Wednesday, 29 May 2013
Public Health (Tobacco)(Amendment) Bill 2013: Committee Stage
I move amendment No. 2:
I welcome the Minister to the House. This is an issue on which everyone is on the same side. There are several people in the Visitors Gallery who are survivors of cancer and I welcome them too.
In page 4, between lines 9 and 10, to insert the following:“(e) the prohibition of the sale of any tobacco product other than in plain packaging to be determined by the Minister;
(f) the prohibition of the sale of any tobacco product in a licensed premises or filling station.”.
On previous visits to the House, the Minister has stated the cost of tobacco smoking to the health service is €1 billion a year. The Health Service Executive estimates 5,000 people die from smoking while anti-smoking groups put it at 7,000. Today, if someone announced he had invented tobacco but it would lead to so many deaths and cost the health service €1 billion, there is no way we would license the product. The Stamp Out Smoking campaign aims to eliminate tobacco consumption from the landscape by 2030. We have to get it across to the industry that it is time to wind up and that we cannot allow this commodity to continue.
If this amendment is of use to the Minister as he plots his course in tackling tobacco consumption, I say more power to his elbow. I do not want to divide the House as there are no pro-smoking Members present.
It was the Minister who first suggested, and it was discussed this morning on “Morning Ireland”, plain wrapping for cigarette packets. If the Minister and others have evidence that younger people are attracted to smoking by colourful packaging, then this amendment would introduce plain packaging to deal with that issue. This also allows the Seanad to express its support for the Minister in his intention in this regard.
As part of the general idea that this commodity would not be licensed if it were introduced today, we must commit to a programme to reduce the availability of this seriously damaging product. The amendment proposes that tobacco products should not be on sale in a licensed premise or filling station so as to reduce the availability of this damaging and toxic product.
The Minister will undoubtedly have his own timetable of how he intends to tackle this problem, and the first item concerning plain packaging is taken from the Minister, as I have said. Were he considering other measures to reduce and hopefully eliminate it, and I would seek to eliminate it long before 2030, we would not sell cigarettes in licensed premises because one cannot smoke them there. In addition, it is probably undesirable that one should smoke anywhere near a filling station. We will later propose measures to restrict smoking in road vehicles.
Those are the two proposals we put forward in this section as suggestions to the Minister as part of a programme to curtail the consumption of tobacco because licensed premises and filling stations might be two good places to start. In recognition of the way this industry attracts young people despite all the medical evidence - the Minister, as a medical man, knows this better than anybody - the plain packaging would be a good deterrent to stop young people taking up smoking.
Before I call Senator Colm Burke, I would like to acknowledge the presence of our visitors from Scoil Ursula, Blackrock, Cork, in the Visitors Gallery and I wish them a pleasant day. I call Senator Burke, another Cork man.
I would also like to welcome those from the school. I hope they are enjoying their day and I wish them every success in their studies. I welcome the Minister. In dealing with the Bill, I welcome the proposal by Senator Barrett. Obviously, the matter needs further attention. With regard to graphic images on packaging, which the Minister has pushed very much, my office has been involved in carrying out a survey on this issue in the past two to three months. The results are interesting in that people who smoke have indicated to us that graphic images are causing them to think long and hard about trying to move away from smoking. This is also highlighting the long-term health costs that smokers will incur in the years to come, aside from the financial cost. It is an important issue to highlight.
With regard to Senator Barrett's amendment on the restriction of sale in licensed premises and filling stations, from a competition point of view I am not sure whether we can do that immediately, but it is obviously something we should consider and should not ignore. I welcome the fact this Bill is being put forward and that we will see it on the Statute Book in a short time.
I thank the Senators for their support and for the sentiments expressed. I will first refer to Senator Barrett's proposed amendment relating to the introduction of plain packaging. As the Senator is aware, Government approval was given yesterday to proceed with such legislation, and I am delighted with the Government's support and its decision in this regard. Despite the ban on tobacco advertising, the ban on point of sale display and the introduction of graphic warnings, a gap still exists which I believe can now be eliminated by the introduction of plain packaging. While I have forgotten to bring them with me, I demonstrated on television yesterday the type of new cigarette pack that is available, which looks very much like perfume and is particularly aimed at young girls. We must compare and contrast that with the reality of what smoking does to people, which is why we want to see a plain pack. It is said that the pack is the silent salesman or the mobile billboard for the industry. The reason they are fighting us so hard on this and in Australia is that they know it works, and it is their last area of advertising.
The Senator referred to the 5,200 people who die in this country every year from tobacco smoking. He is absolutely right, and in fact some 700,000 Europeans die each year from smoking. The tobacco companies have to replace the people who give up and those who sadly die with new recruits, and it is very clear from the surveys we have done that they are going after our kids. Some 78% of smokers in the survey said they started smoking in this country under the age of 18. This begs the question of what choice a person has when he or she is already addicted at the age of 18.
However, a considerable amount of work must now take place on the details of the heads of the Bill. This will not be a cakewalk by any means. Property rights, intellectual rights and every device known to man will be brought to bear by the tobacco companies in order to block this, so we have to make sure we prepare the Bill carefully and that it will stand up to legal scrutiny. I obviously support the principle of the proposed amendment, but this amendment, as drafted, would not successfully meet the needs of the introduction of such an initiative. With this in mind, I reiterate my strong commitment and that of the Government to the development of the legislation. I regret that I am unable to accept the amendment but I accept wholeheartedly the principle and the sentiment behind it.
I will now refer to Senator Barrett's proposed amendment in regard to the sale of tobacco in licensed premises and filling stations. My Department is in the process of finalising a new tobacco policy which will set out plans for reducing the numbers who smoke in Ireland. I intend to bring this policy to Government very soon. The new policy will contain two themes, namely, protecting children and the denormalisation of smoking in our society. The Senators will be aware of the strong stance I have taken regarding our children and young people smoking. While the number of young people smoking has been steadily declining, thankfully, the number is still far too high, in my view. No one measure will effectively reduce the numbers smoking. A suite of measures must be put in place and these measures will be outlined in the tobacco policy. Part of that policy includes looking at the current situation regarding the sale of tobacco products with a view to examining any changes that may be required into the future.
While I understand and support the principle set out in the amendment, I regret that I am unable to accept it. Consideration is currently being given to any legislative changes that may be required following the publication of the Tobacco Free Policy Review Group report next month. I can assure the Senator I am committed to implementing the recommendations contained in that report and I am 100% committed to ridding this country of the scourge of tobacco use given the premature deaths it causes, the lives it ruins and the families it devastates. We have to tackle this head on. I said publicly yesterday and I will say it again that I believe tobacco companies are the purveyors of death. One in two who use their products will die. It is inescapable. If we had a drug that could save 5,200 Irish lives a year or 700,000 European lives a year, there would not be a single voice in this country not calling for it.
I thank the Minister and welcome his statement on plain packaging. We gave him credit for announcing it here in the House and I am delighted he announced it in even stronger terms today. I will not press subsection (e) of the amendment. I also welcome the Minister's comments on what he called the "denormalisation" of smoking by reducing the number of retail outlets. What I had in my own notes was that we need to "de-escalate" smoking, so it would be available in fewer and fewer places until, eventually, it is eliminated. I thank the Minister for his response to both of the points. I assure him of my continued support. In the very welcome light of what he said, I will not press the amendment. We know we are on the same side in this, and any time he comes to the House, I will certainly be supporting any measures. I thank him for his presentation today.
I move amendment No. 3:
Again, this is very much in line with what the Minister has said. It is worthwhile for the Seanad to convey its views and I welcome the views of Senator Colm Burke, as always, on health issues. There was a commendable stand, as I recall it, by the trade unions employed in the licensed trade, which pressed very strongly that these licensed premises are places of employment and that employees would prefer not to be inhaling toxic smoke. I look askance at the development of smoking places in the vicinity of places of employment.
In page 4, before section 2, to insert the following new section:
“2.--The consumption of tobacco products shall be forbidden throughout any place of employment, education, healthcare, sporting venues, areas in the vicinity of such places and in motor vehicles.”.
I wonder whether it is time to push that out. It is controlled in licensed premises but one does see places around various offices and outside shopping centres where people get together to smoke.
The board of Trinity College Dublin, which I attended this morning, has decided to support Professor Shane Allwright's move towards a smoke-free campus. I understand that other universities are moving towards that as well. There are two dimensions to that. One is that this is applying science for the benefit of society, which is what institutes of education should do. The science on this is so definite, as the Minister has said, that if we can persuade people not to smoke this commodity, their lives will be inestimably improved. If universities have that knowledge, they have a duty to push it out and assist the Minister in what he is trying to do in this regard.
There is also the education aspect. If we have responsibility for very large numbers of people - 16,000 in Trinity College - those in charge have a duty, as part of the education process, to say "We are not allowing smoking here because it is bad for you. It is part of your education to realise how harmful this will be." I mentioned one university that is already working on it and I think there are others planning to do it. Explaining to the cohorts of young people for whom they have responsibility that all the knowledge we have says that this is really bad for and detrimental to them is part of their educational role.
On the previous occasion, we mentioned an eminent surgeon who quibbled or disputed that he was performing expensive heart operations on people who would not give up smoking. People not changing their conduct is a classic illustration of a burden on the health service. The other aspect I have in mind are smoking dens or zones outside hospitals. There is no place for them in the message we are trying to get across that one is not doing one's relatives or friends in hospital any favour by having smoking dens around hospitals. We are expending lots of money to make people healthier and smoking should not take place on a hospital campus.
Smoking at sporting venues contradicts the message of sport. On a recent visit to Croke Park, I was disappointed to find that smoking dens have come into play there. It totally contradicts what sport is about in promoting healthy lifestyles. Smoking seems to break out informally outside places of employment, colleges and schools. Is it possible to extend the non-smoking zone as part of the denormalisation of smoking policy mentioned by the Minister?
There were two concerns about motor vehicles, which relate to the final part of that amendment. Regrettably, Senator Crown is in the US but will be here to support the Minister. It is the fact that a car is such a confined space that makes smoking in it so damaging to children. It is like being put in a wardrobe with somebody who is smoking. We have a duty of care regarding protecting those children from adults smoking in cars. Is this the adjunct to the mobile phone penalties the Minister for Transport, Tourism and Sport has been imposing? Does somebody trying to light up, flicking out the ash and lighting up a new one represent a danger in addition to driving in a smoke-filled vehicle? As part of the Minister's denormalisation, we do not want people smoking in motor vehicles. They have enough to do driving that vehicle safely on the roads of Ireland. We also have a duty to protect other people present in those vehicles.
That section extends the smoking ban, which has been an absolute boon to people who work in licensed premises. Mandate deserves great credit in tougher times for supporting the Minister in the face of those who said the pub would die if people could not smoke in it. They were major supporters of the Department of Health. Education should take up the cudgel on the Minister's behalf. It involves the promotion of accurate representation of what science has found for the benefit of society, namely, that people should not take part in this activity. It is taking responsibility for 18 to 22-year-olds in universities and younger groups in other areas.
We mentioned the incongruity of people smoking and requiring hugely expensive surgery allied to that. Of course, we want to help people but we require a contribution from them as well. I am disappointed to see that smoking is developing in sporting venues. We mentioned that smoking in motor vehicles is damaging to other people in them and may be a source of accidents. I think smoking is banned anyway where the motor vehicle is a place of employment. Somebody spoke to me this morning about the incredible change in the upstairs sections of buses in Dublin since smoking was eliminated and how much better it is.
That is a selection of ways to promote the Minister's general view of denormalising smoking and moving to curtail it. I would move to eliminate it long before 2030 but if the Minister is looking at a new shelf of restrictions, perhaps some of the ideas we have in there might be of value.
I thank the Senator. Section 2 of the Bill repeals and revokes those provisions of the 1978 Act and the 1991 regulations in respect of tobacco products that were deemed to contain price fixing provisions by the European Court of Justice. I am very disappointed with the judgment. I am on record here in the past as saying that I want to tackle this and have written to Commissioner Borg about it. Tobacco and alcohol are issues of public health and reside in the Directorate General for Health and Consumers and should not be under the Directorate General for Competition. Public health and the common good should supersede commercial considerations in respect of these issues. I am certainly seeking ways to find a legal basis and political support for doing that.
Senator Barrett spoke about hospitals. Certainly, most hospital campuses will now be smoke-free. The Department of Health is one such campus. That is not to underestimate the addictive nature of this problem. I have seen patients with a small oxygen cylinder on their back sneaking out of a ward to go to the toilet to have a cigarette. Somebody very near and dear to me continued to smoke right up to the time he passed away. This is a really serious addiction, involving probably one of the most addictive substances known to man. The Senator is absolutely right. If we were asked to bring this product to market now, there is no question that it would never be legalised.
The Senator's comments about education are 100% right but education is a very broad stroke that happens at home. I have previously mentioned anecdotal evidence of kids going home to their parents crying and saying "Mammy, you're going to die", being reassured by their parent that they were not going to die, asked why they would think that and replying "Teacher says people who smoke die and you smoke." Immediately, there is a conflict so we need to educate parents and children and continue that education right through their childhood, particularly in their early teenage years when they are particularly vulnerable.
I smoked once and have yet to meet anyone who told me that their first cigarette did not make them feel unwell so why do they persist? They persist because it looks cool and because of the advertisements and subtle subconscious message that one will look cool among one's peers if one smokes.
Or course, once addicted it is too late to realise the error of one's ways. However, it is never too late to give up and people should continue to try to give up smoking until they succeed. Every time a person tries it is easier to stay off them a little longer. We need to do as much as possible to support the smoker to become an ex-smoker. As I have said before, I am not anti-smoker, I am anti-smoking and I am anti-tobacco.
On the issue of smoking in cars, when children are not in the car we have examined this in the past and we will look at it again before any law is introduced. However, there are privacy laws around that too and I do not know that it can be done. I wrote to Commissioner Borg expressing the frustration in Ireland with that ruling and that Seanad Éireann, in particular, was frustrated.
With regard to many of these proposals from Senators, the tobacco policy will set out key recommendations in efforts to denormalise smoking. Senator Barrett's amendment deals with the important issue of extending the ban on smoking to other areas. The tobacco policy will set out recommendations in this area involving partnership with and participation by many key stakeholders, for example, local authorities and education organisations. The Government has taken this on board.
The Healthy Ireland initiative was launched by the Government a few months ago and it involves all Departments. There is a full realisation that in the past the Department of Health has been associated with ill-health, with curing disease, instead of being associated with proactively maintaining good health. We realise that other Departments such as those with responsibility for education, justice, the environment, arts and culture, tourism, transport, sport, all need to be involved and to interact. Yesterday I was very pleased to be at the launch of the Slow Down campaign with the Garda Síochána and the National Road Safety Authority because this aims to keep people safe on the roads and it is a critical message at this time of year. Such a campaign transposes across many Departments from health to justice, the environment and social protection. A total of 75 people have died on the roads this year to date and it is not known how many families have been devastated in the process. Many people have been injured who will spend the remainder of their lives dealing with an injury or a disability. I am thinking of parents of a younger person who is injured and may have suffered a brain injury. They will spend the rest of their lives worrying about how that child will be cared for when they go. All that pain and suffering can be avoided as well as all those admissions to our hospitals if people slow down on the roads. However, so many more deaths occur in multiples of tens and hundreds because of tobacco but we can do something about that. We can protect our children and that is what we aim to do by bringing in plain packaging. I am very pleased that we have such support across all parties and across this House and the other House.
I thank Fingal County Council, my own local authority, for being one of the first to ban smoking in playgrounds. I would like to see that ban extended to beaches and parks and anywhere children are present. I refer to the saying, "Monkey does as monkey sees". I note there is a current advertisement on television that promotes this idea with the father rubbing his chin and the young fellow beside him imitating him. If children see a parent smoking it does not matter how much they are educated, they will smoke because they think it is okay.
I regret I cannot accept the Senator's amendment. I endorse the banning of smoking in other areas, whether by legislation or voluntary measures and I am committed to progressing work in this area as a priority. Senators will be aware that I have supported in principle a Private Members' Bill in this House which proposes a ban on smoking in cars with children present because I agree with every sentiment the Senator has expressed. The idea of a child locked into a baby seat, unable to escape from what amounts to a giant mobile ashtray which is how it was described, is pretty shocking.
A number of productive meetings have been held on this Bill. I understand progress is being made by my officials, Senators Crown, van Turnhout and Daly and the Department of the Justice and Equality, in consultation with the Office of the Attorney General. I have asked my officials to progress this Bill as a priority.
I note the Senators' opposition to section 2 and I understand their frustration in this regard. I reiterate my disappointment at the necessity to put forward these amendments but it is in order to comply with the European Court of Justice ruling and to avoid infringement proceedings being instigated against Ireland. I again state my commitment to tackling at EU level the broader issue of the priority given to public health initiatives.
Senators should also bear in mind that the Government retains the option of increasing the excise duty on cigarettes which would counter any decreases in prices introduced by the tobacco industry. There have been a number of tax increases on tobacco in the past and it is my intention that this practice be continued into the future. As I have said here on other occasions, I would love if each cigarette cost €1 so that people would think long and hard before inhaling long and hard.
The Health Ireland initiative which is a cross-departmental initiative wishes to examine how all the areas of government can co-operate in order to reduce the impact of tobacco smoking as well as promoting more healthy lifestyles.
I regret that I am unable to accept the Senator's amendment. However, I ask him to be assured of my absolute commitment - which I know he shares - to ridding our country and the European Union of this scourge and to protect our children in the future.
It is not being pressed and neither is the section being opposed. On the question of privacy, the Minister and I are ad idem. It seems to me that the cigarette is as lethal as the mobile phone and the Minister for Transport, Tourism and Sport, Deputy Varadkar, has been persuaded with regard to the latter. I refer to trying to light a cigarette while driving and attempting to flick out the ash and throw away the butt because these actions are very distracting. That is my response to those who fear that there is a privacy issue at stake.
I agree with the Minister on the policy of increasing the excise duties since the decision of the court leaves him with little alternative. However, our most helpful Oireachtas Library and Research Service has provided information that the tobacco price here is at 217% of the European average. We have the highest priced cigarettes in Europe. The price is there as a weapon and I will support the Minister in using it. However, we need all these supportive measures. I welcome all he said about the tobacco control policy and I look forward to seeing it in practice. My suggestions are offered in that spirit. Price has not been able to control the level of smoking. The UK price is 166% of the European average and the price in France is at 133%. The price in Ireland is nearly double the French price but it is still not sufficient a deterrent to the 5,200 people facing death each year as a result of this product.
I welcome all the news from the Minister about a ban in places of employment, education, health care and we agree on sporting venues. I welcome what he said about tobacco use in motor vehicles and the progress being made in the talks with Senator Crown, Senator van Turnhout and other Members about the damage to children. We hoped the Bill might be enacted in time for the summer period when people travel on holidays in order to help children travel smoke-free. I wish the Minister good luck in that endeavour. I will not press the amendment. The section is not opposed. I welcome very much the Minister's full response to every point we raised in the amendment which will influence his tobacco control policy.
I regret I was not here for the earlier part of the discussion because I was involved in the Joint Committee on Foreign Affairs and Trade where we had an equally significant discussion. I am happy to have this opportunity to support my colleague. I understand he is not pressing either of these two amendments, largely because the Minister and himself are ad idem on these matters. The Minister has been very strong in this regard. I imagine he must be a little disconcerted but I do not expect him to comment when he discovered that senior Ministers, including the Taoiseach and the Minister for Finance, had a meeting with the leaders of the tobacco industry.
That certainly caused much concern. These people are involved in a trade which is extraordinarily devious and they should find it as difficult as possible. The Taoiseach is a wily west of Ireland man but one needs to be twice as wily as anybody from this island to deal with that shower and they have certainly shown it as anybody who looks at the history of the tobacco industry in the United States of America will see. I speak as somebody who most of the time does not smoke but who was heavily addicted at a very young age because of the blandishments of these awful people, including the Marlboro man and all these very glamorous figures who subsequently died of lung cancer which put an end to their glamour. I commend Senator Barrett on his sterling projection of these ideas. He is a tremendous advantage to Seanad Éireann and, certainly as a colleague, I value him very much. I regret Senator Crown is not here but I understand he is in America at an oncology conference.
The situation in regard to the hospitals is idiotic. People being treated for disease are not only smoking outside hospitals but they are going to local pubs in their pyjamas even though they are taking antibiotics. This is countering the effect of the antibiotics. Something should be done about that.
It may appear absurd to try to restrict smoking in cars but as a former smoker - I like to think I am mainly a former smoker - I have dropped the lighted top of a cigarette. If it lands on one's crotch when one is driving at 60 mph, it certainly does not improve one's driving skills. The same applies to even lighting a cigarette. These things can be lethal. Smoking is as bad as, or is perhaps even more dangerous, than using a mobile telephone while driving.
I agree with Senator Barrett in regard to looking for a non-smoker discount but I am not sure how it could be policed. People are the most awful liars or, as we say now, they are in denial, which just means they are liars. They will lie like hell to get a reduced premium. How can one tell whether they smoke? Does one smell their breath to see if they have been smoking? Perhaps there is a blood test or perhaps people could breathe into something on the way back from Dáil Éireann or Seanad Éireann. This could be problematic. I am not sure how this could be policed even though it is an excellent idea. I compliment the Minister on the introduction of the legislation.
I have heard of burning at the cross but not burning at the crotch. It may be a new trend.
I agree with the Senator that smoking while driving is a distraction and on that basis, it should be looked at. However, we want our laws to be very robust because the tobacco industry is notorious for going after every little chink or weakness it can. The tobacco industry has lost every single court case in Australia and now it is going at it through the World Trade Organisation.
The Scottish Parliament has succeeded in bringing in a minimum price for alcohol, so we are looking very closely at that to see how it could apply to minimum pricing here and I have had conversations with Minister Poots about it. If we can do it for alcohol, we may be revisiting this legislation which we have to enact because as I said, we are law makers and not law breakers and we have to adhere to the law as it stands. However, there is nothing to stop us, as legislators, trying to get that law changed and influencing Europe.
Pricing was mentioned and there is no question but that it is very important. A sudden increase in price often has a desired effect but these incremental increases do not. I am all for a really big hike in the price of cigarettes. People will say it will lead to more smuggling. I have met ASH, the Irish Cancer Society and the Irish Heart Foundation; Professor Luke Clancy gave me an excellent paper showing that this would not lead to more smuggling. There is no evidence to show that. The places where smuggling is at its worst is in the eastern European countries where it is 37% and where the prices are very cheap. Apparently, what influences it is a very large border.
What I really want to warn about is that this is classic tobacco industry tactics. It is called pivoting away in an argument. It is a case of let us not talk about all the people who die, all the lives ruined and all the people who are on oxygen at home because they smoked but let us talk about smuggling. Smuggling has nothing to do with it. Let us keep our focus where it belongs, that is, on the lives and well-being of our people, in particular our children. I will never make any apology to anybody for protecting our children as it is our duty as parents, as adults and, in particular, as legislators. I thank the Senator for his comments, colourful and otherwise, and for his support.
I wish to alert the Minister to something I raised on the Order of Business a couple of weeks ago. We received a very glossy brochure from some crowd with a name like CDFI. They did not identify themselves and I had to go to quite a lot of trouble to discover they were representing a subsidiary of the tobacco industry. They were pushing exactly the line about which the Minister spoke, that is, the notion of tobacco smuggling being an issue. There was no mention of disease or anything else. It was terribly smarmy. Will the Minister look at that and expose these people? We all received this apparently innocent package in the post. I thought it was disgraceful because it was completely disingenuous. I wanted to take the opportunity to alert the Minster to that, although he is probably aware of it already.
I move amendment No. 4:
We have discussed these matters thoroughly. We have tried to have information campaigns to tell people the dangers. I hope the proceedings of the Seanad today are noted because of the amount of information the Minister has placed before us on the damage tobacco can do. The laws on where smoking can take place have had an impact. We are winning but perhaps at a slower pace than we would wish.
In page 4, before section 3, to insert the following new section:
"3.--The Minister may designate a rate of non-smoker discount to be applied to health insurance premiums.".
I realise Senator Norris spoke against the amendment before I even moved it but it states: "The Minister may designate a rate of non-smoker discount". It is for consideration in the Minister's tobacco control policy. We have dealt with advertising and with laws and we are going in the right direction. Doctors would know if someone was a smoker. With inspection of someone's lungs, throat and mouth, it is pretty easy to see if he or she is a smoker.
The third part of this troika of anti-smoking measures, which includes the information campaigns and the laws on where one can smoke, is a financial incentive to giving up smoking. The Minister has been under pressure from other quarters on the rapid rise in health insurance premiums. I know there is a principle of universalism there but could we envisage a situation where giving up smoking would mean cash in one's hand? Could we persuade young people to spend the money on something else because the Minister for Health had designed a scheme to reward them? Is this the kind of inducement the Minister, his colleagues and his advisers think would be a good one to include the tobacco control policy, that is, if one gives up smoking, one would be better off financially in addition to all the other benefits which the Minister enunciated for us?
I thank Senator Barrett for tabling the amendment. It is helpful to raise these matters in order that we can discuss them. In regard to smoking in cars, Senator Crown's proposal was to ban it where there are children in cars but that would be difficult to implement where, for instance, a 17 year old is driving a car and smoking.
It would be very difficult to implement in the case of a 17 year old who was driving a car and smoking. There might be some legal complications in that regard. We should ban smoking completely in cars, as opposed to aiming at banning smoking in cars in which children are travelling.
Senator Sean D. Barrett spoke about the connection to health insurance. I have previously raised the issue of the number of expectant mothers who continue to smoke, although I know GPs try to address it. I recently spoke to someone in a high risk pregnancy clinic who told me about a woman who smoked 300 cigarettes a week, which I believe was a reduction on the number she had been smoking. Is there information on the number of pregnant women who continue to smoke? Have we provided a detailed analysis of the harmful effects it has on the baby? I do not believe we have provided enough information in that regard. We have not had a major campaign on that issue.
We still have problems with alcohol consumption during pregnancy. Each year a number of babies experience delirium tremensafter being born owing to their mothers' level of alcohol consumption. Likewise with smoking, there are knock-on effects for babies when born. It is a real health issue that we need to address and we need to provide information for the public. While welcoming the Bill, it is important that we move as fast as possible on the other issues. We need to work hard on reducing the number of people who smoke. While we have introduced many changes in the past ten years, it has not made a substantial difference to the number of people who smoke. It is a major target for us at which to aim in the next ten years and we all have a part to play.
I thank Senator Sean D. Barrett for tabling his amendments which have given us the opportunity to think about how we should plan into the future. We need to start planning for how we will proactively deal with the issue in the next ten years.
I thank the Senators for their contributions. The main legislative provisions for the regulation of the private health insurance market are included in the Health Insurance Acts 1994 to 2012 and the regulations made under these Acts. The purpose of this legislation is to ensure the market is regulated appropriately. In addition to ensuring appropriate regulation, I have also consistently urged all private health insurers to do everything possible to keep down the cost of private health insurance. I am determined to address costs in this sector in the interests of consumers and I am not happy that this has been done. I reiterate my concerns about the lack of a clinical audit to ensure tests done were necessary.
Despite a smaller number of people being insured last year, there was a 14% rise in claims. We need to ensure tests carried out are necessary. We need to revisit what we pay for what is being done. I have previously mentioned a particular procedure that used to take two hours and now only takes 20 minutes. However, insurance companies are still paying €800 to the treating clinician. If ten of these procedures are performed on a Saturday in the private system, as one gentleman was proud to point out - it took him all week to do nine in the public system - that is €8,000 every Saturday, which comes to €400,000 a year. We need to look at this. We also need to consider how we pay hospitals. We should be paying them per procedure or per bundled treatments, not for the duration of stay, as we do at present.
As Minister for Health, I have no legal powers to intervene in the prices set by health insurance providers. The insurance companies operate as commercial providers and pricing decisions on private health insurance products are matters for individual insurers. However, I reiterate my concern about their failure to address their cost base. I am sorry that I cannot accept the amendment.
We have been joined by many young people in the Visitors Gallery. I let them know that this legislation is about banning smoking in public places and protecting them from the advertising of the tobacco industry. Of the young people in the Visitors Gallery who take up smoking, one in two will die young. That is factual and evidence based. They should never start smoking, regardless of who tells them otherwise.
I appreciate the support of Senators on the Bill. I look forward to pursuing our fight against tobacco on an ongoing basis in every way open to us and on every stage we can access throughout Europe and the broader world. I express my support for the action taken in Australia in its fight with the tobacco industry at the World Trade Organisation.
It is not. Like the Minister, I welcome our young guests who will probably not see this item on the television tonight because the Minister and all Members of the House are in agreement on it. It is only if we start to shout at each other that it would feature on the programme. I assure the young people present that the House universally agrees with the Minister on measures to control smoking, which costs the health service €1 billion. Between 5,000 and 7,000 people die each year as a consequence of smoking. The Minister has the universal support of the House for the measures he is introducing.
I thank Senators Marc MacSharry, John Crown and Sean D. Barrett for their very dynamic and supportive contributions on all Stages of the Bill, on which we all agree. The Minister was right in referring to the young people in the Visitors Gallery. The tobacco industry is so cynical that in a few years these young people will be targeted by the advertising campaigns the Minister mentioned. It is right for us to point to what the tobacco industry does. The average age of those in the Visitors Gallery is 11 or 12 years. In another year or two the tobacco industry will target such young people, particularly girls. Yesterday the Minister highlighted the attractive packaging the tobacco industry used to target people such as those in the Visitors Gallery. It is welcome that he is taking as robust measures as he can. It has been said there will be no markings on the cigarette box. In fact, I hope there will be pictures depicting the detrimental damage tobacco does.
I thank the Minister and my Opposition colleagues for supporting the Bill. We look forward to its passage through the Houses onto the Statute Book.
I thank the Minister for coming to the House, as he always does. I have no difficulty in supporting the legislation. We look forward to further improvements to finally weed out the use of tobacco, the effects of which have probably touched everybody's family at some stage. My mother and three of her younger brothers all died before their time as a direct result of smoking and lung cancer. I smoked and struggled to get off cigarettes, but, thankfully, eight years later I have not looked back. As a smoker, I opposed the smoking ban within the Fianna Fáil Parliamentary Party and how wrong I was because there was no way I would have succeeded in getting off cigarettes without the ban. In bars, it would have been too easy to reach out and take one. This is a further step in weeding it out. I agree with the Minister that the smuggling issue is a red herring.
While it does not arise under this Bill, I am interested in what the Minister takes from the Scottish legislation on minimum pricing of alcohol. We have work to do in that regard.
I thank all Senators for their contributions and support. I did not mention Senator Marc MacSharry earlier because I had not heard what he had had to say. It is most unusual not to hear him. I mean this in a positive way.
I genuinely thank the Senator for sharing his personal experience with us because it is real and true of so many families who have lost loved ones and seen them suffer. It would have been all so unnecessary had we been more aggressive on tobacco policy in the past.
Successful legal cases have been taken in the United States against companies for misleading people in advertising a product that they knew was carcinogenic. There may be a case to be examined in that regard. Our fight against tobacco will be relentless and unforgiving and we will not stop until we rid the country of this scourge. There is tremendous support for the fight in Europe and the European Union must provide cross-Government support for economies that have grown to be dependent on tobacco production. We must encourage them into other areas of production that do not have such catastrophic consequences for the consumer. It is extraordinary to think that by using this product as advised by the manufacturer, one in two people will die. The pain behind it does not hit us when we say it like that, but when we reflect on the matter, we realise it.
I look forward to getting the Bill through. I said I wanted it to be a pyrrhic victory for the tobacco industry. It will turn out to be the beginning of a long road to defeat for it across the Oireachtas - the Seanad and the Dáil - and Europe. I thank everyone concerned for his or her support and contributions.