The perils of devolution in public health
Wednesday, April 19, 2017 at 18:42
Simon Clark

Haringey Council is denying that it has plans to extend the smoking ban to outdoor public places including beer gardens.

The Labour-run council was identified by the Telegraph last week as the protagonist behind a "list of demands from councils and health authorities in London."

When the idea came to light it was criticised by Marcus Jones, minister for local government, who said:

“We already knew that Labour councils charge higher council taxes and levy more red tape.

"Now Labour’s municipal killjoys have been caught with a smoking gun, trying to ban adults enjoying their local pub garden. If implemented, these ill-founded proposals would lead to massive pub closures.

"Conservatives in Government will be vetoing these Labour Party plans. Ahead of May’s local elections, local voters have a right to know the bad and mad ideas that are being peddled by Labour councillors."

See Smoking ban in beer gardens and al-fresco dining areas rejected by ministers (Telegraph).

Haringey Council has now told the Morning Advertiser it has "no plans" to ban smoking in public places but is looking into how it can "increase the number of smoke-free environments" (Council denies claims it led charge to ban smoking in pub gardens).

According to a spokesman:

It is clear that smoking and inhaling second-hand smoke is one of the biggest contributors to premature deaths in the country, and what we are committed to is looking at all the options for reducing the impact on our residents.

Through our health devolution bid, we hope to carry out detailed research into how increasing the number of smoke-free environments in Haringey and across London could improve the health and life chances of all out residents."

I'm not sure how they intend to increase the number of "smoke-free environments" without extending the smoking ban, so where do we stand on the matter?

One document I have seen – Haringey Devolution Pilot, Prevention Pilot, Outline Business Case, dated January 2017 – argues that:

Devolution will enable partners, employers and residents in Haringey to improve the health of local residents at pace and scale ...

Devolution will enable Haringey to shape a healthier borough to improve residents’ choices
and prevent people with health problems dropping out of employment.

According to the document:

Our vision is to fundamentally ‘normalise good health’ by supporting residents to make healthier choices and reducing unhealthy, risky behaviours.

This includes:

Primary Prevention: interventions through population/borough-level policy in order to shape the places where people live so that the healthier choice is the easier choice for residents.

We want an environment which promotes healthy eating and exercise, and is not dominated by premises that sell tobacco, or alcohol, or contribute to debt through gambling.

Primary prevention is the goal of our prevention pilot’s Healthy Environments strand. Local government plays a critical role in this. Devolution enables us to do this more effectively.

The plan proposes to use licensing powers "to create healthier environments" with a specific focus on tobacco and alcohol.

So far so general. However a second (draft) document – London Health and Social Care Devolution: Memorandum of Understanding – is pretty specific:

Some of the prevention policies put forward by the pilots to date would have implications for national policy and legislation [my emphasis] ...

London and national partners should "commit to collaborating on and contributing expertise to establish the opportunities and explore the evidence base for ..."

This is followed by three proposals one of which is:

Granting local authorities the freedom to extend smoke-free areas to include alfresco dining areas of restaurants and pub gardens [my emphasis].

Interestingly the parties to the draft agreement include not only the "London Councils representing the 32 London boroughs and the City of London" but also "national partners", among them the Treasury, the Department of Health and the Department for Communities and Local Government (DCLG).

Marcus Jones, the minister who spoke out against the plan to extend the smoking ban to pub gardens, works at the DCLG, so what exactly is going on?

Is the Government really opposed to extending the smoking ban to beer gardens or is this just Conservative Central Office making party political mischief ahead of the local elections on May 4?

Meanwhile, while most of the headlines focussed on the Conservative Government allegedly blocking the proposal, some newspapers chose a different angle.

Why smoking could soon be BANNED in pub beer gardens, trumpeted the Leicester Mercury:

Plenty of people in Leicestershire will be heading out to beer gardens this summer to enjoy a pint in the sunshine.

However, if you also enjoy a cigarette in a beer garden, that could soon be outlawed.

A London council has suggested "extending smoke-free areas" in the area to protect public health, Mirror Online reports.

If Haringey Council's plans go ahead, that could mean an end to smoking in pub beer gardens and restaurant terraces.

It is now believed that the approach could be adopted by other councils across the country.

The good news is that Haringey Council has been forced on the back foot. The bad news is that issues concerning public and private health are increasingly being devolved to local authorities and it only takes one or two to get behind a policy for it to develop momentum.

That's what happened before the introduction of the current smoking ban. Regional authorities in London and Liverpool wanted the power to unilaterally ban smoking in enclosed public places.

Councils in other towns and cities (Plymouth, Middlesbrough and St Albans to name a few) then began to explore the issue, inviting witnesses such as Forest to give evidence to various committees.

At one point the Labour government seemed happy to allow local councils to devise their own policies. And that's when the pub industry stepped in, demanding a level playing field across the country.

So that's why, despite Marcus Jones' welcome comment to the Telegraph, it's no time to be complacent.

In fact, anyone who recalls the debate about the tobacco display ban is entitled to remain deeply sceptical of anything any politician says.

As Philip Davies MP wrote, following the Coalition government's decision to implement Labour's tobacco display ban:

In answer to a parliamentary question, Mike Penning, then Shadow Health Minister said, “I have looked long and hard for evidence from around the world that the Government’s proposals (to ban displays at the point of sale) are sufficiently evidence-based, but I do not think that they are.” Why the sudden change of heart? It is simply to try to appease anti-smoking fanatics who can never be appeased.

Davies' comment hit the nail on the head. It's one thing for Conservative Central Office to try to embarrass Labour councils before local elections, but after the forthcoming elections (national and local) will a Conservative Government be prepared to ignore the fanatical anti-smoking industry or will there be more years of appeasement?

Yes, I'm encouraged by Marcus Jones' comments, and the Government's apparent refusal to bow to the demands of anti-smoking organisations to publish a new Tobacco Control Plan without further delay, but I remain wary.

We've seen what devolution has done in Scotland. My concern is that devolving even more responsibility for 'public' health to local councils would generate more grandstanding policies designed to grab headlines in order that local authorities are seen to be 'doing something'.

Opinion polls are clear. The public does NOT believe that tackling smoking is a high priority for either national or local government.

That's the non-party political message we have to get across ... to all politicians, national and local.

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