002 resulted in the tobacco industry's classic response to any attempt to control it: companies multiplied the number of brand variations, with all sorts of justifications, and the effect was to double or triple the display area within shops. A question that I regularly ask pupils in primary 6 and 7 when they visit the Parliament is, "What do you see when you go into your local convenience store?" They refer to three things: sweets, alcohol and tobacco. I promise members that tobacco is always mentioned. There can be no doubt that display is a form of advertising. New types of colourful packaging, slide packs, ultra-slims, new products for young women and terms such as "cool", "smooth" and "chill" are all being used by the industry to try to deliver the new generation of smokers who are necessary for their profits. The advertising issue is clear: the industry would not spend the money that it does on it if it was not successful in achieving advertising and delivering the new generation of smokers.
Would a display ban work? Professor Gerard Hastings from the University of Stirling suggested in his evidence that it would in the long term contribute to a reduction in children taking up smoking. Surveys indicate that 83 per cent of children are very aware of smoking and feel that it is more likely to lead to them taking up smoking. The campaign by Cancer Research UK entitled out of sight, out of mind aims not just to denormalise tobacco displays but to ensure that those who try to give up smoking are not confronted with rows and rows of display when they go into shops.
Is the banning of display proportionate? Is the cost of the ban to the small retailer, whom we all want to support, particularly in the economic climate, proportionate? Given that the evidence is still equivocal from Canada—I believe that the evidence will come only in the long term—that is difficult to determine, but the Irish and Canadian experiences give us some insight. First, in Ireland, shops are using cupboards for tobacco, so it is not kept underneath the counter. Shopkeepers raised the issue that having tobacco underneath the counter would cause difficulties, because they would have to bend and would not have sight of the shop. Those cupboards appear to be inexpensive.
Secondly, the evidence from Japan Tobacco International was the most equivocal that I have heard in a committee. It said, "We don't think we'll support tobacco retailers." The evidence in Canada and from the Gallaher Group, which is part of JTI in Ireland, is that if the sales are sufficiently large, it will install £10,000 dispensing machines. The historical evidence is strong that the tobacco industry will do everything that it can to support such retailers.
Was that a guarantee from the Labour Party that if the tobacco industry does not invest that £10,000 the Labour Party in government will, or are small retailers just to trust that that might happen, and if it does not just go out of business?
Jackson Carlaw was not listening to me. I said that we need proportionate measures. The cupboards that are used in Ireland are very cheap. We need to see what discussions take place with the Government to determine the precise terms of the display ban. Once we know those, we will decide whether the ban is proportionate and we can support it. Not all small retailers will get the £10,000 machines. We need to know whether the transition arrangements are satisfactory. We must await the outcome of the discussions on that.
Our party is much clearer on the fact that vending machines must be banned. Thirteen per cent of 13-year-olds start smoking by buying from tobacco vending machines. I recently heard from a significant pub owner in Scotland—it owns 600 pubs—that one of its pubs, in Oban, was the subject of test purchasing. Of the 25 pubs that were tested, 23 failed on vending machine purchase. That is a level of test purchasing that I had not heard of before, and it indicates strongly that the vending machine ban is a small but necessary measure. The transition arrangements will be important to protect jobs. We will see what happens on that.
We will support registration and the committee's views on the changes to enforcement.
I am sorry that I do not have time to deal with part 2, about which we have considerable doubts. We would rather have seen it as a separate bill. We do not believe that the bill does what it says on the tin, and we believe that it will have unintended consequences. We will therefore be looking for a lot of clarity at stage 2.
I will start by addressing part 2 and primary medical services. The Health and Sport Committee's stage 1 report confirms that all members of the committee considered that
"there is no guarantee that the existing model of general practice will survive in the long term."
Against that background, it would be wise for all MSPs to maintain as much flexibility and as many options for the future as possible rather than create and sustain a monopoly.
In 2003, the SNP supported the proposals that it seeks to abolish today. Shona Robison stated:
"I do not subscribe to the conspiracy theory that the SSP promotes that somehow the entire bill has been engineered to open the door to a mass influx of the private sector into the health service".
She accused the Scottish Socialist Party of paranoia. I agree with Ms Robison that the bill has not opened the door to a mass influx of the private sector—the bill never opened the door to a single private provider. Even the wise Stewart Stevenson confirmed:
"The key thing is that we have private contractors in primary medical services … We are now in crisis".—[Official Report, 18 December 2003; c 4390, 4392.]
As there are no commercial providers in Scotland, Helen Eadie and I visited a GP practice in Tower Hamlets and a walk-in centre at Canary Wharf. Both are run by Atos Healthcare and neither could operate in Scotland if the bill were passed. NHS London holds the contract for the walk-in centre at Canary Wharf, which gives 80,000 workers in the area—as well as locals and visitors—simple access to primary medical services without disruption to their working life. There are now plans for seven walk-in centres in London, reflecting local needs and reducing the pressure on accident and emergency departments.
Will the member give way?
No, sorry.
Similar services do not exist in Scotland. The local primary care trust discontinued the GP contract at Tower Hamlets, as it did not achieve the key performance indicators. The five-year contract was given to Atos, which now employs five GPs and staff. They told us of the better information that they receive from Atos in detailed monthly reports. The patient experience indicator was also linked to incentives in that practice in what is a deprived area of London, where more than 80 per cent of the population are Bengali. That health centre, which is run by a commercial provider, now has lower staff turnover, better continuity of care, more stability, better compliance with chronic disease management and an immunisation catch-up campaign. It takes patients from other practices and is now meeting all its targets for screening and health checks. It also runs seven clinics a week and is open from 8 am to 8 pm during the week, and 9 to 5 on Saturdays.
Will the member give way?
No, I have only a short time.
If that company does not deliver for the population, the primary care trust will not renew its contract.
That is an example of a first-class, groundbreaking service, which could be available in future in a modern NHS in Scotland, whether in community pharmacies, walk-in centres or GP practices. For those reasons, and the examples that I have given and that my colleagues will give, we will not support part 2 of the bill.
We can all agree on the destructive effects of smoking on the health and lives of smokers—the premature deaths, the lung cancer and the coronary heart disease. However, the decision that we face today is whether the proposed measures will reduce the number of youth smokers. We support the strengthening of enforcement measures and the register for retailers. We also fully support the Health and Sport Committee's recommendation that the legal position on the proxy purchasing of tobacco be brought into line with the legal position on the proxy purchasing of alcohol. However, that measure was not only supported by small and large retailers, it was proposed by them. If the Government had listened to the evidence from Scotland's retailers prior to producing the bill, that measure would have been in the bill instead of having to be introduced at stage 2. The measure is evidence based. It is a fact that 87 per cent of young smokers obtain cigarettes from family and friends.
However, an evidential base like the one for proxy purchasing is not available for the proposed ban on the display of tobacco products. From all the evidence that has been given, it is clear that there is no conclusive causal relationship between the banning of tobacco displays and the prevalence of youth smoking. The Health and Sport Committee recognised in its report
"that the evidence base for this proposal is at an early stage and that the international evidence to date is inconclusive"
and noted that the minister said that the ban would lead to more evidence—in other words, "We have no evidence to say that the ban will stop young smokers, but we will give it a try in an attempt to find the evidence." That is hardly an empirical base for legislation.
Will the member give way?
I am in my last seconds.
Much of the evidence that is used to justify the display ban comes from before the Tobacco Advertising and Promotion Act 2002, the restrictions on point-of-sale advertising that were introduced in 2004 and the ban on brand sharing and sponsorship in 2005, which Richard Simpson mentioned.
The Canadian province of Saskatchewan has had a tobacco display ban since 2002. Youth smoking has declined there by 18 per cent. The trouble is that the rate of decline for the rest of Canada, which had no display ban, was 32 per cent. The New Zealand Prime Minister, a sensible man, recently rejected the introduction of a display ban for cigarettes because his Government did not find conclusive evidence that that is the most effective strategy for tackling youth smoking.
The display ban would also undoubtedly place a huge financial burden on small shops, estimated by the Scottish Grocers Federation as £5,000 per store. As we all know, many of those stores are already struggling to cope with the imposition of thousands of pounds-worth of alcohol licensing.
Scottish Conservatives will support a modern, flexible health service in Scotland that is focused on patient needs. We will not support a display ban on cigarettes, given that there is no credible evidence that it will reduce the number of young people smoking.
For those reasons, we will not support the general principles of the bill.
It is extraordinarily difficult to get our heads round this bill. We talk about general principles. We would not suggest, as a general principle, that we are in any sense in favour of maintaining tobacco smoking at its current levels; indeed, we might say that as a general principle, denormalising—a horrible word—tobacco smoking might be a good thing. Likewise, the sense of a massive intrusion of private practice into the health service is something that we—certainly on the Liberal Democrat side—are instinctively unhappy about. The difficulty lies in trying to translate those overarching objectives into the provisions in parts 1 and 2 of the bill.
I begin with part 2. In passing, I note, and slightly deprecate, the habit—which has been enunciated in this debate—of a closing speech by the minister being the only Government speech to address particular material; in this case, the issue surrounding part 2. I do not regard the introduction of new material in the final speech as conducive to the good conduct of a debate, and the Presiding Officer might want to reflect on that. It is not a personal criticism, but it has happened in the past and it makes the conduct of debate more difficult.
The conclusions in paragraphs 138 to 146 of the Health and Sport Committee's stage 1 report are a very serious critique of the bill. The committee was unable collectively to believe that the bill as drafted was articulating and enunciating in a statutory form the intended provisions. In some cases, we were left with the impression that the target had been missed and that the bill was taking a blanket approach to a situation that had not arisen in Scotland. In other cases, the bill seemed to seek to impose a degree of rigidity, which—as Mary Scanlon pointed out—might be wholly inappropriate as circumstances regarding the provision of health services change. Those are very serious criticisms, and, although Liberal Democrats are content in some senses with the proposals, I am bound to say that the scrutiny of part 2 will be very rigorous indeed. We need to hear the Government's response, not only at the conclusion of this debate, but well in advance of stage 2, so that members can properly consider whether further amendments might be required.
I now turn to part 1. With regard to advertising, it may be asked whether a trading standards officer will be prancing around the shop to check whether my can of soup complies with the provisions of the advertising legislation, but I will not go there. There are difficulties around that issue, and I understand perfectly that some people are not concerned whether there is a body of evidence. The evidence is very mixed, and it is certainly not helpful, at this stage, to start pitting one state of Canada against another, because the nature of the evidence—
Province, not state.
Province—I apologise.
I do not accept that if we enact the bill there will be no difficulties for small retailers. The fact that we do not know what we are expecting them to do makes it all the more difficult, and we need a clear steer on that so that we can separate the process from the principles. That would be helpful for the small stores, of which I have visited many in my area. Indeed, I had the misfortune of standing in a queue to observe behavioural patterns and when I got to the front and was asked what I wanted to purchase my attempted plea in mitigation that I was only observing behavioural patterns was not welcomed by the local storekeeper.
There are fundamental difficulties in that regard—we could give those stores a year, two years, three years or five years, but the configuration of the shop will not work if we require them not to make use of their existing counters. There must be further clarification on that, without muddying the detail of the bill. That is an important issue. I am not persuaded that those shopkeepers get any money at all from tobacco companies. By golly, the age and state of some of the advertising in their shops suggests that it could be condemned on other grounds.
The other provisions on tobacco are important. However, it would be a retrograde step to provide a defence to a charge of selling tobacco to an underage person that no reasonable person could have suspected that they were under 18. If we are trying to ensure that proof of age is the issue, that should be the test. If a person does not attempt to see proof of age, they will not have acted reasonably. The question of responsibility of the under-18s requires further consideration if we are saying that tobacco is to be regarded as a far more dangerous product than alcohol. I will be disappointed if the minister suggests that there are legal reasons for saying that tobacco cannot be treated in the same way as alcohol is under the licensing provisions.
The evidence on vending machines was much more persuasive than that on displays. We heard about the abuse of vending machines and the difficulties of a satisfactory approach across a range of outlets. Notwithstanding the enormous difficulties that the bill will produce for manufacturers of vending machines, a ban on those machines is justified.
In broad terms, the stiffening of the regulation and the provision of a national register are helpful in regulating tobacco sales. However, we must separate out the issues of principle and process. At this late stage, given all the genuine questions that have been raised, it is not helpful that we still await information on how the legislation will be implemented. A very large number of questions will have to be dealt with in detail at stage 2. I appeal to the business managers to ensure that adequate time is allocated for stage 2 to allow us to address properly the considerable number of outstanding issues.
I speak as the chair of the cross-party group in the Scottish Parliament on tobacco control. I pay tribute to the work of that group and in particular to Richard Simpson, who has made a vital contribution to it in the first session of Parliament and in the present one. In 2000, I lodged a proposal for a member's bill, which called for a ban on smoking in places where food is served. That helped to pave the way for the even more ambitious Smoking, Health and Social Care (Scotland) Act 2005, which has proved such a tremendous success since it came into force in 2006. Towards the end of last year, I called for the sale of cigarettes by vending machine to be banned in a motion that gained the support of 23 members of four political parties. I am therefore delighted that we intend to take further action to resolve the negative impact that smoking has on our nation by banning tobacco displays and vending machines.
The Parliament has done an outstanding job in tackling Scotland's not insignificant smoking problem, but much work remains to be done if the incidence of smoking is to diminish and, ultimately, fewer lives are to be lost to that vile habit. The bans on tobacco advertising and smoking in public places have had positive and direct effects on the health and wellbeing of our nation. Notwithstanding the Tories, we are right to be proud of that. According to the New England Journal of Medicine, in the year following the ban in 2006, the number of patients who were admitted to hospital for heart attacks fell by 17 per cent, with the figure increasing to 36 per cent after three years. It is widely accepted that that is a direct result of the 2006 ban.
The bill is supported by the Scottish coalition on tobacco, which involves organisations such as ASH Scotland, the British Heart Foundation Scotland, the British Medical Association Scotland, Cancer Research UK, Chest, Heart and Stroke Scotland, Macmillan Cancer Support, the Royal College of Nursing Scotland, the Roy Castle Lung Cancer Foundation, the Royal College of Physicians of Edinburgh and the Royal Environmental Health Institute of Scotland. On the vending machine ban, 22 European countries already have such a ban, and the World Health Organization supports extending that to as many countries as possible.
There are still 1.1 million smokers in Scotland and 13,000 Scots die every single year as a direct result of smoking. Those are disturbing figures, but the tobacco industry encourages more young Scots to take up smoking through its advertising and, as Richard Simpson eloquently set out, in not-so-subtle ways involving display and packaging. The measures that we can take through the bill will save the lives of future generations from the scourge of tobacco.
Point-of-sale displays have steadily become a loophole that tobacco companies exploit ruthlessly to advertise their lethal wares and maximise their profits. That is particularly evident when we consider the growth in the number and size of tobacco displays in many premises—for example, the use of clocks, back lighting, non-standard shelving and specially designed towers to highlight specific brands. As we heard from Richard Simpson, brand families are expanding to such a point that 300 brands are now on sale in the United Kingdom.
Research shows that point-of-sale display has a direct impact on young people's smoking. In 2006, 46 per cent of UK teenagers were aware of tobacco displays and those professing an intention to smoke were far more likely to recall brands that they had seen at the point of sale. That is why, for example, BMA Scotland welcomes attempts to crack down on the promotion of tobacco products to young people and believes that the measures included in the bill will help to make tobacco less accessible to young people and prevent illegal sales of tobacco.
Research in Australia and the United States has shown that point-of-sale display normalises tobacco use for children and creates a perception that tobacco is easily obtainable and a social normality. Sadly, we heard Mary Scanlon, who has made so many positive contributions to health debates, almost support the status quo. She should reflect with her colleagues that the Tories were wrong when they opposed the smoking ban and they are wrong today to oppose the measures proposed in the bill.
What Mary Scanlon did not point out about Saskatchewan was that measures applied there have had no impact on retailers, which have not had to close. It is sad that JTI and other tobacco companies are putting scaremongering adverts into magazines such as the one that I am holding up to warn retailers that their livelihoods will be threatened by the measures in this positive bill that will improve the health of the Scottish people.
Jurisdictions that have enforced tobacco bans at the point of sale have seen a marked decrease in smoking prevalence among young people. As the BMA pointed out, there has been a marked decrease in Iceland, for example, from 17 per cent to 10 per cent in only five years.
Recent research has shown that 13 per cent of 13-year-olds and 10 per cent of 15-year-olds purchase cigarettes illegally from vending machines. It is a disgrace that cigarette vending machines have been commonplace for so long and it is irresponsible to allow them when we would not allow vending machines that sold other deadly products such as knives or fireworks. It seems that a ban, which incidentally is supported by 56 per cent of the population, is the only way to curb such illegal purchases. Other systems such as tokens and proof-of-age cards have been found wanting and many youngsters have found it only too easy to cheat them. It is therefore essential that we follow many of our European neighbours.
It is our moral duty to press forward with any and all measures that reduce the number of smokers and smoking-related deaths in Scotland. No one chooses to become addicted to smoking, but innocent and misguided experimentation is only a short step from an early grave. It is essential that we protect future generations so that the huge number of people who die every year from smoking is reduced in the future.
I will highlight several issues, the first of which is the provision of a new defence for selling tobacco to underage people, which is that no reasonable person could have suspected that they were underage. The committee's evidence suggested that that would be a retrograde step, especially for test purchasing. Young people grow up quickly, but the due process of the law takes time. A young person who takes part in a test purchase will look a great deal older when the case comes to court. The defence would allow the unscrupulous to challenge test-purchasing cases.
The committee noted that it was not an offence for a person under 18 to buy or possess tobacco products. That is clearly out of step with the alcohol legislation and the balance needs to be redressed for the protection of both retailers and the young people involved.
The member says that the law on tobacco is out of balance with alcohol legislation. Does she accept that the defence that it is reasonable to think that someone is over 18 is exactly the same provision as in the licensing laws? To be consistent, surely the member would want both laws to be the same.
There are still test-purchasing issues. If the Government were to create that new defence the young person would be asked to turn up at court. We might need to look at that. I would be interested to see how that situation might be avoided in cases of test-purchasing of alcohol because I can foresee the same people making the same defence. The committee was in broad agreement on that issue.
I want to focus on more contentious issues. First, I differed from the majority of the committee and from my colleagues on cigarette vending machines. I believe that the Scottish ministers should take powers to ban such machines through subordinate legislation if the new restrictions do not work. That would give the licensed trade the opportunity to pilot new machines and to make them more secure. Radio-controlled operation has been piloted in England, but it has not been properly evaluated.
We heard in evidence that, although vending machines would be banned, licensees could sell tobacco from behind the bar as long as it was not on public display. Witnesses said that that would create a security problem. If customers and staff were able freely to access cigarettes behind the bar, that would lead to increased theft. More worrying would be the situation in a family-run pub, where children would have free access to those products and could take them for themselves or even be bullied into taking them for other children.
Secondly, a large number of jobs will be at risk if the bill goes through and that cannot be ignored. The information given to the committee when we started our scrutiny of the bill was that a minimal number of jobs would be lost, but we were given evidence that many more would be lost.
Thirdly, for those who live in rural areas the local pub can often be the only source of tobacco products. If it is unworkable to sell tobacco products behind the bar, rural areas would not have the same access to them, which would make the legislation unworkable there. For those reasons, I differed from other members of the committee.
I turn to part 2 of the bill. There was general agreement to back the RCN's call to give the Scottish ministers the power to extend the range of medical practitioners who are able to bid for a GMS contract. It was felt that the original consultation had not been sufficient to allow the Government to make that change in the bill. Giving ministers the power to do that would allow for further consultation prior to implementation. If that consultation showed that the RCN's members were able to deliver these contracts, it would be a retrograde step if we had to wait for further primary legislation. The committee backed the RCN's plea and I hope that the minister will lodge the necessary amendment at stage 2.
That leads me to the thorny issue of the GMS contracts and the commercial sector. I want to be clear: GPs are private contractors. Paragraph 124 of the stage 1 report states:
"Around 88% of primary medical services are delivered through a GMS contract; 9% through a section 17C contract and 3% through salaried staff working directly for health boards."
That means that 88 per cent of GPs are private contractors. In evidence, no one was able to show a clear difference between a private contractor and a commercial organisation. The BMA tried: apparently, a medical training makes someone a better person and better able to put patients above profit. That would appear to suggest that a GP employed by a commercial contractor was a lesser being—an assertion with which the BMA was equally uncomfortable. The BMA's evidence was poor; it smacked of a group of people who were keen to secure their monopoly. I suppose that, as a representative organisation, it was keen to protect the commercial interests of the majority of its members. However, I have a real difficulty in putting in place legislation that gives one profit-making organisation a commercial advantage over another.
Hear, hear.
My preference would be that everyone who works for the NHS delivering front-line patient care should be employed by the NHS. [Interruption.] I see that my colleagues in the Conservative party are perhaps not so happy with that proposition.
The negotiations over the swine flu vaccine should be testament to the fact that the GP contract is crippling the NHS. That is what happens when we give one commercial group a monopoly with no checks and balances. The cabinet secretary refused to give me a hearing on that in the committee, so I am trying again today to make the point.
The committee was united in saying that, if the general principles of the bill were agreed, it would need significant amendment to allow social enterprises and community organisations to hold those contracts, too, especially in areas such as the Highlands and Islands, where recruitment is an issue. Removing solutions from our communities would be wrong.
In conclusion, I want to bring home the points that I made quite fairly. Tobacco products should be subject to the same purchase controls as alcohol. Vending machines in pubs should have a stay of execution until systems have been piloted and assessed. Ministers should be able to use secondary legislation to allow nurses to hold GMS contracts. I look forward to stage 2 amendments that will deal with those important issues.
I will focus on the tobacco control aspects of the bill.
When the Parliament legislated to ban smoking in public places, it took a significant step in tackling the 13,000 deaths that occur each year as a result of smoking-related illnesses. Many of the scare stories that were peddled when the Smoking, Health and Social Care (Scotland) Bill was being considered have never been realised. The accepted norm now is that pubs and other public places are smoke free.
The ban on smoking in public places was not simply about the practicalities of banning people from smoking in public places; it was also about changing public perceptions about what smoking is. For too long, smoking was perceived as the social norm, despite the strong evidence that demonstrated its serious health consequences. Banning smoking in public places has significantly changed the public perception of smoking in our society.
I accept that the individual has a right to choose to smoke or to take up smoking, but, given the health consequences of smoking and their impact on our health service, society has a responsibility to take action to address those consequences in such a way as to indicate that smoking is not the acceptable norm. Policies should reflect that. The steps relating to tobacco control that the bill proposes represent another opportunity to take further action to change tobacco's position in our society, particularly in the eyes of young people.
The tobacco industry has strongly opposed banning the display of tobacco in shops. It was dismissive of the proposal; indeed, at times, it sneered at it in its oral and written evidence to the committee. I confess that I was rather suspicious of its motives, given that it was so ferocious in its opposition to the idea. I recognise that it must be able to recruit new smokers to replace the 300 people a day who die in the United Kingdom as a result of smoking-related illnesses, but if we accept its view that tobacco displays merely let smokers know what is available for purchase in shops, it will have absolutely no objection to the displays being removed and shops having A4 pieces of paper on which are listed all the tobacco products that are available in them. Those pieces of paper will serve exactly the same purpose as, according to the industry, the displays currently serve.
That begs a question. Why have displays grown considerably in size in recent years? Brand variants come out on almost a monthly basis. If tobacco displays have no impact on whether young people take up smoking to replace those who die from smoking, the industry will have no objection to displays being banned.
Even if we accept, despite the evidence from Saskatchewan and Iceland, that there is limited evidence on the possible benefits of a ban on displaying cigarettes, I believe that the evidence that demonstrates the benefits that will come from a ban will become stronger in time. It may take a generation for that body of evidence to become substantial enough to support the overwhelming case for a ban, but I would much prefer to be part of a generation that is prepared to make a decision on that than wait to allow the tobacco industry to reap more misery on people in 30 years' time as a result of their taking up smoking. We should make a decision now and not wait for others to die of tobacco-related illnesses over the next 20 or 30 years.
The Conservatives are very wrong about vending machines. The committee's position on the matter was not reached on the basis that we were unable to witness a practical demonstration of a remotely-controlled vending machine but because we were not persuaded that that would make any difference whatever.
I welcome the announcement that the minister is looking into the issue of proxy purchasing and how to address it. That will be welcomed universally, not only across the industry—including retailers—but in the Parliament.
My father is fighting lung cancer. It will probably take his life. We should take steps to ensure that other families in Scotland are not exposed to the misery that smoking can cause. The bill goes a significant way towards helping to ensure that that will happen.
Smoking is the most important preventable cause of ill health and premature death in Scotland where, every year, there are more than 13,500 smoking-related deaths. I am sorry to hear of Michael Matheson's situation, which is distressing for all of us. Our sympathies go out to him. When we embarked on this work in committee, I had no particular view one way or another on point-of-sale advertising and the associated matters in the bill; now, I support the bill's proposals on tobacco.
However, I remain to be persuaded about the GMS elements. During our stage 1 consideration, I asked the Cabinet Secretary for Health and Wellbeing for assurances on the matter. She responded that she would consider the issues I had raised and respond at a later stage. In turn, I, too, will respond at a later stage to that element of the bill.
There are a number of reasons for my support for the tobacco proposals in the bill. First, second-hand smoke represents a substantial public health hazard. Each year in Scotland, as many as 1,500 to 2,000 deaths among lifelong non-smokers and ex-smokers may relate to exposure to environmental tobacco smoke. Point-of-sale displays are already banned in Iceland, Thailand and nearly all the Canadian provinces. In Ireland, they have been banned from July this year and, in Norway, a ban is due to come into effect in January 2010. A number of Australian states will commence such a ban in 2011.
A large part of the debate on point-of-sale displays is around whether they encourage young people to take up smoking and to continue smoking; and whether they make it more difficult for young people to give up smoking. Both sides refer to the significant body of evidence that supports their argument. Other areas of debate include the evidence from countries such as Canada that have instituted a ban, and what it shows; the economic effect that the ban would have on retailers, particularly smaller retailers; whether a ban would increase the illicit trade in tobacco; and the effect on competitiveness and consumer choice.
Secondly, we know that 15 per cent of 15-year-olds are regular smokers and that 82 per cent of 15-year-olds who are regular smokers report buying cigarettes from a shop. Children who smoke face years of tobacco addiction that can lead to life-threatening diseases and premature death. In reaction to the restrictions on advertising, tobacco companies have become ever more creative with their branding in order to catch the eye of smokers while they are at the shop counter.
In the USA, tobacco companies are known to pay retailers to achieve dominant display of company brands. Having displays at the point of sale normalises tobacco use, making cigarettes appear like an innocent commodity such as milk or bread. That is particularly the case given that tobacco products are placed next to everyday items such as sweets.
Thirdly, international evidence suggests that adolescent exposure to tobacco brands could be reduced by as much as 83 per cent if packs were removed from sight at the point of sale. As other members have said, the first Canadian province to legislate to remove retail tobacco displays was Saskatchewan. Its Tobacco Control Act was passed in 2001. The campaign against the legislation made three key claims: removing point-of-sale displays would not affect the rate of youth smoking; the legislation would drive small shops out of business; and retail businesses would see a reduction in safety and an increase in robbery.
When the law came into force, the prevalence of smoking among Saskatchewan's 15 to 19-year-olds was 29 per cent. The latest smoking rate for 15 to 19-year-olds in Saskatchewan is just 22 per cent. I heard the comments of Jackson Carlaw and Mary Scanlon, who spoke about the wider position, but I was not persuaded by the points that they made, given the expansion of point-of-sale display advertising in other countries across the world. Why would all the other countries that I have mentioned have banned point-of-sale displays if they had not been persuaded of the case for doing so?
The reductions that have been recorded are wholly consistent with a number of academic studies showing that young people are disproportionately influenced by tobacco marketing activities, including in-shop displays. There is no evidence from Saskatchewan or any other jurisdiction that has outlawed retail tobacco displays that any shops have gone out of business as a result of the policy.
Is the member not aware that in Thailand, where the ban has been implemented, 10,000 shops have gone out of business? According to the Canadian Convenience Stores Association, since 31 May 2008, 23 convenience stores have closed permanently every week in Ontario and 12 stores have closed permanently every week in Quebec. Surely that is evidence of stores going out of business.
One needs to have knowledge of what has happened to Thailand's economy in the meantime. We need to think about the issue in a broader context. The closures to which the member refers are not attributable solely to tobacco legislation. Equally, there is no evidence of increased theft from shops that have removed tobacco displays; indeed, there is evidence to the contrary.
Another aspect of the bill that has proved contentious is the proposed ban on vending machines. Those in favour of the ban have pointed to survey evidence that underage smokers are purchasing cigarettes from vending machines together. They make a number of other arguments: first, that no other restricted goods are sold in this way; secondly, that there is no effective way of monitoring vending machines; and thirdly, that age-restrictive measures can be overcome. Those against the ban question the evidence that significant numbers of underage smokers are using vending machines. In addition, they contend that, even accepting the survey data, past surveys indicate that the number of young smokers using vending machines has been falling without a ban; that the increase in the minimum age to 18 makes it easier for licensed premises owners to check age; that better methods of age verification are available; and that a ban would have a significant economic impact on vending machine operators.
It is estimated that there are 6,500 vending machines in Scotland, selling an estimated 36 million to 39 million cigarettes. Richard Simpson was right to say that the Labour Party opposes vending machines. I was not persuaded by the argument that technology would allow vending machines to be controlled by bar or hotel staff. In my view, that simply would not work. However, I am sympathetic to the points that have been made about jobs and will listen carefully to the discussions that will continue on the matter. My colleague Rhoda Grant has fought valiantly in committee on the jobs issue.
I agree with everything that Rhoda Grant said about GMS contracts. As I said at the outset, I remain to be persuaded on a number of issues relating to the primary medical services element of the bill. Only nine of the responses to the committee's call for evidence gave a view on the proposals. That is worrying because, in effect, the proposals will create a monopoly for general practitioners, many of whom are private sector members of the CBI. The cabinet secretary has rejected the request by the Royal College of Nursing that the bill be amended to allow future regulation to permit nurses to hold general medical services contracts. Mary Scanlon described well what we found on our visit to London, and I will not repeat what she said. Suffice it to say that the operation that we saw was impressive. More care and attention needs to be paid to the current contractual arrangements for delivering primary care services.
I would not want to sit down without mentioning community co-operatives, which are close to our hearts. If the cabinet secretary truly thinks about the word "mutual", she will understand its importance in the social enterprise dictionary.
The most powerful and effective trade union in Britain today is not Unite, Unison, the Communication Workers Union, the National Union of Rail, Maritime and Transport Workers or the GMB, but the British Medical Association. The fingerprints of that organisation and its interests are all over part 2 of the Tobacco and Primary Medical Services (Scotland) Bill. I should say at the outset that that is not a criticism of the BMA, but a compliment—it is a compliment to a union that it achieves good results on behalf of its members and plays an influential role in the determination of Government policy. However, we MSPs should not be seduced into thinking that self-interest and public interest are one and the same thing in this case, as the BMA would have us believe. That is most certainly not the experience of the past five years regarding the provision of primary medical services.
To put that in perspective, the cost of providing those services in Scotland in 2003-04 was £488 million; by the following year, when the new GP contract—negotiated by the BMA and the Government—had been implemented, the cost had soared to £628 million. The last available figure, for 2007-08, is £699 million. In other words, the cost of the service has risen by more than £200 million in four years; that has correspondingly impacted on the net income of GPs, which has increased by 40 per cent over the same period.
I mention that because, in considering part 2 of the bill, it is important to understand and appreciate that the Primary Medical Services (Scotland) Act 2004, which the bill seeks to amend, was an integral part of a bargain that was made between the BMA and the Government at the time relative to the provision and funding of general medical services. Just as part of that bargain entailed a substantial increase in GP incomes, so it also made it possible for health boards to contract out the provision of primary medical services to commercial bodies.
That might not have happened in Scotland yet, but the practice is used much more extensively south of the border. I congratulate Mary Scanlon and Helen Eadie on the open minds that they displayed in observing, on behalf of the Health and Sport Committee, what can be done in practice when such an approach is taken. Although the mechanism is not being used in Scotland, it was nonetheless an integral part of the deal that was made. Moreover, the very existence of such a capability provides a measure of competition and choice, which operate to keep down overall costs and to provide an alternative model, which might be better suited to the provision of GP services in some parts of our country in the future.
Those arrangements are not a legal loophole or an oversight, as the SNP now likes to pretend. The bargain, or deal, was made in an act that was supported by every party that is now represented in the Parliament, including the SNP. Members will recall fondly our former colleague Carolyn Leckie of the Scottish Socialist Party, who suggested that the 2004 act would open the door to a mass influx of the private sector into the NHS. At the time, Shona Robison, speaking for the SNP, dismissed that. She said:
"The paranoia exhibited by Carolyn Leckie is staggering even by SSP standards."—[Official Report, 18 December 2003; c 4390.]
Shona Robison, along with the rest of the SNP, voted for the Primary Medical Services (Scotland) Bill. However, that same paranoia is now being exhibited by Nicola Sturgeon and Shona Robison who, as ministers, are trying to elevate the modest change that was made in the 2004 act into some great issue of principle about the nature of the NHS. That hypocrisy is staggering even by SNP standards.
The BMA, as befits any good trade union, just wants to reinstate a restrictive practice that will help to sustain the income of its members. If we think about it from its perspective, who can blame the BMA for that?
We should not fall for the ludicrous argument that only traditional GP practices can provide an appropriate standard of patient care and that salaried GPs who are employed by commercial bodies will not; and that somehow GPs' standards will be corrupted by the profit motive—unlike the selfless angels in GP practices whose motives are, of course, wholly altruistic. That is ludicrous, for two reasons. First, GP practices, like all other businesses, will shortly turn their attention to the submission of their tax returns for 2008-09. When all the figures are crunched, there will be a surplus—a sizeable one, in many cases. That surplus will be taxed under schedule D case 1, on the profits of a trade, profession or vocation. The blunt truth is that GPs make profits out of the NHS and always have done since its inception in 1948. We must ask why profits made by a traditional GP partnership are somehow morally superior to profits made by a commercial body. The distinction defeats me.
Secondly, the most insulting part of the argument is the suggestion that salaried GPs, many of whom are of course members of the BMA, somehow care less about their patients and will provide a poorer service simply because they are employed by commercial bodies, compared with GPs who are self-employed and in private practice on their own account. That is offensive nonsense.
For those reasons, Conservatives will be consistent with our position in 2004. We trust that other parties, including the former Government parties who negotiated the contract in the first place, will likewise continue to honour all aspects of the agreement that was struck at that time. It has cost the taxpayer enough as it is, and given the current state of the public finances we should not take any step that could make the provision of such services even more expensive.
I am grateful to the Health and Sport Committee for its work to analyse the implications of the proposals in the bill. I return to part 1.
The ban on smoking in public places is one of the big successes of recent years. It was totemic and effective and it confounded many critics. I am glad that the Scottish Liberal Democrat party was the first political party to support a ban and I am glad that I could play a part in arguing for a ban, because I was policy convener of the party at the time. It is clear that predictions of a noticeable reduction not just in overall smoking levels but, more important, in the percentage of young people who start smoking, have been realised. The smoking ban has saved lives and reduced illness and will do so for many years to come.
A key to the success of the smoking ban was the strong change in public mood, which swung strongly behind it. Smoking is no longer quite as cool among young people as it used to be—I never quite understood why it was regarded as cool—and has been banished much more to the fringes of many social activities. Smoke-free environments have become much more the norm than they were before the ban came into effect, as Michael Matheson was right to say.
However, it could easily have gone the other way. In our consideration of the bill, we must approach the issues with a sense of cultural and practical realism. I make no bones about the fact that I detest tobacco and all its works. I detest the damage that it wreaks on so many lives. I am with James VI, who regarded it as a foul, noxious, stinking weed. Sir Walter Raleigh should have been left in the Americas or barred from entry to the United Kingdom on his return. There is something particularly insidious about an industry that tries to attract young people and facilitate them in starting smoking, with all the lifelong addiction and illness problems that that will bring.
The bill is important, not least in Glasgow, where smoking levels are high in the more deprived areas and issues of health inequality are very much to the fore. It is right to denormalise cigarettes to a degree. However, there is a real risk, which is underplayed by worthy organisations such as ASH and the BMA—if I dare mention the BMA after the previous speech—that we will cross a line and make cigarettes a forbidden fruit that young people will seek out as a right of passage, in an act of rebellion against parents whom they regard as staid and restrictive.
There are also issues to do with the viability of our high streets, where many shops operate at marginal levels of profitability, and to do with the future of firms that supply the tobacco trade in other ways.
I strongly support the banning of cigarette vending machines, which will reduce sales to young people and perhaps to other people to some extent. However I want to lay before members the representations that I have had from a constituent who runs a long-established business that supplies cigarette vending machines. He has 12 employees, whose jobs are in jeopardy. It is true that the business supplies other types of vending machine, which sell confectionary, snacks and canned drinks. However, until recently tobacco accounted for 90 per cent of the business. The smoking ban hit the business badly, with a 50 per cent drop in turnover. That was evidence of the ban's success on the one hand and the scale of the challenge to my constituent on the other. The company faces the loss of its cigarette trade and the liability of having to recover 500 vending machines, bearing the cost of scrapping them under European waste electrical regulations and redundancy payments to the staff. My constituent is attempting to diversify his business but he cannot do so just like that. He is likely to lose business even before the vending machine ban formally comes into place.
I accept that we would not want or expect businesses to diversify just like that. Is that not an argument to discuss the lead-in times that are required? Indeed, we have been keen to discuss those with businesses and to encourage them to diversify. For example, we have discussed the potential for changing a vending machine to a dispensing machine behind the bar, which would perhaps deal with some of the security issues that other people have raised.
The minister makes a good point and I accept the Government's good will in that regard. However, the matter must be gone through and considered carefully with the trade. My constituent has run an entirely legitimate business since 1963 and it is not his fault that social norms—and, now, legislation—are changing. The minister needs to consider carefully the support that the Government will provide to the company and its employees. I am not sure whether compensation comes into that.
The more difficult point-of-sale ban raises a somewhat similar issue, although it is not quite the same. I rather doubt the suggestion in the Cancer Research UK submission that point-of-sale advertising
"is a greater risk factor than even parental smoking."
The statistics are difficult to interpret and we must be careful not to draw the wrong conclusions and adopt the wrong priorities.
The committee supported on balance the contribution of a point-of-sale ban and I am prepared to go along with that, but the Government must consider carefully the position of small retailers. If the ban achieves nothing, as some people—usually its opponents—suggest, there is no problem. On the other hand, if it reduces sales, which is probably its main purpose, careful consideration must be given to how it is phased in, how it applies to small corner shops and whether other support is needed to help traders to cope with the change.
I will say a word on underage and proxy purchasing. The wider range of powers, including fixed-penalty notices, is welcome. The proposals to ban proxy purchasing are vital but must, furthermore, be accompanied by a ban on underage purchases and be fully enforced. We can learn lessons from alcohol legislation on that. We must also have an eye on smuggling, which has various evil consequences, in the background.
There is a sense that we are on the cusp of an historic opportunity. Cigarettes and tobacco now appear old fashioned, unattractive and uncool; the substantial health dangers are understood, and starting smoking or experimenting with smoking has stopped being the norm for teenagers. The bill deserves support at stage 1. Cultural fashions can change, and change quickly, but the Government must get the balance right and support the parts of Scottish society that are affected adversely and commercially by the proposed bans.
I support the motion.
The evidence that the Health and Sport Committee heard was contradictory. How could it be otherwise when witnesses came from such diverse sources as the tobacco industry and Action on Smoking and Health? I am, however, convinced that the case was made that tobacco displays that are situated prominently in shops that young people patronise serve an advertising function that can attract them. For that reason, I support the section of the bill that will prohibit such displays. I am aware that retailers complain about the potential cost of rearranging their shops to cope with such a prohibition, but I would be surprised if the tobacco industry did not provide some form of support when the bill comes into force, as it has done in other countries. Above all, we must consider the health and cost to society and individuals when young people are persuaded to take up the cigarette habit. The prohibition is a step in the right direction.
There is also the issue of vending machines. I would be more impressed with the measures that the industry has suggested to prevent abuse—such as electronic control—if it had shown any concern for potential misuse of such machines before now. However, all over Scotland, one can see cigarette machines that are located out of the sight of bar staff. The hotel in which the Health and Sport Committee held its most recent away day is a prime example. There are many outlets for cigarette sales already; vending machines are an unnecessary risk and should be removed.
I will concentrate the rest of my speech on part 2 of the bill, which concerns primary care services. There is agreement around the chamber that what we aim for in Scotland is a mutual health service in which the public are not just customers but owners. For that to be achieved, the NHS must remain firmly in the public sector. That does not mean that a relationship between it and the private sector has no place: it would, for example, be inappropriately dogmatic not to make use of surplus capacity in the private sector for waiting list initiatives. However, it would be difficult to square the commitment to mutuality with the sort of purchaser-provider split that has caused so much anguish south of the border.
A strength of primary care in this country in the past has been the link between general practice and patient, which provides continuity of care and a medical records base that is the envy of the world. I appreciate that events over the past few years have combined to weaken that position—no one regrets that more than I do. I am a former salaried general practitioner—David McLetchie might be surprised to hear that I agree with much of what he said about the commercial aspect. However, I regard that as a reason to repair the damage rather than to weaken the system further. Practices that are run by international commercial companies will inevitably mean less continuity and more fragmentation. In addition, as they are run for the profit of remote shareholders, they will ultimately drain money away from front-line services.
It has been said that such developments may be necessary if health boards find it difficult to attract GPs to work in certain areas. The answer to that is that boards already have at their disposal an array of mechanisms with which to plug such gaps, including the ability to employ GPs directly under terms that will attract suitable applicants, which is how I was recruited. That position is little different from that of a commercial company, but it is without the drawbacks that I have mentioned.
My concern has been expressed by witnesses; namely, that the bill does not go far enough. Under its terms, a commercial partnership can provide primary care services as long as all the parties to the agreement have sufficient involvement in primary care and at least one share is owned by a medical practitioner or other health care professional. It was agreed in evidence to the Health and Sport Committee that a person working for one day a week in NHS primary care would satisfy that criterion. Under the terms of the bill, it would therefore be possible for a GP or nurse working one day a week in Edinburgh, for example, to set up a company to run practices in Glasgow, Aberdeen or Inverness. That is not a hypothetical situation: the firm ChilversMcCrea Healthcare was set up by a doctor and nurse in Chelmsford in Essex in 2003, and it now manages about 35 practices all over England. I appreciate that, until now at least, the Cabinet Secretary for Health and Wellbeing has been happy with the proposal that I have described, on the ground that the people running such a company will have sufficient clinical experience. However, I assure members that general practice in Edinburgh is very different from one in Elgin or Eigg. It is difficult to see how health care professionals running such a company could offer a service miles away from where they work professionally that would be in any way different from the commercial service that the bill seeks to outlaw. I therefore hope very much that the Government will relent and seek to remedy that situation in stage 2 by making clinical work in an individual practice a necessary pre-condition.
I do not necessarily disagree with Rhoda Grant that it might be a great benefit one day to have all general practitioners in the health service working as salaried employees. We should remember that all employees in the health service make a profit out of it. I do not know of anyone who, when they fill in their tax returns, records that they have not made any money out of working for the health service.
I hope, too, that the Government will amend the bill to leave the door open for nurses to hold general medical services contracts without the need for further primary legislation, as that ability may be considered necessary in the future, if not now.
Overall, however, this is a much-needed bill, and I strongly support it.
I welcome the opportunity to take part in this important debate. There is no doubt that the bill is significant and that it will make an important contribution to the health and wellbeing of Scotland. All members will have received a number of submissions from different organisations, which shows the level of debate over the bill. The substantive part of the bill is obviously part 1, the main driver of which is to reduce smoking rates, which is an important policy driver in Scotland.
Although significant progress has been made in recent years—the percentage of people who smoke has dropped from 45 to 25 per cent—and the smoking ban has clearly been a success, Michael Matheson was right to point out that 13,000 deaths each year can be attributed to smoking, as can the high prevalence of heart and lung disease.
Smoking also results in significant costs, which one briefing reckons amount to £409 million for the NHS and £837 million for the economy. At a time when we are struggling through an economic downturn, those are costs that we can ill afford.
As Robert Brown pointed out, smoking is also a health inequality issue. Smoking prevalence runs at 43 per cent in poorer areas but at only 12 per cent in more affluent areas. In terms of how people spend their money, the poorest 10 per cent of households spend 2.43 per cent of their income on smoking, whereas the equivalent figure for more affluent households is only 0.52 per cent.
From that point of view, the provisions in part 1 are important because they seek to reduce the incidence of smoking, particularly among young people, by introducing a number of different measures. The first of those is the ban on the display of tobacco products, which has been the subject of some discussion in this afternoon's debate. My feeling, which is backed up by evidence, is that tobacco advertising displays have an influence on young people. One study indicates that young people are 38 per cent more likely to purchase cigarettes if they have been exposed to tobacco advertising. In addition, the statistics from Iceland show that the proportion of 15-year-olds who smoke has dropped from 18 to 11 per cent over an eight-year period. That evidence weighs in favour of those who argue for a ban on tobacco displays. I know that some members, for example Ross Finnie, have cited the practical difficulties involved in such a ban, but I am sympathetic to the Government's proposal. I hope that the minister can work at stage 2 to address some of the concerns that have been raised.
On vending machines, Kenny Gibson was right to point out that 10 per cent of 15-year-olds and 13 per cent of 13-year-olds are able to purchase cigarettes from vending machines. The ban on cigarette vending machines will curtail the ability of young people to purchase cigarettes and to take up smoking. Evidence shows that, in some council areas in England, 100 per cent of young people were able to purchase cigarettes from vending machines. Those statistics are very concerning. Although concerns have been raised about job losses, I hope that appropriate discussions will take place to address the concerns that constituency members have raised.
I support the requirement to draw up a register of retailers, which will help to identify where sales of cigarettes take place. That will contribute to the success of schemes such as the enhanced tobacco sales enforcement programme, which aims to reduce the sale of tobacco to under-18s by 50 per cent by 2011. Information on the incidence of sales and on where tobacco retailers are located will help the targeting of test purchases and visits by trading standards officers.
The fixed penalty notices and tobacco retailing banning orders that the bill will introduce will also help because consistent breaches will result in a ban.
I will touch briefly on part 2. I have concerns about the ability of community co-operatives and social enterprises to enter into contracts for medical services if part 2 is agreed to.
However, in summing up, let me return to part 1. There is no doubt that smoking kills. Eighty per cent of smokers take up smoking before they reach the age of 19, 41 people start smoking every day, and 35 people die every day as a result of tobacco use. Those are chilling statistics, which should focus the minds of the ministers on putting in place a bill that can be supported by all parties at stages 2 and 3.
We move to the wind-up speeches.
It has been an extremely worthy debate. The last two speeches, by James Kelly and Dr Ian McKee, showed the amount of work that members have put in on the subject.
It is a pleasure to speak in the debate because hitherto, as Shona Robison hinted at, I have had to stick to my role as convener of the Subordinate Legislation Committee, in which capacity I must consider the powers in the bill rather than its policy intent. I will enjoy the freedom. I thank Shona Robison for her generous acknowledgement of the contribution that my committee has made to consideration of the bill at stage 1.
The minister gave us a good account of the background to why we are where we are. She talked about the health risks of young people starting to smoke and raised many of the themes that others have touched on. Christine Grahame gave us an extremely workmanlike account—
Workmanlike?
She gave us a workwomanlike account of the work of the Health and Sport Committee thus far. I am extremely impressed by the amount of work that her workwomanlike committee has put in and by the fair-minded way in which she has chaired it.
Dr Simpson got to the heart of the matter with his three questions—on display advertising, whether a ban would work and whether it is a proportionate measure. Those are the issues that lie before us. Later in the debate, Robert Brown mentioned his constituent who would lose business as a result of the bill and who might even be in serious trouble. I will return to that theme.
Mary Scanlon fairly and openly said that she would concentrate on part 2 of the bill. My colleague Ross Finnie quite correctly pointed out that it is a difficult bill, to say the very least. He noted that paragraphs 138 to 146 of the committee's report are a critique of the bill, in which the committee raises a number of questions. He said that the work will be done at stage 2. Every member probably agrees that today's debate flags up the fact that there are unanswered questions. Good work has been done so far, but more will have to be done in the future.
I will be categorical: at stage 1, it is my party's position to support the general principles of the bill. I stand by that. I also stand by the remarks of my colleague Ross Finnie on vending machines.
Kenny Gibson made one of the debate's most impassioned speeches. It is quite clear that he feels extremely strongly. Rhoda Grant—who is no longer in the chamber—brought to bear her knowledge and posed a difficult question, which I trust will be addressed at stage 2. She said that, in her opinion, the ban on vending machines would best be dealt with through subordinate legislation. My view is that the ban is a pretty draconian measure to be dealt with through subordinate legislation and that it should be on the face of the bill, given the strength of the power that it will give to ministers. I do not understand how Rhoda Grant's view on that issue sits with her belief that rural pubs and whatnot should be able to supply tobacco. She has to square that circle. She may well have a solution, but we need to hear more.
I take slight issue with Michael Matheson's assertion that smoking is no longer the social norm. I hope that that is the case and that it is not just how we in the chattering classes view the situation. If one goes to a dance in a town or a city anywhere in Scotland on a Saturday night and looks at what happens outside in the wee small hours, one will see people smoking in very great numbers. Let us not kid ourselves—we face a challenge. However, we are taking steps in the right direction. Michael Matheson flew the flag for a ban on smoking in public places at an early stage. He was courageous in doing so and has every right to be proud of that.
David McLetchie's speech was impassioned, to say the very least, and was worth waiting for. I trust that the British Medical Association will read it with great interest. He said nothing less than the truth, in that the BMA is, indeed, a trade union for its members that is delivering the goods for those members. As ever with a speech from David McLetchie, it is advisable to allow some hours to elapse after the speech before deciding whether he is right or wrong. I sometimes feel that it is like playing dice. It is very easy to be charmed by Mr McLetchie, but in 10 years I have developed some experience in this matter.
As colleagues know, until five years ago I was to be seen out behind the bike shed, so to speak, of the Parliament, puffing away. Members may say that it is typical of a Liberal Democrat that I started smoking when I was kidded by a school friend into smoking rolled up lettuce leaves—I assure members that they were perfectly disgusting.
The point that Rhoda Grant made is valid—a small rural shop can depend on the trade in tobacco. Where there is no shop, people must go to the hotel or the pub. It is not so easy for many to give up smoking. It is, tragically, well nigh impossible for many—as was the case with my father, who died of lung cancer. We must remember what Rhoda Grant said, because it is true, about outlets in the most rural locations.
It is right to make it harder to sell cigarettes, but in the case of small, remote rural shops we must think more widely about other ways in which we can support such shops and not let this rightful action, which is being taken for the highest of motives, be the straw that breaks the camel's back. It is about retaining rural post offices and it is about encouraging and supporting small retail outlets not to sell fags but to survive and prosper in other ways. That is the message that I am getting very clearly from my constituents. I support from the bottom of my heart, for personal reasons, the general principles of the bill and I look forward to stage 2.
As many have observed, the primary medical services provisions in the bill are unnecessary, prejudicial and short-sighted. Parliament must do better than seeking to find legislative solutions for which there are no known problems. What might come next? A bill to preclude triple-decker buses? A new civil aviation (Scotland) bill providing against the possible use of Princes Street by airliners? Part 2 of the bill, the necessity for which appears to be validated only by the standing ovations that have been conferred upon the cabinet secretary by the doctors' trade union, to which part 2 seeks to extend an absolute monopoly, is not needed and not wanted and is typical of the vanity projects in which this minority Government is inclined to specialise.
As David McLetchie detailed, we remain pragmatic. Even as ministers issue briefing papers detailing the extraordinary challenges and demands that face the NHS in the decade ahead, they seek to close down possible solutions to those challenges via a centralised diktat. Even as politicians and the public wake up to the reality of the demographic changes that face the national health service and GP practices, and which arise from an ageing population, the Government moves to foreclose any ability for the independent sector potentially to assist in as yet unforeseen circumstances. Even as we appreciate the challenge of approximately 20 per cent of GPs retiring in the next five years, ministers bury their heads in the sands of ideological prejudice. Part 2 of the bill is the latest in a long line of examples of the minority SNP Administration being more concerned about ideological purity than it is about what delivers the best care for Scottish patients. We hope that together with others we can make a common cause and remove part 2 at the earliest opportunity.
Turning to part 1, I am happy to admit to being a lifelong non-smoker. Is that because the displays in small retail shops were not sufficiently eye-catching when I was a teenager? Get real. Perhaps I was aware of the inherent dangers of smoking. I was, in fact, far less aware of them than teenagers today are. According to the Scottish schools adolescent lifestyle and substance abuse survey, among those aged 13 to 15 approximately 89 per cent are fully aware that smoking can cause heart disease, approximately 96 per cent are fully aware that smoking can cause lung cancer, and approximately 91 per cent are fully aware that other people's smoking can harm the health of non-smokers. Despite that, it is depressing that too many young teenagers start smoking.
In my case, I just did not care for it. As someone who can remember needing a knife and fork to cut through the smoke when sitting on the old bench seats on the top deck of the bus home from school and who can remember when, from the back row in the cinema, while pursuing altogether more healthy pursuits, I—
Like smoking lettuce.
Certainly not that—we could afford better in Newton Mearns.
From the back row of the cinema, I watched the beam of the projector cut a swathe through the acrid smoke, so I welcome the joys of smoke-free public places.
Let us be clear that the Scottish Conservatives are in no doubt that the Government is right to continue to focus on measures to reduce smoking and, in particular, to dissuade teenagers, whom I mentioned a moment ago and at whom the measures in the bill are specifically aimed.
As a spokesman on public health in the Parliament, I find myself in the anomalous position of proposing that we remove a central measure from the bill that, superficially, appears to be aimed at the betterment of public health. However, the proposal to ban the display of tobacco on retail premises is misconceived. I believe that the measures that we introduce should not be other than firmly evidence based, likely to be effective and properly enforced once they are implemented.
As Mary Scanlon, David McLetchie and others have demonstrated, the evidence just does not pass muster. In nearly all cases, the authors of reports cited in evidence clearly state that the claims of causation between the displaying of tobacco and people starting smoking should be made with great care. For a number of technical reasons, including the fact that display bans have been part of a range of interventions, it is not possible definitively to claim causation. I share that view, which was expressed in those very words—reluctantly and recently—by ASH, although it does not appear in any briefing that MSPs received ahead of the debate and has since been deleted from the ASH website.
Kenny Gibson referred to brand awareness evidence, by which I presume he means the 2006 Wakefield/Henriksen research. That research was based on the old parlour game of remembering items on a cloth-covered tray. Teenagers were shown photographs and then asked which ones they could remember. Being bright and willing to impress, they did. However, no evidence was subsequently produced to show that that encouraged them to go out and buy the things that they could remember. Indeed, having heard all the evidence, the best that the Health and Sport Committee could say in its report was that
"On balance"—
only on balance, mind—
"the majority of Committee members consider that the display of cigarettes at the point of sale constitutes advertisement and … recognises that the evidence base for this proposal is at an early stage and that the international evidence to date is inconclusive."
That is hardly a ringing endorsement.
In its report, the Health and Sport Committee accepted that it had not witnessed trials of radio frequency-controlled cigarette vending machines by organisations such as the National Association of Cigarette Machine Operators. It was an extraordinary admission by Christine Grahame—emphasised by Michael Matheson with pride bursting from his pores—that the committee would rather not see those machines operate in case they work. Richard Simpson's concerns about pre-radio-controlled machines is shared by the industry, hence its investment in the new technology to address the matter. Rhoda Grant's comments, by contrast, were much more constructive and worth while.
The Government insists that the bill will not prove to be a burden of any consequence to small businesses. With due respect to the ministers concerned, I point out that they have not owned or run small businesses themselves. Small retailers regard themselves as the Government's partners in preventing young people from getting hold of cigarettes. They support enforcement actions and, like us, they support the new licensing proposals. They also expect the Government to respond to the Health and Sport Committee's view that proxy purchasing should be tackled—that the deliberate falsification of documents to obtain cigarettes from responsible retailers should lead to punishment not just for those who are deceived; those who are doing the deceiving should face consequences, as well.
This afternoon, we have seen writ large before us that we have a minister for wishful thinking and a cabinet secretary for fantasy politics. Consequently, although we will support the measures in the bill that we believe will be effective, we will oppose the bill at stage 1 in the hope that part 2 will attract insufficient support as the bill progresses, and in the expectation that the final measures that are presented to Parliament to tackle and reduce youth smoking—which we will support—will be effective, evidence based and inclusive of the recommendations that have, so far, been ignored by the Government.
I should declare an interest as a member of the BMA, although whether I will still be a member at the end of this process is another matter. I am also a member of the Royal College of General Practitioners.
I hope that Ross Finnie will forgive me, but I will concentrate on part 2 in my summing up.
As other members have said, David McLetchie's speech needs to be read carefully before we can come to a conclusion. There is no doubt that, if the bill was successful and did what it purports to do, it would entrench in primary legislation one model of general medical services. That is the basic flaw in the bill, as we have no idea exactly what we will need in four or five years' time. At that point, if we need something different we will have to go back and amend the primary legislation. I am unhappy about that.
I am also unhappy because, in practice, there has been only one attempt by a commercial company to intervene in primary care, and that ended up not progressing. That might be because the remuneration offered to that company was inadequate. There is some evidence from England that Atos and other companies are being unduly promoted by primary care trusts by being given extra rewards beyond those given to general practices. That approach would not therefore fulfil the criteria, which David McLetchie quite correctly set out, for the sort of competition that pushes prices down. In England, it might be that, in order to have competition, primary care trusts are actually paying considerably more.
A lot more remains to be done on the bill. The Labour Party will be considering its position, depending on amendments that are lodged at stage 2. First, there needs to be an amendment to clarify the position with regard to future competition from other groups, such as nurses, that might provide general medical services. There also needs to be clarity on whether other groups might come into being, such as co-operatives, social enterprises and new models of community-owned practices, which might indeed be profit-distributing organisations.
A number of speakers have made the point that general practice is a profit-making business. As a GP, I can tell them that that is absolutely the case. Profit, in this case, is not a dirty word—indeed, I do not think that it is ever a dirty word—but there is no doubt that the income that is obtained by general practice partners, on which they are taxed, is the surplus income that exists at the end of the year, once all the costs are met. To be frank, there are bad GPs who will skimp on staff and premises and do the absolute minimum in order to maximise their profits. That is rare in Scotland, but I tell ministers that they are about to be confronted with a serious problem the likes of which we have not seen since the 1960s. Since the Primary Medical Services (Scotland) Act 2004 came into force, the number of partners is dropping—that is very evident in England—and the number of salaried doctors who are employed by those partners is increasing. The result is that there are now doctors who earn £150,000 or £250,000. I received an e-mail from a doctor who moved from England to Scotland in which she complained bitterly that her income, as a salaried doctor employed by a partnership, is less than half what she was earning in England, and is less than a registrar's income.
We talked about exploitation this morning in relation to teachers, but exploitation of doctors is now beginning to occur. Substantial numbers of qualified general practitioners are having to queue up as locums in order to try to get work.
The bill is not flexible, so we need to think seriously about part 2.
Already, communities such as Rannoch are facing particular problems. The other day, Lindsay Roy told me about a community in Fife that was having problems attracting GPs. GPs are closing down branch surgeries because they are no longer profitable or sustainable, which means that some people are now faced with having to travel considerable distances to get GP services.
Part 2 is seriously flawed. Although the Labour Party will agree to the general principles of the bill when we vote tonight, we have serious concerns about the bill.
I addressed the provisions on tobacco in detail earlier, but I will deal with them again briefly.
The Conservatives opposed the ban on smoking in public places because they felt that the evidence was not clear and that that ban would be an unnecessary restriction on individuals. Now that we can see that the outcome was a 30 per cent reduction in heart attacks and an undoubted improvement in people's health, as well as the fact that Scotland has a higher standing because it led on the issue in the UK, will the Conservatives reflect on whether their opposition to that ban was appropriate? We did not hear today whether they now feel that the smoking ban was a good thing and that they were mistaken in their opposition to it.
I raise that issue because it reminds me of the Conservatives' position on a ban on tobacco displays. There has been an increase in the number of brands that are displayed and the volume that there is in a particular area. The first thing that a shopper sees when they go into a supermarket is a vast array of tobacco. There is no doubt in my mind that the tobacco industry is using that as a loophole to get around the ban on advertising.
As the only party that has adopted a stance of total opposition to a ban on tobacco displays, the Conservatives ask, "Will it work? Is there evidence that it will work?" There is partial evidence that it will, and the committee made clear that it felt, on balance, that the evidence was there. If so, the ban is worth pursuing.
The fact that we do not have all the evidence is not a reason not to have such a ban. I promise members that if we always wait for the evidence, the tobacco industry—this is particularly the case with that industry—will use every means in its power to get around every piece of legislation that every country passes. When Judith Mackay, an Edinburgh graduate who was given the British Medical Journal award for her work on tobacco control in Asia, worked in Thailand, there was massive opposition to the controls on tobacco, and she was vilified and personally threatened by tobacco companies for her actions in that country.
If 10,000 shops have closed in Thailand, that may simply reflect a change in economic circumstances. The number of businesses such as convenience stores in Canada that have closed since the ban there is no greater than the number that closed due to changes in purchasing patterns before the ban was introduced. There is no evidence whatsoever that a single retailer in Canada has closed because of the ban alone.
Having said that, we need to ensure that what is being proposed is proportionate. Ross Finnie stated clearly that we do not know exactly what the Government is proposing in parts of the bill, and we need to be totally clear about that before we can support without amendment any of the bill at stage 2. Small retailers are entitled to measures that are proportionate, and interim measures—such as cupboards or covers at first, pending a longer-term ban—should be examined carefully.
The same applies to vending machines—
You should finish now, Dr Simpson.
The results of the radio-controlled vending machine pilot—which we now have but did not when the committee produced its report—indicate a massive increase in control of sales, but it still stands at only slightly more than 80 per cent.
The test purchasing in Oban that I mentioned—
I am sorry, Dr Simpson, but you should finish now.
The illustration that I gave indicates that we must ban vending machines. [Applause.]
I have not even started yet—I thank members for the applause.
This has been a good debate, of the high quality that I have come to expect from any debate that involves the health fraternity in the Parliament. At the outset, Christine Grahame eloquently outlined—in a completely non-workmanlike way—the key points in what I think is an excellent committee report, to which the Government will pay close attention as we progress through the later stages of the bill.
I will deal with the first two parts of the bill, beginning with part 1. The provisions in part 1 that relate to tobacco build on the good work that has already been done by the Parliament. In his opening speech, Richard Simpson was right to point to the evidence that suggests that the ban on smoking in public places is already leading to a reduction in heart attacks. Listening to Mary Scanlon and Jackson Carlaw, I found that many of their arguments were reminiscent of the arguments that the Tories made against the ban on smoking in public places. The Tories were wrong then, and they are wrong now in the objections that they are making to part 1.
I believe that the provisions in the bill are a proportionate and appropriate response to the scale of the problem, which we should not forget. Shona Robison was right to say that the implications of the bill for retailers or for vending machine companies, which the Parliament has a duty to consider, must be weighed against the immense social and economic costs that are associated with smoking.
The bill makes provision to end point-of-sale displays in shops, and Richard Simpson rightly asked whether such displays are a form of advertising. I agree with him that they are, and I think that that assertion is evidenced by the effort that tobacco companies put into such displays. It is not only a form of advertising, but an extremely powerful marketing and advertising tool.
I also agree with Richard Simpson that, based on the compelling evidence of Gerard Hastings and others, the ban will be effective in the long term.
Ross Finnie fairly and legitimately raised the question whether retailers know what will be expected of them in complying with the bill. We are in discussions with retailers about simple and cost-effective ways of keeping tobacco out of sight, which is what they will be asked to do. The bill will not give ministers the power to tell retailers that they must keep tobacco under the counter. The bill will not impede retailers from modifying existing gantries in a way that keeps tobacco out of sight. We will continue to have discussions with retailers so that they have the clarity that Ross Finnie talked about.
Christine Grahame, Rhoda Grant and other members expressed concern about retailers' defence to a charge of selling tobacco to an underage person that it was reasonable to believe that the person was over 18. It is important to stress that that provision will bring the law on tobacco into line with the law on the sale of alcohol. However, we will consider carefully the points that have been made. I am sure that the issue will crop up again at stage 2.
I have not heard any good argument that we should allow cigarettes to be sold in vending machines, with the easy access that that provides for young people—the very people whom we are trying to discourage from smoking in the first place. The Government has suggested to the companies concerned that vending machines could well be turned into dispensing machines. It is for the industry to take forward that suggestion.
I have heard considerable support for the registration scheme for tobacco retailers, notwithstanding the points that the Tories have made. I am sure that the details of that will occupy us at stage 2.
I turn to part 2, on primary medical services. As Ian McKee said, the provisions in part 2 build on the Government's strong commitment to a mutual NHS—one that is in the public sector and run in the public interest. Our objective is absolutely clear. Some members pointed out that GPs are already independent contractors. Of course they are, but they are also directly involved in the front-line delivery of health care. The problem with the existing law is that it leaves it open to a health board to award a contract to a body in which none of the individuals is a registered medical practitioner or health care professional.
Would the member therefore care to tell us why she voted for the existing law?
I am coming to that, if David McLetchie cares to be patient.
A contract can be awarded to a body in which no party is a medical practitioner. Of course, that body would employ staff to provide health services. To respond to an earlier point that David McLetchie made, I do not think that doctors who are employed in that way care any less about their patients than other GPs do, but the fact remains that they are employed by organisations whose only interest in the NHS is its potential to make profit for them.
I believe that that is wrong. I do not agree with Jamie Stone that David McLetchie's speech was charming in any way, shape or form, but it was a powerful speech. He said that the law that we are trying to amend was part of a deal surrounding the negotiation of the GP contract, although I think that, if he checks, he will find that the contract does not cost less in England than it does in Scotland, even though commercialisation is much more prevalent in England. If I had been party to that negotiation, I would not have been party to a deal that paved the way for the commercialisation of general practice. The fact that Shona Robison did not think that the entire Primary Medical Services (Scotland) Bill was a conspiracy does not mean that we share David McLetchie's analysis of the situation.
I appreciate that there is a point of principle, certainly for the Tories. Jackson Carlaw's pragmatism is perhaps better described as the Tories' passion for privatisation, which appears to know no bounds whatever. I accept that the Tories are much more positive about the sort of commercial involvement in GP services that the bill seeks to prevent. That is an honest disagreement and I respect that position. However, I was a wee bit surprised to hear members on the Labour benches make the Tory argument perhaps more effectively than the Tories did.
Will the cabinet secretary give way?
No—I am in my last minute. However, I am about to address the member's comments.
I do not think that the difference of principle that exists between the Government and the Tories exists between the Government and members on the Labour benches. A number of reasonable points that have been raised in the report and again in this debate deserve our full consideration as we go through the bill's later stages.
The committee raised three main issues: first, the position of co-operatives and social enterprises; secondly, the amount of time that a practitioner would have to spend in a practice to meet the minimum commitment requirement, which is the point that Ian McKee highlighted; and thirdly, the ability of nurses to hold GMS contracts. Although the bill does not change the status quo around nurses, the committee has asked for an amendment to allow future changes to be made by regulation rather than through primary legislation. I assure members that we will consider that point—and indeed the other points of detail—very carefully, and I look forward to discussing them further at stage 2.