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Smoking in Public Places
A Consultation on Reducing Exposure to Second Hand Smoke
Report of Regional and Area Events

REPORT FROM THE FIRST SCOTTISH EXECUTIVE REGIONAL CONSULTATION EVENT - DUNDEE DISCOVERY POINT

29 June 2004

Introduction

This event was the first in the series of public consultation events on smoking in public places. The event was extremely well attended, with 113 participants, and attracted considerable media attention.

Dr Drew Walker, Director of Public Health (Tayside NHS Board), chaired proceedings. The meeting was opened with a welcome to all participants, then the Deputy Minister for Health and Community Care, Tom McCabe MSP gave an introductory talk on why the Scottish Executive was launching this consultation process.

Following the Minister's talk, a panel of experts fielded questions from the floor. The panel consisted of:

• Tom McCabe MSP, Deputy Minister for Health and Community Care

• Sally Haw, NHS Health Scotland

• Maureen Moore, ASH Scotland

• Gordon Millar, Scottish Voluntary Charter Signatory Group

• Paul Ballard, Consultant in Health Promotion, NHS Tayside

The panel session was chaired by Debbie Wilkie (Director, Scottish Civic Forum).

Points raised included:

• Effect on children if smoking transferred as a result of a ban from pubs to the home.

• Licensees have invested in extractors and ventilators and should not now be being penalised further by risking their business turnover.

• The voluntary approach is working with a great many more pubs now participating.

• Conflicting statistical information fuelled confusion and lack of trust in what is being proposed.

• The question was raised as to why smoking was being tackled when people are exposed to other carcinogens e.g. from fuel emissions etc.

• People should have freedom of choice to smoke or not to smoke - non-smokers can choose not to go to pubs where people smoke if it bothers them.

• Businesses in New York and in Ireland had suffered a downturn following the introduction of bans there.

After the panel session, all those in attendance were invited to join one of four discussion groups, which ran simultaneously and on the same subjects. The group discussions were aimed at allowing participants to put forward their views on the proposals and on the consultation. Each group discussion was facilitated by a member of the Scottish Civic Forum's network of facilitators.

Each group addressed the same questions, as posed in the consultation document itself, namely:

• Having considered the health risks associated with passive smoking, do you think that further action needs to be taken to reduce people's exposure to second-hand smoke?

• Would you support a law that would make enclosed public places smoke-free? (Public places include workplaces and public transport)

• If a law was introduced, do you think there should be any exemptions to it? (i.e. any enclosed public places where smoking should be allowed)

• If we decide not to introduce a law, what more could be done to encourage individual businesses to take voluntary action to become smoke-free or to provide more smoke-free provision?

• What else could be done to reduce people's exposure to second-hand smoke?

The group consisted of 15 participants, including one representative from the Scottish Executive. The overwhelming majority of the group represented the licensed trade, and it has to be said that the discussion focused, primarily, on the concerns of this group as to how a "smoking ban" would affect their livelihoods. After agreeing some ground rules for the discussion and outlining the role of SCF as facilitators to the event, the discussion got underway.

Before detailed discussion on people's views relating to the way forward a number of concerns were expressed. Perhaps the first comment on the day was a view that "Their minds are already made up", interpreted as legislation will be the outcome of the "consultation" process thus banning smoking in public places. This view was endorsed by the majority of the participants.

The second concern related to the composition of the panel - with a view expressed that it only contained people who put forward arguments in support of positive action towards a ban. There should be a re-think on the panel for future meetings with some representation from the other side of the argument.

An attempt was made to guide the group through the five questions as set out in the response form. This was resisted by some who felt this was an attempt to influence the proceedings, and did not provide a genuine consultation opportunity. Having been offered the chance to suggest an alternative way forward the group commenced to focus on the first question, i.e. is further action required over and above the current voluntary approach?

However, this was as far as things went with regards to the questions, with no view expressed that legislation was needed. The following points/issues were raised in support of the overwhelming opinion that what was needed was to pursue the voluntary approach that has been in place to date:

• Susan Deacon's voluntary practices had made a very positive difference and should be further developed - "is it not already working?"

• What was required was further open discussion and meaningful dialogue on how the voluntary approach could be improved.

• A pub atmosphere was the attraction for those who used the pubs and it was not accepted that the 70% of Scotland's population who were non-smokers would be attracted by a no-smoking environment.

• If a "no smoking" pub was such an attractive proposition why had nobody tried it? Perhaps the Executive should support one and see what sort of success it had?

• No smoking in pubs would push the practice back into the home even more, where children and young people would be further exposed to smoking as an acceptable habit, as well as being exposed to more second hand smoke.

• Any action to legislate against smoking in public places was seen as "life-style" interference and the question was raised as to what would be next?

• Very unhappy that this would be government control on individual businesses.

• The fact that "Joe public" was not there (at the event) to support any proposed ban was seen as a fact that the issue was not of great importance to them.

At this point the discussion moved on to the fact that the question being asked to consider related to all enclosed public places and not just licensed premises. This made no difference to people's views, and it was reinforced that legislation to ban smoking would further worsen a situation seen as bad practice i.e. pushing smokers out to the entrances of work-places and patients to the front doors of hospitals. This situation needed to be tackled by providing proper facilities for smokers, not by further action to push more and more of them out on to the street.

Other points made in relation to possible legislation were -

• Would legislation actually stop people smoking?

• How would it be policed? This was seen as a real problem. Viewed by licensees as "yet another" reason for customers to get antagonistic if asked not to smoke.

There was strong support for the view that the real issue was in relation to providing better education to children and young people. This is seen as the key, and far more resources should be made available for future generations. Experiences from Arbroath College indicated that young people like smoking and, therefore, legislation will not deter them, but a better understanding of the health issues might have the desired effect.

In conclusion the overall message from the whole group was "more education, not legislation".

This workshop was attended by a section of the audience. 80% of the participants were against a smoking ban and 20% were for a total ban.

All participants agreed that a forceful statement should be made to the organisers that if they wanted to persuade participants that the event was a genuine consultation and that minds had not been made up, then they needed to ensure that there was a fairer balance of views on any panel and that if displays were to be allowed from one side, then they should be allowed from the other. No displays or representation was available from the tobacco trade. People felt that the whole presentation of the meeting was biased against smokers.

Members of the licensed trade agreed that under question 1, more needed to be done to cut down smoking in public places. They felt that this should be done through a greater effort from Government to support the voluntary scheme, which had now brought around 11% of premises up to an acceptable standard. Perhaps the voluntary scheme standards should be made more compulsory for licensed premises and the Government should police improvements through the use of licensing boards and Environmental Health departments of local councils.

To achieve this, the Government should consider introducing grants for improvements to licensed premises or other financial incentives to try and ensure that landlords participated in the scheme.

Licensed premises landlords made the point that 70% of them are non-smokers but that they reckoned (from local surveys) that 80-90% of their customers were smokers. They felt that MSPs and civil servants did not come out to visit premises enough and to understand the real nature of their customers' habits and preferences.

People felt that they had been 'blasted' by health statistics at the meeting. Some people simply did not believe them and some felt that Government and health professionals were manipulating them.

If the Government really believed the health statistics and that cigarettes were killing people, then they should have the courage to ban them completely. Many people felt that the Government were hypocritical because they continued to take the tax revenue from cigarettes yet preach to people that they should stop smoking. The government were about to spend millions on Smoking Cessation, yet would not ban cigarettes!

Many landlords felt that the work that they had done to improve ventilation in their premises had significantly helped the health risks and cleaned the air. This was disputed by the professionals, and many landlords may feel that they had been encouraged to waste valuable money putting in systems that did not work, or did not meet the objective.

It was agreed that there were major training opportunities for staff to help understand the dangers better, and to better manage premises for all concerned. It was generally agreed that the proposals in the Maxwell Bill were unworkable and impractical.

One person put up a strong case for better protection for staff under Health and Safety. He did not believe that the entertainment industry could justify continuing to employ people in smoky environments. Mention was made of the increase in litigation in society and it was felt that many employees would sue in the future if their health was damaged in their workplace.

Mention was made of Ireland but people felt that to see many people standing in the street smoking was not sending out a positive image of the new Ireland. People also felt that there was likely to be potential for trouble and disturbance at the main doors of premises. They could become intimidating and generate rubbish, litter, and trouble.

It was generally agreed that more needed to be done. A plea was made that whatever was done should be consistent across the country and not vary from one local area to another. This would create particular problems at national borders (e.g. Carlisle). It was suggested that Scotland should only implement changes if they were implemented in the rest of the UK. Otherwise there would be differences throughout the UK and this would be unfair on some. If Ireland, England, and Scotland, all adopted different standards and timescales, then this could lead to chaos and unfairness.

No one in the workshop made a passionate plea for an outright ban on smoking. All agreed that more needed to be done. A final point was that certain licensed premises should be allowed to choose whether they would be smoking or non-smoking. If they chose to be a smoking establishment then they should be made fully aware of the risks.

There were 2 people in the group who were linked to the licensed trade. They were in favour of freedom of choice for the smoker. The remainder of those in the group were in favour of action against smoking in public places. The discussion was structured around the questions in the Scottish Exec's leaflet/response form.

It was pointed out that in order to be fair, FOREST, who say that the risks don't exist, should also have been on the top table for the panel discussion.

Do you think that further action needs to be taken to reduce people's exposure to second-hand smoke?

There was some debate about the situation that faces members of the public in assessing the issues. Points raised were:

• How was the layman to ascertain the correct view from conflicting advice?

• People felt bombarded with disparate information, which made it difficult for some to come to a decision, although others did not find this such a problem.

• A distinction should be made between lobbies (FOREST and ASH) and the BMA's 5-year longitudinal study.

The predominant view was that smoking was damaging. The majority supported further action. Specific comments made included:

Scottish Government must have the courage to pass legislation.

If there were strict legal controls on exposing us to asbestos in buildings, why not protect us against tobacco in buildings?

People who worked in licensed premises should be protected.

Would you support a law that would make enclosed public places smoke-free? (Public places include workplaces and public transport)

The majority supported this proposed legislation.

The minority viewpoint was that it would do away with freedom of choice, and that smokers were entitled to go wherever they want.

The discussion focussed on pubs. The minority who were against legislation argued that non-smokers simply shouldn't go to smoking pubs and that legislation would destroy licensees' businesses. From the opposite viewpoint, it was doubted whether people would really desert pubs because they weren't allowed to smoke in them.

Consideration was given to whether specific smoking clubs were viable. It was concluded that this was unviable if viewed in terms of the statutory requirement to provide a safe workplace. This would have to be got round by using volunteers, not employees.

Those arguing for freedom of choice doubted whether there was evidence of people being damaged by passive smoking. In response, Roy Castle was mentioned, and it was argued that what it did to children is difficult to assess/know. The supporters of a ban argued that young people should not be exposed to/encouraged to smoke, and that smoking amongst young people had fallen in New York after the smoking ban

If a law was introduced, do you think there should be any exemptions to it? (i.e. any enclosed places where smoking should be allowed)

The distinction between/definition of public and private places was considered. The general view was that, if nursing homes were exempted because they were someone's home, then non-smoking residents, workers and visitors would be exposed to the smoke.

The discussion returned to the subject of licensed premises and covered the following points:

• The representatives of the licensed trade argued that small local pubs would be particularly hurt by a ban and should be exempted.

• There seemed to be conflicting views/information on the likely effect of a ban on pub takings.

• It was pointed out that smoking bans hadn't killed use of cinemas or trains, and that it may even attract back trade from non-smokers which was currently being lost.

• Separate, designated smoking areas in pubs and other public places were discussed. No clear conclusion was arrived at.

The overall view was that exemptions would undermine the policy and they were therefore not supported.

If we decide not to introduce a law, what more could be done to encourage individual businesses to take voluntary action to become smoke-free or to provide more smoke-free provision?

The following suggestions were made:

• Might it be possible to have selective pub licences (smoking and non-smoking) with a presumption more in favour of granting non-smoking licences, or other sorts of incentives to pursue non-smoking licences?

• Might it be possible to have specific smoking rooms?

Some of those present were sceptical about whether anything could be achieved through voluntary action, not least because there were issues over how/whether it could be enforced, whereas the all-encompassing legislation put everyone on a level playing field.

What else could we do to reduce people's exposure to second-hand smoke?

The following suggestions were made:

• More advertisements aimed at protecting children.

• More general public information.

• The California General Assembly was considering legislation against smoking in a car in which there were children.

• Could the ban on smoking be extended to non-enclosed public spaces? Football stadiums were particularly mentioned.

Any other views you have about smoking in public places.

The following comments were made:

• In Dundee, local community centres were run by community-based committees. The members of these committees were often smokers. However, they had said they were in favour of a ban, but wanted some top level leadership.

• There had been no massive 'rebellions' against this sort of legislation in New York or Dublin.

Introduction of facilitator and ground rules

The Group were not asked to introduce each other. Instead an exercise was done that allowed everyone's stance on the issue to be visually seen, quickly and easily. This exercise also gave the facilitator an idea of the range of opinions and support for different stances which aided in the facilitation of the group.

The group was asked to stand along a continuum:

Take no action -----voluntary ban--------targeted action/action ------------- total ban by Local authorities

Most of the group stood at the total ban end, with three in the middle, one at voluntary ban and two at no action.

Report back to the Plenary

All agreed to the feedback to the plenary. Six people did not want the total ban but most did (see sederunt for the group for overall numbers). Those who wanted the ban supported the need for action to help businesses.

Action

Total ban wanted by the majority of the group.

Legislation

There is cynicism. Why was the government targeting smoking when there were other equally serious problems to be tackled?

The Government was willing for businesses to be ruined but not their own tax revenues

Implementation

The policies had to be workable and clear.

There had to be a level playing field so that all businesses were equally affected, and 'all at once', not phased. Otherwise people would just move on to other premises where they could smoke .

Research had to be done into the problems that a ban would create for businesses, and support provided for business and local authorities. Specifically:

Research to gather evidence of how a ban might impact on businesses, and to seek solutions.

Guides for businesses on how to implement a ban and how to do it in a way that would make the minimum impact on business.

Guides for local authorities on how to implement fairly i.e. introducing the rules to all businesses at the same time so no-one gained any advantage, giving adequate warning and support, consideration of how to introduce rules about children and smoking, and food and smoking, in a way that minimised the impact on those developing family pubs.

Real and effective policing would have to be in place.

Action should be evidence based.

Education for all was required on the effects of smoking.

Attitudes to smoking and drinking needed to be changed in Scotland.

We should prioritise what is most important to do first.

The language being used should be thought about carefully. 'Ban' was a negative word. Changes should be marketed, and positive images and language developed

Residential care should be exempted.

Notes from the Discussion

Currently, a Local Authority made a licensee make a choice with no warning and little time to make it, between providing for smokers or providing for children. Some had spent years working to attract families and found this very hard to deal with suddenly

People who wanted to build their businesses would find it hard in the circumstances

The timing of when licenses were renewed was crucial i.e. a person having a license renewed just now having to comply, while the pub down the road may have two years to run on it's license and so would not have to comply yet.

Research was needed, business backup and real discussion about the problems.

There was a huge issue regarding attitudes to tobacco and drink that needed to be tackled.

The positives should be looked at, instead of the negatives. Using different language e.g. 'ban' was a negative word.

Should action be taken?

• Yes, but there should be a level playing field.

• We're moving that way anyway, so should continue.

• Action should be seen to be taken.

• A complete ban would be clearer and easier.

• The evidence was there to support a ban

• There should be a priority to action that benefits children and staff.

• It would be a big change, but it would become the norm and 'new drinkers' would find the benefit.

• Despite what had been said about Ireland and New York, some felt that business would be affected.

• Some felt that the current experience was that voluntary approaches didn't work, while the publicans felt they were working towards it and that process should continue.

Conclusion

There appears to be little dispute about the need for action: the disagreement focuses around 'what' should be done.

The majority of non-licensee participants were in favour of a ban on smoking in enclosed public places. There were some concerns raised about whether or not it would increase smoking in the home thus increasing the exposure of children to second-hand smoke. A few participants raised the issue of personal choice. However, it appeared to be the general view that a ban would be easier to enforce than a voluntary approach and would produce a level playing field.

Licencees are almost without exception opposed to a ban on the grounds that it will have a severe effect on their business. They largely support a continued voluntary approach or an approach based around the proposals from the Voluntary Signatory Charter Group.

In relation to exemptions in the event that legislation was introduced, licensees suggested that small pubs should be exempt.

There was concern about exemptions in, for example, care homes where non-smokers and smokers lived and shared common areas and about the health and safety issues for staff who worked in any exempt premises.

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