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Commentary from Westminster

FROM A CORRESPONDENT

No Smoking in the Queen’s SpeechTHE Queen’s Speech last week, announcing the Gov-

ernment’s new legislative programme, was notable morefor its omissions than its contents. The massive devolu-tion Bill which will dominate the coming session meansthat a host of other measures have to be shelved, amongthem action on the Briggs Report on nursing, publishedmore than four years ago. Although lack of time was thereason for the postponement of many Bills, this was notso for legislation on smoking, which has long been pro-mised by the Government. Here the Government hasdeliberately drawn back from a legal confrontation withthe tobacco industry. Public comment by the Govern-ment has been confined to one sentence in the PrimeMinister’s Commons speech last week: "We intend in1977-78 to legislate on smoking and health, there beinga particular need to divorce to some extent the provi-sions on smoking from the financial machinery thatChancellors of the Exchequer have used in the past andto transfer them to the Medicines Act".

The Government’s original intention, first announcedto Parliament earlier this year, was to lay an Order un-der the Medicines Act to control the new synthetic cigar-ettes now being tested. This would have given the Gov-ernment statutory powers to license the use of tobaccosubstitutes and additives and would have represented atough new approach to smoking. But, since then, thetobacco industry has proved itself rather tougher thanthe Government. Several companies took legal opinionand were advised that an Order under the Medicines Actwould be "ultra vires" and would leave the Government

open to action in the courts on the grounds that the Actwas never intended for controlling the contents of cigar-ettes. At first the Government thought to take a risk andgo ahead with the Order. But after their embarrassinglegal defeats over Tameside comprehensive schools andLaker Airways, Government lawyers were clearlyanxious to suffer no further court action, and Ministershave now backed down.

The present intention is to put the legal positionbeyond doubt with a Bill next session amending theMedicines Act. Only then will an Order be laid undersection 105 to control additives and substitutes. Mean-while, control is expected to be exercised under a volun-tary agreement which the Department of Health is nowseeking with the tobacco industry and which wouldallow the marketing of synthetic cigarettes before theamending Bill comes into effect. Hopes are high in theindustry that Britain’s first synthetic cigarettes will

appear on the market next year. The Hunter Committeewhich advises the Government on smoking and health isexamining products with substitutes and additives, inparticular ’New Smoking Material’ and ’Cytrel’. Earlynext year the committee will announce whether or notit gives approval to the products. If it does, the tobaccocompanies will immediately apply for a licence from the

Medicines Commission and the world will watch withinterest to see the reaction of Britain’s 19 millionsmokers. Health Ministers are anxious that the new pro-ducts should not become known as safe cigarettes. Theyprefer to describe them as "less dangerous cigarettes".On that basis they are continuing their attempts to

tighten the voluntary arrangements which the D.H.S.S.already has with the tobacco industry. Ministers want tosee a stronger emphasis given to health warnings oncigarette packets, (particularly those with high tar con-tents), greater control over advertisements, and a newcode of practice governing sports sponsorship by tobaccocompanies.

Service Hospitals and the N.H.S.More than three years ago a committee under Sir

Clifford Jarrett recommended a reduction in the numberof Service hospitals (for the Armed Forces, that is) andan increase in bed occupancy. But, as a group of M.P.Sreported lately progress has been disappointingly slow.Jarrett recommended that bed numbers in the 17 UnitedKingdom Service hospitals should be reduced progres-sively over ten years from 3175 beds to about 2300. Buta subcommittee of the Commons Expenditure Commit-tee heard that bed numbers this year totalled 2732 andthat bed occupancy, which Jarrett wanted to see raisedto 85%, actually fell to 67%. The committee expressedparticular concern about the imbalance of the presentknock-for-knock arrangements under which N.H.S.

patients are treated in Service hospitals and Servicemenin N.H.S. hospitals without financial adjustment, anarrangement which favours the N.H.S. at the expense ofthe Defence budget. N.H.S. hospitals are treating some3000 Service patients a year compared with 20 000N.H.S. patients treated in Service hospitals, whichamounts to a ,4 million bonus for the Department ofHealth and Social Security. A further 6000 N.H.S.patients are treated under contractual agreements. Pro-gress on extending these agreements has been delayed bythe Defence review. The D.H.S.S. has declined to giveany central direction, preferring local negotiations.The M.p.s want to see contractual arrangements

extended as a matter of urgency. They favour a full-costsettlement for facilities now provided free "as a factormaking for greater financial discipline in determiningN.H.S. actual requirements and in assuring their fullutilisation". The Jarrett report rejected the idea of rep-lacing Service hospitals by military wings in N.H.S. hos-pitals. But the Government agreed to consider the possi-bility of positioning Service hospitals with existing orplanned N.H.S. hospitals in future planning.

Last week’s report suggests that this process should beexamined with more urgency than is being shown andwants to see the use of military wings extended, despiteJarrett. The t.P.s emphasise that it is important forGovernment departments to cooperate in the nationalinterest to ensure the best usage of scarce hospitalresources. They recommend better liaison and coordina-tion between the D.H.S.S. and the Ministry of Defenceand a closer personal interest by Ministers in the plan-ning and organisation of both Service and N.H.S. hospi-tals. Ministers, after all, should not be involved only inhospital closures.