Health Bill [Lords]

If the hon. Gentleman listens to the rest of my speech, perhaps he will rethink his argument. I do not think that the studies he cites are quite that large. The bottom line is that, whatever we think about smoking, tobacco is a legal product that can be bought by consenting adults, yet we are planning to restrict its display even more than we restrict that of pornographic material. That seems to be a rather strange attitude to take. A compromise approach that would be worthy of consideration would involve the introduction of plain packaging, and we shall certainly table amendments on that in Committee. If the aim of the proposed changes is really to reduce under-age smoking, the Bill is making the wrong proposals and missing a few tricks. For example, there should be greater penalties for shopkeepers who sell tobacco to under-age people, as the hon. Member for South Cambridgeshire (Mr. Lansley) suggested. It should also be an offence to buy cigarettes and pass them on to someone under the age of 18. It seems odd that the Government are proposing only one measure, when a whole basket of measures such as these would have a much greater effect. I do not understand the Government's objection to such measures; it would be helpful if the Minister explained it in summing up. The proposals on vending machines are weak. The Secretary of State said that if they did not work, the Government would consider a total ban. My hon. Friend the Member for Leeds, North-West (Greg Mulholland) mentioned places with a strict age restriction, and there may be a case for an exemption, but if we are serious about trying to stop under-age smokers gaining access to cigarettes, we should consider a ban on vending machines and restrict the sale of cigarettes in pubs to behind the bar. The British Heart Foundation estimated that machines were the source of cigarettes for approximately 46,000 children in England and Wales, so if the Government were really committed to doing something about it, they would go a step further. Children are very clever in getting hold of tokens and other means of accessing the products. Other age-limited products can be bought only through a face-to-face, over-the-counter type of transaction, so why can we not have the same for tobacco products? I hope that the Government will consider the issue further. Many children obtain cigarettes from black-market sources, car boot sales and the like, so it is disappointing that the Government are not using the Bill to address smuggling, which would start to tackle some of the supply problems at source. The concept of an NHS constitution has received widespread support from the British Medical Association and patient groups, and there even seems to be some agreement between the two main political parties. I agree with the comments of the hon. Member for South Cambridgeshire about whether the proposal really amounts to a constitution or whether much of it is new, but having all the rights and entitlements written down in one easily accessible format is helpful. The problem is how to prevent yet another motherhood and apple pie exercise and how to make the constitution meaningful so that it effectively becomes a bible of good practice for health professionals while commanding the trust and respect of patients. It is important that we try in Committee to put some more meat on the bones. For example, it would be helpful to have further clarification of the duty to""have regard to the NHS Constitution"" and of how it might be challenged. To give a simple example, a person has the right to be treated with dignity and respect. We all know that there is a widespread problem with mixed-sex wards; they were supposed to have been abolished years ago, but that has still not happened. Older people, who are often from a private generation, object to being in a mixed-sex ward and are much more against such wards than younger people. If treated in a mixed-sex ward, the patient could understandably become upset, but could the trust then say, "Well, we had regard to the NHS constitution and the rights in it, but the physical constraints gave us no other option"? It is not clear whether the constitution will act as a driver for change and improvement in that area. If it does so, that will be a very good thing, but it is not yet clear how much in the way of teeth the constitution will provide.