Sunday
Oct222017

Banning smokers from surgery is cruel and pointless, writes Dominis Lawson

I was asked to comment on two NHS/smoking-related stories last week.

The first concerned smokers being forced to take breath tests and refused non-urgent operations if they don't quit smoking before an operation. The second was about hospital smoking bans.

As I noted here, Forest wasn't alone in condemning the latest proposal to deny smokers treatment:

The Royal College of Surgeons (RCS) said the plan seemed to be "against the principles of the NHS".

Ian Eardley, senior vice president at the RCS, said losing weight or stopping smoking "should not be a condition of them [patients] receiving surgery".

"This goes against clinical guidance and leaves patients waiting long periods of time in pain and discomfort. It can even lead to worse outcomes following surgery in some cases."

See Hertfordshire NHS breath tests for smokers before surgery (BBC new).

The Telegraph (NHS provokes fury with indefinite surgery ban for smokers and obese) quoted the RCS and Joyce Robins from Patient Concern who said:

"This is absolutely disgraceful - we all pay our taxes, and the NHS should be there when we need it; we did not agree to a two-tier system."

Today the Sunday Times has a timely column by Dominic Lawson, son of Nigel and former editor of the Sunday Telegraph. Highlighting what he calls an "especially cruel" new form of discrimination, Lawson quotes the RCS's Ian Eardley before moving on to what he calls the "institutionalised terror of passive smoking":

This idea that smokers are ruining the health of innocent bystanders — especially children — has taken such a grip on our legislators that in 2014 parliament passed a completely unenforceable law to fine drivers who smoke while children are in their vehicles. But there is no statistical link between adults smoking and increased early mortality rates among their children. Research on “passive smoking” published in 1998 by the World Health Organisation suggested that the children of smokers had a lung cancer rate lower — yes, lower — than children of non-smokers.

This seemed to have come as a shock to the WHO, which initially kept back the details of its research, but its conclusion that there was no statistically significant connection between passive smoking and lung cancer has been most recently confirmed by a 2013 study of more than 76,000 American women published by the Journal of the National Cancer Institute. It said it “found no link between the disease and secondhand smoke”.

The article is behind a paywall, sadly, but worth reading if you can get a copy (Face it, doctor, smoking props up the NHS).

As for hospital smoking bans, I'm confident the issue won't go away, not simply because so many people are ignoring orders not to smoke on hospital sites, but because it is fundamentally inhumane.

Meanwhile, faced with adults openly flouting the regulations, the Scottish Government announced this week that it intends to get tough. According to the Scottish Mail on Sunday today:

Patients who smoke outside hospitals face fines of up to £1,000 under plans to extend the crackdown on tobacco.

Smoking and permitting others to smoke will be dealt with by £50 on-the-spot fines, but that could rise if offenders are taken to court.

The paper adds:

The Scottish Government also intends to ht health boards and managers with penalties of up to £2,500 if they fail to act on it.

A Scottish Government spokesman said:

"If a case is taken to court the offender could be fined up to £1,000 and those gound to have permitted others to smoke outside a hospital could be fined up to £2,500.

The threat to fine health boards could of course lead to the absurd situation whereby these taxpayer-funded institutions end up using public money to pay for fines imposed by government.

Another outcome could be long-serving NHS staff being disciplined or fined for turning a blind eye to someone having a quiet smoke outside. (To many people this is known as compassion.)

I'm quoted by the paper as follows:

"The Scottish Government is behaving like Big Brother. Smoking outside doesn't put anyone else's health at risk. As long as people are considerate and don't smoke directly outside the hospital entrance what's the problem?"

There wasn't room for the full quote that also included the comment that:

"Banning smoking on hospital grounds and threatening patients, staff and visitors with fines or other penalties is not just heavy-handed, it shows a desperate lack of compassion for those who enjoy the comfort of a cigarette in a stressful environment.

"Excessive regulation is not a legacy any government should be proud of. Ministers need to come to their senses and focus on the big issues, not someone have a quiet smoke in the open air."

This issue is definitely going to run and run.

Friday
Oct202017

Oi! Hammond! No!!!

I don't need to tell smokers how expensive it is to buy tobacco.

The UK is currently the second most expensive place in Europe to buy cigarettes and hand-rolling tobacco.

Ireland is the most expensive (their recent Budget pushed a pack of 20 cigarettes up to €12) but the UK isn't far behind.

Next month Philip Hammond will present his first Autumn Budget, having switched the Budget from the spring.

At the last Budget in March he announced that duty on tobacco products would increase by two per cent above inflation (the so-called tobacco escalator that was reintroduced by George Osborne in 2010).

As a result a packet of 20 cigarettes went up by 35p and the price of a 30g pack of rolling tobacco (which is now the minimum pouch size) went up by 42p.

At the same time Hammond announced the introduction, from May 20, of a minimum excise duty based on a packet price of £7.35, pushing the minimum price for a packet of 20 cigarettes up to £8.82.

Premium brands meanwhile went up to £10.26 (or more) per pack.

The fear is Hammond will take advantage of the new Autumn Budget to hike tobacco duty for a second time in nine months, which would be almost unprecedented.

Yesterday Forest published two briefing notes. The first highlights 'The effects of tobacco duty on households across the income distribution'. The second notes the 'The impact of using the retail price index in the tobacco duty escalator'.

Neither are what I would call bedtime reading but the press release offers a basic explanation:

Chancellor urged to reject a second tobacco duty increase this year

AUTUMN BUDGET – Campaigners have urged the Chancellor to help consumers who are “just about managing” and reject a second increase in tobacco duty this year.

According to the smokers’ group Forest, tobacco duty costs those with low incomes a far larger proportion of their income than those on higher incomes and further hikes would only exacerbate this unfairness.

Measuring expenditure on tobacco duty as a percentage of disposable income, in 2015/16 tobacco duty cost the average household in the lowest income bracket almost eight times what it cost the average highest earning household.

Although the average household among middle earners spent 38 per cent more on tobacco duty than the poorest households, as a percentage of disposable income the poorer households were still worse off.

Tobacco duty, says Forest, costs the poorest households 2.3 per cent of their disposable incomes compared to 0.3 per cent in the wealthiest households.

Simon Clark, director of Forest, said: “Tobacco duty is a regressive tax because it hurts low income households more than the average household and far more than the wealthiest households.

“In order to help those who, in Theresa May’s words, are ‘just about managing’, we urge the Chancellor to resist the temptation to increase tobacco duty for a second time this year."

Forest also claim the use of a “flawed” measure of inflation has cost smokers an additional £1.35 billion in tobacco duty since 2010.

According to the group, the practise of increasing tobacco duty using the retail price index (RPI) rather than the consumer price index (CPI), which experts believe is a more accurate measurement of inflation, has resulted in smokers being unfairly overtaxed.

The duty escalator, which was reintroduced in 2010, increased the price of tobacco every year by inflation plus two per cent. Inflation, says Forest, was calculated using the RPI not the CPI. This, says the group, has resulted in smokers paying even more duty than they should reasonably have been expected to pay.

Forest estimates that smokers were overtaxed by almost £46 million in 2010/11, rising to £252 million in 2016/17. The forecast for 2017/18 is almost £310 million which means smokers will have been overtaxed by over £1.35 billion since 2010.

Clark added: “Smokers have been punished enough for their habit. Tobacco duty is already scandalously high without the Chancellor using a flawed measure of inflation to extract even more money from the pockets of law-abiding consumers.”

Let's hope the PM and her Chancellor are listening.

Thursday
Oct192017

Taoiseach and health minister head nominations for nanny state awards

The Times (Ireland edition) has an exclusive report about our Farewell to Freedom Dinner in Dublin next month (see previous post).

The paper naturally focussed on the Golden Nanny Awards we are presenting to the politicians and NGOs that have done most to put Ireland into the top three of Chris Snowdon's Nanny State Index.

The full list of nominations will be published before the event which takes place on November 13. In the meantime, in the words of The Times:

Leo Varadkar, Simon Harris, and Marcella Corcoran Kennedy could be honoured for their contribution to the nanny state at an upcoming dinner hosted by a smoker’s rights group.

The taoiseach, health minister, and former health promotion minister are shortlisted for Golden Nanny awards at Forest’s “farewell to freedom” dinner next month.

The group have based the nomination criteria on the endorsement of restrictions on what it deems “lifestyle choices” such as smoking, drinking, and consuming unhealthy foods.

It claims that it is not opposed to fair regulations, but that the Irish government has been “over-zealous” with its policies.

Alcohol Action Ireland, a government-funded charity, and Action on Smoking Health Ireland, an anti-tobacco advocacy group, have also been nominated.

A “special award” is also being considered for the Irish Times, whose editorial pages are “relentlessly” in favour of lifestyle regulation, according to Simon Clark, director of Forest UK.

“We are trying to get the message out that adults have a right to choose how they live their lives, and we thought that this dinner would be a way to convey that in a humorous way.”

Full article: Nanny state champions make rights group fume.

Thursday
Oct192017

Coming soon: Farewell to Freedom dinner featuring the Golden Nanny Awards

Delighted to announce a brand new Forest event.

Next month in Dublin we are hosting a Farewell to Freedom dinner featuring the inaugural Golden Nanny Awards.

'Farewell to Freedom' is a nod to what is currently happening in Ireland – the introduction of plain packaging of tobacco, the forthcoming sugar tax and calls for minimum pricing of alcohol.

It's not a good time to be a consumer in Ireland and the introduction of a sugar tax could push the country even higher in the Nanny State Index. (Ireland currently sits at #3 behind Finland and the UK.)

The event, on Monday November 13, will feature a drinks reception on a smoking terrace with fireplace and heaters, followed by a three-course meal and after dinner 'entertainment' including the Golden Nanny Awards.

'The Nannies' will highlight the role of leading politicians and NGOs in promoting a nanny state agenda.

The event is supported by Hibernia Forum, a free market think tank, the Dublin Salon discussion group ('Everything begins with debate'), Students for Liberty Ireland and Consumer Choice Center.

If it's a success we plan to take the concept to London, Edinburgh and even Brussels. Watch this space.

Funnily enough we had a minor panic yesterday morning when we discovered that Ireland had been drawn to play a World Cup qualifying match against Denmark in Dublin on November 14, the original date for our event.

Invitations had already started going out but the restaurant – which is usually closed on Mondays – very kindly agreed to open for us on Monday 13th.

Hopefully that's the only hiccup between now and then but I wouldn't put money on it.

Wednesday
Oct182017

"The NHS is becoming more like Big Brother every day"

According to the Telegraph today:

 The NHS will ban patients from surgery indefinitely unless they lose weight or quit smoking, under controversial plans drawn up in Hertfordshire.

... the new rules, drawn up by clinical commissioning groups (CCGs) in Hertfordshire, say that obese patients “will not get non-urgent surgery until they reduce their weight” at all, unless the circumstances are exceptional.

The criteria also mean smokers will only be referred for operations if they have stopped smoking for at least eight weeks, with such patients breathalysed before referral.

The MailOnline added:

Under the proposals, which were uncovered by the Health Service Journal, smokers must quit completely and doctors won't just take their word on it. They will be breathalysed to monitor levels of carbon monoxide in blood, to ensure they are telling the truth.

To be honest, I feel I've heard this story (or something very similar) several times before, which indeed I have. It's a story that comes round again and again, with minor variations.

This time however there seems to be more opposition. The Telegraph, for example, featured a long quote from Ian Eardley, senior vice president of the Royal College of Surgeons, who said it was wrong to bar NHS treatment to any group of patients:

"Singling out patients in this way goes against the principles of the NHS,” he said.

"This goes against clinical guidance and leaves patients waiting long periods of time in pain and discomfort. It can even lead to worse outcomes following surgery in some cases," he said.

"There is simply no justification for these policies, and we urge all clinical commissioning groups (CCGs) to urgently reverse these discriminatory measures."

The Telegraph also quoted Joyce Robins from Patient Concern who didn't mince her words:

"This is absolutely disgraceful - we all pay our taxes, and the NHS should be there when we need it; we did not agree to a two-tier system."

Eardley's comments were also featured by the Mail which concluded its report with a quote from me:

"Forcing smokers to take a breath test is not only heavy-handed, it's a gross intrusion of privacy.

"If adults choose to ignore advice to quit smoking that's a matter for them. They shouldn't be treated like criminals and denied treatment.

"The NHS is becoming more like Big Brother every day."

Tuesday
Oct172017

BCH: results of consultation on extending 'smokefree' zone to nearby streets

I suppose I ought to write about the outcome of a consultation conducted last year by Birmingham Children's Hospital (BCH).

You may remember it. I wrote about it here (Action alert – hospital wants to extend smoking ban to nearby streets) and here (Why 'smoke-free' consultation should be declared null and void) and invited readers to submit a response.

The consultation report has been sitting in my inbox for a few weeks. I'd like to say the outcome was a victory for those who opposed extending the hospital's 'smokefree' zone to neighbouring streets but I can't because there was a majority in favour.

That said, it was hardly a great win for BCH. I say that because it took a Freedom of Information request to get the hospital to reveal the existence of the report which wasn't on its website.

Nor had the results of the consultation been reported by the local media, which suggested two things. Either they hadn't been released or the results were insufficiently robust to merit any coverage.

Anyway, after submitting an FOI request in August I was sent a copy of the report (Proposal for a smoke-free zone around BCH: consultation responses) plus this brief summary:

  • Birmingham Children’s Hospital remains a smokefree site. There has been no recent change in this.
  • As outlined prior to last year’s consultation, any changes to ask people not to smoke around the hospital would need to be developed as a proposal with the local authority. At this stage, no formal proposal has been made. However, our consultation showed that the vast majority of respondents who actually use the hospital, live in Birmingham or use the streets around our site were in favour of a smokefree zone, and we therefore continue to explore ways of achieving this.

The 19-page report, dated November 8, 2016, is slightly more interesting. Here are three things I noted. One:

More smokers were strongly against the zone than were for it. Previous smokers were more evenly split between supporting and being against the zone. The majority of support came from non-smokers.

I'm sure this won't won't surprise anyone. It is however another example of what I call the 'tyranny of the majority' and it's a problem for smokers because non-smokers now outnumber smokers five to one and those who express an opinion in surveys like this are invariably anti-smoking.

My guess is that most non-smokers don't feel strongly about people smoking in the street, regardless of whether it's near a hospital, but that also means they're unlikely to be motivated to take part in a consultation on the subject.  

Inevitably therefore what we're up against is a hardcore of anti-smokers plus members of staff who I imagine were encouraged to submit a response that, lo and behold, supported their employers' proposed policy.

Two, people are generally reluctant to ask smokers to move on not because they think they are interfering in someone else's business and it has nothing to do with them but because they are frightened to do so.

Indeed the most extraordinary comment in the entire report reads:

Having been a police officer for 30 years I feel it would be dangerous to get into conflict with people who are smoking.

Goodness, if an experienced police officer is intimidated by the thought of asking someone to stub out a cigarette or move further away from the hospital to smoke you wouldn't back them to protect you from a knife-wielding terrorist, would you?

Three, the hospital wants to ban smoking and vaping in nearby streets. This is based on responses to the question 'Should the zone apply to e-cigarettes?' and the following key points:

  • Respondents in favour of the zone were largely for it applying to e-cigarettes.
  • Several respondents highlighted that a zone might discourage quit attempts using e-cigarettes, although no respondents indicated that they personally would be affected in this way.

What I deduce from this is that respondents opposed to the zone were largely against it applying to e-cigarettes (I know I was) but very few (if any) vapers bothered to submit a response, presumably because it was promoted as a consultation about smoking. (Forest gets a mention in the report but there's no reference to any vaping-related organisations.)

In other words, by declining to engage in a consultation on a "proposal for a smoke-free zone around BCH", the vaping advocacy community has effectively given the green light to a policy which, if implemented, will prohibit both smoking and vaping in neighbouring streets.

Here are the full recommendations:

1. Given the strong support from the significant majority of the public, families and staff who regularly use the area around the hospital, BCH strongly believes that the introduction of a smoke-free zone around the hospital site is a positive step.

2. BCH believes it will improve the experience of visitors, whilst also offering an opportunity to communicate a consistent and important public health message.

3. Based on consultation feedback, BCH believes that the zone should include vaping and e-cigarettes, maintaining consistency with the hospital site itself.

4. BCH will initially pursue the introduction of a voluntary zone, supported through signage that highlights the importance of the zone to children and families visiting the hospital.

5. BCH recognises the views of a number of people that they would like to see a more formal, enforceable zone introduced. BCH will ensure that any implementation of zone is appropriately monitored, and will support exploration of a stronger approach if a voluntary zone fails to address sufficiently the level of concern that the consultation has highlighted.

The good news is that nothing much appears to have happened since the report was produced in November last year.

According to the hospital, in response to my FOI, "any changes to ask people not to smoke around the hospital would need to be developed as a proposal with the local authority. At this stage, no formal proposal has been made."

It's hardly a positive result but in the circumstances it'll do.

Full report here.

Monday
Oct162017

Stoptober 2017 limps on and we're still waiting for the 2016 evaluation

We're just past the midway point for Stoptober 2017.

I only wrote about this 16 days ago so you may remember that in November last year I requested a report from Public Health England on the outcome of Stoptober 2016.

This was treated as a freedom of information request and I was told that "all strands of the evaluation will be finalised in early February (2017)."

February came and went and nothing was published.

In August I submitted a further FOI request asking for a "full evaluation of the outcome of Stoptober 2016".

PHE, as I wrote here, responded as follows:

We are releasing an evaluation document of Stoptober 2016 during Stoptober 2017; this will be available on the PHE website ... The original publication date was delayed.

The FOI response was dated September 22. This morning I checked the PHE website again and I still couldn't find the document they said was going to be published "during Stoptober 2017".

OK, I know Stoptober still has 15 days to go but doesn't it strike you as odd that the evaluation document for 2016 has been delayed this long and still hasn't been published?

As I've commented before, the budget for Stoptober 2017 is substantially more than it was last year (£1.08 million versus £390,000 in 2016) so how can Public Health England justify that sort of increase without an evaluation of the previous year's campaign?

We know that the number of smokers signing up to Stoptober fell significantly in 2015 compared to 2014. That, I suspect, is why PHE moved the goalposts and decided not to ask smokers to register in 2016 as they had done previously.

Now – and quite blatantly in my view – PHE has procrastinated for as long it can, perhaps in the hope we'd give up asking awkward questions about the success or otherwise of an event whose greatest legacy is giving one or two minor celebrities a small pay day and a number of well-remunerated PR and advertising agencies a substantially larger one.

Update: I rang PHE this morning to ask when, exactly, the evaluation document for Stoptober 2016 is to be published.

I was asked to put my question in writing – again – so shortly before lunch I sent this email :

Further to our phone conversation, see FOI response attached. It includes the statement, 'We are releasing an evaluation document of Stoptober 2016 during Stoptober 2017; this will be available on the PHE website.

We are now beyond the midway point in the Stoptober 2017 campaign and it would be helpful to know when exactly the evaluation document for Stoptober 2016 will be made available.

Please note that my original enquiry, which was treated as an FOI, was made on 3rd November 2016. I received a response that stated: 'It is expected that all strands of the evaluation will be finalised early February.'

Now, here we are, in October 2017, and to the best of my knowledge the evaluation document for Stoptober 2016 is still unavailable.

Therefore my very simple question (not to be treated as another FOI request!) is: 'Can PHE give a date for the publication of the Stoptober 2016 evaluation document and, if not, what is the reason for the continued delay?'

If I get a reply today I'll let you know. I'm not holding my breath.

Update: I have had a reply, to be fair, from a very helpful FOI officer. The long-awaited document is complete apparently and will be uploaded on to the PHE website in the next 14 days.

You have to hand it to government. The speed at which civil servants work is breathtaking.

Monday
Oct162017

ASH Scotland, Big Brother and the eradication of choice

Update on yesterday's post.

Following a report in the Sunday Times Scotland that featured calls for smoking to be banned in the home, with the emphasis on social housing, the Herald asked Forest to comment.

Here's our full response:

"Banning smoking in any home would be a gross invasion of people's privacy.

"Targeting social housing is particularly obnoxious because it penalises unfairly those who can't afford to buy their own home.

"Prohibiting smoking at home would be almost impossible to enforce but it could create a snooper's charter encouraging people to snitch on neighbours they don't like.

"What happens if someone is caught and prosecuted? The consequences, including possible eviction, are out of all proportion to the alleged offence.

"The puritanical health lobby needs to get a grip and realise there are far worse things in the world than smoking.

"If campaigners really want to reduce children's exposure to tobacco smoke at home they should lobby government to allow separate smoking rooms in pubs and clubs.

"Tobacco is a legal product and adults must to be allowed to smoke somewhere without constant harassment and discrimination."

A substantial part of that quote is featured in today's paper under the headline, 'Smokers fuming over plan to ban tenants from lighting up at home'. If and when the report goes online I'll add a link.

We subsequently sent a press release to other Scottish media with the result that Forest has also been quoted in the Daily Record and Scottish Daily Mail.

Interestingly the Record (which supports most anti-smoking legislation) has also published a leader urging caution:

For the estimated one in five adults left in Scotland who does smoke, where else can they light up but in their own homes?

A public health campaign on why it is wrong to expose children to second-hand smoke would be far more effective than Big Brother legislation that takes the power of the state into living rooms.

Smoking out of sight of kids makes sense – if smoking makes any sense at all – but there is no need to hound people out of their own houses to prove the point.

See Smoking ban in people's private homes is a step too far – but we must educate on dangers to kids' health (Daily Record).

Meanwhile the Herald quotes a Scottish Government spokesman who says:

"We have no plans to ban smoking in people's homes. We'll continue to explore other ways to support out ambition of creating a tobacco-free generation by 2034."

Ironically ASH Scotland is employing the 'choice' argument. Instead of joining calls for a blanket ban on smoking in the home (a policy that even the Record describes as 'Big Brother legislation'), CEO Sheila Duffy talks of giving tenants a "choice" of smoking or non-smoking accommodation.

"We would like people to have the choice to live in smoke free accommodation. At the moment there's not an option."

This is so disingenuous I don't know where to begin but it reminds me of those anti-smoking campaigners who, 20 years ago, said they wanted to give people a choice of smoking or non-smoking areas in pubs and restaurants.

I had no problem with that, nor did I have a problem with giving people a choice of smoking and non-smoking pubs.

Eventually however the same people who began by calling for choice demanded the eradication of smoking in every single pub and club in the country.

In fact, as soon as legislation was introduced everyone was denied choice – even belligerent anti-smokers – because if there's only one option the state has made the choice for us.

Imagine a one-party state where you can vote but there's only one party to vote for. There's a word for that.

Likewise, when tobacco control campaigners talk about "choice", what they mean is the complete opposite. In their mad, bad, authoritarian world, "choice" means no choice at all.

Everywhere – workplace, the home – has to be non-smoking in order to give non-smokers a "choice".

But what about the nine million people who smoke, one in six of the adult population? Should they be denied choice, even in their own homes?

Increasingly tobacco control campaigners are behaving like autocrats and dictators, bending even the language to suit their smoke-free agenda.

The good news is, when even the Daily Record recognises the danger ('This Big Brother legislation on lighting up would take the power of the state into living rooms.'), there's a glimmer of hope we can turn the tide against this aggressive, oppressive lobbying.

Update: You can read the Herald report here (Should smoking be banned in the home?). Rather chuffed that it features my full quote including:

"The puritanical health lobby needs to get a grip and realise there are far worse things in the world than smoking.

"Tobacco is a legal product and adults must to be allowed to smoke somewhere without constant harassment and discrimination."