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Health and Education

I made the point that there would be many circumstances in which such an approach would be inappropriate, but we should consider having such a power, and run pilot schemes. The hon. Gentleman raises the point about a system of overbooking, but if he were to talk to any GP or hospital clinician, he would find that there is a massive problem with missed appointments. If we are having to deal with delivering health services in a much tighter financial situation, we must examine ways of saving wasted costs, and this is one area that we should examine. The main point I am making is that if the constitution talks about responsibilities, those must be genuine responsibilities. If they are not, we ought not even to refer to them, because the concept is meaningless. The King's Fund also discusses whether the constitution will endure and whether it will be vulnerable to change by successive Governments for political reasons, suggesting that if it is to have any real value, it ought to be a document that does endure, and cannot simply be changed on a whim by successive Governments. However, the constitution appears to contain no mechanism to prevent that from happening, which is also a criticism. It says nothing, either, about continuing health care or the funding of people with complex needs, which is surely a critical aspect of health care. If the constitution fails to address that at all, it is surely weak. The idea of having second opinions in child care cases has been mentioned, but the constitution says nothing about the right to a second opinion either. That, too, should be addressed. Let me turn to smoking. We all agree that action should be taken to enable people to give up smoking and to warn people, particularly youngsters, of the risks of taking it up. There is clear evidence that a proportion of young people buy their cigarettes from vending machines, so we readily support action to clamp down on the sale of tobacco from vending machines. Indeed, we might need to go further than the Government have proposed, so as to avoid any risk of youngsters below the legal age buying tobacco in that way. However, the Government's case on displaying tobacco is not as good. The Conservative spokesman, the hon. Member for South Cambridgeshire (Mr. Lansley), referred to the risks of misinterpreting the statistics, but it was fascinating to read that the real price of cigarettes in Canada increased by 159 per cent. between 1979 and 1991. That led to the teenage smoking rate falling from 42 to 16 per cent., which clearly shows a direct link between price and teenage smoking rates. We know that price has an effect, but there has been no proposal on price. Canada cut the tax in 1994, because of concerns about smuggled cigarettes, and the real price fell by a third. That led to the teenage smoking rate increasing, from 16 to 20 per cent. We know that price is a relevant factor—it was referred to by the World Health Organisation—yet the Government have made no proposals on price. We advocate other measures. We should establish a criminal offence of supplying tobacco to an under-age smoker. The Government appear to be flunking that one and have not come forward with any proposals. It is a criminal offence to buy alcohol in order to supply it to an under-age drinker, but why is it not a criminal offence to supply tobacco in the same way? As for smuggled tobacco, the current statistics show that one in six cigarettes purchased in this country has been smuggled, as has 50 per cent. of the rolling tobacco. A recent article in the European Journal of Public Health highlighted the link between smuggled tobacco and deprived communities, saying:"““the people with the highest likelihood of having bought smuggled tobacco…are…heavier smokers with higher levels of addiction, living in socially deprived areas and with low educational attainment.””" People in deprived communities are obtaining their tobacco across the table in the pub or at the front door, yet we are talking about removing displays from shops—a controlled environment, after all—which will do very little to address health inequalities.