The proceedings are
reported in the language in which they were spoken in the
committee. In addition, a transcription of the simultaneous
interpretation is included. Where contributors have supplied
corrections to their evidence, these are noted in the
transcript.
Dechreuodd y cyfarfod am 09:02.
The meeting began at
09:02.
|
Cyflwyniad,
Ymddiheuriadau, Dirprwyon a Datgan Buddiannau
Introductions, Apologies, Substitutions and Declarations of
Interest
|
[1]
Dai Lloyd: Bore da i chi i gyd a chroeso i gyfarfod
diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn
y Cynulliad. Ar y dechrau, felly, a gaf i gyhoeddi croeso i’m
cyd-Aelodau? Hefyd, rydym wedi derbyn ymddiheuriadau oddi wrth
Rhun ap Iorwerth; nid yw’n gallu
bod yn bresennol y bore yma. Gallaf ymhellach egluro fod y cyfarfod
yn naturiol ddwyieithog a gellir defnyddio clustffonau i glywed
cyfieithu ar y pryd o’r Gymraeg i’r Saesneg ar sianel 1
a chlywed cyfraniadau yn yr iaith wreiddiol yn well ar sianel 2. A
allaf i atgoffa pawb i ddiffodd eu ffonau symudol ac unrhyw offer
electronig arall a allai ymyrryd â’r offer darlledu?
Hefyd, rwy’n hysbysu pobl, yn y bôn, nad ydym yn
disgwyl larwm tân y bore yma. Os bydd yna larwm tân,
dylid dilyn cyfarwyddiadau’r tywyswyr ar y ffordd
allan.
|
Dai
Lloyd: Good morning to you all and welcome to the latest
meeting of the Health, Social Care and Sport Committee here in the
Assembly. At the beginning, here, may I also welcome my fellow
Members? We’ve also received apologies from Rhun ap Iorwerth;
he can’t be present this morning. I can further explain that
the meeting, naturally, is bilingual and that headphones can be
used for simultaneous translation from Welsh to English on channel
1 or for amplification in the original language on channel 2. May I
remind people to turn off their mobile phones and any other
electronic equipment that may interfere with broadcasting
equipment? Also, I'll let people know that, essentially,
we’re not expecting a fire alarm this morning. If there is a
fire alarm, we should follow directions from the ushers on the way
out.
|
09:03
|
Bil Iechyd y Cyhoedd
(Cymru)—Cyfnod 1, Sesiwn Dystiolaeth 7—Gweinidog Iechyd
y Cyhoedd a Gwasanaethau Cymdeithasol Public Health
(Wales) Bill—Stage 1 Evidence Session 7—the Minister
for Social Services and Public Health
|
[2]
Dai Lloyd: Gyda chymaint â hynny o ragymadrodd,
felly, symudwn ni ymlaen i eitem 2, rhagor o graffu ar Fil Iechyd y Cyhoedd
(Cymru), Cyfnod 1, sesiwn dystiolaeth 7. Yn bresennol am y
sesiwn yma mae Gweinidog Iechyd y Cyhoedd a Gwasanaethau
Cymdeithasol—bore da i chi—Rebecca Evans, ynghyd â Chris Tudor-Smith,
uwch-swyddog cyfrifol, Rhian Williams, gwasanaethau cyfreithiol,
Chris Brereton, prif swyddog iechyd yr amgylchedd, a Sue Bowker,
cangen polisi tybaco Llywodraeth Cymru. Croeso i chi i gyd. Fel
rydych yn gwybod, y drefn nawr yw: fe awn ni’n syth at
gwestiynau. Mae Aelodau, yn naturiol, wedi darllen y papurau
angenrheidiol gerbron ac mae cwestiynau yn deillio o hynny ac, wrth
gwrs, o rhan o’r dystiolaeth rydym wedi’i derbyn oddi
wrth dystion eraill hefyd yn y maes ynglŷn â’r
Mesur yma. Felly, rydym yn mynd i ddechrau'r bore yma efo
Julie.
|
Dai Lloyd: With that introduction, we
move on to item 2, more scrutiny on the Public Health (Wales) Bill,
Stage 1, evidence session 7. Present for this session is the
Minister for Social Services and Public Health—good morning
to you—Rebecca Evans, as well as Chris Tudor-Smith, senior
responsible officer, Rhian Williams, legal services, Chris
Brereton, chief environmental health officer, and Sue Bowker, the
tobacco policy branch of the Welsh Government. Welcome to you all.
You know, the arrangements now: we’ll go straight into
questions. Members, naturally, have read the necessary papers
before them and questions stem from those papers and from part of
the evidence that we’ve received from other witnesses in the
area on this Bill. So, we’ll start this morning with
Julie.
|
[3]
Julie Morgan: Diolch. Bore da, Minister. I know you’re aware
that some stakeholders have suggested additional things to be put
into the Bill. I think we wanted to know what your response was to
some of those proposals. The first one was provision for a
statutory basis for nutritional standards in early years and care
home settings and in hospitals, similar to what exists in school
settings under the Healthy Eating in Schools (Wales) Measure 2009.
I wondered what your views were about that proposal.
|
[4]
The Minister for Social Services and Public Health (Rebecca
Evans): Okay. Well, thank you, and good morning, Chair and
committee. We’ve been watching the evidence that’s been
given to committee very closely, as we did when the Bill went
through the first series of scrutiny in the Assembly as well. And I
think it’s important, I suppose, at the start, to recognise
that one piece of legislation can’t address all of the public
health challenges facing us in Wales. In fact, some things
won’t actually need to be addressed through legislation; they
might be better addressed through policy initiatives or working
with the UK Government, with industry, and so on, as well.
|
[5]
But with regard to nutritional standards, I know that was something
that was included in the Bill the first time around, but then it
was removed because, actually, we thought, ‘Well, we can just
get on and make some progress with nutritional standards without
them necessarily needing to be on the face of the Bill.’ So,
when I came to committee last time, I said that we were currently
looking at the nutritional standards for early years settings and
older people in care homes, and I’m pleased to say
we’re making good progress with that. So, we’re
finalising those nutritional standards at the moment. Many
nurseries, for example, are already covered under this legislation,
because they actually sit on the sites of schools, so they’ll
be covered under the schools legislation, and we’re already
introducing a wide range of nutritional standards and nutritional
work in our hospital settings. For example, all local health boards
have received directions in relation to mandatory food and fluid
nutrition standards for patients, mandatory food and drink
standards for vending machines, and also guidance in terms of food
and drink for the people who are visiting the hospitals as well.
And we’re having ongoing discussions with stakeholders in
terms of what we can do to improve nutritional standards in canteen
settings and in retail settings in hospitals as well.
|
[6]
So, this work is already going on, and we also have the revised
nutritional criteria for the corporate health standard as well,
which requires all of our health boards to achieve gold standard in
that, and to make the necessary changes that they have to do in
order to achieve that through nutritional improvements as well. So,
whilst I understand there’s a keenness to explore what more
we can possibly add to the Bill, I do think that nutritional
standards have been addressed, and are being addressed, outside of
the scope of the Bill. However, if the committee does feel strongly
about it, I would obviously give it further consideration. I do see
legislation as part of a journey, not necessarily the starting
point. So, if there are things that can be achieved outside of
legislation, then I think it’s perfectly appropriate to do
that, and I think that we are doing that through nutritional
standards. But if committee has had evidence that suggests that a
stronger approach is necessary obviously I will consider that.
|
[7]
Julie Morgan: Basically, most areas seem to be covered by
the policy initiatives you’re taking. Are there any areas
that aren’t covered by the policy initiatives? I was just
thinking of nurseries that aren’t on school premises, for
example. Are you able to address that?
|
[8]
Rebecca Evans: We would hope then that that would be covered
through the work that we’re doing on early years settings
more widely.
|
[9]
Julie Morgan: Right, right. Thank you for that response.
Another proposal was that the future generations legislation should
be strengthened to ensure that public services boards’ local
well-being plans should include actions to address public health
issues, such as obesity, physical inactivity, loneliness and
isolation. Are there—? I don’t know what your views are
on that.
|
[10]
Rebecca Evans: I do think that the Well-being of Future
Generations (Wales) Act 2015 will be an important mechanism for
addressing things like obesity, physical inactivity, and loneliness
and isolation, as you’ve outlined. But I’m not sure
that putting a specific requirement in the Bill is necessarily the
way to do that, because, under the Act, the public services boards
have to publish their local well-being strategies, setting out the
objectives that they want to see achieved on a local basis, and
that will also demonstrate how the public services boards will be
working towards meeting the goals of a healthier Wales, and that
will include addressing all of the issues that you’ve just
discussed there. The overriding purpose of those public services
boards is to improve the economic, social, environmental and
cultural well-being of our communities, and I think that that is
a—you know, it’s a very broad requirement on them. So,
perhaps to introduce one aspect of public health or one challenge
within it does not necessarily fit with the broad approach of it.
However, that doesn’t mean that public services boards
couldn’t take that decision locally to address these issues
or others if they see those as being particularly pertinent to
their communities.
|
[11]
Julie Morgan: So, you’d see it as their decision on
these issues.
|
[12]
Rebecca Evans: I think so, yes, but, importantly, Ministers
have to also be involved with the public services boards and have a
voice on them. So, if it does mean that, in future, the Welsh
Government believes that there would need to be a specific focus,
that could be addressed either through Ministers, the voice on
those public services boards, or potentially through any future
changes to the statutory guidance that underpins the future
generations Act as well. So, that guidance might be the more
appropriate place for this to be addressed within the context of
the WFG Act itself.
|
[13]
Julie Morgan: Right. The third proposal that I’m
raising was raised by Diabetes UK Cymru about mandatory calorie
information on food establishment menus.
|
[14]
Rebecca Evans: I know this is something that’s been
addressed on a voluntary basis through the work that the UK
Government is doing with the food industry more widely, especially
in terms of out-of-home settings for food. So, for example, most
major food retailers—I won’t name any of them, but we
all know who they are—do now include the calorie data, and
often much more wide nutritional data is available as well on their
websites and so on. In terms of making it mandatory, I think that
we would have to balance that against the burden that it might put
on small businesses in Wales, particularly in terms of the burden
it would take in terms of working it out, publicising the
information and so on. I think that the evidence isn’t
necessarily strong enough to suggest that taking a mandatory
approach to this would necessarily have as big an impact as we
would require it to have on the basis of the impact it would have
on small businesses in Wales. I think that taking a voluntary
approach to this in the first instance is the right way to go.
Actually, this is part of the journey that we’ve looked at
throughout the Bill, for example, with the work that we’re
doing on smoking in outdoor spaces. This is part of a journey. So,
where a voluntary approach hasn’t worked thus far, or where
there have been enforcement issues, now we’re looking at
including those within legislation. So, we could keep this as a
watching brief in terms of whether or not it is having an impact.
But it is about balancing the impact it would have on public health
with the impact it would have on the burden on small
businesses.
|
[15]
Julie Morgan: So, you’d prefer to go ahead on a
voluntary basis on that issue at the moment—
|
[16]
Rebecca Evans: Yes, I think so.
|
[17]
Julie Morgan: —with the hope that it will work on a
voluntary basis.
|
[18]
Rebecca Evans: Yes, I think a voluntary approach would be
best unless the evidence does become more strong in terms of the
impact it would have, having the calories displayed. I think it
also is part of a wider approach in terms of what we’re doing
in order to try and educate people about the nutritional values of
various foods anyway so that people can make good choices, and that
the obvious healthy choice becomes more apparent to people when
they look at a menu, because they’re educated and because
they understand what different foods involve both in terms of
calories, but their wider nutritional values as well.
|
[19]
Dai Lloyd: Ar y pwynt yma, Angela.
|
Dai Lloyd: On this point, Angela.
|
[20]
Angela Burns: Thank you. Can I just push you on this
particular point that Julie has raised, Minister? Because we sit
here looking at the public health Bill. We all recognise that
obesity is one of the biggest challenges, and I speak as someone
who’s been big for most of her life. And, once you get big,
it’s damn hard to get small again. I’ve got young
children, and I spend a lot of my time trying really hard to
educate them into how to be a better size and how to be more fit so
that, when they get older, they’re not going to be facing the
challenges that I will face. We say that obesity causes cancer,
causes heart diseases, causes all of these other appalling
pressures upon our NHS—not to mention the appalling pressure
it places on the individual. So, why not be brave and take this? I
do hear what you say about making sure it doesn’t put an
unnecessary burden upon businesses, but we’ve been
talking—you know, on and off, various Governments have
flirted with the ideas of a sugar tax, about looking at cutting the
sugar levels in drinks and all the rest of it. And there is
evidence from New York, that—. Admittedly, it is New York,
but they do say that it isn’t just the fact that people have
that choice, but that one of the side benefits is that it’s
persuaded restaurants to reformulate their food. So, this is a
subtle way of actually getting those amazing chefs and all the rest
of it, who actually create the food that we eat and that we like to
go out and buy, to actually look at a way of producing it in an
incredibly healthy way. I’d really like to push you on this
point, because we are having a tsunami of overweight children and
overweight adults, with all the disbenefits to them and to the
society. But this is a really small thing that perhaps we could do,
so that even if I do go out with my kids to eat a pizza somewhere
then I actually might be eating a marginally healthier pizza than I
would be today.
|
09:15
|
[21]
Rebecca Evans: Well, we’ll certainly look at the evidence.
I’m aware of the evidence from New York, but I’m not
aware that there’s much more evidence beyond that.
We’ll certainly look again to see if there is further
evidence available, but my understanding is that the balance of
evidence doesn’t suggest that this would have enough of an
impact to warrant the extra burden on small businesses across
Wales. That doesn’t mean that we’re not doing a great
deal already in terms of the work that we’re doing with
healthy schools, for example, 10 steps to a healthy weight, the
healthy child programme, in terms of ensuring that children get off
on a right start that you’ve just described as well, but then
the national exercise referral scheme, all the other work
that’s going on right across Government departments, the
active travel Act and so on—there’s a great deal of
work going on. I’m sensing that Chris might want to come in
at this point.
|
[22]
Mr
Tudor-Smith:
I think, just in terms of the effect in
this of the calorie information, the people it affects are those
people who are actually interested in the first place in that type
of information. It doesn’t necessarily impact on those people
that we really want to make a difference with. So, I think
that’s one of the limitations of the approach. And then
there’s the cost to small retailers, which consists of having
to purchase software to convert their menus into calorie amounts,
and, secondly, it’s the time that it takes to do that, with
menus changing. Some bigger chains, who have standard menus,
it’s quite easy for them to do, but for a small restaurant
that changes its menus quite regularly, it does require quite a lot
of work to provide that sort of information. So, as the Minister
said, it’s balancing how effective it is against what is
likely to be the impact on small cafes and restaurants.
|
[23]
Angela Burns: But it’s not just small cafes and restaurants
we’re talking about either, is it? There are enormous chains
out there that produce huge quantities of food eaten by a vast
number of the population, and it’s getting there. We talk
constantly about looking at a sugar tax on drinks, which is a
really big thing to try to do and it is fraught with huge corporate
issues, and it’s Westminster, Cardiff, et cetera, et cetera.
We’re all trying to push and push and push and say we ought
to be doing this, so we say that on that hand, but, on this hand,
where, actually, it’s within our competence to perhaps make
some changes that could be effective and to be leading the home
nations on something, we’re kind of shying away from it, so
that’s just why I wanted to push you on it.
|
[24]
Rebecca Evans: You referred to the major retailers and the big
chains. Well, I think the vast majority of those provide their
nutritional data, beyond calorie content, through part of the UK
Government’s responsibility deal, which it’s brokered
with retailers and restaurant chains, and so on. I appreciate it
feels like we’re pushing back on lots of suggestions that are
coming forward to committee, but I think it’s important to
reflect, really, that the Bill has already been through scrutiny
once, and it did have some quite important changes added to it. For
example, health impact assessments were introduced, and, hopefully,
that will have an impact on not only obesity, but many other
aspects of public health in Wales as well. Originally, the Bill
only included powers to take action on smoking in outdoor spaces,
but the Bill now includes specific places on the face of the Bill,
for example. In terms of special procedures, we’ve included
the fact that people can’t be tattooed when they’re
drunk or appear to be on drugs, and so on. So, there have been
major changes made to the Bill, which is why I know it’s more
difficult when it comes to second scrutiny to explore the
issues.
|
[25]
Dai
Lloyd: Ie, rydym ni yn deall hynny i gyd, Weinidog, ond hefyd rydym
ni wedi cael toreth eang o dystiolaeth a syniadau newydd, efallai,
ar sut i ehangu’r Mesur yma hefyd. Dawn sy’n gofyn y
cwestiynau nesaf.
|
Dai
Lloyd: Yes, we understand all
of that, Minister, but also we’ve had a wide range of
evidence and new ideas on how to expand on this Bill. Dawn has the
next questions.
|
[26]
Dawn Bowden: Diolch, Chair. Three areas I think I particularly
wanted to follow up—can I start with oral health? The
evidence that we had from the British Dental Association was
suggesting that we should look at banning all drinks with added
sugar in schools as a way of tackling poor health. I wasn’t
actually aware that there wasn’t a ban on some of these very
sugary drinks in secondary schools. In fact, there isn’t a
ban either on some sugary drinks in primary schools—fruit
juice with added sugars is not banned in primary schools and so on.
So, would you consider looking at that area, as part of the
nutritional standards in schools, to see whether we should have
these vending machines—you know, however they sell these
drinks in schools—and whether they should only be healthy
drinks and non-sugary drinks in all of those areas of secondary and
primary schools?
|
[27]
Rebecca Evans: I’m interested in the evidence that the
committee has received on this particular issue. Obviously, we have
the healthy eating in schools regulations, which relate to the food
and drinks that can be served in schools, but those regulations
don’t apply to food that children can bring on to the schools
premises, for example, in their packed lunch and so on. Although
schools can develop their own policies at a local level in terms of
what is allowed to be consumed on the school premises, there
isn’t that protection underneath the regulations
themselves.
|
[28]
We are supporting schools through our
healthy schools network to take a whole-school approach to healthy
eating and that does include looking at what schools should be
promoting as a good packed lunch to bring to school. So, the
healthy schools network is about more than just the children;
it’s about the wider school community, including taking
opportunities where they exist, to engage with and educate parents
as well. So, any changes would come, really, under the healthy
eating regulations rather than necessarily through this Bill, but I
am very interested in what the committee would say in terms of
changes that might be desirable.
|
[29]
Dawn Bowden: Okay, thank you. I think, specifically, it’s
about what schools sell on their premises as much as anything, I
guess.
|
[30]
The other area I wanted to have a look at
was alcohol misuse. Again, the Royal College of Physicians has
talked about alcohol harm reduction being identified as a
significant public health priority, as I’m sure you have,
Minister. So, have you considered measures to ensure that local
authorities do consider the public health impact of alcohol when
they are carrying out their licensing responsibilities? Is that an
area that you’ve given some consideration to or do you think
that that could be strengthened within the parameters of this
Bill?
|
[31]
Rebecca Evans: We very much support the inclusion of considerations
of public health when licensing decisions are being undertaken. But
unfortunately, despite numerous efforts by me, previous Ministers
and officials on a regular basis, we haven’t been able to
have those powers on the sale and display of alcohol and the
licensing of alcohol devolved to us in the Assembly, unfortunately.
But we do lobby frequently for those powers to be devolved to us,
but I’m not overly optimistic, I think it’s fair to
say.
|
[32]
Dawn Bowden: So, what is it that you feel that you can do within
that area at the moment?
|
[33]
Rebecca Evans: We don’t have the powers
devolved—
|
[34]
Dawn Bowden: It’s not devolved—that aspect.
|
[35]
Rebecca Evans: —to take action. All we can do at the moment is
press the case with the UK Government and try and seek those
powers, which we are actively doing, but without
success.
|
[36]
Dawn Bowden: Okay. The next area, really, was around air quality
and whether you’d given consideration—again, it’s
part of another Act, so I kind of anticipate what your answer might
be, but it’s around safe routes to schools and that sort of
thing—to improving air quality around schools and around
areas, particularly where children are going to be and on active
travel routes. I don’t know specifically whether that is
covered in the active travel regulations or Act—whatever it
is—but is it something that could be looked at, again within
the parameters of this Bill, or is it something that could be
strengthened in the active travel regulations?
|
[37]
Rebecca Evans: The Welsh Government has recently consulted widely on
air pollution. This is something that has been led by the Cabinet
Secretary for Environment and Rural Affairs. The consultation
closed, I believe, in December and I actually met the Cabinet
Secretary this week to discuss how we can work together from a
public health perspective in terms of addressing issues of air
quality. The Cabinet Secretary said that she’d be happy to
consider evidence that we receive as part of this inquiry, in terms
of the wider work that she’s doing there, to address air
quality. I think it would be, I suppose, inconsistent if we were to
take action within the public health Bill on air quality whilst
there is an existing consultation, which has only just closed, at
the moment. But I see that consultation, and the evidence that
you’ve been receiving, very much as being—
|
[38]
Dawn Bowden: As part of it, yes.
|
[39]
Rebecca Evans: —close together. So, our officials in health,
and in the Cabinet Secretary for environment’s department,
are working closely on this. And any recommendations the committee
would like to make with regard to this I think would be of interest
for the Cabinet Secretary as well. And I’ll be meeting with
her again to discuss the issues that have come out of this inquiry.
I know you have several evidence sessions left to go, in terms of
the inquiry as well.
|
[40]
Dawn Bowden: Okay, that’s great. Thank you very
much.
|
[41]
Dai
Lloyd: Ocê. Diolch yn fawr, Dawn. Rydym yn symud ymlaen nawr at ysmygu
a’r mangreoedd di-fwg. Lynne.
|
Dai Lloyd: Okay. Thank you very much,
Dawn. We now move on to smoking and smoke-free premises. Lynne.
|
[42]
Lynne Neagle: Thanks, Chair. Can I ask first of all about school
grounds? Is it your intention that the smoke-free requirements will
apply only to the grounds of primary and secondary schools, or are
you considering including other education settings, such as
nurseries, early years settings, in those?
|
[43]
Rebecca Evans: Well, primary and secondary schools are named on the
face of the Bill, and, as I said—and, as you’ll
remember, this was one of the things that was amended within the
process of the Bill, as it came through previously—it does
include the grounds where you have maintained school nurseries as
well, which sit on the sites of schools as well. These areas, and
hospitals as well, were identified in the tobacco control action
plan as important settings, both in terms of making sure that
children aren’t exposed to smoking—so it doesn’t
become a normal thing for them to see—but also within the
hospital setting, because that’s a place of health, where
people spend extended periods of time, and it’s often a place
where people make that decision that they want to give up smoking.
So, we would want to support that as well. I know that the
voluntary restrictions have been pursued in playgrounds, for
example, and in hospital settings. And, as we’ve discussed
before, there have been enforcement problems, which is why
we’re taking this opportunity now to put them on the face of
the Bill.
|
[44]
I think in terms of extending it to other
settings—and, when I first came to this, I thought it would
be simple to stop smoking in areas that just seem like common
sense, places where you don’t want to see smoking and so on,
but actually it is more complicated than I at first envisaged.
Because, actually, we’re seeking to prohibit a legal
activity, in a public space, and there are a lot of sensitivities
there, and a lot of arguments and evidence that have to be made.
So, whenever we’re thinking about places to add to that, we
have to think about it within the context of the human rights of
the individual to smoke, within existing European Union and other
legislation, and the wider policy context as well. So, were we to
extend it at all, it would have to be through
consultation.
|
[45]
The Bill, as you know, does give powers
to Ministers to extend the areas of outdoor spaces in
future—I know you’ve had lots of suggestions as a
committee as to areas you’d like to see it extended
to—and I’d be interested in your priority areas for
that, so that we consider what areas we want to look at in terms of
scoping out those legal issues, and also the policy and the
practicality issues as well. Because, again, it’s not always
as easy to define an open space in practical terms. But, obviously,
we’re keen to see where else we could extend it to. I was
just surprised as to how difficult it is to do that.
|
[46]
Lynne Neagle: I hear what you’re saying, because, obviously,
we had very detailed discussions last time about the human rights
elements of this. But there doesn’t seem to be much of a jump
between a primary school and, say, a private day nursery. I mean, I
don’t really see that there’s much distinction there,
really. So, have you given any particular thought to those kinds of
settings, where, basically, children are receiving the same service
as they would receive in a state-maintained setting?
|
09:30
|
[47]
Rebecca Evans: Well, I agree with you that a childcare setting is
particularly important, and would be, in my view, a priority
area. So, that’s something, depending on other ideas that
might come forward through the process and what committee thinks,
that would be one of the priority areas that we would consider in
terms of scoping out those legal issues—those practical
issues for future action.
|
[48]
Lynne Neagle: Because one of the suggestions that
we’ve had off a number of witnesses is that the areas around
schools et cetera should be smoke free. I can see, based on what
you’ve said, that you might view that as more difficult, but
have you got any comments on that particular suggestion?
|
[49]
Rebecca Evans: Again, I think that it will be difficult to
define the area. I know that there has been some good work done by
ASH Wales with schools on a voluntary basis, making school-gate
areas smoke free. Again, this is one of these things that start off
on a voluntary approach and then you consider how enforceable it is
and so on. But, certainly, this could be an area that we would be
interested in looking at as well.
|
[50]
Lynne Neagle: In a similar vein, the legislation deals with
hospital premises but not with primary care settings et cetera. So,
I suppose it’s a similar argument, really. You know, why do
the one without doing the other, really, especially as, obviously,
we fund GPs et cetera? Have you got any comments on that?
|
[51]
Rebecca Evans: Again, hospital settings, like playgrounds
and schools, were priority areas within the tobacco control plan.
Also, those three areas had particularly strong support amongst the
public as well, because I think we are doing something novel and we
are taking quite a big step. Again, as I said before, this is a
legal activity. So, there are sensitivities in terms of how people
view their own rights and so on. So, I think these three areas are
the right ones to start off with, but in future, the Bill does give
powers to Ministers to include other areas, but it would have to be
done through some quite detailed scrutiny, and it would have to be
through public consultation as well and be subject to the
affirmative process in the Assembly.
|
[52]
Lynne Neagle: Okay. Thank you. Just one final question on
the issue of playgrounds. There does seem to be some confusion
about what would constitute a playground. So, if there’s play
equipment, that would be a playground. If it’s a sort of park
where children congregate or a playing field, that wouldn’t
be covered. Can you just clarify that and give any thoughts you may
have had on extending it to those kinds of settings as well?
|
[53]
Rebecca Evans: Well, section 25 indicates what we would
consider to be playgrounds. So, things that would be traditionally
used by children—sandpits and things like that. It is more
difficult to extend it to areas that are of use to people of all
ages. I’ll ask Chris to say a little bit about the work that
went into developing that, or perhaps Sue would be the right person
to do that. But, you know, it is something that we would obviously
be looking at. I think it’s important to recognise as well
that we will be issuing detailed guidance to local authorities,
because I think good law has to be clear law. Local authorities
have to understand it in order to enforce it, but actually, the
public has to have it easily understandable as well so that they
don’t fall foul of the law unintentionally.
|
[54]
Lynne Neagle: Thank you.
|
[55]
Ms Bowker: The idea was to
look at playgrounds, which had already had voluntary bans in
place—what the Minister was talking about: the route in which
we’ve moved to legislation. ASH Wales has done a lot of work
so that all local authorities have designated all of their
playgrounds as smoke free, and we were wanting to bring those into
legislation to support the enforcement. Those are the things that
you would normally define as a children’s playground, which
is mainly for the use of children, whereas some of the other areas,
as the Minister said, are not just for the use of children. So, it
becomes much more difficult. We would produce guidance, of course,
and we have been talking to local authorities about whether they
have got any difficulties with the definitions. Of those that have
responded to us, none of them have said that they have any
difficulty with understanding what would be covered.
|
[56]
Lynne Neagle: Okay, thank you.
|
[57]
Rebecca Evans: That’s some additional work that
we’ve been undertaking over the past few months, as the Bill
goes through this second scrutiny.
|
[58]
Dai Lloyd: Diolch yn fawr. Symudwn ymlaen at y cwestiwn
nesaf. Mae hwnnw gan Caroline Jones.
|
Dai Lloyd: Thank you very much. We move
on to the next question, which is from Caroline Jones.
|
[59]
Caroline Jones: Good morning. Community Pharmacy Wales and
the Company Chemists’ Association highlight the important
role of nicotine replacement therapy in smoking cessation, and both
suggest that nicotine products that are medically licensed be
exempt from the retailers register. So, can you clarify please how
this part of the Bill will deal with nicotine products licensed as
medicines, and will pharmacies that supply nicotine-replacement
therapy be required to join the retailers list?
|
[60]
Rebecca Evans: Retailers and pharmacists who sell
nicotine-replacement therapies that have been given a licence for
medical use won’t be required to be part of the register.
However, many of them sell things that have been licensed for
medical purposes alongside other nicotine products. So, those who
sell both would have to be registered on the basis that they are
selling ones that haven’t been registered for medical
use.
|
[61]
Caroline Jones:
Okay, thank you.
|
[62]
Dai Lloyd: Mae’r cwestiwn nesaf, sydd
yn dal ar dybaco, gan Jayne Bryant.
|
Dai
Lloyd: The next question,
staying on tobacco, is from Jayne Bryant.
|
[63]
Jayne Bryant: Thank you, Chair. Just to follow on from
Caroline’s question on this, we heard evidence from pharmacy
representatives who were concerned that the legislation must not
stop young people from being able to access nicotine-replacement
therapy. Can you perhaps comment on that part and to perhaps
alleviate some concerns that they had over that access for younger
people?
|
[64]
Rebecca Evans: Our approach is the same as in the regulations that
come under the Children and Families Act 2014 regarding the sale
and proxy purchase of nicotine-inhaling products. These regulations
provide an exemption for medicines to be handed over to under-18s.
So, there should be no issue in terms of under-18s receiving those
medicines.
|
[65]
Jayne Bryant: Thank you.
|
[66]
Dai Lloyd: Symudwn ymlaen yn awr at
driniaethau arbenigol, fel tatŵio ac aciwbigo ac ati. Dros yr
wythnosau diwethaf, mae nifer ohonom ni wedi cael agoriad llygaid
i’r nifer o driniaethau arbenigol sydd yn cael eu cario allan
yn y byd yma. Mae Angela wedi bod yn arbenigo. Angela.
|
Dai
Lloyd: We’ll move on now
to specialist treatments such as tattooing and acupuncture and so
forth. Over the past few weeks, it’s been a real eye-opener
for some of us in terms of some of these specialist procedures.
Angela has specialised in this. Angela.
|
[67]
Angela Burns: Minister, there are a couple of areas in the Bill
that I feel require further clarification. So, I’d like to
slightly take my questions in a different format and start off with
the first one, which is over the age of consent for intimate
piercings. I listened very carefully in your first evidence session
to your officials and the reason why 16 had been chosen and that
that 16 was chosen to protect, if you like, the public rights of a
child et cetera, rather than 18, and that 18 for tattooing was an
old leftover from a Bill from many, many years ago. However, I have
to say that, I think, almost without exception, the evidence that
we have taken from a wide variety of specialists is that they would
prefer to see 18. They bring forward a number of reasons for it:
they think that, in terms of intimate piercings, a young
person’s body is still changing and that they may undertake
procedures that they then come to regret. They talk about the fact
that many of the practitioners themselves are very uncomfortable
with dealing with people who are under 18 years of age.
There’s talk by authorities that the licensing regime would
be easier if it was all standardised at 18. So, I’d really
like you to clarify why you have chosen to look at 16 as the age
for intimate piercings. What evidence would you require to make you
review that decision and re-look at 18 as the age? Because, of
course, children are still technically children until the age of
18.
|
[68]
Rebecca Evans: Thank you for that question. I know that this was one
of the areas that attracted quite a lot of interest and discussion
through the previous scrutiny session and perhaps Chris might say
something about the arguments that were discussed and considered
then. But I know that your committee has received evidence from the
children’s commissioner, agreeing that the age of 16 does
ensure a clear and consistent message in terms of the protection of
children. It’s also in line then with the fact that children
or young people, of the age of 16 and 17, can, for example, agree
to medical treatment without the permission of their parents and so
on.
|
[69]
The age of 16 is, of course, consistent
with the fact that children can take other decisions—I should
say ‘young people’—at that age. For example,
it’s the age of sexual consent, and so on, and there
are various things that you’re able to do at the age of 16.
When considering the Bill, I know that a lot of consideration was
given to the UN Convention on the Rights of the Child, which
includes a wide range of protections and rights—for example
to assert their identity, having due regard afforded to their
views, and to be able to express themselves, and not to be
discriminated on the basis of their age as well. So, we felt that
16 was very much consistent, really, with both the UN Convention on
the Rights of the Child and the wider list of things that young
people can do when they reach the age of 16. It is important as
well—there’s nothing in the Bill that would suggest
that practitioners shouldn’t or couldn’t increase the
age to 18 if they felt uncomfortable undertaking intimate piercings
on people under the age of 18, as businesspeople.
|
[70]
Angela Burns: Well, actually, that leads me on to my next
question to you, Minister, which would have been to flip it on its
head slightly and say: will there be any problems for people who
say, ‘Actually, I have a licence to perform this, but I
don’t want to treat you, because you are under 18 years
old’? Will they be subjected to legal action for
discrimination against young people? Because, of course, that does
happen in many other areas, where people, individuals, make an
individual choice about what they will or will not do, and the law
isn’t there to support them. Because I would not like to see
practitioners—. You know, the Directors of Public Protection
Wales said that
|
[71]
‘our registered practitioners are uncomfortable with 16
generally, and they often put best practice in place—the
better registered practitioners—and won’t do intimate
piercing until 18 anyway.’
|
[72]
This was Directors of Public Protection Wales. So, I want to ensure
that, if you are wedded to the idea that, actually, 16 is the age
of consent, those who choose not to practice at 16 and 17 will not
be penalised and will not be taken to court for discrimination
against young people.
|
[73]
Rebecca Evans: Thank you for raising that. I’ll ask
Rhian to comment on the legal aspect. But I did want to check
whether there was anything that Chris wanted to raise in terms of
the arguments we’ve heard.
|
[74]
Mr Brereton: Perhaps on that point, Minister, if I could add
that I think we’ve got to remember our starting point, which
currently is that there is no age of consent for any piercing. You
can have what you want, when you want it, subject to your ability
to make that decision in a competent way. Many practitioners will
automatically turn down young people going for this type of
piercing now. They suffer a commercial loss as a result, because
presumably that person would go to someone else who would do it.
But they aren’t penalised in law, and I don’t think
they could be criticised in that way for making that decision on a
discretionary or voluntary basis.
|
[75]
In relation to young people having a piercing that they later
regret, I think the good thing about piercings—if there is a
good thing—is that they can be removed, and, generally, they
will heal. They might leave a small scar, but they will generally
heal quite effectively. When the Tattooing of Minors Act was
introduced in 1969, as you said, it was a different age, but the
argument then was, really, all about permanency. And I know that
tattoos can be removed—some quite successfully, others not.
But that argument still remains—that they’re making a
decision early in life, with something that they will carry on in
life, whereas that piercing could be removed, and will,
effectively, heal. So, I think there’s less likelihood of
them taking a decision to have a piercing that they later regret
because they could remove it.
|
[76]
Ms Williams: And, as I say, you know, a piercer would
maintain a discretion not to perform an intimate piercing on
someone under the age of 18 if that was their personal
preference.
|
[77]
Angela Burns: And there’s no legal comeback on
them—they won’t then have some particularly stroppy
individual saying, ‘Right, you’ve discriminated against
me because of my age, and therefore I intend to take you to
court’?
|
[78]
Ms Williams: No.
|
[79]
Angela Burns: And they’d be absolutely protected?
|
[80]
Ms Williams: I believe so, yes.
|
[81]
Angela Burns: Okay. I’d be grateful for absolute
clarity on that.
|
[82]
Rebecca Evans: Shall we write to committee?
|
[83]
Angela Burns: That would be absolutely fabulous. Which
brings me on to the next little bit that I wanted to really chase
down, which is the list of procedures. I understand that
there’s going to be multiple views on this, and people are
adding in procedures all the time—thoughts about,
‘Let’s add this on to the face of the Bill, that on to
the face of the Bill’. When you started off looking at this
Bill, and looking at the regulation of these procedures, did you at
that time at all consider a blanket clause that actually prohibits
piercings full stop until 18, or, as somebody put it very well,
‘involving piercing of the skin or mucous membrane’,
rather than naming specific procedures? And if not, why not? Could
you perhaps just restate your thoughts on why you decided just to
pick off procedures one at a time? Because, of course, if you were
to have that catch-all phrase that covers all of these tricky
procedures, you would solve two of the problems that you’ve
mentioned before: one is that you’ve said you don’t
want to identify particular procedures because you don’t want
to make them ‘fashionable’ by suddenly making them
illegal—but of course, they are not going to be named, so
they’re not going to be raised in public awareness—and
the second thing, of course, is you get over the future legislative
issues of constantly trying to bring back and go through all of the
process of bringing back, actually, a new procedure. And as
I’m learning more and more about procedures that none of us
ever even knew existed, I suspect that there will be—as we
lift the lid on this, there’ll be more things that people
come up with; frankly, dafter ideas than putting the ashes of your
beloved dead pet into a scar that you’ve decided to create on
your arm. More of these things will happen, whereas this will
actually protect the 18-year-olds and under full stop. So, I
wondered what your view was on that.
|
09:45
|
[84]
Rebecca Evans: I’ll ask Chris to say a little bit about how
the proposals for the Bill were developed originally and what the
thinking was behind that, but the only proviso we have in the Bill
is that a procedure is capable of being performed for aesthetic or
therapeutic purposes, and the performance for those purposes is
capable of causing harm to human health. So, although we’re
naming four procedures on the face of the Bill, actually, I think
the Bill is better futureproofed in terms of allowing us to add
further procedures to it in future by not being restricted just to
things that pierce the skin. For example, artificial UV tanning,
chemical peels, colonic irrigation, for example—all of these
things might come under the therapeutic or aesthetic definition and
also are capable of causing harm to the individual, but they
don’t pierce the skin. So I think that the Bill, as drafted,
will give us greater scope to respond to changing fashions,
changing trends and, as you suggest, procedures perhaps we
can’t even imagine now that might become popular in just a
few years’ time as well. So I think that the Bill is well
futureproofed in that sense, and also the fact that it would
require consultation and the affirmative procedure in the Assembly
does give us that safeguard that it would be reasonable to add
things to the Bill as well. The four things that are on the face of
the Bill at the moment are things that local authorities as
enforcement bodies are familiar with, and I think that’s
important as we start out on this journey as well. But, in terms of
the history of why this particular approach was taken at the start,
perhaps Chris would say something.
|
[85]
Mr Brereton: Certainly, Minister. When we researched the
legislation, we had a very old piece of legislation that
wasn’t fit for purpose and it did encompass those four
procedures, as the Minister said. What they do have in common is
they all involve the piercing of the skin. I listened carefully to
the evidence that was being given to committee by other bodies, and
they acknowledged that was the key risk. If you look at the London
special treatment regulations, they have grown incrementally over
time and there are probably over 110 or 113 procedures that they
would license as a special treatment in London. And when you look
down that list, probably 40 or so of those would involve piercing
of the skin. Many of those are captured by our definition for the
four procedures on the face of the Bill. But, if we were to
automatically request a licence for any procedure that involved
piercing, whether it was aesthetic, therapeutic or not, it would be
quite a daunting prospect, to say the least. The preference is to
look at those procedures that involve the piercing of the skin,
assess their risk, assess their frequency and then add them, on an
incremental basis and subject to consultation, using the
regulations under section 90, at a pace that local government could
cope with in terms of regulation. I think we’ve got to
remember that we are saying with this Bill that there is no
automatic right to a licence, should you already be licensed or
registered with a local authority under the Local Government Act
1972.
|
[86]
We’ve looked at the evidence from
the Newport case, and that clearly shows that just being registered
doesn’t show you are competent to carry out the procedure. So
we want local authorities to test the competence of all those
individuals currently registered under those four, and that will
take some time. There will be some transition and it will require
those practitioners to gear up, and then I think we can move on
apace to look at what other procedures could be added to these
special procedures, using those affirmative regulations, subject to
a consultation and subject to the evidence being there, and them
passing the test of being aesthetic or therapeutic and capable of
causing harm to human health. I think it’s not that
we’re opposed to looking at piercing per se as being an
automatic registration issue, because we’ve demonstrated
there is a risk, but we’ve got to say, ‘Does it pass
that test; does it happen in Wales; and what is the frequency of
it?’ and do it at a pace that is proportionate and would
allow both local authorities and practitioners to gear up to the
competency criteria that we’re requiring.
|
[87]
Angela Burns: Thank you for that answer, and I hear what you
have to say on that. So, again, can I flip it slightly on its head?
You used the words ‘local authorities to test the
competence’. So, in this Bill, you’ve got exemptions:
if you’re a nurse, a doctor or a dentist, you’re
exempted from having to go and get a licence, and yet a
physiotherapist, for example, isn’t. So, why would a dentist,
who, as far as I know, fiddles around mainly with teeth, or a
physiotherapist who is going to stretch our muscles—who is to
say that the dentist is more competent to take up Botoxing or to
take up, I don’t know, one of the others on the lists here
than a physiotherapist is, because, again, I just see these
anomalies? I would say to you: would you not consider actually
saying that, if you’re going to practise any of these,
whether you are a doctor or not, a nurse or not, a dentist or not,
you would need to go out and get a licence? We heard some quite
interesting evidence from the doctors that said, just because you
are a doctor, it doesn’t mean to say, actually, that
you’ve got any experience of doing this. So, we’re
putting an awful lot of trust, and I would be more comfortable,
personally, I think, to see a Bill where we’re saying that
local authorities must test the competence of practitioners and,
whether you are a physio, a doctor or actually somebody who has
gone to college and has taken various courses in this, you should
all be tested relatively equally. So, I’d be interested in
your view on that.
|
[88]
Rebecca Evans: Can you start on this, Chris?
|
[89]
Mr Brereton: Yes. It’s a very important point, and I think
the Bill acknowledges it, because exempt individuals will perform
special procedures without a licence and it’s important that
they, as you say, can demonstrate their competence to do so. There
is a list of exemptions on the face of the Bill of bodies, such as
doctors, dentists, nurses, et cetera, who could potentially be
exempt, and I say ‘potentially be exempt’ because what
the Bill allows for is regulations. We’d have to talk to
those regulating bodies, the General Dental Council and others, to
say, ‘Are these special procedures within the scope of
competence of that individual within your regulated body?’ It
could well be that a chiropractor’s training includes
acupuncture, for example, but it certainly probably doesn’t
include tattooing, in which case, they will be required to have a
licence for tattooing. The regulations would make that the case. So
it’s only those professions that have it within their scope
of competence and can demonstrate that that would be exempt from
the licensing requirement, because we don’t want to duplicate
regulation. If they are not competent within their professional
scope—and you gave a good example with acupuncture; many
would be competent within that—they could be exempt, but if
they were not competent and the regulating body said,
‘We’re quite happy to exempt for acupuncture, but not
necessarily tattooing or piercing—it’s not the normal
work they would do’, then there would be a requirement for
them to be licensed.
|
[90]
Rebecca Evans: I think it’s worth adding as well that the Bill
provides Ministers with regulation-making powers to enable
individuals who are exempt on the face of the Bill to be brought
back within the licensing regime as well. So there’s that.
And it is intended that we will have some detailed consultation
with the regulating bodies to determine whether each of the listed
special procedures is within the scope of the professional
competence of their members as well.
|
[91]
Angela Burns: I’ve got one last, very quick, question, which
is more of a legal issue, if I may, Minister. Evidence has
highlighted that the current list of relevant offences does not
include, for example, sexual offences, and given the nature of the
procedures we’re talking about and the ages, I just wondered
are you satisfied that there’s adequate protection for those,
particularly the younger ones, the 18 to 16-year-olds, undergoing
special procedures.
|
[92]
Ms Williams: Yes, we’re satisfied that section 63 offers
adequate protection to those undergoing special procedures, but we
are aware that it’s an area of concern for the committee.
It’s important to remember that this is a public health Bill,
and the purpose of Part 3 is to minimise the chance of injury or
illness caused by the performance of a special procedure in an
unhygienic manner. The relevant
offences that are listed in section 63(3) are those that could have
a material impact upon a person’s ability to perform a
special procedure in accordance with law and in a hygienic manner.
In terms of competence, any provision needs to be compatible with
the European convention on human rights and, as such, a balance
needs to be struck between the right of a person to practice their
profession and earn a living with the need to safeguard clients
from potential illness or injury. As you’ll be aware, section
63(5) of the Bill contains a regulation-making power that allows
the Welsh Ministers to add an offence to the list of relevant
offences, but any additions will need to be considered carefully to
ensure that this balance is maintained, and detailed assessments of
human rights, EU law and policy implications will need to be
carried out.
|
[93]
Angela Burns: Would you intend to have a look at
additional—if I can get the right word for it—relevant
offences? Would you intend to look at that, just to expand it?
Because there are a couple—again—of small anomalies
there.
|
[94]
Rebecca Evans: I know that this has been an issue
that’s been of interest to members of the committee. With
regard to sexual offences, I think I’m right in saying that
we’ve had some early discussions in terms of whether it would
have to have been a sexual offence carried out in the carrying out
of the special procedure in order to bring it within this Bill. Is
that—?
|
[95]
Mr Brereton: Rhian would be best placed to answer that.
|
[96]
Ms Williams: I think it’s more a case that the purpose
of the Bill is a public health purpose. It’s not a
safeguarding Bill as such. So, the offences that are currently
listed on the face of the Bill are those that we are satisfied are
proportionate and can lawfully and legitimately be taken into
account when a licensing committee will be determining whether or
not to grant a special procedure licence. So, as I say, we are
convinced about the—
|
[97]
Angela Burns: Although, may I just very quickly add that I
thought the whole purpose of putting intimate piercings to 16 was a
safeguarding issue?
|
[98]
Ms Williams: Well, we’re talking in terms of relevant
offences under Part 3. As I say, we are aware of a recent case
where an unregistered 18-year-old tattooed three young children.
She admitted charges of assault occasioning actual bodily harm and
was sentenced to an eight-month prison sentence, which was
suspended for two years. I think the Minister has previously
indicated that she may welcome the committee’s views on the
matter of relevant offences listed on the face of the Bill, but any
potential changes would need to be considered carefully in terms of
human rights, EU law and policy implications because, as I say, we
do have to be very careful that we are balancing the rights of
individuals to practice a profession with the need to ensure that
the procedures are performed in a safe and hygienic manner. If we
go too far in taking into account offences that don’t provide
for procedures to be carried out in a safe manner, we could tip the
balance too far and we could be subject to legal challenge, which,
I’m sure you’ll agree, we wouldn’t want to be
doing.
|
[99]
Angela Burns: I really don’t understand the force of
your argument, but I am very aware of time. So, if the Chair wants,
we can discuss it separately.
|
[100] Dai
Lloyd: Dawn has a follow-on.
|
[101] Angela
Burns: Okay.
|
[102] Dawn
Bowden: It’s a short follow-on. I think it’s a very
important point that Angela is raising. In the example you’ve
just given of somebody tattooing a child and then actually being
prosecuted for actual bodily harm, what is the action—the
deterrent—to a practitioner, then? What is the offence if
they breach the regulation? In that case, it was quite an extreme
case, so the person was charged with assault. Taking up
Angela’s point, if we were to say—and we haven’t
yet got to that point—that all intimate tattooing—. Not
intimate tattooing, but intimate piercing—or intimate
tattooing maybe, I don’t know. If that was carried out, say,
under 18—say we’d got to that point where we decided it
was 18—and a practitioner continued and did the intimate
work, or even if they did it under the age of 16, what is the
offence? Is that not sexual assault? I understand what you’re
saying, that this is a public health Bill, but I’m interested
to know what the offence would be if somebody breaches the
regulation and does it anyway to a child who is under-age,
basically.
|
10:00
|
[103] Ms
Williams: Intimately piercing someone under the age of 16
isn’t automatically a sexual assault. Under the Sexual
Offences Act 2003, there needs to be an intention to touch a person
in a sexual way in order to commit a sexual assault.
|
[104]
Rebecca Evans: Chris.
|
[105]
Mr Brereton: I just wanted to comment, Minister, if I may, that
the case that Rhian referred to is quite an exceptional case,
because what could have happened is that individual could have been
prosecuted under the Tattooing of Minors Act 1969, and they could
have been prosecuted for failing to have a local authority
registration. Both of those offences would have been relevant
offences for this Bill. But I think, because of the circumstances
and, you know, the affront because they were so young, they chose
to go to an assault charge because it carried a higher penalty.
That’s why it wasn’t captured.
|
[106]
We do need flexibility within the Bill to
add further relevant offences, and that is provided by way of
affirmative regulations. I just wanted to give an indication of
that. For example, if, later in the day, we decided to add sunbeds
to the list of special procedures, then we would also want to add
an offence under the Sunbeds (Regulation) Act 2010 to the list of
relevant offences, because that already exists. So, that does
provide the flexibility to add in relevant offences as we go along,
if circumstances change and if we see a problem arising.
|
[107]
Rebecca Evans: Can I suggest that we write to committee on the issue
that Angela raised about sexual offences, and the list under the
special procedures section of the Bill? Because this isn’t
something that was scrutinised, I don’t believe, previously
in the Bill, it will require some research and thinking on our
parts. So, if we respond to you in future.
|
[108]
Dai Lloyd: Good, because there is a complicated issue of consent
there as well, which needs to at least be explored, in terms of,
‘Is the young person absolutely content to have this
procedure done to them, and free of any duress whatsoever?’
and how we go around proving that. But, I’m sure you could
incorporate that.
|
[109]
Just to clear up another issue that
Angela brought forward. We had some pretty powerful medical
evidence that, actually, puncturing the skin is a big deal, even if
it’s just a needle. There are blood-borne viruses, and all
those sorts of stuff. So, I know that there are various procedures
that are out with puncturing the skin, but would we take it that
any procedure that does puncture the skin is captured by this
legislation? Or, if not, why not?
|
[110]
Mr Brereton: Provided it’s carried out for an aesthetic or
therapeutic purpose, and it’s capable of causing harm to you
in health, then it is capable of being listed as a special
procedure for the purposes of the Bill.
|
[111]
Dai Lloyd: Okay.
|
[112]
Rebecca Evans: But it won’t necessarily be in the first
instance, in terms of being named within those four procedures on
the face of the Bill. However, as Chris outlined, the vast majority
of things that are considered aesthetic or therapeutic and that
also puncture the skin are covered within the four, one way or
another, being piercing or tattooing or so on.
|
[113]
Dai Lloyd: Okay, turning to health impact assessments, Jayne
Bryant.
|
[114]
Jayne Bryant: You mentioned previously the inclusion of the health
impact assessments. How confident are you that the Bill will ensure
a consistent and robust approach for requiring and carrying out
these health impact assessments?
|
[115]
Rebecca Evans: Thank you for that. The reason, really, that we
brought health impact assessments within the scope of the Bill was
to provide that clarity and consistency across the health impact
assessments that take place in Wales. It does place a duty on Welsh
Ministers to make regulations about both the circumstances in which
public bodies must carry out those health impact assessments, and
then the detail in terms of what will be involved in those health
impact assessments as well. That detail will be determined through
a process of public consultation.
|
[116]
Jayne Bryant: Okay. You answered that. How will the regulations
ensure that proper consideration is given to the issues raised
through the evidence that we’ve heard in committee, such as
air quality, health inequalities and mental health?
|
[117]
Rebecca Evans: Well, the fact that we deal with this through
regulations will give us the flexibility to consider all of the
evidence that you’ve had, but also to undertake some specific
consultation on health impact assessments as well. I think
it’s really important that, within the Bill, the Bill defines
a health impact assessment as:
|
[118] ‘an
assessment of the likely effect, both in the short term and in the
long term, of a proposed action or decision on the physical and
mental health of the people of Wales or of some of the people of
Wales.’
|
[119]
I think that’s really important
because it does give parity between physical and mental health in
legislation. I think that sends, really, a strong message in terms
of the importance that we put on mental health alongside physical
health as well.
|
[120]
Jayne Bryant: Thank you.
|
[121]
Julie Morgan: Can I just ask about children—how do you see
children being brought under this?
|
[122]
Rebecca Evans: Well, under the Children and Families (Wales) Measure
2010, obviously, Welsh Government Ministers will have a duty to
consider children in doing this. So, we would seek to include the
views of children and young people, and the people who represent
them, within the consultation work that we do in terms of accessing
the advice and ideas and support in terms of developing those
health impact assessment details.
|
[123]
Julie Morgan: And would you be, sort of, bearing in mind the
present inequalities that exist between the different ways or
different settings that children live in?
|
[124]
Rebecca Evans: In what sort of sense?
|
[125]
Julie Morgan: Well, if you’re going to have as children part
of the impact statement, obviously some children are very
disadvantaged already. How are you going to ensure that their voice
is heard, really?
|
[126]
Rebecca Evans: Well, the health impact assessment should obviously,
well, will be undertaken in those situations where the policy plan
or programme has an outcome of national or major significance, or
which has a significant effect on public health at a local level.
Obviously, we’d want to ensure that children, regardless of
their backgrounds, are considered within those health impact
assessments.
|
[127]
Mr Tudor-Smith:
I think the important point here is about
the guidance that goes with the health impact assessment, to make
sure it sets out very carefully the way in which a health impact
assessment has to be conducted, which is appropriate to the issue
being looked at. Secondly, it has to identify the sort of topics
that should actually be covered by the health impact assessment.
So, I think that guidance is going to be critical to the success of
how this legislation is carried forward, covering the points that
you’ve raised and other stakeholders have raised.
|
[128]
Dai Lloyd: Before I ask Lynne to come in on pharmaceutical
services, can I just press you a little bit further on that?
Following on from one of Dawn’s original questions about air
pollution, and tying that into health impact assessments and air
quality, I take it that the detail of how you’re going to
measure air quality—and we’re trying to capture our
concerns about air pollution and the health impacts of
that—the actual minutiae of how you’re going to carry
out a health impact assessment monitoring local air pollution will
become clear in guidance, I take it, then. Is that the
case?
|
[129]
Rebecca Evans: All of the aspects—I mean, the Bill really
places a duty on Welsh Ministers to make those regulations, to make
sure that health impact assessments occur in those circumstances.
Then we’ll provide the guidance and regulations to ensure
that those health impact assessments are consistent and robust and
so on. In terms of the detail then, as to whether it includes air
pollution or any other aspect of issues that affect public health,
that would be following consultation. So, we’ll be listening
to what people have said here in giving evidence to you, but also
in a specific consultation piece of work as well.
|
[130]
Dai Lloyd: Diolch. Rydym yn symud ymlaen i wasanaethau
fferyllol. Lynne.
|
Dai Lloyd: Thanks. We move on to
pharmaceutical services. Lynne.
|
[131]
Lynne Neagle: Thank you. When this Bill was going through
previously, the then Minister was able to give assurances to the
British Medical Association that, on the pharmaceutical needs
assessment, they would be involved in the design of those, and also
that those assessments would take account of the contribution of
dispensing GPs. Are you able to give that same assurance to the BMA
this time?
|
[132]
Rebecca Evans: Yes. I know the BMA, in their evidence to you, also
shared their concern that they were keen to have that reassurance
reiterated to them. So, following the evidence that they provided
to you, I wrote to the BMA restating our commitment that we would
do that. I did that on 21 December, and I’d be more than
happy to share the letter that we sent to the BMA with the
committee as well, confirming that pharmaceutical needs assessments
would reflect the consideration and contribution of all providers
addressing the local health needs. So, that clearly includes
dispensing doctors as well. I also took the opportunity to confirm
the amendments made previously to the Bill to address the
BMA’s concerns, and their interest, for example, in health
impact assessments, so they will all obviously remain in the Bill
as well.
|
[133]
Lynne Neagle: Okay, thank you. And how will this Bill actually
contribute to the development of Welsh-language pharmaceutical
services?
|
[134]
Rebecca Evans: Well, meeting the pharmaceutical needs of the
population is, you know, about all of the population, and meeting
them through the Welsh language will be part of that.
|
[135]
Lynne Neagle: Okay, thank you.
|
[136]
Dai Lloyd: Diolch. Rydym ni wedi dod i’r adran olaf
yn y sesiwn yma, sef toiledau mewn mannau cyhoeddus. Rydym ni wedi
derbyn cryn dipyn o dystiolaeth achos, yn amlwg, mae hwn yn fater
pwysig iawn i filoedd o bobl. Caroline Jones.
|
Dai Lloyd: Thank you. We now turn to
the final section of this session, namely the provision of toilets
in public places. We have received a lot of evidence because,
clearly, this is a very important matter for thousands of people.
Caroline Jones.
|
[137] Caroline
Jones: Diolch, Chair. Could you tell me, please, regarding the
provision of toilets, how the Bill, and the guidelines issued under
it, will ensure that each local authority’s strategy will
take into account the needs of the whole community and visitors to
that community, special needs, such as mobility issues with people,
sensory loss, and mobility issues regarding wheelchair access, and
also young families, children, and so on? So, the whole community
and visitors to that community, particularly people with a
disability. Thank you.
|
[138] Rebecca
Evans: So, the Bill seeks to improve toilet provision for
everybody, and it does place a duty on each local authority to
prepare and publish their local toilet strategy, and that must
include an assessment of the whole community’s need for
toilets, so, including changing facilities for babies and changing
places for disabled people, as well as, then, the detail on how the
local authority intends to meet those needs as well. Public
authorities are already requested by the public sector disability
equality duty to consider how they can improve and contribute to a
fairer society through their day-to-day activities, including
provision of public toilets as well and, if passed, the Bill will
extend that to include those strategies within that as well.
|
[139] The Bill does
acknowledge that, you know, to use a toilet in safety and in
comfort is different for different people, depending on their
needs, and that some people might need more space or different
equipment, for example. And that’s why, under the definition
of toilets in the Bill, we do include disabled changing
places—changing places for disabled people—as well. I
think the guidance that follows with regard to the provision of
toilets and the local toilet strategies will be really important,
and I’ll take that opportunity to set out Welsh
Government’s expectations with regard to access for
people—you mentioned sensory loss, people who use
wheelchairs, families, and so on—within existing legal
obligations. So, I’ll set that out within the guidance.
|
[140] Caroline
Jones: Thank you. And will there be any public consultation
regarding the placement of toilets—you know, where
they’re going to be placed? You know, there may be facilities
required that we haven’t thought about, or the Bill
hasn’t considered. So, I think wider public engagement could
be beneficial in this area. Also, can we confirm how local
authorities will convey where these public toilets will be, the
times of opening, and so on, and closing? Because a lot of people
depend on all of this information, due to incontinence issues, and
so on. So, it is vitally important that the message gets through to
every member of the community as to where the location of the
toilets will be, times of opening, the provision, and so on and so
forth.
|
[141] Rebecca
Evans: Okay, thank you. I think it’s really important
that the Bill actually requires that local authorities must publish
their local toilet strategies, so that the information is available
to everybody who wants to see it. And it also requires Welsh
Ministers to issue guidance to local authorities on the specified
matters, including promoting the public awareness of the toilets
available for use by the public as well. So, that could include
issues such as opening times, as you suggested, locations,
accessibility descriptions, and so on, and local authorities will
then have to have regard to that guidance. I think it’s
important as well that we consider that signposting is going to be
really important for people as well. So, all of that will be
consideration in the guidance that we give.
|
[142] And in terms of
public consultation—.
|
10:15
|
[143] Mr
Brereton: There is a statutory duty for local authorities to
consult under section 112 of the Bill on their local toilet
strategies with interested groups and provide them with a copy of
that strategy. I think our guidance will help signpost them to what
those relevant groups would be, and that would include people
representing the disadvantaged and disabled, et cetera.
|
[144] Caroline
Jones: And how much consideration will we be giving to the fact
that not everyone can access information online?
|
[145]
Rebecca Evans: As I’ve said, it is important that information
is accessible to people, which is why signage in windows and so on
might be important as well. So, we’ll be considering all of
the options in terms of ensuring that people are aware of the
toilets that are available. I think, as I’ve said to
committee before, there is something to do in terms of creating a
culture change where people are comfortable to go into places, such
as a library or a coffee shop, for example, to use the toilet
there, if the owners are happy for them to do so, and so on. Some
people do not feel confident to go into certain settings if
they’re not buying something, or they’re not taking out
a book or using the service there. So, there’s something for
us to do there in terms of changing that culture, with what people
are comfortable doing, as well.
|
[146]
You mentioned online, of course, and I
did meet recently with the British Toilet Association and
they’ve created a changing places map online. I know
officials are having some discussions with them in terms of
potential for widening that, and so on.
|
[147] Caroline Jones: Thank you.
|
[148]
Dai Lloyd: Julie.
|
[149]
Julie Morgan: Yes, thank you, Chair. I support this proposal
and I think it’s a step in the right direction, but would you
agree that there’s no real guarantee that this legislation
would actually produce one extra toilet?
|
[150]
Rebecca Evans: Well, the legislation—. I understand what
you’re saying and, in terms of building new toilets, it is
expensive. I don’t want the legislation to be burdensome on
local authorities. It might be that new toilets are built but,
actually, it might be that the toilets and facilities that we have
available are better used and better promoted—opened up to
the public where they’re not already at the moment, and so
on. So, it’s about using what we have already and mapping out
what we have, and understanding whether that already meets the
needs of the local population, as identified through the work the
local authorities will be doing, and, if it doesn’t, then
taking action to address those gaps.
|
[151]
Julie Morgan: Yes, because I think, certainly from my knowledge, it
won’t meet the needs of the local populations that I know in
my constituency, and I wouldn’t want there to be a public
expectation that this legislation would produce new toilets,
because it’s a sort of step in the direction isn’t it,
really?
|
[152]
Rebecca Evans: It is difficult in terms of suggesting an extra
number of toilets that might result from this. As I say, it’s
not necessarily about building more; it’s about using what we
have more effectively.
|
[153]
Mr Brereton: I think what it will do is expose public toilet
provision, be it directly by a local authority, by other public
sector bodies, or through community facility grants to public
scrutiny for the first time, really. And it will rely on local
authority scrutiny processes and the role of ward members within
local authorities to represent their local populations to make sure
provision is adequate for the needs of all of the community. I
think it will bring a measure of accountability on the issue within
local government.
|
[154]
Julie Morgan: I think that’s very much to be welcomed. Would
you see this as being any sort of debate on the type of toilets
that are provided, because a lot of people are not happy with the
newest types of toilets, where the whole of the door shuts? In
fact, in my constituency, those are the ones that have now been
taken away, presumably because they’re not used enough. I
don’t know if you have any comments on that.
|
[155]
Mr Brereton: Yes, I think the automatic public
conveniences—‘APCs’ as we used to call
them—with those types of toilet, you can actually very
accurately measure the usage versus the cost, and you get a cost
per use. It could be more economic, as in Cardiff’s case when
they reviewed theirs, to direct the money elsewhere to provision
that would be more frequently used. So, I think, in developing
their local toilet strategy, part of the role of guidance will be
to help local authorities to ask, ‘What decisions do we have
to make in terms of best provision?’ and the accounting side
of public toilets is part of that process, I think.
|
[156]
Dai
Lloyd: Jest i ddilyn i fyny ar hynny cyn i ni orffen, rydym ni wedi
derbyn cryn dipyn o dystiolaeth gref iawn ynglŷn
â’r pwyntiau hyn. Yn benodol, roedd pobl eisiau cael hyder yn y defnydd o
doiledau cyhoeddus. Yn dilyn y lein roedd Julie yn ei ddweud
rŵan, mae nhw eisiau hyder bod y cyfleuster yn mynd i fod yna,
ac yn mynd i weithio, ac yn mynd i fod yn lân, ac mae
nhw’n gwybod ymlaen llaw lle mae e. Hefyd, rhan gref
o’r dystiolaeth oedd yr angen am y bas data yma roedd
Caroline wedi cyfeirio ato—hynny yw, ei fod yn eglur i bawb
lle mae’r toiledau cyhoeddus, eu bod nhw’n lân,
eu bod nhw ar agor, a’u bod nhw yn cael eu defnyddio yn
rheolaidd ac ati.
|
Dai
Lloyd: Just to follow up on
that before we come to an end, we have received a lot of strong
evidence on these points. Specifically, people wanted
confidence in the use of public toilets. Following the line that
Julie said now, they want confidence that the conveniences are
going to be there, and are going to be working, and clean, and they
want to know beforehand where they are. Another strong part of the
evidence was the need for this database that Caroline referred
to—that is, that it’s clear for everyone where the
public toilets are, that they’re clean, that they’re
open, and that they’re used on a regular basis.
|
[157]
Mae eisiau gwneud y peth yn hawdd
iawn ac yn wybodus iawn i bobl allu defnyddio hyn, ac yn benodol
felly i’r grŵp o bobl hynny sydd angen darganfod toiled
mewn brys, mewn argyfwng. Mae yna nifer o gyflyrau meddygol i wneud
efo’r coluddion, ond hefyd efo’r system arennau, sydd
yn golygu os oes rhaid i chi fynd i’r toiled, mae rhaid
gwneud nawr. Ie, mae eisiau i chi wybod lle mae pethau, ond hefyd,
mae eisiau rhyw system fel ei bod hi’n iawn i jest gerdded
mewn i rywle. Rwy’n derbyn beth rydych yn ei ddweud
ynglŷn a weithiau rydym yn swil ynglŷn â cherdded
mewn i rywle a jest defnyddio’r toiled heb brynu rywbeth, ond
hefyd mae eisiau newid fel mae’r sawl sydd yn darparu siopau
coffi ac ati yn trin pobl hefyd, ac i ddisgwyl hynny, yn enwedig i
bobl sydd â chyflyrau meddygol, sydd rhaid mynd i’r
tŷ bach nawr ar fyrder. Nid wyf yn gwybod os fedrwch chi
gadarnhau bod gyda chi unrhyw syniad lle gallwch chi gryfhau hynny
yn y Mesur yma.
|
It needs to be done in an easy way for people
to be able to use this, and specifically for that group of people
who need to find toilets in a hurry, in an emergency. There are a
number of medical conditions that relate to the bowels, but also
relate to the kidney system, that mean that if you use the toilet,
you need to go now. Yes, you need to know where things are, but
also, there needs to be a system where it’s okay to just walk
into somewhere. I accept what you say that sometimes we’re
shy about walking into somewhere and just using the toilet without
buying something, but also, there is a need to change how those who
provide coffee shops and so forth treat people, and to expect that,
especially for those with medical conditions, who have to go and
use the toilet now and quite urgently. I don’t know whether
you can confirm if you have any ideas on how that could be
strengthened in this Bill.
|
[158] Rebecca
Evans: Thank you. I know that you’re taking evidence
shortly from Crohn’s and Colitis UK, and I know that
they’ll have some views on this, and I’ve also met with
them to discuss their views on access to public toilets. They are
supportive of what we’re trying to achieve through the Bill.
I mentioned previously the work that the British Toilet Association
have done in terms of their Changing Places toilet map, which is
available online, and it allows for geo-centering, which allows the
person to use the map in relation to where they are at that moment
in time, to find the most accessible toilet, or the nearest toilet
that meets their needs, and I think that’s something really
interesting in terms of potential moves forward beyond this
Bill.
|
[159] I think your
issue about shop owners and other people not necessarily
understanding how important it is for some people particularly to
be able to access the toilet probably goes beyond the scope of the
Bill in terms of setting out a requirement to have toilet
strategies. However, I think there’s a much bigger issue
there in terms of disability, discrimination and understanding of
unseen disabilities particularly, and creating more awareness
amongst the public generally and people in particular professions
as to what people’s needs might be. I’m not sure that
that could necessarily be addressed through this legislation
particularly, but it is an important issue.
|
[160]
Dai Lloyd: Angela ar hyn.
|
Dai Lloyd: Angela on this.
|
[161] Angela
Burns: Just a tiny question. We put the onus on shops and
everything and making people aware of how important it is to be
able to provide toilets and what a good public service it is. But
it does strike me that one of the great architects are our county
councils, and they have outposts in all sorts of towns and cities,
and yet you try going into a local county council to use their
facilities as a member of the public and you are rebuffed. So,
should we start by actually saying to the local councils,
‘You need to open up your facilities’? Because
they’re in the middle of town centres. They’re easy to
access and if somebody gets stuck or gets caught short, and
we’re saying to the local fish and chip shop, ‘You
ought to consider being kind and open up your loo’, how about
saying to the county councils: ‘Why don’t you practice
what you’re trying to preach here?’
|
[162] Rebecca
Evans: Well, in terms of councils preparing their strategies, I
suppose the first place you would imagine that they would look
would be to their own estate—
|
[163] Angela
Burns: I can tell you for a fact though that they’re not
imagining that at all.
|
[164] Rebecca
Evans: In terms of the guidance, we would obviously be
exploring what onus there would be on local authorities themselves
to start with the facilities that they have. Did you want to add
anything?
|
[165] Mr
Brereton: Yes. On both points, I think there’s an
opportunity in local authorities’ dialogue with businesses
and offices to try to prompt an attitudinal change in relation to
accessibility for their toilets. And perhaps that’s something
we could prompt with the guidance to say that when they are
consulting, and bringing to those businesses the problems that some
people face, and some of the methods in relation to cards that are
used to prove that you have a problem—to be more accepting.
It is an opportunity to communicate on what is a very important
issue.
|
[166] On public
buildings, there’s always a balance to be struck between
security and accessibility and some are better at achieving that
because the design allows for the toilet to be in front of the
barrier and not behind the barrier. It’s something that we
have to put in public sector minds—that when they are
designing buildings, they have to be both accessible and secure,
and it is a difficult balance.
|
[167]
Dai Lloyd: Diolch yn fawr. Dyna ddiwedd y sesiwn
dystiolaeth. A allaf ddiolch yn fawr iawn i’r Gweinidog,
Rebecca Evans, am ei thystiolaeth a hefyd
diolch i’r swyddogion am eu tystiolaeth ac am eu presenoldeb?
Diolch yn fawr iawn i chi i gyd. Gallaf hefyd rhoi gwybod i chi y
bydd trawsgrifiad o’r cyfarfod yma yn cael ei basio ymlaen
ichi i’ch galluogi chi i’w wirio i wneud yn siŵr
ei fod yn ffeithiol gywir. Gyda chymaint â hynny o eiriau,
diolch yn fawr iawn i chi unwaith eto, Weinidog, am eich
presenoldeb. Gallaf gyhoeddi i’m cyd-Aelodau y cawn ni egwyl
fach am y naw munud nesaf, cyn y sesiwn dystiolaeth nesaf, pan fydd
Coleg Brenhinol y Meddygon yma am 10:35. Diolch yn
fawr.
|
Dai Lloyd: Thank you. That’s the
end of this evidence session. Can I thank the Minister,
Rebecca Evans, for her evidence and the
officials for their evidence and for their attendance? Thank you
very much to you all. I can also inform you that you will receive a
transcript of this meeting for you to check that it is factually
accurate. So, I’d like to thank you again, Minister, for your
attendance. I can also announce to my fellow Members that
we’ll have a short break for the next nine minutes before the
next evidence session when the Royal College of Physicians will
join us at 10:35. Thank you.
|
Gohiriwyd y cyfarfod rhwng 10:26 ac
10:36.
The meeting adjourned between 10:26 and 10:36.
|
Bil Iechyd y Cyhoedd
(Cymru)—Cyfnod 1, Sesiwn Dystiolaeth 8—Coleg Brenhinol
y Meddygon
Public Health (Wales) Bill—Stage 1 Evidence Session
8—Royal College of Physicians
|
[168]
Dai Lloyd: Croeso nôl i bawb i’r sesiwn
ddiweddaraf o’r Pwyllgor Iechyd, Gofal Cymdeithasol a
Chwaraeon yma yn y Cynulliad. O dan eitem 3, mae rhagor o graffu ar
Fil Iechyd y Cyhoedd (Cymru), Cyfnod 1, a dyma sesiwn dystiolaeth
rhif 8. Rwy’n falch i groesawu Coleg Brenhinol y Meddygon
yma, ac yn benodol, felly, Dr Olwen Williams, sydd yn swyddog
iechyd cyhoeddus Cymru Coleg Brenhinol y Meddygon. Rwy’n
credu eich bod chi’n ymwybodol o’r drefn. Rydym ni wedi
derbyn eich tystiolaeth ysgrifenedig gerllaw eisoes, ac felly, fel
sy’n draddodiadol, awn ni yn syth i mewn i gwestiynau oddi
wrth Aelodau. Felly, i ddechrau, rydym ni’n mynd i gael Dawn
Bowden—Dawn.
|
Dai Lloyd: Welcome back, everybody, to
the latest session of the Health, Social Care and Sport Committee
here in the Assembly. Under item 3, there is more scrutiny of the
Public Health (Wales) Bill, Stage 1, and this is evidence session
number 8. I’m pleased to welcome the Royal College of
Physicians here, and specifically Dr Olwen Williams, who is the
Wales officer for public health with the RCP. I think you’re
aware of the order of things. We’ve received your written
evidence beforehand already. So, as is traditional, we’ll go
straight into questions from Members. So, to start, we’ll
have questions from Dawn Bowden—Dawn.
|
[169] Dawn
Bowden: Diolch, and good morning, Dr Williams.
|
[170] Dr
Williams: Good morning.
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[171] Dawn
Bowden: A nice easy one to start with; a nice open question to
start with: can you just tell us whether you think, in your
opinion, the Bill has maximised all the opportunities available to
it to address public health issues?
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[172] Dr
Williams: Obviously, we really do welcome this Bill, but
actually feel that it could go further. It might be that parts of
the issue are outside the legislative powers of the Welsh
Government at the moment, especially our main concerns around the
minimum pricing of alcohol, and also on the sugar tax, because we
feel that they would have a significant impact on the health of
individuals in Wales and the population of Wales.
|
[173] Dawn
Bowden: So, those two areas in particular.
|
[174] Dr
Williams: Those two areas are major areas of concern for the
college. Obviously, the college has got a significant investment in
this, as regards the health of the adult population. Most of our
membership are consultants and physicians’ assistants, who
have to deal with the outcomes of some of the ill health related to
both of these situations—alcohol abuse and the obesity
crisis.
|
[175] Dawn
Bowden: Presumably, you’ve had views back from colleagues
in Scotland about the impact of minimum pricing in Scotland, which
is leading you to believe that it would be—
|
[176] Dr
Williams: Yes, and I think, if we look at the alcohol
situation, I think what’s changed—there are several
ways that we can look at the way people have changed the way they
drink. Certainly, with the changes around smoking in public places,
older people are not now going to the pubs in the same way;
they’re actually drinking at home. They have no regulation of
how much they drink, and actually what they’re drinking is
cheap alcohol at home. So, actually, for the average person,
putting, say, 50p per unit is not going to affect the majority of
people who drink socially, but actually might affect those who are
drinking—and I will use the words in inverted
commas—‘covertly’ at home because they are saving
money. There are two sides there. They’re smoking at home as
well, so the two things tend to go together, So we feel that,
actually, that minimum pricing would have a huge impact on those
people.
|
[177] Dawn
Bowden: Because there’s this trend, isn’t there,
for what they call ‘pre-loading’—is that it? When
kids go out, generally, they talk about pre-loading.
|
[178] Dr
Williams: Yes. When you actually look at young people’s
drinking—and my background is as a sexual health
practitioner, so I regularly ask my young people—what
we’re finding is that young people under the age of 18 are
not drinking as much, or not drinking at all. There has been a
significant drop in alcohol consumption among the 18 to
25-year-olds. They can go for weeks without drinking but, when they
drink, they do the pre-load and they probably drink their
month’s—you know, they drink a significant amount.
I’m more concerned, actually, with the people I see in the
age group of 45 to 55-year-olds who say, ‘I have a glass of
wine’, and when you ask them what size glass of wine, it is
half a bottle of wine. So, I think there’s a lot of messages
out there around how we consume alcohol. But actually putting a 50p
per unit price on that will not affect that age group’s
drinking because they’re already paying over 50p or probably
£1 a unit.
|
[179] Dawn
Bowden: Sorry to interrupt you there. What would you suggest
would be the answer to dealing with that? From what you’re
saying, it seems to be a particularly high-risk group,
doesn’t it?
|
[180] Dr
Williams: Yes, it is because, obviously, we know that women
drinking increase their risk of breast cancer, they don’t
recognise that they have an alcohol issue, they don’t
understand that they’re more prone to having fatty liver and
cirrhosis and, actually, there’s a message out there.
They’re certainly drinking much more than their children are,
in comparison. So, there needs to be some targeted public health
around that. The 50p minimum pricing won’t affect them
necessarily. What that does is affect the people who run into
significant problems around their drinking, the people who are in
that spiral, who drink the cider, who drink the very cheap alcohol,
and, you know, that side. So, it might limit them getting into that
next stage of ill health.
|
[181] Also, the
alcohol issue around obesity as well. I don’t think people
understand how many calories there are in alcohol, in that the
consumption of a large glass of wine equals a doughnut. Well, we
might treat ourselves to a doughnut once a week, but, are we having
a glass of wine every night? That’s the questioning. So, I
think there are a lot of public health messages that need to go
out. But, having a regulation and an Act that actually say,
‘We are supporting the 50p’, might make people wake up
a little bit more to the risks of alcohol and their
consumption.
|
[182] Dawn
Bowden: Okay, thank you for that. Can I just briefly move on
now to your evidence? In your evidence, you do talk about:
|
[183] ‘The focus
of public health should lie on preventing, not just managing poor
health. Many of the underlying reasons for health inequality in
Wales cannot be solved by solely local initiatives and local
authorities but will need a more strategic national approach by the
Welsh Government.’
|
[184] Can you perhaps
enlarge on that a little bit and tell us what you think?
|
[185] Dr
Williams: I think what we go into there is that we have a
fantastic opportunity in Wales with the well-being of future
generations Act, with this public health Bill, and with the
engagement with organisations like BMA, like ourselves, to actually
have that strategic working together. This links into the
health-impact assessment, that we all work together, with our
population, in getting that message out so that people are very
aware that things like sugar, alcohol and some of the other things,
like smoking, are really fundamental things that need to
change.
|
[186] Dawn
Bowden: So, you’re really talking about everybody taking
ownership of the issue.
|
[187] Dr
Williams: Yes. We should have all our citizens actually making
this a citizen-based movement forward. If you look
at—I’ll bring in the organ donation Act. If you see how
that has been embraced by the citizens of Wales, it has been a
phenomenal change in what we’ve managed to do for the health
of maybe only a few people as regards getting an organ, but it has
been a phenomenal change. That has been driven by legislation but
it’s also about buy-in by our population. So, we need that
population from the bottom up, driving things. So, creating public
health as a social movement, not necessarily as a legislative
movement, but legislation does have its place.
|
[188] Dawn
Bowden: It’s quite evangelical, that is.
|
[189] Dr
Williams: Pardon?
|
[190] Dawn
Bowden: That’s quite evangelical, isn’t it?
[Laughter.] Okay, thank you, Dr Williams.
|
[191] Dai
Lloyd: Julie.
|
[192]
Julie Morgan: Yes, thanks very much. The Royal College of
Paediatrics and Child Health have suggested a number of other areas
that could be included in the Bill as well as the alcohol and
obesity issues, including it being used to promote breastfeeding as
one issue, and accident prevention. I just wondered if you could
comment on that and whether you did see that the Bill should
include these sort of issues.
|
[193]
Dr Williams: Obviously, the college covers adults, but we also
look at transition. We look at adolescents and their movement into
adulthood, so we work quite closely with the college.
|
10:45
|
[194]
I think that’s really
important—other areas around making breastfeeding the norm
and ensuring that facilities are advertising that they’re
breastfeeding-norm. Again, there’s an education point of
view.
|
[195]
But I think that there are other issues
that we should be thinking about. The public health research on
adverse childhood experiences actually highlights nine areas, and
if an individual has more than four of those—what they call
ACEs, which I’m not sure is the appropriate
acronym—then the risk of adult disease, which our members
actually have to deal with, so diabetes, heart disease and
respiratory disease, is increased threefold. So, I think there are
areas that we could actually look at that expand on that, such as
breastfeeding, but also looking at—and it probably
doesn’t go into a public health Bill—other areas around
sexual assault, sexual violence, the risks around smoking in the
household and those other things around social deprivation and
poverty.
|
[196] Julie
Morgan: So, you see those as being—
|
[197] Dr
Williams: Yes, I think they’re—. I think if you
invest in your childhood then you will get a healthy adulthood.
|
[198] Julie
Morgan: Yes. The other issue I wanted to raise was about
accident prevention. There is the issue of accidents in the home
and small children, and there’s also the issue of driving
licences, and I wondered what your view was about having a
graduated driving licence.
|
[199] Dr
Williams: I don’t think we’ve got any particular
views on that. Obviously, we do have a view on alcohol consumption
and driving, but also on illegal drugs, and obviously we want
people to be driving safely. It’s not just substance misuse
or alcohol that actually might be the cause there; extreme
tiredness has the same effect, as well. So, actually,
people’s awareness. It might be that the Bill needs to raise
awareness of risks to people who drive after a long night’s
shift, and we know that, in medicine, that’s been a
significant problem for junior doctors on call, who have then gone
and had accidents the next morning.
|
[200] Julie
Morgan: Thank you. I think that’s all.
|
[201]
Dai Lloyd: Symudwn ymlaen i’r adran nesaf rŵan,
ac rydym ni’n mynd i sôn am fangreoedd di-fwg a’r
holl fusnes tybaco. Mae Lynne yn mynd i arwain ar hyn.
|
Dai Lloyd: Moving on to the next
section, and we’re going to talk about smoke-free premises
and tobacco and so forth. Lynne is going to lead on this.
|
[202] Lynne
Neagle: Thanks, Chair. We have had some evidence that witnesses
would like to see the Bill go further in terms of the settings that
are set out as being tobacco free. For instance, the Bill currently
covers schools, and witnesses have told us they think that places
like childcare settings, private nurseries, et cetera, should be
included. Have you got a view on that?
|
[203] Dr
Williams: I think what we’d like to do is define what you
mean by a hospital and healthcare, because I think, when it comes
to places where care is being delivered, then it’s around GP
premises, it’s about community hospitals and community
clinics. So, yes, as regards the hospital. As regards places where
children seek either care or education, or, actually, recreational
facilities, I think the difficulty there is around how you govern
and how you police that, bearing in mind that you’ve got some
care facilities that will be in hospital grounds. So, if you omit
nurseries, can people smoke around the nursery on a hospital
ground? There are all these—.
|
[204] I really do
appreciate that this is a really difficult one, and, again,
it’s how we police it. I know we are advised to challenge
individuals who smoke on hospital premises. It is actually quite
difficult, and then, what they ask you is, ‘Well, where can I
smoke?’ and you have to say, ‘You have to go out on the
main road.’ We should be thinking about where these people
then go, because they might be going somewhere where it’s
unsafe to smoke. So I think you’ve got to actually think
about, maybe, facilities for people to go and smoke. But, also, use
those facilities to actually engage them in smoking cessation.
Don’t just move the problem; actually give the people real,
clear messages in those sorts of areas as well. Because what
we’re doing at the moment is we’re shifting the
problem, so they’re not smoking in pubs, but all we’re
doing is shifting people outside the pub and what happens then is
that the people who don’t smoke actually move with those
people who do smoke. So, inadvertently, they’re passively
smoking, or they might actually smoke themselves, and that’s
what people are telling me, ‘Oh, I only smoke when I’m
out with my friends who smoke.’ So, I think we’ve got
to really be careful on that one.
|
[205] Lynne
Neagle: Okay. So, the royal college, then, isn’t
advocating an extension of what’s proposed in the Bill to
cover more areas where children are.
|
[206] Dr
Williams: Yes, we’d like to see that, but we recognise
that it’s really difficult to enact it. That’s the
thing.
|
[207] Lynne
Neagle: Okay. Can I just ask about the issue of public
playgrounds? Playgrounds that have got play equipment in will be
covered, but things like playing fields and general parks
won’t be. How effective do you think that will be?
|
[208] Dr
Williams: We welcome the play areas and the restricted areas,
but thinking of my own space where I walk my dog and see that sort
of thing, one thing is the policing of it. I think, actually, that
all people do is stand around that area where the play equipment
is. The visual of the smoking will be there still. So, unless you
actually make recreational grounds, including play areas,
smoke-free, then it’s going to be, again, a difficult thing
to police. But we’d obviously support as many places as
possible for people not to be seen smoking.
|
[209] Lynne
Neagle: Does that include, then, areas like outdoor cafes?
Would you go that far?
|
[210] Dr
Williams: That then becomes your issue. You’ve got a cafe
with a play area next to it, and parents want to observe their
children. Yes, I suppose. I think if you link the two together,
that would be an area where you would say that you wouldn’t
want people to smoke.
|
[211] Lynne
Neagle: Okay. Just finally, you referred to people not being
seen smoking. A lot of the evidence we’ve taken has been
around the need not to normalise smoking as an activity but, of
course, vaping will be allowed in all these places now where we are
banning the use of tobacco. What’s your view on that as an
effective public health measure?
|
[212] Dr
Williams: We see vaping as an alternative. We would prefer
people to not use cigarettes because we know the harmful effect of
them. I think it’s too early to actually move to banning
vaping. I think our view is that. But yes, I think that walking
down a high street, seeing a vaping stall in the middle of Queen
Street, gives off the wrong message. I think, when it comes to
licensing premises, that will take the vaping into somewhere else.
I think that’s something that we—
|
[213] Lynne
Neagle: So, you don’t have any concerns that children are
going to see people vaping in their local playground, where the
play equipment is, and think—
|
[214] Dr
Williams: Yes, I said that we have that concern, but at the
moment I’m not sure that we’re prepared to ban vaping,
to go as far as saying that, as a college.
|
[215]
Lynne Neagle: Okay.
|
[216] Dai
Lloyd: Julie.
|
[217] Julie
Morgan: Yes, just to go back to the issue that Lynne raised
about hospitals and hospital grounds, I think that this is a really
difficult issue, but from your answer, were you saying that you
think there should be a place in the hospital or hospital grounds
where people who smoke can go? You think that’s—
|
[218] Dr
Williams: Yes. That’s a personal view, whether it’s
my colleagues’ view—. But actually what it does is that
it gives you an opportunity to work then with those people.
|
[219] Julie
Morgan: Right. And in the situation, for example, of a cancer
hospital, which feels that they couldn’t do that, which I
would understand because of their seeing the consequences of
it—
|
[220] Dr
Williams: Yes, I agree.
|
[221] Julie
Morgan: —that is then displaced onto the—
|
[222] Dr
Williams: To outside the front door.
|
[223] Julie
Morgan: Yes. I’ve got a particular situation at the
moment where people living around a hospital are experiencing lots
of people sitting on the front wall and causing a great deal of
distress to them and their children, who they’re particularly
concerned about. So, your answer is to have a place for them.
|
[224] Dr
Williams: If you think from a public health point of view, what
are we aiming to do? We’re aiming to actually engage people
in not doing something. So, by supporting them in a transition from
doing it to not doing it, if you actually give them a facility
where they might actually gain some—. You might want to have
an interactive thing that tells them about where they can get
smoking cessation advice from. So, it’s actually promoting
not smoking.
|
[225] Julie
Morgan: Right. Does that happen in hospitals? Do you know?
|
[226] Dr
Williams: Not that I know. I know that the maternity units have
a little stand and have a little sign saying, ‘It’s
best not to smoke in pregnancy.’ I think a lot needs to be
invested in a lot of the behavioural change around what we’re
doing.
|
[227]
Dai Lloyd: Diolch am hynny. Gan symud ymlaen at yr adran
nesaf ynglŷn â thybaco a’r angen i greu cofrestr
o’r sawl sy’n gwerthu tybaco, mae gan Caroline gwestiwn
ar hynny.
|
Dai Lloyd: Thank you for that. Moving
on to the next section regarding tobacco and the need to create a
register of those who sell tobacco, Caroline has a question on
that.
|
[228] Caroline
Jones: Diolch, Chair. Could I ask, please, your views on the
proposals to create a register of all retailers who sell tobacco
and nicotine products, and how do you think the creation of such a
register would impact on the reduction of children’s access
to such products?
|
[229] Dr
Williams: We think, as an organisation, that, yes, a register
will help. It will mean that these premises will have to be
scrutinised, they will actually pay money and therefore it’s
not just everyone that can sell. I bear in mind that tobacco
products, or nicotine products, do include some non-smoking
products—so, chewing gum and things like that—that we
need to be aware of. I was hearing earlier about the pharmacy and
the difference between the nicotine prescribed patches and chewing
gum versus the actual nicotine products that are not for
therapeutic. I think the ability to not and to actually challenge
young people around their age is something that now young people
are very much aware of. They carry their ID, they expect to be
asked, and that’s a normal situation now. Everyone under 21
seems to have ID of some sort with them, and that was not our case
when we were young. I think that they wouldn’t even attempt
now. I think my worry is where they get the tobacco from.
It’s the covert nicking mum’s or having a quick vape of
dad’s sort of thing that is our biggest challenge. So, the
retailers know that they are going to lose their licence,
potentially, if they’re caught. They don’t want to get
people hooked either.
|
[230] Caroline
Jones: But that does happen now, doesn’t it?
|
[231] Dr
Williams: Yes.
|
[232] Caroline
Jones: You lose your licence if you sell to under-age people
anyway, so, when you say they would be under scrutiny,
everyone’s under scrutiny now who sell tobacco products. So,
how do you envisage—
|
[233] Dr
Williams: Well, I think there will be a register there,
won’t there? They’ll be able to be visited because
they’re on the register to ensure that they’re
complying with the regulations.
|
[234] Caroline
Jones: So, how do you envisage the scrutiny progressing? What
do you mean by scrutiny, they’ll be under scrutiny? In what
way?
|
[235] Dr
Williams: I haven’t read in detail what’s in the
Bill, so I’m probably not going to take this any—. What
I would expect, if you’re on a register, is that you have to
relicense that premises so that the local authority will come in
and look at what’s happened in the last year. They might look
at your sales, they might even look at your CCTV to see what you
have been doing, have you been selling to under-age—I mean,
most premises now do have that—and that you’re
complying with not displaying your tobacco.
|
[236] Caroline
Jones: So, do you see expansion of the public sector in order
to carry out these duties?
|
[237] Dr
Williams: Of the public sector? I can’t answer that
question with any degree of authority, I’m afraid.
|
[238]
Dai Lloyd: Symud ymlaen yn awr i driniaethau arbenigol, fel
aciwbigo a thatŵio a nifer o bethau amgen rydym ni wedi bod yn
clywed amdanyn nhw ac wedi bod yn cynyddu ein gwybodaeth yn wir
amdanyn nhw ers rhai wythnosau yn awr, mae Angela yn arbenigo yn y
maes.
|
Dai Lloyd: Moving on now to special
procedures, such as acupuncture and tattooing and a number of
alternative things we’ve been hearing about and have been
increasing our knowledge of for a few weeks now, Angela is a
specialist in this area.
|
[239] Angela
Burns: Thank you. Good morning.
|
[240] Dr
Williams: Good morning, Angela.
|
[241] Angela
Burns: It’s such a tough subject.
|
[242] Dr
Williams: You’ve walked into my territory professionally,
I think.
|
[243] Angela
Burns: I have learnt more things that I never knew anything
about—. In your evidence that came to the committee,
you’re very, very clear that you think that the intimidate
procedures should be at an age of 18. We are having a bit of a
battle with the Minister who, for very good reasons, believes it
should be 16. Could you please just go through with some clarity
why the royal college believes it should be 18? Because, to be
frank, if we are going to shift her mind on this, we need to be
able to evidence why it should be 18, rather than 16, very
clearly.
|
11:00
|
[244] Dr
Williams: Yes. This comes, probably, from my own professional
background in working in sexual health. So, I’m a consultant
in sexual health, and I also work in a sexual assault referral
centre. My concerns, and our concerns, over the last few years are
that we are seeing a lot of vulnerable young women between the ages
of 16 up to the ages of 18 who don’t really have the maturity
to make some of the decisions that they’re being put through.
They’re, maybe not of their own choice, having things done,
and therefore we’re concerned about that vulnerable group.
So, it’s not necessarily the age, but it’s their
vulnerability as well—around child sexual exploitation,
around where this fits in with female genital mutilation. Also, I
was here earlier, and piercing isn’t necessarily reversible,
in the sense that it does leave a hole, and I have seen
some—and I won’t go into detail—significant
damage being done as a result of the piercing and the connotations
from the anatomy being changed. It’s practically
irreversible, or—you know, is regarded a very much major
reconfiguration of genital anatomy as a result. So, I’m not
quite as keen.
|
[245] So, we feel
that, in line with the 18, it would be much better, actually, to
have that as the cut off. I do hear the human rights, I do hear the
European convention on the rights of the child, and things like
that, but also I’m very aware that, as you’ve probably
found out, trends change over time, and individuals change, and
what you’re like at 15, 16, is not necessarily how you feel
at 25 and 26 about things as well. I am concerned that going for a
piercing of the genitals specifically at that age suggests other
things that are going on in life. It’s a very sexualised
thing to have done. What has happened to that 16-year-old up until
that age? I think, if it was to go to 16, I seriously do believe
that, as part of this, there would have to be very rigorous child
protection training and monitoring of the practitioners that are
registered to do this procedure.
|
[246] Angela
Burns: It’s very interesting, because we’ve had
evidence from the public protection teams who are saying that,
actually, good practitioners won’t do this kind of procedure
on anyone who is under 18. I’m interested in this whole
element of coercive control. I do think that we live in a very
sexualised society and there’s a lot of abuse that goes on
over the internet and pressures and all the rest, on boys as well
as girls.
|
[247] Dr
Williams: Oh yes.
|
[248] Angela
Burns: So, I would be really interested in any evidence or
anything that the royal college might be able to give us or add to
about your experience of the types of young people who come to you
for—well, you’re picking up the pieces, I guess,
afterwards of this. And anything about the psychology about it,
because I do think this is one area where—I mean, the whole
sex business is one area where young people are under immense
pressure to either conform or not to conform, and they’re
either the in-crowd or they’re the out-crowd, they’re
either one of them or not, and so on. It’s just absolutely
never-ending. So, you’ve added a dimension that I don’t
think we’ve really talked about before.
|
[249] Dr
Williams: That’s where, immediately I saw that 16, I
thought, ‘Oh, I’m spending most of my time, actually,
now reassessing the 16 to 18-year-olds that come to our clinic
around coercive control, CSE, all these things that actually are
sort of allowing people to do stuff at 16’. It’s also
what is the scope of this, as well, that concerns me. Can I
be—? Body hair: so, does this mean that a 16-year-old can go
and have electrolysis of all body hair in intimate places?
It’s not a piercing, but it’s a body modification and
it’s permanent. There are lots of things that it brings out
that, possibly, you know, you start thinking about. It’s not
a therapeutic procedure. Would we—? You know, if you then ask
a question about, ‘Right, if age of consent is 16, how do we
feel about breast augmentation in 16-year-old girls?’ They
can consent for it, but, actually, how many practitioners actually
will do it? We’re talking about experienced surgeons making
decisions who will probably put that person through a
psychological—you know, see a psychologist around is it going
to do more harm than damage. But what we’re talking about
here is a 16-year-old can walk into a high-street practitioner and
basically get on a bed and have his or her bits have something done
to them without anyone asking the question about what’s going
on in their lives, why they’re having it done, how their
psychology is at the time. And that is quite worrying.
|
[250] Angela
Burns: Gosh, I hadn’t even thought about that, because, I
guess, body hair removal is actually a very sexual—
|
[251] Dr
Williams: It’s a big thing at the moment.
|
[252] Angela
Burns: It’s a thing.
|
[253] Dr
Williams: Yes. I don’t see it any more.
|
[254] Angela
Burns: In that case, then, without going into sort of too many
details, probably, but are there obvious—? When we look at
the list of the four procedures that are exempted, would you want
to make a comment on the types of procedures, or is there—?
Do you feel, have a view, that a more catch-all phrase would be
better to protect the sub-18 and sub-16 ages?
|
[255] Dr
Williams: I think you probably need an overarching—. I
think the thing is you will always be caught out by something that
comes up and you haven’t thought about. So, an
overarching—. But is it piercing of skin and mucous
membranes, or permanent alteration to intimate areas? Because, you
know, although the thing is particularly about piercing, there are
other things that, you know, they—. If you think about
tattooing, where does electrolysis come between piercing and
tattooing? It’s not quite a piercing, but it is a procedure
that you might want to think about.
|
[256] Angela
Burns: I’m going to show my utter ignorance here, and
naivety, probably, but I kind of think that, if a young person goes
and gets a jewel in their belly button, that’s for fun, I
guess, you know, like pierced ears, all these things here and
something in your nose. So, I guess I hadn’t really thought
about what an intimate piercing might actually be like, and,
therefore, the question is: of the intimate piercings, would you
have a feel for what proportion of them are for fun—you know,
they’re liked because people just want to express their
personality—and what proportion of them are of a very sexual
nature? I’m probably saying that so badly, because, of
course, sex is fun, but I’m trying to—. Well, it used
to be, anyway, when I was younger. [Laughter.] I don’t
remember anything these days. [Laughter.] But do you see
what I’m trying to say? So, a 26-year-old going to have
something put on because it’s fun and it adds to their life
is fantastic, but I’m talking about the bits that are less
fun and perhaps are—.
|
[257] Dr
Williams: I mean, it is not a pleasant procedure.
|
[258] Angela
Burns: Why do I get this question every time?
[Laughter.]
|
[259] Dr
Williams: I was looking forward to this. [Laughter.] I
think what we’ve got to ask is that—. Most genital
piercings are to enhance pleasure. That is the purpose. They
don’t tend to be rebellion or things like that. So,
you’d ask the question why would someone at 16 be already in
that—where’ve they got that information from?
That’s the thing. By 18, they’re much more likely to be
a bit more worldly, they well might be in a relationship where that
is the norm within their cohort of people, but, coming up to 16,
where have they been for the last four or five years to learn that
that’s why they need, you know, their bits piercing?
|
[260] Angela
Burns: Thank you. You’ve encapsulated it very well. I
understand that now about rebellion or—.
|
[261] Dr
Williams: It’s that, you know—. And we do know that
there is a piercing movement among people, and a tattooing
movement, but it’s actually how people get into that. And
we’re talking, if you say they can do it at 16, they’ve
been thinking about it for a lot longer, and why have they been
thinking? So, I think the psychology behind this is as important to
understand as actually the public health remit.
|
[262] Angela
Burns: And if we had this legislation, if it was, say, at 16 or
even 18, there are obviously the younger people. Is there a
definition of a vulnerable adult? Because I guess you could argue
that a child who’s coming forward at 16 to have this done is
a ‘vulnerable adult’ anyway, but there’s also the
other kind of vulnerable adult.
|
[263] Dr
Williams: Yes. I think what we’ve got to look at is
learning disabilities, people with mental health issues, people
that have been—the coercion of those individuals and putting
in a capacity to consent to a procedure. There is that issue around
the capacity to consent, and is this something that is built into
the regulation of the operator? I listened earlier to who’s
got the competency. Well, I would never pierce or tattoo anyone. I
wouldn’t do that to their genitals even though I’ve
been a practitioner in that field for nearly 30 years now. So, the
fact that my title is ‘doctor’ doesn’t mean that
I’m competent. I worry that we’re saying that
individuals who’ve got that title—. Their colleges need
to make sure that there is a mechanism for doing that.
|
[264] The thing about
Botox and the dentist—yes, that’s great. Anyone can go
to a dentist—well, not anyone—and actually set up Botox
because they’re licensed to prescribe Botox as a dentist.
It’s usually not them that does it; they usually get someone
else in, who may have the title ‘nurse’, to do it on
their premises, but they’re licensed. It’s
understanding that people will get through these loopholes because
1) it makes money and 2) there’s a demand, and that’s
the thing.
|
[265] Angela
Burns: There are a lot of companies out there that offer all
sorts of procedures and they fly under the medical banner.
|
[266] Dr
Williams: It might be interesting to actually have a discussion
with the British College of Aesthetic Medicine as well, because
they control the plastic surgery and body-alteration areas, so
they’re, sort of, on that fine line as well. They might have
an opinion on this.
|
[267] Angela
Burns: Thank you. I think, in fact, you’ve
answered—. My other question was going to be about the
exemptions, because I can’t understand why a dentist can do
it but a physiotherapist can’t or whatever, because
they’re all deemed to be professions. So, would you advocate
that, whoever you are, whether you’re going to train at 20 to
do this as a career or whether you are a professional that’s
decided to take a side step into a new area, actually you should be
regulated and licensed as that individual and competent to do
that?
|
[268] Dr
Williams: Yes. Because I’m a registered doctor,
I’ve got an area of competency, I meet the GMC—. I
mean, you probably are covered if you were doing this practice.
You’d be covered with your annual appraisal and your
revalidation, and you’d need your medical protection to cover
you for that sort of work, and it would probably be done outside
your NHS remit, but the thing is, what it means at the moment is
that anyone who’s a qualified doctor can set themselves up.
So, there does need to be that regulation as well.
|
[269] Angela
Burns: That’s the end of my questions to you, except
perhaps to say that this is your speciality subject, it is an area
in which I’m woefully ignorant, so if there’s anything
you feel I should have asked you on the subject in this particular
area, please feel free to say if you think I’ve missed a
question.
|
[270] Dr
Williams: If there’s something that comes to mind, can I
write to you and give written evidence through the Chair?
|
[271] Angela
Burns: Please. Thank you very much.
|
[272] Dai
Lloyd: Before we leave this, there’s a question from Dawn
and then from Lynne.
|
[273] Dawn
Bowden: Yes, just for some clarity actually, because obviously
the Bill covers all piercings. So, ear piercing, you know, which
is—
|
[274] Dr
Williams: No, it doesn’t cover that. Ear piercing is not
covered; it’s the intimate piercing. I don’t think the
belly button is—
|
[275] Dawn
Bowden: Intimate piercing, sorry. It covers things—.
Sorry, what I should have been saying then is it covers things
other than genital piercings. So, are you saying, just so that
I’m clear, that your concern is really just the genital
piercing and that that would be the area that you would be
suggesting shouldn’t be done at 16, but that other piercings
that are covered are not such a concern?
|
[276] Dr
Williams: They’re not such a concern, but I think, for
ease of legislation, it should all be the same. Everything should
be the same with one age for everything.
|
[277] Dawn
Bowden: If it’s covered by the Bill, that age
group—okay, that’s fine.
|
[278] Dr
Williams: The alternative is, you bring everything down to
16—so tattooing goes to 16, that sort of stuff. I think it
should, personally, and I think the college agrees—
|
[279] Dawn
Bowden: But your specific concern is about genital
piercing.
|
[280] Dr
Williams: Although, the breasts are intimate, so it also
depends what happens at that point as well.
|
[281] Dawn
Bowden: Sure, I understand. That’s fine. Thank you,
Chair.
|
[282] Dai
Lloyd: Lynne.
|
[283]
Lynne Neagle: I don’t know whether you heard the discussion
that we had in the previous session with the Minister about who
should be excluded from these kind of things and the discussion
that we had about people who had a
record of sexual offences.
|
11:15
|
[284] One of the
officials said that the purpose of this legislation, by the
exclusions, is actually to make sure that people can administer the
procedures in a safe and hygienic way. She said this wasn’t a
safeguarding issue, which rang some alarm bells for me really. I
just wanted to get your comments on that.
|
[285] Dr
Williams: My comments on that are that—I was in the
gallery—I was concerned about that because there have to be
some safeguards, even more so with what we’ve been hearing
with people in a position of power and authority in all sorts of
areas. I think they need to be realistic. We’re very aware
that, in Wales, we do have issues around coercion and exploitation
and where this leads to. I think, possibly, we could be
short-sighted in not taking safeguarding on board here.
|
[286] Lynne
Neagle: Thank you.
|
[287] Dr
Williams: Can I just address intimate tattooing? There has been
some evidence from some of the child sexual exploitation work done
with gangs in England around tattooing of intimate places of girls,
and that branding then stays with them for life as a sort of mark
of being kind of—
|
[288] Dai
Lloyd: Property.
|
[289] Dr
Williams: Yes. I think we have to think about the wider bit of
this, and that’s in the last five years.
|
[290] Angela
Burns: You’ve brought in a dimension that we perhaps
haven’t quite got our heads around. Jayne chairs the
cross-party group on child sexual abuse and stuff like that.
|
[291] Jayne
Bryant: I’m really pleased that you’ve been here to
make these points today because, as Angela said, and Lynne
previously, I was concerned when it was said by the official about
it not being a safeguarding issue. For me, it has to be. As Angela
said, you’ve brought an aspect that we definitely should be
thinking of and that we haven’t heard evidence on before. So,
I’m personally very grateful that you’ve brought that
to us today, so, thank you. As Angela says, if there’s
anything that you think we should be raising, and even the
issue—sorry, Chair—
|
[292] Dai
Lloyd: No, carry on.
|
[293] Jayne
Bryant:—about hair removal. That’s something that I
hadn’t thought of and that is a growing issue and is a trend
at the moment, and I think that has to be thought of.
|
[294] Dr
Williams: Coming back, obviously, my passion as well is young
people, but the smoking, the tattooing, the piercing, the lack of
hair—they all seem to me to be a trigger. If I see a young
girl who smokes, I am really worried about what else she’s
doing. It is one of those things that we need to think about around
their risk-taking behaviour. With all young adolescents who do
that, you usually find the other things follow and it’s
actually about supporting them as well. So, there is a protection
around a lot of things that you’re discussing in this Bill
that really needs to be focused on in terms of targeting the early
years—the 11 to 13-year-olds.
|
[295] Angela
Burns: You recommended perhaps talking to the—
|
[296] Dr
Williams: The British College of Aesthetic Medicine.
|
[297] Angela
Burns: Do you think it will be beneficial, or is there anybody
we might also approach, to talk about the psychology behind all
this because that’s an element that we might want to
investigate, Chair?
|
[298] Dai
Lloyd: There are timing issues, but—
|
[299] Dr
Williams: Maybe they would come to you personally. I’ll
have a think about that.
|
[300] Dai
Lloyd: Moving on, Jayne, you’ve got the floor now as
regards health impact assessments. You’re on a roll.
[Laughter.]
|
[301] Jayne
Bryant: You said to come back in, earlier. You mentioned health
impact assessments and the importance of creating a social movement
and changing attitudes. On the written evidence that you’ve
provided, you’ve welcomed the health impact assessment, but
you’ve also warned against the prospect of it becoming a
box-ticking exercise. Do you think there needs to be any
strengthening in this area at all?
|
[302] Dr
Williams: Not particularly. I think the challenge is delivering
it and making sure that there are enough resources supporting all
the partners in actually doing it, and also making sure that there
is co-production happening. I think that, you know, we are now
having that co-production movement in Wales, but it’s
actually making sure that there’s that drive, you know, that
network that is there, pushing the buttons to say that you’ve
got to do this and you’ve got to do it properly. You know, I
think that we are sometimes short-sighted; we plan for five years,
not 10, not 15, and we’re certainly not looking towards my
eightieth birthday. Well, actually, I’m going to be one of
the highest numbers of 80-year-olds ever alive.
|
[303] Jayne
Bryant: Wow, that’s—
|
[304] Dr
Williams: Yes, 1959 has the highest birth rate and the highest
surviving number of individuals, so, you know, you put that into
context, it makes—.
|
[305] Jayne
Bryant: Yes, definitely. Thanks very much for that.
|
[306]
Dai Lloyd: Symudwn ni ymlaen i’r adran nesaf,
asesiadau fferyllol, ac mae Lynne Neagle yn mynd i ofyn y
cwestiynau yna.
|
Dai Lloyd: Moving on to the next
section, pharmaceutical assessments, and Lynne Neagle will ask the
questions.
|
[307] Lynne
Neagle: Okay. Thank you. You didn’t make any specific
reference to these provisions, and I just wanted to ask whether
there are any things that you want to bring to the
committee’s attention.
|
[308] Dr
Williams: No, not at the moment.
|
[309] Lynne
Neagle: You don’t see any particular potential for the
Bill to actually address some of the concerns that you’ve
raised in other aspects?
|
[310] Dr
Williams: Probably strengthening of the availability of the
community-based smoking cessation. We would welcome that, you know,
to make sure that—. I mean, I know that it’s already
there, but it’s actually promoting it and the facilities that
our pharmacies have and our dispensing GP pharmacies have, so that
their dispensing pharmacists can actually engage in that sort of
activity.
|
[311] Lynne
Neagle: And what about the young people side of things, because
you obviously feel very strongly about that?
|
[312] Dr
Williams: Well, I think that is something that we really do
need to address, and that could be multipronged. But, you know, the
way to young people is not necessarily through conventional
mechanisms; its social media, it’s where they hang out, and,
actually, do we look to a different way of actually guiding them
into going to their chemist or going to—? I mean, they
certainly don’t go to their GPs very often. But, also,
agencies like my own, who actually see young people, have more than
one health remit.
|
[313] Lynne
Neagle: Thank you.
|
[314]
Dai Lloyd: Diolch yn fawr. A’r adran olaf ydy
toiledau cyhoeddus. Caroline.
|
Dai Lloyd: Thank you very much. And the
final section is the provision of public toilets. Caroline.
|
[315] Caroline
Jones: I was wondering if you’d like to comment generally
on the provision.
|
[316] Dr
Williams: We fully support the need for toilets. I mean,
obviously, it’s not just about the disability; it’s
about the faecal and urine incontinence. I think it’s just a
no-brainer, and our college supports that they need to do—.
You know, you could have the ‘toilet app of Wales’,
couldn’t you, so that you actually have the locations, the
opening times, that people can download? Because I’m very
aware that all groups of individuals will know where their toilets
are, but, actually, they might be a bit taken aback when
they’re closed for whatever reason.
|
[317] I do believe
that they need to be secure environments as well, with proper
lighting, proper access, that they’re visible, and with the
possibility of CCTV available around the areas. We are aware that
other activities are carried out in public toilets, and we need to
make sure that the people that want/need to use them for the right
mechanism get to use them.
|
[318] Caroline
Jones: So, do you think that it’s not sort of recognised
enough how important it is to people’s lives to be able to
access a toilet?
|
[319] Dr
Williams: Yes.
|
[320] Caroline
Jones: It makes a difference, doesn’t it, to people with,
say, incontinence, of going out and doing their daily duties or
not, really?
|
[321] Dr
Williams: I think it’s for everybody. You know, every
woman who’s been pregnant knows that she knows for nine
months where the toilets are in her area. So, it’s not an
issue just for those other individuals, but it’s also being
able to take the buggy in, that the toilets are clean—
|
[322] Caroline
Jones: Yes, the practicalities that have to be taken. Thank you
very much.
|
[323] Dr
Williams: You’re welcome.
|
[324]
Dai Lloyd: Diolch yn fawr. Dyna ddiwedd y sesiwn. Mae wedi
bod yn drawiadol, ac mae nifer ohonom ni, yn amlwg, wedi dysgu
llawer, ac mae Angela wedi ychwanegu at ei harbenigedd yn y maes,
yn amlwg. Felly, dyna’r sesiwn ar ben. Diolch yn fawr i chi
am eich cyfraniad ac am eich presenoldeb. Fe allaf i gyhoeddi y
cewch chi drawsgrifiad o’r cyfarfod yma i’w wirio fe i
wneud yn siŵr ei fod yn ffeithiol gywir. Ond, gyda hynny o
eiriau, a gaf i ddiolch yn fawr iawn i chi unwaith eto?
|
Dai Lloyd: Thank you very much. That's
the end of the session. It's been striking, and a number of us,
clearly, have learned a lot, and Angela has added to her expertise
in this area, clearly. So, that's the end of the session. Thank you
for your contribution and for your attendance. You will receive a
transcript of this meeting to check the factual accuracy. But, with
those few words, I'd like to thank you once more.
|
[325]
Dr Williams:
Diolch yn fawr iawn i chi.
|
Dr Williams: Thank you very much.
|
[326] Thank you very
much, Chair.
|
[327]
Dai Lloyd: Ac a gaf i gyhoeddi i’r Aelodau y cawn ni
egwyl fer rŵan am 10 munud, gan ddod yn ôl wedyn am
sesiwn dystiolaeth olaf y bore?
|
Dai Lloyd: And may I say to the Members
that we'll have a short break for 10 minutes and come back for the
last evidence session of the morning?
|
Gohiriwyd y cyfarfod rhwng 11:25 a
11:36. The meeting adjourned between 11:25 and
11:36.
|
Bil Iechyd y Cyhoedd
(Cymru): Cyfnod 1—Sesiwn Dystiolaeth 9—ASH
Cymru
Public Health (Wales) Bill: Stage 1—Evidence Session
9—ASH Wales
|
[328]
Dai Lloyd: Croeso yn ôl i sesiwn ddiweddaraf y
Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn y Cynulliad.
O dan eitem 4, rydym yn parhau efo’n craffu ar Fil Iechyd y
Cyhoedd (Cymru), Cyfnod 1. Byddwch yn ymwybodol ein bod wedi cael
nifer o sesiynau tystiolaeth i fyny at rŵan; hwn, yn wir, yw
sesiwn dystiolaeth rhif 9. Mae ein tystion o ASH Cymru gerbron, ac
felly hoffwn groesawu Suzanne Cass, prif weithredwr ASH Cymru, a
hefyd Dr Steven Macey, swyddog ymchwil a pholisi ASH Cymru.
Mae’r Aelodau wedi darllen y dystiolaeth ysgrifenedig, ac yn
ôl ein traddodiad rŵan, byddwn yn symud yn syth i mewn i
gwestiynau, gyda’ch caniatâd, ac felly dyna beth y
gwnawn ni. Yn naturiol, mae yna nifer o agweddau i Fil iechyd y
cyhoedd, ond chi sydd yma, ac rydym yn mynd i ddechrau, felly, gyda
mangreoedd di-fwg a’r holl agenda ysmygu. Felly, Lynne Neagle.
|
Dai Lloyd: Welcome back to the latest
session of the Health, Social Care and Sport Committee here at the
National Assembly. Under item 4, we will continue our scrutiny of
the Public Health (Wales) Bill, Stage 1. You will be aware that we
have had a number of evidence sessions up until this point; this,
indeed, is evidence session 9. Our witnesses from ASH Wales are
before us, and I would therefor like to welcome Suzanne Cass, ASH
Wales chief executive, and Dr Steven Macey, ASH Wales research and
policy officer. The Members have read the written evidence, and in
accordance with our traditions, we will move straight to questions,
with your permission, and therefore that is what we will do.
Naturally, there are a number of aspects to the public health Bill,
but you are here, and so we will start with smoke-free premises and
the whole smoking agenda. Therefore, Lynne Neagle.
|
[329]
Lynne Neagle: Thanks, Chair. You are strongly in support of the
extension of smoking restrictions in Wales. Can I just go into that
in a bit more detail? One of the areas covered would be school
grounds, which would be primary and secondary schools. How
confident are you that that goes far enough to protect children,
because it doesn’t include things like day nurseries,
child-care settings et cetera?
|
[330]
Dr Macey: I think, ideally, we would like them to include those
additional settings that you mentioned there. Also, school gates
are another area where, if smoking is to be banned on the school
grounds, being able to distinguish whether the school gate is in
the grounds or not can be a bit confusing. It might also diminish
the impact of the actual denormalisation that’s taking place
if children can still see smoking at the school gate, sort of
thing. So, with school gates and the other settings that you
mentioned there, we’d be in favour of the ban being extended
to those areas—yes, definitely.
|
[331]
Lynne Neagle: Would you go further then than school gates and, say,
include the areas around the perimeter of the school generally, or
are you just saying school gates?
|
[332]
Ms Cass: Well, we think that, actually, when you look at the
rationale behind the legislation as it stands, the rationale would
extend it to the perimeters of the schools as well. Because if you
are looking to denormalise smoking as a normal habit and to ensure
that children see less smoking in the world around them, that is
actually a key area of where children are and where children see
this activity.
|
[333]
Lynne Neagle: Okay, thank you. What about playgrounds? At the
moment, ‘playgrounds’ would just be ones with play
equipment in—you know, the enclosed type. Would about things
like areas where children play, like playing fields and what have
you? What’s your view on whether the Bill is strong enough on
that?
|
[334] Dr Macey: I
think, again, we’d like to see the Bill include those
additional areas where children congregate: you know, around the
playground, the playing fields, the sports grounds and areas like
that—even beaches, perhaps—where children do attend and
go to on a regular basis. You know, in terms of, again,
enforcing the ban, if it’s just in the playground, what
actually counts as a playground? Are they including skate parks and
things like that? So, it would be a bit clearer if the Bill
specified any areas around the playground, like you say, playing
fields, sports grounds and all those types of facilities where
children congregate. I think we’d be in favour of that being
included in the Bill as well.
|
[335] Lynne
Neagle: Okay, thank you. And in terms of hospitals, are you
satisfied that the right balance is struck? Obviously, hospitals do
have lots of people who are under a lot of stress and might be
having a difficult time. Are you satisfied that the right balance
is struck there with what’s being proposed? Do you think the
balance is right with the rights of visitors, patients, et
cetera?
|
[336] Ms Cass:
We’d like to see a blanket ban of smoking in hospitals. We
think that there should be no shelters provided for smokers. Our
view on this is that we know that 70 per cent of smokers want to
give up smoking. We know that stopping smoking makes the stay in
hospital shorter, patient recovery quicker, and that we’ve
introduced—. We know that the smoking ban in prisons, for
example, has worked and is working, and that when you
compare—. I’m not saying that we compare hospitals to
prisons, but there is a similar kind of experience in the fact that
they’re in an enclosed space and they’re unable to get
out. So, providing the correct cessation support is really
important, making sure that there’s nicotine replacement
therapy available for those who have that addiction and need that
support. But I think, in our opinion, if you’re going to send
an unambiguous message that smoking is not accepted behaviour
within the NHS premises—. We believe that smoking should be
banned in hospital grounds across the board.
|
[337] Lynne
Neagle: Okay. And I’m guessing that your answer, then, to
the question of whether you think that this should be extended to
other NHS premises, such as GPs practices et cetera, is going to be
‘yes’.
|
[338] Dr Macey:
Yes.
|
[339] Ms Cass:
Absolutely.
|
[340] Lynne
Neagle: Okay. And what about other outdoor areas then, like
cafes et cetera? The Bill doesn’t cover those.
‘Yes’?
|
[341] Dr Macey:
Yes, we’d be in favour of that as well. I think, particularly
thinking of cafes and places like that, with outdoor seating areas,
they’re often located very close to the cafe itself. If
windows are open, doors are open, smoke drifts and goes into the
actual premise itself. So, in terms of the second-hand smoke issue,
and also, the denormalisation of smoking and that agenda, then I
think we’d be in favour of outdoor cafe and restaurant areas
being smoke free.
|
[342] Lynne
Neagle: Okay, thank you. And just one final question: your
evidence the last time around with the Bill was very key in
changing the committee’s view on the whole e-cigarette
debate, but you’ve referred a few times to the dangers of
normalising smoking. I’m guessing that your primary concern
with e-cigarettes would still be the gateway into smoking, but have
you got any concerns at all that tobacco will be banned in all
these places, but people will still be able to use e-cigarettes in
all these areas where particularly children are present?
|
[343] Ms Cass:
When it comes to e-cigarettes, our stance on e-cigarettes is that
they are being used now as the No. 1 cessation tool. So, we need to
ensure that smokers have access to this product and can use this
product and are aware of the health benefits of this product in
order to help them to give up smoking. We’re very mindful of
the fact the way that e-cigarettes are marketed and ensuring that
actually they’re not seen as a product to be used by
children. So, when it comes to the normalisation of e-cigarettes
and tobacco products, we think that children—the evidence
that we’ve got so far is that children can distinguish
between an e-cigarette and a tobacco product. So, as far as the
normalisation of using e-cigarettes to normalise smoking is
concerned, there is a distinction between the two products.
|
[344] Lynne
Neagle: So, your position is basically exactly the same as it
was last time around, then, on e-cigarettes?
|
[345] Ms Cass:
Yes.
|
[346] Lynne
Neagle: Okay, thank you.
|
11:45
|
[347] Dai
Lloyd: Could I just probe that a little bit further in terms
of—? Nobody’s talking about banning e-cigarettes as
such, only banning their use—well, making them subject to the
same qualifications as normal cigarettes, really. And there’s
no such consideration about other nicotine-replacement products,
like gums and tablets, for instance. The commercial imperative of
the large tobacco companies is behind vaping and e-cigarettes. We
take the point that, yes, it’s a tool, one of many, to help
you stop smoking, but nobody’s talking about banning
e-cigarettes in totality, we’re just talking about
restricting them, like we would normal cigarettes, because, at the
end of the day, 19 per cent of people in Wales smoke at the moment,
so if we’re saying that e-cigarettes are fine, even though
they contain nicotine to varying amounts that we don’t
know—and nicotine is one of the most addictive substances
known to man or woman—you’re in favour, then, of
potentially the 80 per cent of people who are not smokers being
subject to a decision by others to be in touch with nicotine, not
the decision they’ve taken themselves not to be in touch with
nicotine. You say the rights of the 19 per cent, then, should
override the decision of the 81 per cent to have free fresh
air.
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[348] Dr Macey:
We’re continually reviewing the evidence on e-cigarettes, so
it is something that we’re continually reviewing, and from
all the evidence that I’ve seen personally, there is no
evidence that there is any harm from a bystander breathing in
nicotine vapour. So, it’s getting that right balance and
supporting smokers to give up that habit of tobacco. I understand
you’re saying that you’re not proposing a complete ban
on e-cigarettes, but even just bringing them into line with tobacco
cigarettes gives that message that they are the same thing, they
are the same product, when they are not. E-cigarettes, from all the
evidence out there, have been found to be a lot less harmful than
tobacco cigarettes. So, we’re very keen to get that message
across: that e-cigarettes should only be used as a cessation tool,
not for recreational purposes. Clouding the message, as such, to
bring them into line with tobacco cigarettes, is not something that
we’d be in favour of as an organisation.
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[349] Dai
Lloyd: Dawn.
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[350] Dawn
Bowden: Thank you, Chair. It is quite clear, isn’t it,
that vaping and e-cigarettes are not actually just used as smoking
cessation tools—they are being marketed now as a recreational
pastime in their own right? You see the vape shops and how
attractive they are, and all that kind of thing. Have you got any
evidence to suggest that people are taking up vaping who have never
smoked? Because, as Dai has said, it’s a hugely addictive
thing, nicotine, and so, even though you haven’t got the
by-product of the tar and the potential for cancers and that sort
of thing, you do nevertheless have the potential for nicotine
addiction by starting with them, even if you’ve never smoked.
So, do you have any evidence around that at all?
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[351] Dr Macey:
Yes, and all the evidence that we do have suggests that very, very
few non-smokers are regularly using e-cigarettes. So, there might
be non-smokers who are trying e-cigarettes once or twice, but
regular use among non-smokers is very rare, and they are most
frequently used by smokers. So, that’s the evidence that
we’ve got at the moment. But, like you said, it is an
evolving issue, and it’s something that we’re
monitoring all the time as an organisation; we’re continually
looking at the evidence on this. So, it’s something that
we’re keeping on top of.
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[352] Dawn
Bowden: Okay, right. Thank you.
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[353] Ms Cass:
I think we need to be mindful and we need to make sure that we
don’t lose sight of the fact that e-cigarettes are the No. 1
go-to nicotine-replacement therapy for people who are trying to
give up smoking. So, they now are the go-to product for people who
are trying to stop smoking. We’re also very mindful of the
fact we’ve got new regulations coming into play with regard
to the content of e-cigarettes and how they’re sold. So,
we’re welcoming that level of regulation around this product.
We obviously don’t want to see this product being marketed to
young people, but we do want to ensure that the public understand
that, actually, as a harm-reduction tool and a cessation tool, this
could help them to give up smoking. Actually, we feel as an
organisation that that message, due to the evidence that is being
thrown around about e-cigarettes, is being lost, and the evidence
that we’ve found is that people are increasingly believing
that e-cigarettes are as harmful as cigarettes. So, the
understanding amongst the public is somewhat skewed, and we need to
ensure that, actually, e-cigarettes are seen as a cessation tool,
and a viable cessation tool, for smokers.
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[354] Dai
Lloyd: I think we’d agree with that, and nobody’s
disputing the fact of their role in smoking cessation. So, treat
them like any other smoking cessation drug then, because
that’s what nicotine is, and register them, medicalise them,
if you like, on prescription, just like all the other smoking
cessation tools that we have now: the patches, the gums, the
tablets, the varenicline, the Champix, all the rest of it. So,
there’s a job of work to be done there, because with my
doctor’s hat on, we do view with suspicion something that the
large tobacco companies are involved in promoting, and blurring the
margins between e-cigarettes and proper tobacco. But that’s a
debate for another day, I suspect.
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[355] Still on
tobacco, though, we’re moving on to tobacco retailers and
Caroline.
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[356] Caroline
Jones: Yes, we are. Thank you, Chair. What would the benefits
be of ASH’s suggestion that there should be a separate
register for tobacco and nicotine products?
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[357] Ms Carr:
We’re really keen that the two products are seen as two
separate entities, and we want to ensure, when you’re sending
out messages regarding tobacco products, that they hit the right
market, and actually, when you’re sending out messages about
e-cigarettes, that they hit the right market too. We would look for
assurances that, within the retail register as it stands, you would
be able to distinguish between those that sell tobacco products and
those that, as you say, are vaping shops that are set up separately
and are just selling e-cigarettes or vaping materials. So,
we’d be keen to ensure that those two are seen as separate
entities and have different messages going out to them.
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[358] Caroline
Jones: Okay. Thank you. And what do we know from the experience
of operating a register in Scotland? What knowledge have we gained
there? Are there ways in which the Bill could be strengthened in
the area of compliance and enforcement?
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[359] Dr Macey:
In Scotland they’ve had the register there since 2011, I
think. Since that time they’ve averaged, I think, one or two
retailers being removed from the register a year. So there have
only been five or six since it actually began. So, I think, from an
enforcement point of view, we’ve got a fair bit to learn from
Scotland. It’s been very successful in terms of communication
and in terms of getting the message out to retailers about trading
standards and the messages that they’ve got, and also in
terms of knowing where retailers are, which is handy in terms of
knowing whether they approach the schools, and things like that.
But I think in terms of enforcement and compliance, I certainly
think there need to be sufficient teeth to this register to ensure
that the deterrent is there for the retailers not to infringe
against the law. So, I think at the moment the policy is that if
there have been three offences within three years, you get removed
from the register. We would like to see just one offence and then
you get removed from the register. It’s such an important and
dangerous product, tobacco, that just one infringement against the
law, you’d get removed from the register. So, we’d like
to see that potentially added into the register as it stands at the
moment.
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[360] Ms Cass:
And actually Scotland are reviewing that retail register at the
moment, and one of the things that they’re calling for in
there is to come up with this one-strike policy.
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[361] Caroline
Jones: Can I just ask one further question? You mentioned that
it has been a success in prisons, the smoking ban, and I accept
that, but how do you measure success? What sort of tools were given
inside the prisons? Because when a prisoner is locked up for 90 per
cent of his time, frustration builds. Have you looked at the
incident levels? Have the incident levels risen—you know,
prisoner on staff, prisoner on prisoner, and so on and so forth,
and the incidence of self-harm? Have you looked at the whole
picture? Thank you.
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[362] Dr Macey:
We haven’t had any reports. We’ve been working with
NOMS on this—the National Offenders Management Service. We
haven’t had any reports that there has been any major
backlash or anything like that in terms of the smoking ban coming
into place in prisons, from what we’re aware of. In terms of
the success, it has been introduced and all prisons are now
smoke-free, and it shows that it can be done. So, it’s
obviously something that we’ll continue monitoring.
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[363] Caroline
Jones: Have you looked at the incident levels?
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[364] Ms Cass:
As far as the introduction of the ban was concerned, there were two
important aspects to that. There was the cessation support that was
offered within the prison service and for those who were coming
in—
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[365] Caroline
Jones: Yes, but with a revolving door, that would be very
difficult, wouldn’t it?
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[366] Ms Cass:
Yes. And then, also what was important was the fact that they were
offered nicotine replacement therapy, and e-cigarettes were being
sold within the prisons as well. So, there was a number of options
for them. As far as the incidents are concerned, we’ve had no
reports of any further incidents with regard to the ban.
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[367] Caroline
Jones: Okay. Thank you.
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[368]
Dai Lloyd: Mae’r ddau gwestiwn olaf y bore yma,
felly, o dan law Jayne Bryant.
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Dai Lloyd: The final two questions this
morning, then, are from Jayne Bryant.
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[369] Jayne
Bryant: You’re supportive of the proposals to prohibit
the handing of tobacco products and nicotine products to people
under the age of 18. Do you have any further comments you’d
like to add to that?
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[370] Dr Macey:
I just think that it follows on, really, with the whole age of sale
restrictions and things like that, and the fact that we don’t
want people under the age of 18 having easy access to tobacco. So,
if you have a way of restricting that, I think it’s a good
thing. We’re very much in favour of that measure.
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[371] Jayne
Bryant: Thank you. The British Lung Foundation suggested that
the Bill should include statutory targets for reducing smoking
prevalence, for example. What’s your view on that and, also,
do you think there are other tobacco control measures that should
be considered within this Bill?
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[372] Dr Macey:
Yes. We’d be very much in favour of statutory targets being
put in, and also maybe more specific targets being put into the
tobacco control action plan for Wales. There is an overarching
target of 16 per cent smoking prevalence by 2020. We would possibly
like to see some more specific targets looking at particular
sub-groups of the population where smoking is a lot higher. So,
maybe, in more deprived communities, people with mental illnesses,
perhaps, and smoking among those who are pregnant. Those are all
areas where smoking is a lot higher. So, although the overall
smoking prevalence might be falling, in those certain sub-groups of
the population, it’s either stagnant or reducing a lot less.
So, more targeted targets, then, are perhaps what we’d like
to see included.
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[373] The second part
of the question, then, was any other tobacco control
policies—
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[374] Jayne
Bryant: Yes.
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[375] Dr Macey:
Illegal tobacco, for instance, that’s not mentioned at all in
the Bill, but I know that’s being tackled with the illegal
tobacco task and finish group that the Welsh Government has set up.
Illegal tobacco is always an item on our agenda. Is there anything
else, Suzanne?
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[376] Ms Cass:
I think we’ve covered it in the extension of the smoke-free
spaces. We’d like to see beaches included, we’d like to
see school gates included and parks. We’d like to see that,
wherever children gather—family attractions, you
know—and wherever they are, we’d like there to be
smoking bans in those places to ensure that we de-normalise smoking
and that children see less smoking in the world around them, and
that we can really hammer home the fact that passive smoking is an
issue and still accounts for 9,000 hospital admissions in children
in the UK every single year. So, passive smoking is an issue,
smoking in the home is still an issue, and we hope that the
legislation that is proposed and maybe the additional things that
we’ve asked for will help to address those issues.
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[377] Dr Macey:
The additional things that we’re calling for—and
we’re not sure whether they could be included in this
particular Bill—are things like smoking cessation, and to
make sure that they are sufficiently funded and that that funding
is protected. Other campaigns we’re looking at are things
like smoking in the home and making sure that people are educated
that smoking in the home is not good for the children living in the
home and that smoking needs to be taken outside and things like
that. So, maybe a public awareness campaign or some mass media
around smoking in the home and things like that. But we’re
not sure whether that is to be included in this Bill.
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12:00
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[378] Ms Cass:
And tackling illegal tobacco is a real issue for us in Wales. We
commissioned a report back in 2014 that found that the illegal
tobacco market in Wales stands at 15 per cent. It’s the
highest of any UK region. We’ve got the highest level of
illegal tobacco in the UK, so we’re working on that,
we’re working on a task and finish group to address those
issues, but we hope that the measures being put forward in the Bill
with regard to the premises restriction orders and the retail
register will help us to tackle this issue. So, we’re very
keen that the premises restriction orders include as many offences
as possible, to make sure that those who are selling illegal
tobacco or selling to under-age children are prosecuted.
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[379] Dr Macey:
And also maybe for the retail register to include not just those
retailers at the street level, but further up the supply chains to
the manufacturer, so the whole supply chain is included in that
retail register. That is certainly something that we’d be
supportive of, to make sure that the whole supply chain is
accounted for. Because, obviously, the illegal tobacco is just at
the retailers, just at the sharp end, as such, when really it goes
back a lot further. So, any attempt to tackle that would be
welcome.
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[380] Ms Cass:
The evidence that we’ve got around that is that 19 per cent
of illegal tobacco is being sold in shops and premises. So, illegal
tobacco is being sold at that level, so it is an issue and
it’s something that we can make a difference to, and
we’re hoping that this legislation will go some way to doing
that.
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[381]
Dai Lloyd: Grêt, diolch yn fawr iawn ichi. Dyna
ddiwedd y sesiwn cymryd tystiolaeth. A allaf ddiolch i Suzanne Cass
a Dr Steven Macey am eu presenoldeb ac am eu tystiolaeth y bore
yma? Diolch yn fawr iawn ichi. Fe fyddwn ni yn gyrru trawsgrifiad
o’r cyfarfod yma atoch er mwyn ichi ei wirio i fod yn
ffeithiol gywir, ac fel ein bod ni ddim yn eich camddyfynnu chi o
gwbl. Felly, diolch yn fawr iawn i chi am eich
presenoldeb.
|
Dai Lloyd: Great, thank you very much.
That’s the end of the evidence-taking session. May I thank
Suzanne Cass and Dr Steven Macey for attending today and for their
evidence this morning? Thank you very much. We will be sending you
a transcript of this meeting so that you can check it for factual
accuracy and that we haven’t misquoted you at all. So, thank
you very much for your attendance.
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12:02
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Papurau i’w
Nodi
Papers to Note
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[382]
Dai Lloyd: Fe wnawn ni droi at eitem 5 nawr, papurau
i’w nodi. Fe fydd Aelodau wedi darllen y pedwar llythyr, a
dim ond materion i’w nodi yw’r rhain, cyn i ni fynd i
eitem 6.
|
Dai
Lloyd: We’ll turn to
item 5 now and papers note. Members will have read the four
letters, and these are only matters to note before we go to item
6.
|
Cynnig o dan Reol
Sefydlog 17.42 i Benderfynu Gwahardd y Cyhoedd Motion
under Standing Order 17.42 to Resolve to Exclude the Public
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Cynnig:
|
Motion:
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bod y
pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y
cyfarfod ac o’r
cyfarfod ar 23 Tachwedd yn unol â Rheol Sefydlog 17.42(vi).
|
that the committee resolves to exclude the
public from the remainder of the meeting and from the
meeting on 23 November in accordance with Standing Order
17.42(vi).
|
[383]
Dai Lloyd: Rydw i’n cynnig o dan Reol Sefydlog 17.42
i benderfynu gwahardd y cyhoedd o weddill y cyfarfod ac fe fyddwn
ni’n symud i fewn i sesiwn breifat i ddygymod efo’r
dystiolaeth rydym ni wedi’i dderbyn y bore yma. Diolch yn
fawr iawn i chi.
|
Dai Lloyd: I move a motion under
Standing Orders 17.42 to resolve to exclude the public from the
remainder of the meeting, and we'll move into private session to
consider the evidence we have received this morning. Thank you very
much.
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Derbyniwyd y cynnig.
Motion agreed.
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Daeth rhan gyhoeddus y cyfarfod i ben am
12:02.
The public part of the meeting ended at 12:02.
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