§ Mr. Peter Hardy (Wentworth)
I make no apology for raising this matter, as experience suggests that hon. Members have an obligation to maintain an interest in agencies and local organisations that serve their constituencies. National health service trusts and other bodies that administer the health service are extremely important in their regions and nationally. Their duties are vital. The funding for which they are responsible is large and needs to be larger. As the taxpayer provides those funds, the Member of Parliament, the taxpayer's representative, is entitled to maintain an interest—indeed, it may be an obligation.
That interest may not always be convenient to, or welcomed by, those bodies, but they need to appreciate that national health service trusts owe their position to the Minister. They are not directly democratically based or clearly representative in their nature—Members of Parliament are. I make the point because, on two or three occasions over the years, my relationship with bodies serving my constituency has not always been smooth and easy. It has usually been cordial, and I have great respect for the people who serve on those bodies. Some years ago, however, one chief officer imagined that he could refuse to meet local Members of Parliament: the Minister will appreciate that the meeting did take place.
Two or three years ago, hon. Members had cause for concern when a project of major importance was not drawn to their attention at a reasonably early stage and the trust's initial response to the public's growing concern was less than sensible. In another matter, I expressed serious concern about the fact that my constituency provided no lay member to serve on Rotherham health authority, an authority of considerable quality, which serves three constituencies: Rother Valley, Rotherham and my own. That was a serious omission. It led me to see the then Health Minister—the present Secretary of State for Health—who, unfortunately, was ill-informed about the position as he said that my constituency did not provide the authority with a lay member before it was reorganised. I was able to give him the relevant names and addresses.
Lest it be suggested that I am wholly critical, I make it clear that I recognise the fact that many of my constituents are justifiably grateful for, and appreciate, the services and help that they have received from the national health service in Rotherham, and that I share their view that the medical, nursing and caring staff at the hospital and in the service generally maintain high standards and show a commendable dedication to their work, which should be consistently recognised. Their position led me to seek this debate. I am not sure that the people responsible for the leadership of the service have adequately recognised their obligation to consider staff and to give proper regard to their views.
I accept that smoking is bad for health—that is beyond dispute. I agree that people, especially the young, should not be encouraged to smoke. I do not quarrel with the efforts of public bodies such as health trusts to discourage smoking and to take steps to protect others from the effects of smoking. Nor do I object to the Department of Health's advice on that matter—that point needs to be made clear from the outset. In effect, this debate is about not smoking, but the conduct of public business and Rotherham trust's approach.
708 The trust decided to introduce a complete ban on smoking, phasing it in until full implementation on 1 April 1995. That met the wish of Rotherham health authority, which, in compliance with its obligation to the Department, required its providers to operate an anti-smoking policy within Government guidelines. Just before the complete ban came into effect, constituents expressed their concern to me that they were to be prevented from smoking, not only in the hospital but within its grounds and in the car park, including in their motor cars.
On 28 March 1995, I wrote to the trust to express concern about the absolute nature of the ban. The acting chief executive responded promptly to say that the trust had unanimously approved the decision, and he informed me that that was in accordance with Department of Health guidelines. Constituents then said to me that they had been told that the ban had been introduced on the Minister's advice or instructions, so I wrote to the Minister involved—the noble Lady Cumberlege—who replied on 22 April. Her letter referred to the setting aside of a limited number of smoking rooms for staff. That position was significantly different from that of the trust.
National health service guidelines cover the point. They say specifically that a limited number of smoking rooms are to be set aside for members of staff who cannot give up smoking. They assume that all members of staff wish to give up smoking. The Minister who is to reply will accept that not all of them do—it is a free society. The Department asked district health authorities to implement the anti-smoking policy and specific reference was made in the guidelines to the provision of separate smoking rooms for patients and visitors. Rotherham appears to have disregarded that.
Many staff were unhappy about that absolute approach. I understand that the hospital administration department was unhelpful in the drawing up of a petition. The Minister will be aware that more than 500 members of staff at the hospital—500 dedicated and hard-working people—signed a petition seeking the provision of a smoking room. The petition was submitted to the trust and rejected, despite the fact that the Department's guidelines provided for that facility.
Following receipt of the noble Lady's letter, I wrote to the trust and said that the position was anomalous. The noble Lady had advised me that patients could be allowed to smoke if the clinician approved and if the arrangements to allow that had been put in place, and that the facility would be only for patients and not for staff, visitors or anyone else. However, given the number of patients who gather around to smoke outside the hospital, it is peculiar that the trust tells me that facilities have been provided for patients to smoke. If they had, they would not be standing by the hospital doorways in wet and cold weather indulging in the habit.
I wrote to the trust after I had received the noble Lady's letter and waited for a reply. Unfortunately, none came. At a function, I saw the chairman of the trust, a local and distinguished citizen whom I view highly and have known a long time. We still have a cordial relationship. I said that I had not received a reply to my letter. He assured me that the contents of my letter were being taken seriously, but I still did not get a reply.
Like other hon. Members, during recesses I make a number of visits and hold a number of meetings to fulfil my constituency obligations. Following usual practice, 709 a meeting with the trust was arranged for 12 September last year, which my hon. Friend the Member for Rother Valley (Mr. Barron) and I attended. As soon as the meeting began, I drew attention to the fact that I had not received a reply to my letter and the chairman unhesitatingly offered a full apology. We discussed the problem of the smoking ban in detail. I hoped that, following that meeting, a rather more sensitive approach would be taken. However, within a short time I learnt that the trust had endorsed its existing policy in every particular and again claimed that it was complying with Department of Health policy—which it clearly was not.
I wrote to Baroness Cumberlege again, but I received a reply that I thought was inconsistent with her previous letter. The Minister may disagree about that. Baroness Cumberlege said that she stood by everything that she had stated in her previous letter about the provision of smoking rooms, but she then expressed total support for the trust's decision. I am sure that the Minister has seen the correspondence.
Baroness Cumberlege also referred to the claim that the vast majority of patients, staff and visitors wholeheartedly supported the trust's policy. I have very real doubts about that—514 members of staff requesting a different arrangement can hardly be described as overwhelming support. As far as I know, the trust has made no attempt to discover whether it actually does have the overwhelming support of the community, patients and visitors. Indeed, as far as I am aware, the only exercise to establish that was carried out by members of staff. It revealed that the majority of people who do not smoke as well as the overwhelming majority of people who do smoke disagreed with the trust's policy. That clearly shows that the trust's claim that its policy enjoys overwhelming support is not well founded.
I am concerned about people who visit the hospital and use their own cars. Despite the enormous successes of hospitals in modern times, they remain places of stress. To add additional stress by refusing to allow any opportunity to smoke is not necessarily wise. It is also rather oppressive to tell people that they cannot smoke in their own cars. I pointed out to the trust last September that it would face wholesale disregard of its ban. South Yorkshire is not the sort of area where big brother immediately and automatically commands obedience and respect. I told the trust that docile, obedient, responsible citizens would obey the ban, but a very large number of people would not, which would make those who respected the ban feel somewhat angry and embittered. The ban does not help to foster good relationships. It is much too oppressive to tell people that they cannot smoke in their own cars.
There has been a slight advance because the chairman has now told me that the trust will not enforce the ban. I am not happy about that because I believe that regulations should be sensible and enforceable. If they are not, they should not have been made. I hope that there will be a different approach.
The Department of Health is responsible for the trust and it appoints its members. It has issued guidance to which I do not object and nor do the majority of people and the staff of Rotherham hospital. However, the trust, which does not have a democratic mandate, has chosen to disregard the staff and impose a ban. That places a burden 710 on staff, one of whom is a constituent of mine who has not had a day off work for health reasons in 20 years. She is now told that she cannot smoke within the precincts of the hospital.
The trust feels entitled to disregard the Department's advice on the provision of smoking rooms. It is distasteful that the trust, having decided to differ from the Department's advice, has not acknowledged that difference but instead claimed, both before and after the ban and during our meeting, that its action was in accordance with departmental advice. Will the Minister make it clear to the trust that it should not say that it is following ministerial instructions when it is not?
We are concerned here not with the merits or demerits of smoking but with the proper conduct of public business. Perhaps it would be appropriate for the Minister to confirm that trusts should always be willing to meet Members of Parliament and that they should never mislead them. Hon. Members are entitled to be, and must be, given accurate information by all the public bodies that serve their constituents. In this case, I do not think that I was given accurate information. Neither do I think that the trust recognised its obligations to the community and to its parliamentary representatives.
The dedicated and caring staff of Rotherham hospital should have received adequate information. I am not sure whether it is correct, but I have been told by several members of staff that they were not properly consulted. The Minister will acknowledge that departmental advice makes it absolutely clear that staff should be consulted. In this case, I have a real suspicion that they were not. I hope that there will not again be the same insensitive disregard of the views of staff that has clearly been the case until now. I hope that there will be an understanding that sometimes a draconian attitude can be counter-productive.
As I said earlier, when I have driven around the hospital area, I have been surprised by the number of people smoking. Not long ago, someone counted 250 cigarette ends by the front door. That shows that a hard and insensitive approach does not produce the desired result. I suspect that more tobacco has been consumed in and around the hospital since the ban than was ever the case before. Many people, including myself, would not smoke in the hospital when attending meetings and so on. However, as I was leaving after my last visit, I noticed that a great number of people were smoking. Therefore, the trust might wish to consider whether its policy is wise. Coercion should always be avoided and the views of the staff should be more carefully considered.
The matter was fully discussed at the recent annual meeting of the hospital trust. I was concerned to hear that when someone who attended the meeting asked to see the minutes, he was told that legal opinion was being sought on whether they could be shown to him. The trust should recognise that we are still living in a democracy. I hope that democracy will play a larger part in its future consideration of such matters.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Horam)
I am glad to have the opportunity to respond to the hon. Member for Wentworth (Mr. Hardy), who raised some important points. I have always respected his talents as an implacable pursuer of 711 causes that are dear to his heart—which certainly include bodies that are not democratically elected. Indeed, he is quite right to point out that it is precisely the function of Members of Parliament, who are democratically elected, to raise such matters. Incidentally, I am also glad to note that he paid particular tribute to the staff of Rotherham district general hospital, and I would like to associate myself with that tribute.
I understand that this debate is not so much about smoking policy or anti-smoking policy per se, but about what the hon. Member for Wentworth called the proper conduct of public business—in this case the conduct of the trust. None the less, before coming to that matter, I shall briefly comment on Government policy on smoking, since it was the origin of the problem.
The Government believe that people are entitled to breathe air unpolluted by tobacco smoke and that non-smoking should be the norm in buildings frequented by the public, with special provision for smoking where local managers feel that it is appropriate. National health service premises are required to be virtually smoke-free. Smoking is responsible for about 110,000 premature deaths in the United Kingdom each year, and the treatment of smoking-related diseases costs the NHS, and therefore the taxpayer, about £610 million a year.
As the largest employer in the United Kingdom, and as the manager of premises used by thousands of members of the public, the NHS has a responsibility to protect patients, visitors and staff from the health risks of smoking. I do not think that the hon. Gentleman would disagree with that. The NHS, precisely because it is the NHS, should and does develop an exemplary role, leading the way and providing the model for other employers to follow.
In July 1992; the White Paper "The Health of the Nation" set out a requirement for the NHS to work towards a virtually smoke-free environment for staff, patients and visitors as rapidly as possible. Soon after that, guidance was issued in October 1992, to which the hon. Gentleman has referred, which set out the action required of NHS hospitals and authorities. That guidance is called "Towards Smoke-Free NHS Premises".
The Department co-operated with the Health Education Authority in the production and distribution of guidance on the design and implementation of smoking policies. That publication set out the basic requirements of an NHS policy, but left management free to tailor arrangements to suit local circumstances. Advice was also included on the responsibility of health authorities to specify that, wherever possible, NHS services should be provided in a smoke-free atmosphere.
It is worth remembering that the Government guidance issued to help implementation of that policy does not require hospitals to provide separate smoking facilities for staff and patients. It sets a minimum standard, which all parts of the NHS are expected to achieve. It is up to local managers—I emphasise that—to decide whether they feel that it is necessary or practicable to set aside such smoking rooms for staff and/or patients.
Following receipt of the Department of Health guidance, the Rotherham General Hospitals NHS trust set up a task group in 1993 to look at the question. On 4 October 1993, it sent out a letter, which was—to use the bureaucratic terminology—cascaded to staff via the team-brief network, and a policy statement, which I think that the hon. Gentleman has seen, setting out its 712 position on anti-smoking policy. The letter asked for comments or questions by the end of December of that year. The consultation lasted for three months from the beginning of October to the end of December 1993. I am told—the hon. Member for Wentworth has not controverted this—that only two members of staff individually made representations during that three-month period.
The first stage of the policy, which was issued to staff—I understand—in a letter with their pay packets, was implemented on 1 April 1994. It made it plain that to help staff, a smoking room would be set aside until 1 April 1995, after which—two years after the beginning of the process—the whole policy would come into force. That is the burden of the problem raised by the hon. Member for Wentworth.
I am also aware that in February 1995, a 500-name staff petition against banning smoking was considered by the trust board. I should point out that although the hon. Member for Wentworth said that the petition received substantial support, the trust employs 3,000 staff and the petition therefore represents quite a small proportion of employees—fewer than one in five.
§ Mr. Hardy
I am sure that there would have been a much larger response to the petition had the people responsible for it been allowed to put a notice on the staff notice board and the administration had not been especially discouraging. Many staff work strange hours, including night shifts, and so on, and I am assured by those responsible for the petition that many more signatures would have been obtained had it been simple to do so.
§ Mr. Horam
I hear what the hon. Gentleman says, but I can obviously go only on the facts in front of me.
Since April 1995, when its policy was introduced, the trust, which treats about 300,000 patients a year, has received only three formal complaints from patients about its smoking policy.
I shall deal with the effect on patients before I deal with the effect on staff. The trust decided to allow discretion for clinicians to designate smoking areas for wards where certain patients are allowed to smoke. Long-stay patients who are addicted to smoking are allowed to smoke, as are terminally ill patients, where the medical staff in charge of their care feel that it is in the patients' best interests. The trust is considering offering free nicotine patches to all in-patients for use during their stay. I am aware from the correspondence that some patients do indeed go outside the building to smoke, but they do so against medical and nursing advice. I stress to the hon. Member for Wentworth that about 500 deaths a year in Rotherham are attributed to smoking—that is one in five.
I understand that some staff reacted strongly when the trust removed the designated smoking room, although ample notice was given in the course of the procedure that I have described, and proper consultation was conducted. As the hon. Member for Wentworth has pointed out, the trust has adopted a lenient approach to staff smoking in hospital grounds. Although the trust cannot of course forbid smoking in private cars—that would be quite oppressive, to use the hon. Gentleman's word—it has every right to forbid smoking in its own vehicles.
The hon. Member for Wentworth kindly wrote to me on 13 January, raising a number of points related to the debate. He said: 713I do not entirely disagree with your comments about smoking. However, your letter overlooks several of the matters which I have raised.The NHS guidelines do refer to the provision of smoking rooms. Rotherham has refused to provide these.Simply, my point is that that is a matter for local decision. It is a matter for the Rotherham General Hospitals NHS trust and it is not therefore in conflict with Government policy. It is simply exercising its right to carry it a step further than the Government guidance suggests.
The hon. Member for Wentworth also asked whether the Department knew about the 500-name petition. It is not clear from the chain of documentation whether we were fully aware of it. As far as my noble Friend Lady Cumberlege could determine from all the evidence, we were, however, fully aware that there was not a majority in favour of reversing the ban imposed by the trust. We have discussed the figures and the hon. Gentleman has made his point. None the less, the petition contained only about 500 signatures, and there are 3,000 employees of the trust.
The hon. Member for Wentworth went on to ask what arrangements had been made to enable patients to smoke where a clinician agreed that they should be able to do so. That is an important and practical point. An arrangement may be made between staff and a patient so that he or she may smoke at agreed times, for example after meals. In such a case, a single room off the main ward may be made available or a sister's office can be allocated for that purpose by agreement with staff. The trust has made it clear that there are no spare rooms and no specific rooms are designated for smoking.
The hon. Gentleman finally raised the question of smoking out of doors and in cars. I take his point that a general ban was imposed at first. However, in the light of experience and, perhaps, common sense, the trust now operates that aspect of the policy leniently.
All those matters were raised again by the acting chief executive and by the non-smoking policy group just before Christmas—in October or November—and the trust board considered them at its meeting in December. Various recommendations were made—