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Health and Education

That is certainly an option. I share the hon. Gentleman's concern that village shops are under enormous pressure already. Many are teetering on the brink—indeed, many have already closed—and any further loss of income could tip them into closure. That is something that we should all be concerned about. I understand that it is already the practice in many areas for shops to sell smuggled tobacco under the counter. The hon. Member for Norwich, North (Dr. Gibson) has confirmed that he is aware of the practice, and I have heard of it happening in Haringey. If that is true, then removing the display of legally sold cigarettes in shops will only open the door to a vastly greater risk of smuggled tobacco being sold under the counter. How on earth can that be policed? This is one of those cases in which the law of unintended consequences might well apply. I also want to mention smoking cessation, because there appears to be little evidence that the steps that the Government are taking having any real effect. At the moment, under the quality and outcomes framework— QOF—system, GPs get paid for mentioning smoking cessation to their patients and for telling them to suggest a date by which they could have given up. That is it; they get the payment just for doing that. There is no requirement to demonstrate success in the strategy of encouraging their patients to give up; they get the payment simply for mentioning it. In California, however, under the Kaiser Permanente insurance scheme, there is a much more intensive focus on counselling, on prevention, on mechanisms to encourage people to give up smoking, on smoking cessation programmes and on nicotine replacement therapy. Within that community of insured people in California, the smoking rate has been reduced from 18 per cent. to 9 per cent. It has been halved, and people benefit much more from that intensive approach. Rather than taking a nanny state approach, or, as the hon. Member for Gainsborough (Mr. Leigh) has pointed out, taking steps that could push small village shops into closure, we should do things that are effective in helping people, and which will actually facilitate their giving up smoking.