- The Convener (Des McNulty):
Good morning, everyone. I remind members and others that all pagers and mobile phones should be switched off. This is the Finance Committee's fifth meeting of 2005. Our first agenda item is consideration of the financial memorandum to the Smoking, Health and Social Care (Scotland) Bill, which the Minister for Health and Community Care, Andy Kerr, introduced on 16 December 2004.
Our evidence session will be split into two parts. Our first panel comprises witnesses from the Scottish Licensed Trade Association, the Convention of Scottish Local Authorities and the Scottish NHS Confederation. That panel will deal with part 1 of the bill, which is on the prohibition of smoking in public places. After that, the Scottish NHS Confederation will stay to give evidence on the remaining parts of the bill.
Members have a copy of the bill and accompanying documents. We also have a significant number of weighty submissions, which include submissions from our witnesses. I am pleased to welcome Paul Waterson, who is the SLTA's chief executive, and Stuart Ross, who is the SLTA's immediate past chairman. From COSLA, we expect Councillor Eric Jackson, who is the social work and health improvement spokesperson, and Alan McKeown, who is the team leader of the health and social care team, but they are not here yet. However, we have Gordon Greenhill, who is from the Society of Chief Officers of Environmental Health of Scotland. From the Scottish NHS Confederation, we have Hilary Robertson, who is the director, and Susan Aitken, who is the policy manager.
COSLA contacted us to say that the figure that is shown in its submission for the City of Edinburgh Council should be £230,000, not £403,000, but that does not affect the total implementation figure.
I propose to invite each group of witnesses to make a brief opening statement—our time is restricted—after which I will proceed to questions from members, who will seek elucidation of the evidence. At the end of the process, the committee will make a submission that is based on its analysis of the financial memorandum to the lead committee, which is the Health Committee, before that committee takes evidence from ministers. That is the Finance Committee's standard practice.
I will give the SLTA the first opportunity to speak.
- Paul Waterson (Scottish Licensed Trade Association):
Good morning, everyone. I thank the committee for inviting the Scottish Licensed Trade Association to give evidence. We contend that the research that the Executive conducted into the health and financial impacts of the proposed smoking ban is inadequate, to an extent irrelevant and definitely incomplete. Our research clearly shows that few total smoking bans are in place worldwide from which to draw conclusions. The Irish ban, which is the closest to home, has not been in place long enough for full evaluation. Health and economic benefits could be maximised by adopting a controlled and structured approach to curbing smoking and many countries have taken that course of action.
With that in mind, in May 2004, we asked the Government to legislate on our proposals, which included a ban on smoking at the bar counter in all pubs and whenever and wherever hot food is served, and the suggestion that, within three years, 50 per cent of the total floor space of all pubs should be given over to a non-smoking area. Those are fair and enforceable proposals that our membership strongly backs. They would reflect public opinion, give our customers choice, protect our industry and contribute to improving health. We ask the Finance Committee to urge the Parliament to take more time to conduct proper in-depth research into the financial and health benefits of that alternative to a total ban.
I will finish by quoting Dr John Reid, who said:
"we believe that in a free society men and women ultimately have the right within the law to choose their own lifestyle".—[Official Report, House of Commons, 16 November 2004; Vol 426, c 1164.]
- The Convener:
Can Gordon Greenhill make COSLA's opening statement?
- Gordon Greenhill (Convention of Scottish Local Authorities):
I am happy to do that, but I will not use Eric Jackson's words.
I thank the committee for inviting us to give evidence today. COSLA has openly said that it supports the bill, which is groundbreaking, because it will effect by enforcement a public health improvement that will be felt for many years to come. Education has been tried for many years as a tool for changing people's habits, but the bill will make a cultural change with enforcement.
Law is effective only if it is enforced. The thrust of COSLA's submission is that enforcement must be properly funded. If the Parliament wants the law to be an effective public health tool, funding must be forthcoming for enforcement officers, training and education.
- Hilary Robertson (Scottish NHS Confederation):
I thank the committee for inviting the Scottish NHS Confederation. Our members fully support the bill's aim of reducing smoking and firmly believe that the provisions will reduce smoking. The health benefits that will flow from that will be most welcome. The provisions will make a significant difference to Scotland's health over time. Our evidence concentrates purely on those aspects of the bill that will have a direct financial impact on boards; we do not comment on the areas that will not.
- The Convener:
Thank you for your opening statements. I invite questions from members.
- Mr Ted Brocklebank (Mid Scotland and Fife) (Con):
I begin by asking the witnesses from the Scottish Licensed Trade Association how they quantify the research that they did. We would expect you to disagree with the official figures, which we got from the research that was carried out by the University of Aberdeen, but why do you disagree with them so much? How do you justify your comment that its report is "incomplete, irrelevant and rushed"?
- Stuart Ross (Scottish Licensed Trade Association):
We say that the research is incomplete and, to a certain extent, irrelevant because there are few countries in the world in which outright smoking bans have been implemented. There are only three—Ireland, New Zealand and Norway—and the bans in those countries are all recent. No research has been conducted into whether a phased approach to a smoking ban—as opposed to an outright ban—has greater benefits for health and less financial impact.
- Mr Brocklebank:
You produce statistics from the Moffat centre for travel and tourism business development at Glasgow Caledonian University, which suggest that your turnover will decline by £105 million, that
"annual profits in licensed premises may decline by £86 million",
that
"employment in the licensed trade can be expected to decline by 2,300 jobs",
and that
"some 142 average-sized licensed premises may close down as a result of decreased trade."
To an extent, the Moffat centre must be guessing in the same way that others are guessing, because we do not know that those things will happen. Why should we believe the projections of the Glasgow Caledonian University survey rather than the projections of the University of Aberdeen survey?
- Stuart Ross:
The research by the Centre for Economics and Business Research Ltd was conducted by examining the information that is available from the situation in Ireland. It concludes that turnover in Ireland is down by more than 7 per cent in value and 10 per cent in volume and that the number of jobs has reduced by 6 per cent. It took those figures, assigned them to the Scottish situation and worked out the numbers. The figures are quite scary and they are of considerable concern to our membership.
- Paul Waterson:
The Aberdeen research considered only one study and that was from California, where there is not a total ban. That study examined hotels and restaurants but not pubs, which is one of the reasons why we think that it is fundamentally flawed. There is a sectoral difference, but the study took only an aggregate look at the situation. We do not believe that one study from California should be the basis for such an important piece of legislation.
- Mr Brocklebank:
On the one hand, you say that the Irish example has not been in place long enough for us to make any real judgments, but on the other you outline facts and figures that appear to be produced from what we have seen already from the Irish legislation. You seem to want the best of both sides from the Irish experiment.
- Paul Waterson:
We have been put in that position by the timing of the bill. We are saying that we should wait for at least a year to see what the Irish experience throws up, because it is the closest experience to home on which we can work. We had to go with something because of the timing of the situation that we are in.
- The Convener:
I welcome Councillor Eric Jackson and Alan McKeown to the meeting; Gordon Greenhill was able to give an opening statement on behalf of COSLA.
I raise an issue on which we would like a view from both the SLTA and COSLA. If people are forced outside pubs to smoke, there will be consequences in the form of litter—not just cigarettes, but other things—on the pavements and streets. Do you have any thoughts on the impact of that? Secondly, where should the responsibility lie for clearing up litter on the public pavement outside licensed premises?
- Paul Waterson:
We can imagine that when people leave pubs and stand outside—especially pubs in tenements—noise will emanate upwards, particularly late at night. From the publican's point of view, it is difficult to control patrons and the level of noise when people go out into the street with alcohol. Also, there may be bans on drinking alcohol in the street. We can imagine that where there are a lot of nightclubs together in a street in the middle of a town, there could be more people out in the street than in the nightclubs.
In Ireland, apparently, a new society is growing up outside pubs and people like to go out to talk and so on. There are obvious problems with litter, with noise and with trying to control the number of people outside pubs. It is hard enough to control them inside pubs, let alone outside. We have a responsibility to try to do something about the problem, but it is difficult to put publicans and licence holders in that position.
- Stuart Ross:
One of the big differences between Scotland and Ireland is that we have so many more tenement properties. In such premises, there are no facilities to the rear of the pub because of the noise that would be caused to neighbours. In streets where there are rows of pubs, such as in the east end of Glasgow, there would be difficulties on busy soccer nights, with everybody spilling out of the pubs to smoke. We can imagine issues arising that do not apply in Ireland because of the different type of property structures there.
- The Convener:
Many pubs have people on the door—I will not call them bouncers—to control access and egress, and obviously bar staff have control inside the pub. Will the ban mean that pubs will have to have somebody standing at the door or in the vicinity to ensure that there is some regulation of noise and other nuisance?
- Paul Waterson:
Where does the responsibility end? Do we allow doormen to intervene in situations that arise outside public houses? Where does the police's responsibility come in? Trying to control people outside premises is a major difficulty and it is obvious that that will be a major problem with the ban.
- Stuart Ross:
Recently, Belhaven Brewery Company, which I work for, sent a team of people to Ireland to look at the situation there. They found that drinks were being poured from glass containers into plastic containers and then taken outside to be consumed. In Scotland, we have a different situation; in certain cities it is against the byelaws to drink alcohol outside, but in other cities that is permitted. When the regulations come out, there needs to be some clarification of where responsibility starts and stops on the issue.
- Councillor Eric Jackson (Convention of Scottish Local Authorities):
The litter issue is addressed in our submission. At the moment, litter is a particular problem outside shopping centres and large office complexes and we expect similar problems to arise when the ban comes in. Local authorities have different views about the implications and the cost, and we are working through that. We assume that there will be a need for additional fixed litter appliances outside pubs.
- Alan McKeown (Convention of Scottish Local Authorities):
We have the estimated costs from a couple of councils. Glasgow City Council estimates that the cost will be about £144,000 for three years, which includes the purchase of fixed litter bins with ash-trays and the cost of additional street cleaning. If such cleaning is to be done outwith normal hours, there will be an additional cost. South Ayrshire Council estimates the cost at £81,000. We can aggregate those costs up throughout Scotland and we expect that they will be significant. It is fair to say that local government will be expected to be responsible, but we hope that people who use pubs will take some personal responsibility and that licensed and other premises will provide some signage to assist us.
- The Convener:
As well as litter issues, there are environmental health issues and possibly police issues. Would you like to say anything about those?
- Alan McKeown:
To consider the matter in the round, we need to examine the implications of the bill and the review of licensing. Gordon Greenhill can give us some more detail on that.
- Gordon Greenhill:
There are two elements. First, it is an offence to drop litter and the Scottish Executive has adequately funded local authorities under the quality of life and cleaner, safer funding streams to put in place environmental wardens and agencies to enforce the legislation on litter. We have embraced that approach in Edinburgh, but the funding for it is temporary. If we wish it to continue, the funding will have to be made permanent. If people who go outside offices and the like to smoke drop litter, they will be issued with a fixed penalty; it is as simple as that. After people have been fined, they do not drop litter again.
We have worked closely with the offices in which smoking is currently not permitted. They have agreed to clear up 20yd or 30yd on either side of their front door, so that they do not cause a nuisance to their neighbourhood. That is the law. The street litter control provision in the Environmental Protection Act 1990 can be implemented. There are street litter control notices on all the hot food shops in Edinburgh, which have to clean up after their patrons. The situation will be no different because of the Smoking, Health and Social Care (Scotland) Bill. At present, if someone smokes inside a shopping mall, pub or club, the ash-trays are not taken outside by the licensee and emptied on to the pavement—they are trade waste. If someone steps outside a pub to smoke, the licensee should be responsible for cleaning up outside the premises.
The issue of noise has been raised. Most tenement properties are on busy thoroughfares and general speaking is covered by the ambient noise level. Loud shouting in the street is already an offence. I do not believe that there will be a major problem of litter and noise if people step outside to smoke. That can be done in an orderly manner if, when they leave the premises to have a cigarette, people are provided with a facility in which to put their cigarette end. There is legislation to ensure that that happens.
- Alasdair Morgan (South of Scotland) (SNP):
You have offered a rose-tinted view of life in cities. The idea that people standing outside a pub at night drinking will have conversations that are not above the ambient noise level is bizarre. You said that if people drop litter they are issued with fixed-penalty notices. If that provision applied to every piece of litter in Edinburgh, the coffers of the City of Edinburgh Council would be rather large, which they are not.
The SLTA is arguing for a phased approach. We have heard about the costs—probably legitimate costs—that will arise from extra litter and the need for extra policing. How would a phased approach make any difference, except to ensure that we reached the same end point over a slightly longer period?
- Stuart Ross:
Are you referring to the cost to the licensed trade?
- Alasdair Morgan:
I am referring to the general costs—the cost of clearing up litter and perhaps needing extra police to deal with people outside pubs. Even if we take a phased approach, we will eventually reach the same end point. Are you suggesting that people's behaviour will change if the policy is implemented over five years rather than one?
- Stuart Ross:
That is exactly the argument that we are making. We believe that if, over a period of years, we maintain choice for consumers but restrict tobacco in the way in which Paul Waterson suggested in his opening statement, consumers will continue to come to pubs. There will be choice for them, but gradually, through education and watching more floor space being given over to no-smoking areas, they will come to realise that smoking is an antisocial habit and get used to the idea of a smoking ban. The phased approach will bring the health benefits that the bill seeks.
- Alasdair Morgan:
You argue that there is a lack of evidence to support the Government's approach. Do you have evidence for the success of a phased approach?
- Stuart Ross:
At the smoking conference in Edinburgh, which was organised by the Scottish Executive, there were presentations from around the world, notably from Australia and America, on phased approaches and how well they have worked. Norway has been working towards a total ban for 10 years. We heard speakers give different viewpoints, but the consensus view at the conference was that giving people choice works and that we must give people time to come to terms with a smoking ban. Smoking is an addiction and people cannot stop just because politicians change the rules.
- Mr Frank McAveety (Glasgow Shettleston) (Lab):
Do you share the view that enforcement costs could be reasonable and manageable? Who should meet those costs?
- Paul Waterson:
It would be totally unfair for licence holders simply to be told that they are responsible for everything that happens outside their pubs. We have put proposals on the table that do not include a ban and would allow us to retain control of our customers inside the premises. That is the way in which we should proceed. There may be noise problems even if five or six people are having a normal conversation outside a pub that is based in a tenement. It would be wrong for us to dismiss that issue—there will be significant problems. A large proportion of pubs are located in tenement properties.
- Stuart Ross:
We must take into account the fact that, at the moment, 60 per cent of the people who use pubs are smokers. That is not a small proportion.
- Mr McAveety:
Understandably, much of your evidence has focused on the economic disbenefits of an outright smoking ban. Have you undertaken any work to analyse the opportunities that may exist for the trade in respect of people who at the moment are not encouraged to enter pub environments because of the presence of smoke? Is there a significant imbalance between those kinds of pubs and clubs that could accommodate an outright ban and the many others in areas that you have identified where there is a tradition of what have been called working men's pubs? What would be the impact of a ban on such pubs? Casual customers who would go into a city centre pub would not necessarily go into "The Wee Man" somewhere in the east end of Glasgow.
- Paul Waterson:
The health professionals keep telling us that this is a tremendous opportunity for us to attract a new range of customers. However, last week a non-smoking pub in Elgin, which had the whole market to itself, closed within a month or so of opening because there was no business there. There will be a major problem in rural areas, where I am sure the pubs will close. Such pubs are very concerned, because they do not have the opportunity to reinvest in the environments that they offer. There is no doubt that the people who go to traditional working men's pubs will be forced out of the pub and will smoke at home. All our members are agreed on that point. Admittedly, the evidence is anecdotal, but many people say that they will not go to the pub if there is a smoking ban. That will lead to an increase in home drinking, with its associated problems. The pubs in some sectors are very vulnerable. We know that in Ireland the turnover of some pubs that are totally land-locked and have no facility for smokers is down by 50 or 60 per cent. Such pubs are especially hard hit.
- Councillor Jackson:
The issue of who should be responsible for paying for the extra work that the bill will create was raised. Our position is that, because this is a new burden on local authorities, it should be funded. It is for members to decide where the money should come from, but there is a cost to the extra work that is involved and we would expect to be reimbursed for it.
- Mr McAveety:
In its submission, COSLA notes that at the moment there is a difficulty in recruiting environmental health officers. The bill represents a substantial change in direction and there are passionate views on different sides of the argument. If the bill is implemented, whom will we recruit to enforce it, given that there are already difficulties with recruitment of EHOs?
- Councillor Jackson:
We have already raised that issue with the Executive. We mentioned the possibility of introducing a fast-track system, of the sort that has been developed for social workers. Clearly, we need to start the recruitment process now, so that we can build up the number of people whom we employ and expect to need. In part, that involves building up the profile of the job.
- Mr Andrew Arbuckle (Mid Scotland and Fife) (LD):
I am sorry to say that my identity card is still not recognised—I can get through doors in Parliament, but my card is not recognised in the Finance Committee.
Can we have more information on the enforcement or monitoring costs that will fall on local authorities? Do those costs take into account the fact that most of the work will take place during unsocial times outside normal working hours, such as at weekends?
- Councillor Jackson:
Yes—those costs are built into all the submissions that we received from our member councils. The work that EHOs do at the moment contains an element of that kind of work; they consider noise control and check establishments that sell food, so a lot of their work is done out of hours.
- Mr Arbuckle:
Will somebody expand on the view that it is the landlord's responsibility to clean up litter and cigarette ends in the area outwith his property? Is that legally enforceable?
- The Convener:
I am not sure that that is a financial question. We need to be careful not to get into the policy.
- Mr Arbuckle:
I ask about the cost implications of cleaning up.
- The Convener:
Let us get COSLA's view on the SLTA's evidence that the cost of enforcing the ban could be £6 million per annum. Perhaps Alan McKeown will respond to that.
- Alan McKeown:
The £6 million is our estimated cost in view of the fact that the bill has been published before detailed regulations have been drafted. We have tried to direct our authorities through areas such as training and recruitment costs, which includes the cost of paying for staff and introducing new systems, associated legal costs, additional out-of-hours and street-cleaning costs, the security cost for staff; the cost of providing assertiveness training or training in dealing with aggressive customers for staff; and mobile phone and other communications costs.
We have been able to pull together a detailed picture of the costs. At this stage, we think that £6 million per annum is a reasonable cost for the next couple of years, given the intensive work that will need to be done. Who will be wholly responsible for that is still to be decided—the regulations that follow the legislation will dictate that. We will all have a route into the regulations. We will look at which areas we are responsible for and which will therefore build up a cost.
Once we have the regulations, we intend to review and firm up the £6 million cost. Perhaps we will develop a framework with key headings that will be cost drivers. Then, we can discuss how that picture will be built up, how resources will be distributed and, indeed, where the resources will come from.
There will be a number of direct routes and additional resources will be provided. If there is a cost saving to the national health service, we want to know whether resource will be transferred back to local government to facilitate implementation of the ban. We also want to know what income will be generated from fines. We need to look at that picture, which is still unclear. It is just one of the things that one works through in such a process.
- The Convener:
The general view of the Finance Committee in respect of much legislation is that we want—before bills are passed—to see precisely what will happen and how the proposals will be implemented so that cost calculations can be checked. You are flagging up clearly that there are a number of areas of uncertainty because you do not know the enforcement mechanisms and you cannot make an exact guess.
- Alan McKeown:
That is fair—we have to deal with such conflicts in the process. However, we have been able to build up a detailed picture of costs. Almost all our authorities have replied to us in some detail. There is a bit of fog around the exact numbers that they have given us and we acknowledge that that represents a slight failing in our figures, but no one could be exact in their figures right now. The figures that we have produced in our evidence are fairly close to what will be required; I do not anticipate their being hugely different one way or the other. Some of the costs could be met centrally—we could do some training and recruitment and provide information centrally. We are trying to see what best value we can get for our money.
However, individual authorities will have additional costs. Let us consider rural authorities. The Highland Council, for example, will have to cover huge distances in enforcing the ban, so it will have significant transport costs. We need to be alive to those costs and we need to be able to present a detailed picture on behalf of our members so that they do not miss out.
- John Swinburne (Central Scotland) (SSCUP):
I read with great interest the submission from the Scottish Licensed Trade Association. The amount of income and profit that will be lost if a ban is imposed is staggering. You say in your evidence that if people stop smoking, it will impact on the reduction of costs in health treatment. Recent reports have shown that alcohol is as big a danger to health as tobacco. Therefore, would it not be a good thing if sales of alcohol were vastly reduced in this country?
In your submission, you mention the cost to the country of people living longer. There is a bit of an ageist reference to "geriatric healthcare", which I find totally unacceptable. However, I concur with one accurate point in your submission, which is that pensions are not funded adequately. Do you agree that it would help the nation's health if alcohol consumption were vastly reduced?
- Stuart Ross:
I do not think that the question is relevant to the debate, but the argument about smoking in public places potentially shifts the consumption of alcohol from public places to domestic settings. The question of why people consume alcohol is different to the question of why they use tobacco.
- John Swinburne:
That argument is not borne out by the amount of profit that you will lose. There is nothing to suggest that people will go home to drink.
- Stuart Ross:
There is, in fact. The Centre for Economics and Business Research Ltd study touches on that and contains figures on switching of alcohol consumption from on-premise to off-premise. The statistics from Ireland show that there has so far been about a 10 per cent swing; those statistics are incorporated in the report.
- Paul Waterson:
Drinking at home introduces serious problems as far as alcohol abuse is concerned. As soon as drinking is forced into a domestic setting in a jurisdiction that has a big off-sales industry, there are real problems with alcohol abuse. If we force people to drink outside the controlled environment of the pub, we will simply add to alcohol abuse problems.
- Jim Mather (Highlands and Islands) (SNP):
I am keen to ask about the overall adequacy of the financial memorandum. I ask COSLA and the SLTA whether the full financial scenario has been properly modelled. Have we captured all the positive and negative impacts on the public purse? When they answer, I ask the witnesses to consider evidence that we heard last year from the Allander series of lectures: Nicholas Crafts of the London School of Economics told us that if Scotland could bring its life expectancy up to the UK level, that would increase our gross domestic product by 21.3 per cent. He quoted W D Nordhaus of Yale University in coming to that conclusion. That 21.3 per cent represents £16 billion. If we moved towards that, what impact would that have on your business and the public purse vis-à-vis the public sector and local government in particular?
- Stuart Ross:
At the national conference on smoking that was held in September, speakers from around the world gave us an account of how the provision of choice and a phased or ratcheted approach to tobacco restrictions have worked adequately. In answering John Swinburne's question about longevity, I do not think that any research has been conducted into whether the Scottish Executive proposals would be more effective than the proposals that we make today.
As I said, there are only three outright bans in over 200 countries throughout the world—in Norway, Ireland and New Zealand—and they are all very recent. It is impossible to conduct research that would answer Jim Mather's question because enough evidence is just not available.
- Jim Mather:
Okay, I understand that. Equally, is there any worldwide example of another jurisdiction's being involved in the gradualist approach that you advocate?
- Stuart Ross:
Yes. Australia is a good example. Although there have been significant tobacco restrictions there, there has been no impact on the economy. People who do not want to smoke can go to a non-smoking bar and people who want to smoke can go to a smoking bar. Our argument is based on allowing people the right to make lifestyle choices, which we believe is a fundamental right of anyone in this country.
- Jim Mather:
I understand that people have that right. Are you saying that the Australian migration has been public-purse neutral?
- Stuart Ross:
That is what came over at the conference.
- Councillor Jackson:
I agree with that. I will let Alan McKeown speak to the financial memorandum but, on the general point, there will be costs and there will be savings. Our experience is that, given that people are living longer, we are involved actively in looking after them when they become frail and need our support later in their lives. The fact that people are living longer means that they are living more healthily until they need our help. My view is that the proposals could be cost neutral.
- Jim Mather:
What actions could you take at local authority level to load the dice in favour of more savings being made, rather than more costs being incurred?
- Alan McKeown:
It is difficult to estimate the broader impact of a ban on the use of tobacco in wholly enclosed public spaces on life expectancy and the national health service, although that would be an interesting exercise and we should perhaps consider doing it. The cost of meeting the policy objective of maintaining the position whereby people are living longer and more healthily in the community falls invariably on local authorities. People's needs become more complex as they get older; therefore some of the care packages become more expensive. However, that debate is for another day. Research on the broader impact would be fascinating, if someone were to commission it.
On the adequacy of the financial memorandum and the stage of development that we had reached when it was produced, it is clear from the financial memorandum that there was more work to be done on the figures. Our evidence is that, in terms of costs, the financial memorandum is by no means as accurate as we would like, although it is as good as it can be right now and we are willing to work with the Executive to refine it. The message from us is that if we ain't funded 100 per cent, 100 per cent implementation of the bill will be difficult, unless costs are shifted from somewhere else, which is about making political choices.
- Mr Brocklebank:
I want to follow up that point, which relates to some of my concerns about the methodology and costings of policing the ban. As I understand it, the Association of Chief Police Officers in Scotland has said that the police do not wish to be involved in policing the ban, therefore the burden will fall on local authorities. You say in your submission that there is a shortage of environmental health officers and that their age profile is increasing. Trying to police the ban will be a massive job for you, especially if the police are not involved. Clubs and private places will also be covered by the bill. Can you tackle the scale of work that will be involved?
- Gordon Greenhill:
All those questions are valid. The majority of the enforcement will be carried out by enforcement officers. People do not need an honours degree in environmental health to issue a fixed penalty notice, but training and management elements have to be put in place. The environmental wardens, whom many councils employ, enforce the litter legislation adequately at present. We are not criminalising smoking—if people pay their fixed penalty, the criminal offence will be discharged. Matters will become slightly complicated if cases progress to the next stage and a report is presented to the procurator fiscal, which is where training will be needed. The evidence is that the majority of people pay fixed penalties and cases do not proceed to the next stage. I am confident that throughout Scotland more than enough people can be trained up to the level that will be necessary to enforce the eventual legislation.
- Mr Brocklebank:
What is the reaction of the Scottish Licensed Trade Association witnesses?
- Paul Waterson:
The fixed penalty might be the end of the matter for the person who is smoking, but the licensed trader involved in running the premises could lose his licence. Andy Kerr stated in our journal last week that we would not be responsible for enforcement, so there seems to be confusion. Will it be worth our while to have legislation that will be so difficult to enforce? Will that be good law, given that it will be difficult to enforce at 1 o'clock in the morning, 12 o'clock at night or throughout the afternoon? There will be a massive cost to having inspectors police a business that runs 24 hours a day. We do not think that it is worth while; our proposals are far more practical, workable and enforceable.
- The Convener:
I want to wind up this discussion with a couple of questions. Stuart Ross came before the committee to give evidence on Stewart Maxwell's bill, which was the Prohibition of Smoking in Regulated Areas (Scotland) Bill. One of the debates that we got into was about the relative advantages of a partial ban, which involved structural issues for many licensed premises, compared with a total ban. I know that you would prefer a phased-in ban. Will you give a sense of the relative advantages and disadvantages of the two options from your perspective?
- Stuart Ross:
Yes. When Stewart Maxwell lodged his bill we said that we would have been happy to support the proposals if they had related to where and when food was served. There were technical issues in respect of segregation of properties, which caused us considerable concern. Obviously segregation could take place and a total ban could follow. We debated the issues that were specific to the Maxwell bill at the time. As Paul Waterson said in his opening remarks, we have not changed our position. We met the then Deputy Minister for Health and Community Care as far back as May last year, when we proposed the phased approach. Throughout the four-month consultation period we have heard nothing from any other country to make us change our minds and say that we are not on the right tack. I believe that there are health and financial benefits in going down the route that we suggest and we have done our best to put those benefits down on paper. Some of the issues are complex, but we have made a full written submission that we have backed up with research which, although we commissioned it, is independent in the conclusions that it reaches.
- The Convener:
What is COSLA's view of the enforcement of a partial ban—having smoking and non-smoking areas in pubs—compared to a total ban, as is proposed in the bill?
- Gordon Greenhill:
It is acknowledged that the Maxwell bill was almost unenforceable and difficult to put in place. I envisaged that if it became law we would spend most of our time in the courts defining premises. It is for health professionals to determine the overall effect of a phasing-in approach. The bill that is before us is simple—it will be good law because it is enforceable. Parliament must decide whether it wants phased implementation.
- Hilary Robertson:
May I comment?
- The Convener:
I was going to ask you a specific question on your estimate of £5 million funding for smoking cessation programmes and the suggestion that that might need to be supplemented. Will you give us more information on that?
- Hilary Robertson:
Yes. First, I apologise to the committee, because that figure should be the £7 million that the Executive includes in the financial memorandum. May I make a couple of points about what we heard earlier?
- The Convener:
Yes.
- Hilary Robertson:
We have not consulted our members specifically on a phased approach, but I say without doubt that they support a one-step move.
It is recognised that the majority of smokers would like to give up. Our contention is that the bill will help to provide them with the impetus to do that. However, in order to give up successfully they need access to services to support them. We are not necessarily asking for additional funding because, until we begin to see implementation of the bill's provisions, we will not know for sure what its cost implications will be. We would certainly like to hear an undertaking that there will be flexibility so that if the £7 million per annum that will be available from 2005-06 onwards proves to be inadequate, additional central funding will be available for support services. It is well documented that smoking cessation services are a very effective health intervention. As a cost-benefit exercise, smoking cessation services are very effective, so we want to ensure that boards are in a position to support smokers who want to give up, and that they do not have to divert resources from other services to do so.
I will pick up on a couple of points that were made earlier about people going home to smoke. I cannot cite any evidence, but our members' contention is that implementation of the bill would help to change the smoking culture in Scotland. We expect people to want to give up—the bill will act as a trigger to push them into wanting to give up and taking action to do it.
If the choice were between a phased ban and no ban I am sure that our members would support a phased ban, but our preference is certainly for a one-step arrangement.
- Susan Aitken (Scottish NHS Confederation):
The Executive confirmed an investment of £7 million in the breath of fresh air for Scotland strategy. Although the strategy is welcome and important, it came out before we started talking seriously about a ban, so it does not take into account the impact that the ban might have. Obviously, our hope is that the ban will have a considerable impact and that people will actively seek out the NHS's support to give up smoking. In some ways we want smoking cessation services to be flooded by people looking for support and help, but we must ensure that there are sufficient resources to back that up. The ban must not be seen as an end in itself but as a lead in the wider strategy to reduce smoking considerably throughout Scotland.
- Hilary Robertson:
It is worth remembering that many of the public places to which the ban will apply are also workplaces, so people who work there and who are not smokers will be protected from smoke to which they would otherwise be exposed. That will have significant health benefits for them.
- The Convener:
I thank all the witnesses. As I said at the beginning, the substantive policy issues that are involved are not really for the committee; we are specifically interested in the financial matters. It has been agreed across the board that there has been a lack of definition of some issues on enforcement and other matters. We may wish to continue correspondence with the witnesses to establish the facts. I thank the witnesses for giving oral evidence today.
That concludes the evidence from the first panel. The representatives from the Scottish Licensed Trade Association and COSLA will leave us at this point, but the representatives from the Scottish NHS Confederation will stay to discuss other matters.
I remind committee members that on 1 March we will take evidence on the bill from Executive officials. The second panel is witnesses from the Scottish NHS Confederation. We will talk about the other elements of the bill. We move straight to questions.
- Dr Elaine Murray (Dumfries) (Lab):
I come from an area where there is an extreme shortage of dentists. In fact, no dentist in Dumfries and Galloway—private or NHS—has a list open. I am concerned about the costs that you identify in your submission and the burdens that will fall on boards where there are shortages of NHS dentists. The expectation might be that additional incentives may have to be given to dentists to do checks. What might happen in areas where there are no dentists to do them in the first place?
- Hilary Robertson:
There are varying estimates of the total shortfall of dentists around Scotland. One of the most recent figures is in a report by NHS Education for Scotland, which estimates—in its workforce planning for dentistry—that Scotland is lacking approximately 215 dentists in total throughout the country. We contacted our members in areas where we know there is a particular issue and we managed to get an estimate for the Grampian area based on work that was conducted there about 18 months ago. It was estimated that NHS Grampian is about 40 dentists short; that situation is likely to be replicated in other parts of the country. The picture is changing. More dentists are leaving NHS dentistry, but not necessarily all the NHS patients are going with them.
The provision in the bill that allows boards to contract with groups of dentists and co-operatives is welcome and the additional support is welcome. We think that that may be an incentive. However, we are concerned that the fact that there is under-provision, which is well recognised throughout the country, may mean that the requirement to provide the incentives falls unduly heavily on board areas where there is currently greater under-provision of NHS dentistry than in other parts of the country. When we asked our members about the issue, they found it extremely difficult to put any figures on the cost, because until they map current provision accurately and identify where gaps exist it will be impossible for them to say what they expect the costs to be.
- Dr Murray:
Are you able to say how many Scots are not registered with a dentist?
- Hilary Robertson:
I do not have that figure.
- Susan Aitken:
I do not have the figure here, but I know that the Health Committee published a report last week that contains such figures. The figure is quite high; I think that it is slightly more than half of Scots, but the figures are slightly different when they are broken down into adults and children. That information is in the research report that the Health Committee published last week. We could certainly find the figures and provide them to the Finance Committee.
The ability of boards to offer incentives to dentists, to dental practices or to groups of dentists to set up in their area is a useful tool; it would be helpful for boards to be able to do that. However, we anticipate that although boards would not have to do it, the fact that the tool exists will lead to an expectation that financial support will be available. In many ways that is good because it is, perhaps, too much to expect dentists to come into areas where there is no provision, to set up premises and to purchase equipment on their own without any support. However, we must bear it in mind that in areas such as Dumfries and Galloway—the Health Committee's report found consistently that Dumfries and Galloway, Grampian, Ayrshire and Arran and the Western Isles are, under the various ways of measuring the situation, the ones with the biggest under-provision problems—provision of incentives could lead to significant costs.
Our argument is that boards do not currently have flexibility within their arrangements and the money is not there. Peter Collings, the director of finance in the Health Department, gave evidence to the Audit Committee a couple of weeks ago and the new NHS allocations were announced on Friday. Peter Collings estimates that £400 million to £450 million of the £550 million allocation uplift across Scotland will be accounted for by the time it reaches boards, mainly through pay modernisation, although there are other factors such as pay uplift and the annual increase in prescribing costs.
Therefore there is not a lot of money to play with for service development, although we are talking about a major service development in relation to which all boards will bear a burden and some boards will bear a particular burden. Boards will have a useful tool, which I hope will contribute to setting up dentists in areas that are not currently served and encourage dentists to take on more NHS patients and give more time to the NHS. However, the quid pro quo is that the policy will be expensive and the funds are not really there to implement it. There is not a great deal of flexibility in the allocations.
- Dr Murray:
There is also a capacity issue. There are not enough dentists and we cannot create dentists out of nowhere. A free check-up might be desirable, but there is not much point in the patient having one and being told, "You've got a mouth full of caries", if nobody can do anything about it and the patient cannot get treatment.
- Susan Aitken:
NHS Education for Scotland calculated that as a result of the entry into the system of newly qualified dentists and better workforce planning, which will make more appropriate use of the entire dental workforce, including dental assistants and hygienists, it should be possible to make up the shortfall by 2008, which is not terribly far away. However we must ask how many of the new dentists who enter the system will be NHS dentists. There is a shortfall in the numbers of qualified professionals, but it is not so drastic that it cannot be addressed, according to NHS Education for Scotland. The key issue is how we persuade dentists to remain in the NHS and carry on treating NHS patients. That is the crux of the matter.
- Alasdair Morgan:
Do you have any idea how many extra dentist hours per year will be needed to fulfil the requirements of the bill?
- Susan Aitken:
The short answer is no, and I do not think that the boards know the answer to that yet, either.
- Alasdair Morgan:
How can we estimate the costs of the policy, if we do not know how many additional dentist hours will be required?
- Susan Aitken:
We cannot.
- Hilary Robertson:
That is the point. When we consulted our members about the implications of the bill and the accuracy of the financial memorandum, they simply could not give us an answer, because they have not yet mapped out the areas in which there is overprovision or underprovision. In most cases there is underprovision, but until there is a clear picture of the situation our members will find it very difficult to calculate the number of hours of NHS dentistry that they will need to provide to make up the shortfall.
- Alasdair Morgan:
Is there a suggestion that somewhere in the country dentists are sitting around doing nothing?
- Susan Aitken:
No.
- Alasdair Morgan:
A substantial number of extra dentist hours will be required, but we do not know how many. How can we be sure that the bill's requirements will be met by the new dentists who will come into the system?
- Susan Aitken:
Dentists are not sitting around doing nothing, but some dentists do not treat NHS patients—that is the context of the shortfall and underprovision and the reason why people have to go private. The issue is how we encourage those dentists to treat NHS patients.
- Alasdair Morgan:
Let us leave aside the suspension of credibility that is needed if we are to believe that dentists who have discovered that they can make a lot of money from treating private patients will suddenly come back to the public sector. Even if such dentists were to come back to the public sector, all the patients who were being treated privately and presumably quite liked that system would try to find another private dentist. The pressure and the demand on the system would be exactly the same. If we simply move people from one sector to the other without increasing the total number of dentists, we will not solve the problem. Somebody will still not get treatment.
- Susan Aitken:
According to NHS Education for Scotland, total capacity will increase over the next four years, not only because of an increase in the total number of dentists in practice but as a result of better planning for the entire dental workforce. Such planning is going on in other parts of the NHS workforce, in which people are working differently and not doing certain jobs when they would be better employed doing something else. For example, dentists might be undertaking jobs that a dental assistant could do. We hope that the workforce planning that is being undertaken will eliminate such situations over the next four years. That is another element of what is happening.
Boards find it difficult to put a figure on the costs because no proper mapping has been undertaken to show precisely where the gaps are and how many dentists are needed to fill the gaps. Only boards can address that matter. Grampian NHS Board told us that about 18 months ago it estimated that it needed about 40 extra dentists. The board calculated the figure using a fairly simple dentist-to-population ratio, but the situation is more complex because since then some dentists have left the NHS without taking all their patients with them, which has increased the number of patients who do not have NHS provision. A big mapping job needs to be done to identify the gaps and to consider how they can be filled, who can fill them and the number of hours that will be needed from dentists and dental teams.
- Alasdair Morgan:
The other corollary of the issue that Elaine Murray raised is that, in the short and medium term, dentists who perform free dental examinations will detect a lot of work that needs to be done on people's teeth. Has an estimate been made of the amount of work that the examinations will identify?
- Susan Aitken:
Not to my knowledge.
- Alasdair Morgan:
I presume that a dental examination takes 10 or 15 minutes, but if someone needs treatment after their examination they will need a significantly longer course of treatment. We do not know how much work the free examinations will generate, because we do not know how many examinations will take place.
- Susan Aitken:
NHS National Services Scotland might have a clearer idea of the number of examinations that will be needed. Eye and dental examinations are a slightly different issue from the one that you raise, although there are obvious connections. The issues are financially slightly separate, in that there is a centrally held general dental services budget from which boards draw down costs, whereas increases in the number of dentists and in dental provision must be funded by the boards themselves.
Free eye and dental examinations will have an impact on provision. I am not sure that anyone will be able to predict the extent of that impact until implementation begins and we start to get an idea of the number of people who currently do not go for checks because they have to pay for them but who will take advantage of the free examinations.
- Alasdair Morgan:
Would it be too cynical to suggest that the cost could be estimated quite well? We know how many dentists there will be and we know that they can work only so many hours per week, so we know what the cost would be. The more problematic issue might be whether the hours that are worked will deliver the number of dental checks and the amount of treatment that will be required. The costs will be fixed, anyway.
- Susan Aitken:
The costs will be to the NHS and will depend on the number of hours that dentists give to the NHS. We cannot predict the costs, because we do not know the number of hours.
We should remember that we are considering the matter in advance of the Executive's response to last summer's consultation, "Modernising NHS dental services in Scotland". We are in a wee bit of a vacuum, because we do not yet know how the modernisation will be effected. Also, the new dental contract is not yet with us. Elements of the bill anticipate measures that will have to be put in place to modernise the service and the contract, but we do not yet know the full details of the modernisation plans.
- The Convener:
The Finance Committee's problem is that it must consider a financial memorandum that is based on a number of imponderables.
- Jim Mather:
I apologise for returning to the provisions on the prohibition of smoking in public places, but I have a significant number of questions that I did not ask earlier because I thought that we would get a second pass.
The Scottish NHS Confederation says in its submission that the proposals will result in
"a considerable reduction of the estimated £200m per annum that smoking-related ill-health currently costs NHS Scotland."
That figure is equivalent to about 2.5 per cent of the NHS budget. Given that smoking is linked to cancer, strokes, lung disease and other illnesses, is the estimate a little low?
- Susan Aitken:
I am sure that the estimate is low. A number of academic researchers have used that figure in relation to direct links between smoking and ill health. Of course, smoking is a contributory factor in many conditions but is not the primary cause. The ultimate cost of smoking to the NHS is probably unquantifiable. Equally, the ultimate saving to the NHS of reducing smoking is probably unquantifiable. It is impossible to say how many people will not start smoking because they are not in a pub in which smoking is allowed and will therefore not contract a smoking-related illness later in life. We hope that that will be the case with many people, but we cannot put a figure on it.
- Jim Mather:
I accept all that you say. However, I am contrasting the suggested saving of £200 million, which could be higher, with the £5.7 million to £15.7 million estimated gross savings in the financial memorandum.
My question is quite simple: could the prohibition of smoking be a trigger for a higher level of personal responsibility for health, which would bring about a sea change in people's health and in the way in which the health budget is spent?
- Hilary Robertson:
We expect the legislation to act as such a trigger, because we know that a majority of smokers would like to give up. Our concern about the financial memorandum relates to the support for them to do that. When we consulted our members on the previous bill, one of the major points that was made related to the cultural aspects of smoking. If a piece of legislation can change some of those cultural aspects and ensure that the cultural norm is that people do not smoke when they are out for a drink, that will have a beneficial effect. However, quantifying all that is difficult.
- Jim Mather:
I want to try to consolidate that and get some hard numbers and hard methodology around it. Do you have any plans to talk to the health services in Ireland and other countries in which a smoking ban has been implemented to find out whether there are lessons to be learned that might result in better and more cost-effective provision of health services?
- Susan Aitken:
Do you mean health services specifically related to smoking or health services generally?
- Jim Mather:
I wondered whether you had tried to find out what other health services had done to take advantage of smoking bans, whether their efforts had worked and what they would do differently if they had a second chance, which is, in effect, what we have got. Do you have any plans to do that?
- Susan Aitken:
We have no such specific plans at the moment. However, we would be happy to support the Executive in any work that it wants to do in that regard. The lessons that might be learned are hugely important.
I am not sure that the legislation will make a huge difference to the way in which health services are funded in the short term. The bill is designed to deal with the long-term problems and is part of a wider programme of ensuring that people take responsibility for their health, which you talked about. The Wanless report on public health, which the Treasury commissioned last year, spoke about the ideal scenario being one in which people were fully engaged in thinking about and making choices about their own health. We should aspire to such a situation. The bill is an important step towards it, but it does not go all the way.
There has always been—and probably will be for some time—an issue about the balance of health spending in terms of how much goes into prevention and health improvement and how much goes into health care and health services. That is a very involved debate, which deals with questions of how much money goes into primary care and services in the community as opposed to acute services, for example. The bill will not change that balance in the short term, but we hope that it will help us to move towards a fully engaged scenario in which we are able to think about the health service differently and to move away from the current focus on acute services.
- Jim Mather:
It can be useful to consider other people's experiences. Listening to your answer, I was thinking that it might be more helpful to talk to the New York police department than to the New York health department, as its policy of zero tolerance for fare dodging and littering on the subway had a disproportionate impact on the murder rate. The causal link between certain initiatives and their results can be somewhat oblique, but the signal can, nevertheless, be powerful. That shows that it is possible to make step changes over time, if we learn from other jurisdictions.
- The Convener:
Given the work that has been done by people such as Michael Marmot, who has clearly defined issues relating to health causation, I am surprised that it is not possible to make rather better estimates of impacts on health. For example, it should be possible to work out statistically the issues relating to smoking-connected illnesses that affect people's capacity to work for what should be the normal period of their working life. We do not know what the ban would deliver in reducing the number of people who are inclined to smoke, but it should be possible to produce a range of estimates of, for example, the impact that a 5 per cent, 10 per cent or 15 per cent reduction in the number of people who smoke would have on working hours over a period. That is the kind of figure that Jim Mather and others are looking for.
- Mr Arbuckle:
The only firm figure that we have in relation to free dental checks is the figure of £500,000 for establishing administrative back-up. I am concerned about that, because we should not go down that road until we know the financial consequences. The move is progressive, but it is quite a big one to make without our knowing what the cost will be. I am sure that it is within the committee's remit to ask for more information on what the cost will be and on whether the human resources are available for delivery.
- The Convener:
I am not sure that that is a financial question in relation to the memorandum. I think that you are quite clearly straying into policy areas. I will let our witnesses talk about the financial issues that arise from that question, but I think that we need to be a bit cautious with regard to the policy aspects.
- Susan Aitken:
The figure of £500,000 relates to the predicted increase in administrative costs as a result of the new provisions, such as the cost of administering the new list. According to our members, it is difficult to say whether that estimate is accurate but it is probably not unreasonable. If the costs fall within that scope, they could probably be fairly easily found within existing allocations. The service development element could stretch what is available within allocations at the moment.
- The Convener:
I think that we have concluded our questions. I thank Hilary Robertson and Susan Aitken for attending.
On 1 March, we will take evidence from Executive officials. The bill is quite complex and wide ranging and it might be helpful if members could identify the bits that they want to ask questions about. From what members have said so far, it is clear that we are interested in the smoking and dentistry issues. Are there any other strands that members want to pull out?
- Alasdair Morgan:
Pharmacy.
- The Convener:
Okay.
- John Swinburne:
Compensation for hepatitis C sufferers.
- The Convener:
I am not sure that that relates to finance in this particular—
- John Swinburne:
Is it not money that they are going to get?
- The Convener:
I am sure that our suggestions will be helpful to the clerks.
- Alasdair Morgan:
Basically, we are interested in a bit of everything.
- The Convener:
It is basically pharmacy, dentistry and smoking. In relation to smoking in particular, are members interested in the enforcement issues or the broader health issues?
- Mr Brocklebank:
Others may be interested in the health aspects, but I am interested in enforcement.
- The Convener:
The key financial issues are about enforcement, so perhaps we can focus on that.