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The Committee reports to the Health Committee as follows—

Introduction

1. Under Standing Orders, Rule 9.6, the lead committee in relation to a Bill must consider and report on the Bill’s Financial Memorandum at Stage 1. In doing so, it is obliged to take account of any views submitted to it by the Finance Committee.

2. This report sets out the views of the Finance Committee on the Financial Memorandum of the Smoking, Health and Social Care (Scotland) Bill, for which the Health Committee has been designated by the Parliamentary Bureau as the lead committee at Stage 1.

3. At its meeting on 8 February 2004, the Committee took evidence from representatives from the Scottish Licensed Trade Association (SLTA), COSLA and the Scottish NHS Confederation. Oral evidence for this meeting can be viewed by clicking here.

4. The Committee then took oral evidence from officials from the Scottish Executive on 1 March 2005. Oral evidence for this meeting can be viewed by clicking here. In addition to receiving written submissions from the SLTA, COSLA and the Scottish NHS Confederation, the Committee also received submissions from: ASH Scotland, the British Dental Association, the Care Commission, Health Scotland, Optometry Scotland, the Scottish Social Services Council and the Scottish Hospital Endowments Research Trust.

5. The Committee would like to express its thanks to all those who submitted their views.

Objectives and the Financial Memorandum

The Bill is split into 5 distinct parts. Part 1 of the Bill deals with the Prohibition of Smoking in Certain Wholly Enclosed Places. Part 2 looks at General Dental Services, General Opthalmic Services and Personal Dental Services, Part 3 deals with Pharmaceutical Care Services, Part 4 deals with Discipline and Part 5 deals with miscellaneous provisions such as joint ventures and amendments to the Regulation of Care (Scotland) Act 2001.

The Committee agreed that it would concentrate on 3 specific parts of the Bill – Parts 1, 2 and 3. The additional costs of these provisions as estimated by the Executive are laid out in the Bill’s Financial Memorandum and are summarised as follows:

Policy Area Cost on Scottish Administration Health Boards Local Authorities Cost on Other Bodies Para Reference
Smoking £2m for communications ahead of implementation and £1m p.a. for 3 years following implementation. £50,000 - £100,000 in the first year for compliance line. Ongoing costs not known Gross savings of £5.7m to £15.7m p.a. on NHS costs in the longer term Enforcement costs to be developed in full RIA. Between £104m cost to £137 benefit to hospitality sector p.a. 193, 195, 197, 203, 207
Free Eye and Dental Checks £7.5m - £17.9m p.a. for eye checks and £9.1m - £12.4m p.a. for dental checks Nil Nil Not known 212
Dentistry N/A £500,000 p.a. additional professional and administrative costs. Nil Nil 224
Listing Nil Nil Nil £10,000-£20,000 one-off NSS database costs. 230

Part 1 – Prohibition of Smoking

8. This part of the Bill seeks to ban smoking in wholly enclosed public places. In the Financial Memorandum, the Executive states that it will cost £2m for communications ahead of any ban and £1m per annum for 3 years following implementation. In addition, it will cost between £50,000 and £100,000 in the first year for a compliance line to be set up. The Executive has also estimated that as a result of the ban, there would be a cost of £104m to the hospitality sector which would be offset by benefits of £137m1. In terms of enforcing the Bill, the Financial Memorandum does not provide costs as precise details of the enforcement role have yet to be determined through consultation with COSLA.

9. The SLTA fundamentally disagreed with the costs to business as estimated by the Executive and questioned the research upon which the Executive’s figures were based. The SLTA claim that research carried out by the University of Aberdeen is incomplete as it only considered one study based on California which does not have a complete smoking ban. In addition, they claim that the study examined hotels and restaurants but not pubs. The SLTA noted that there were only three countries where outright smoking bans have been implemented – Ireland, New Zealand and Norway.

10. For their part, the SLTA produced research which they had commissioned which suggested that “annual profits in licenses premises may decline by £86m”, that “employment in the licensed trade can be expected to decline by 2,300 jobs” and that “some 142 average-sized licensed premises may close down as a result of decreased trade”.2

11. However, the Committee noted that these figures were based on those available in Ireland and the SLTA had previously made it clear that the Irish ban had not been in place long enough for a full evaluation3. When asked about their apparently contradictory position, the SLTA stated:

“We have been put in that position by the timing of the bill. We are saying that we should wait for at least a year to see what the Irish experience throws up, because it is the closest experience to home on which we can work”4

12. In their submission to the Committee, Health Scotland questioned the comments made by the SLTA with regard to the research carried out by the University of Aberdeen. They said:

“The SLTA claim that the research was incomplete but fail to identify any studies that the evidence review missed.

All of the evidence reviewed related to the health and economic impacts of the regulation of smoking in public places and was entirely relevant. It is true that there was little evidence relating to impact on bars and this is made clear in the report. We excluded evidence from New York relating to the one year follow up of the comprehensive ban on smoking because it was not published in a peer reviewed source. However, it should be noted that this report showed a positive impact on bars and restaurants but did not show results for the sectors separately. As with all aspects of the research, the authors have been careful not to overstate the case for regulation.“ 5

13. Subsequent to the publication of the Bill, the Executive published a Regulatory Impact Assessment (RIA) which gave a cost benefit analysis of 3 options – a voluntary approach, smoke-free legislation and legislation but with exemption for the hospitality sector which gives further details on potential costs to business and benefits to both business and the health service.

14. It is difficult for the Committee to come to a firm conclusion on the costs to business of an outright ban, given the contradictory figures which have been submitted to it not just on costs to business but also with regard to the potential benefits to business from attracting non-smokers into pubs. It is also difficult to make a precise assessment of the potential savings to the health service if the legislation succeeds in helping to reduce the number of smokers and smoking-related diseases . The Committee notes that the SLTA is proposing that a phased ban be introduced. This is a matter of policy and therefore is for the lead Committee to consider but it was not clear from the evidence how much of an impact a phased ban would have on the financial implications of the Bill.

15. The other cost of a smoking ban which the Committee scrutinised was the cost of enforcing the ban. COSLA estimated that enforcement could cost £6m pa for the first two years of the ban although they emphasised that their figures may need to be adjusted in light of the consultation. This cost includes estimates for training and recruitment costs, including the cost of paying for staff and introducing new systems, associated legal costs, additional out-of-hours and street-cleaning costs, the security cost for staff and other associated training. 6

16. The Committee raised concerns over the increased litter and noise levels outside pubs that might arise as a result of a ban and therefore, an increased need for enforcement. Gordon Greenhill from the Society of Chief Officers of Environmental Health explained that it was already an offence to drop litter and that the Executive has already provided funding to have environmental wards to enforce the legislation on litter. However, he also pointed out that the funding was temporary and would require to be made permanent. He also said that loud shouting in the street is already an offence and that he did not believe that there would be a major problem with increased litter and noise levels.7 The Committee was not convinced by this argument. The Committee was also sceptical about the Executive’s claim in the Financial Memorandum that the costs of enforcement will diminish over time.

17. Assuming the enforcement will rest predominantly with local authorities, the Committee was concerned about the current difficulties in recruiting and retaining Environmental Health Officers and the impact that any staff shortages could have on the implementation of this part of the Bill.

18. The Executive responded that COSLA had raised these concerns and that “there is an issue about how to get people in at the right level but, as COSLA noted, one does not have to have a fully qualified environmental health officer to provide corroboration or to serve a fixed penalty notice. COSLA and the Executive have to think about whether there is room for being creative – in the best possible sense of the word – in that area.” 8

19. However, the Committee remains very concerned that the costs of enforcement are largely unknown. The Committee certainly welcomes the fact that there will be consultation between the Executive, COSLA and the hospitality sector to establish these costs, however, it is extremely difficult for the Committee to carry out its scrutiny function when the costs are unknown. The Committee acknowledges that some figures have been incorporated into the RIA subsequently published by the Executive. This RIA assesses costs over a 30 year period and assumes £1m in 2006 and £5m in 2007. Costs are then predicted to fall to £2.5m in 2008 and to £1m thereafter for the rest of the 30 year period. 9 The draft RIA states that the figure of £6m in the first two years is based on a submission by COSLA but that figure must be regarded as approximate because, in the absence of detailed Regulations, COSLA were not able to provide a more precise figure. The Executive confirmed that “the outcome of those discussions [with COSLA] will be reported to you [the Committee] in due course and will be incorporated into the final version of the RIA [Regulatory Impact Assessment] later in the year.” 10

Part 2 – General Dental Services, General Ophthalmic Services and Personal Dental Services

20. This part of the Bill has various provisions, including introducing free eye and dental check-ups, extending the range of general ophthalmic services, improving dental services and providing a national framework for charging for dental services.

21. The current cost of providing free NHS eye and dental checks is £15.2m and £7.7m respectively. The Financial Memorandum estimates that the cost of extending these free checks will be an additional £7.5m - £17.9m for eye checks and £9.1m - £12.4m for dental checks.

22. The Bill provides for a new system of charging to be established. However, the Bill itself does not specify the new payment arrangement and therefore, the Financial Memorandum does not state exactly what the cost implications will be for the Executive. The Memorandum does say that it expects any changes through the General Dental Services contract to be cost neutral. It estimates that NHS boards will require additional staff and that this will cost £500,000 across all NHS boards. In addition, it is estimated that National Services Scotland will incur initial development costs of between £10,000 and £20,000.

23. The Executive explained that the costs of providing free dental check-ups are based on dental examinations for the existing number of registered patients. These costs have then been increased by 25 per cent to reflect the fact that more people might seek dental check-ups if they are free. 11 The Executive did not offer any evidence as to the basis for this additional 25 per cent figure and the Committee recommends that the lead Committee pursues this with the Minister.

24. However, the new oral health assessments proposed by the Bill are likely to be more extensive than the current dental examinations 12 and therefore it can be assumed they will taken longer and are more likely to uncover dental problems which in turn will have to be treated. The Financial Memorandum does not quantify the costs associated with the additional dental hours that will be required as a consequence of the introduction of this part of the Bill. When asked about this, the Executive responded that “we are still working through with the dental profession the details of that oral health assessment and any possible manpower consequences”. 13

25. When pressed on this, the Executive stated that an external quantification of the current gap in the number of NHS dentists was 215. 14 In addition, an approximation of the number of additional dental hours required was as follows:

“it has been roughly calculated that about 1 million examinations might be substituted by new oral health assessments. At present, approximately 2 million examinations are done under the NHS.. and given that it will take an average of, say, 20 minutes for an oral health assessment, we might be talking about 300,000 hours of dentist time, which might come down to about 150 dentists.” 15

26. The Executive went on to say that other factors could come into play such as professionals 16 other than dentists being able to carry out follow-up treatment.

27. Leaving aside the debate about whether it will be possible to recruit the additional number of dentists which will be needed, the Committee is deeply concerned that it is being asked to scrutinise the financial implications of a Bill where the staffing and service implications which crucially determine the cost do not appear to have costed in a manner that gives the Committee confidence in the figures.

28. There will be consultation not only about the form of new oral health examinations, but also on the issues of fees, capitation and allowances. The Executive has said that the specific costs that are allied to charges under the heading of “provision of General Dental Services” will be cost neutral, but that general improvements in dental services will have a cost and that improvement measures and funding for them will be included in a Ministerial announcement. The Committee deeply regrets that such an announcement was not made prior to the introduction of this Bill.

29. The Committee recognises that there are broader issues of dental services which are not necessarily a direct consequence of the Bill. However, it would argue that the number of additional dentist hours required and the results of the consultation on a new charging framework are a direct consequence of the Bill and therefore, it is unacceptable that the Executive is not able to provide even a “best estimate” of costs. When scrutinising the Transport (Scotland) Bill, the Committee raised concerns over the major difficulties in scrutinising legislation where consultations on provisions have not yet been concluded. The Committee is dismayed that the same problems have arisen with this bill. The Committee is extremely concerned that Parliament is being asked to authorise the release of funds when it is not certain of what the cost of legislation is likely to be.

30. Following the evidence given by officials, the Deputy Minister wrote to the convener explaining that she believed that Financial Memorandum was adequate and appropriate. The Deputy Minister argued that the more extensive oral health assessments are part of the dental modernisation package and therefore the cost of these would be part of the overall financial package underpinning the modernisation of dental services. The implication of this being that this is not being directly proposed by the Bill. However, the fact remains that this will flow from the Bill (and indeed the policy memorandum makes specific mention of the consultation) and therefore, even if the figures were not included in the Financial Memorandum, then some indication of the likely costs should have been given. The Deputy Minister confirmed that the Ministerial statement would be made on 17 March. However, the Committee would reiterate its point that such a statement should have been made prior to scrutiny of the Bill, to provide a necessary policy context.

Part 3 – Pharmaceutical Care Services

31. This part of the Bill deals with expansion and changes to pharmaceutical care services. The Financial Memorandum estimates it will cost £500,000 across all NHS boards for administrative support for the new planning and monitoring role. The cost of delivering any new or enhanced services will depend on what a Board’s plan actually contains but the Financial Memorandum estimates revenue provision of around £85,000 if a full range of pharmaceutical services is to be delivered and additionally, gives a range of between £30,000 and £85,000 for fitting out premises. The cost to the NSS for the maintenance of “virtual” pharmaceutical lists is estimated to be £10,000 for initial development costs.

32. The Committee raised concerns that £500,000 did not seem adequate for the work that is likely to be involved and also questioned whether health boards will have to make changes, and therefore spend money, or would expenditure be optional. The Executive responded that not all services would add cost and that efficiencies could be sought. When asked what the costs actually represented, the Executive responded that:

“The £500,000 is for support staffing in health boards. As for additional service costs, the planning process that health boards will be required to follow will identify gaps. We cannot quantify those gaps at present because that planning process has not taken place. That is the chicken-and-egg situation again. 17

33. The Committee welcomes the fact that the Executive confirmed that if resource implications are identified during the course of negotiations on the contract’s implementation then the case will be taken to Ministers 18 but once again, it is not clear what these final costs are likely to be.

Conclusions

34. The Committee notes that there are contradictory figures about the potential loss to business from a ban on smoking and recommends that the lead Committee pursue this issue with the Minister.

35. The Committee, whilst welcoming the fact that the Executive will be fully consulting with COSLA and the hospitality industry on enforcement, is very concerned that no firm figures have been produced, and will not be produced until the consultation has concluded, albeit that estimates have now been published in the draft Regulatory Impact Assessment. The Committee has raised this issue of principle with the Minister for Parliamentary Business and with the Minister for Finance and Public Sector Reform and hopes to have early discussions to resolve what is becoming a familiar problem. However, the Committee recommends that the lead Committee seeks assurances from the Minister that the results of such a consultation be reported as soon as possible and certainly before Stage 3.

36. The Executive did not offer any evidence as to the basis for the additional 25 per cent figure it has assumed in calculating the costs of introducing free oral health checks and the Committee recommends that the lead Committee pursues this with the Minister.

37. The Committee was even more concerned about the lack of information with regard to the provision of free oral health assessments. It records its dissatisfaction that the Ministerial Statement on dental services was not made prior to the introduction of this legislation as this could have provided a policy and funding context for some of the provisions of the Bill. As with the enforcement of a smoking ban, the Committee strongly recommends that the lead Committee seeks assurances from the Minister on this matter.

Appendix

This appendix contains the following submissions and correspondence:

Submission from Ash Scotland
Submission from the British Dental Association
Submission from Care Commission
Submission from COSLA
Submission from Health Scotland
Submission from Optometry Scotland
Scottish Health Endowment Research Trust
Submission from the Scottish Licence Trade Association
Submission from Scottish NHS Confederation
Submission from The Scottish Social Services Council
Correspondence from the Deputy Minister for Health and Community Care’s Office dated 9 March 2005. [
PDF]

Please also note that the reports entitled:

The Economic Impact of a Smoking Ban in Public Places on the Licenced Trade and Beer Industry in Scotland;
and Research Analysis of the Economic Impact of an outright Smoking Ban in Scotland, are available in hard copy only on requests to the Finance Committee Clerks.

Written Submission to Finance Committee from ASH Scotland

Name: Maureen Moore, Chief Executive, ASH Scotland

Address: ASH Scotland, 8 Frederick Street, Edinburgh EH2 2HB

Part of Bill: Part 1

Main Objective: Prohibiting Smoking in Enclosed Public Places

International Evidence: Economic Impacts of Smoke-Free Legislation

The Scottish Licensed Trade Association (SLTA) has recently claimed that there are few examples of extensive smoke-free legislation in place from which to draw conclusions regarding the possible economic impact of introducing smoke-free legislation in Scotland. However, there is a wealth of international evidenceto demonstrate that smoke-free enclosed public places don’t have a negative impact on business.

a) Republic of Ireland

The Licensed Vintners Association (LVA)recently published research concluding that the economic impact of smoke-free legislation is unfavourable for the licensed trade in the Republic of Ireland. 19 However, t he LVA’s study was based on subjective interviews with over 270 publicans around Dublin. They were asked to describe how they viewed the impact of legislation, to estimate the effects the legislation has had, and to predict the economic future of their business. This material is entirely unreliable as a proper economic assessment as it is not based on hard financial or economic data.

It is interesting to note that the publicans’ estimates of their sales figures are significantly different to the hard data available, such as the drink sale figures produced by the Central Statistics Office (CSO) as well as the drinks manufacturers themselves. According to the latest figures from the CSO, bar sales are reported to have picked up sharply, with sales figures rising by 2.3% between September and November 2004. 20 This rise marks a turnaround after two months of declining volumes. Whilst bar sales continued to be down on 2003, falling by around 5.1%, this is dramatically less than the 29% fall in volumes claimed by the LVA, whose figures do not take account of seasonal changes to drinking purchases. 21

Smoke-free legislation in the Republic of Ireland was introduced in what was already a shrinking bar sales market. Sales reportedly hit their peak in May 2001, and since then, the volume of drink sold in Irish bars has fallen by approximately 15%. 2 Many factors have contributed to this climate, including changing demographics, the price of drink, increased price competition from supermarkets and off-licences, increased excise duty on alcohol, and changing working patterns and lifestyles. 22 Yet the LVA report attributes all of the alleged downturn in the trade to smoke-free legislation. This is simply not credible, and claims to this effect don’t stand up to scrutiny.

T he LVA has also claimed that the introduction of smoke-free legislation in the Republic of Ireland has led directly to the loss of 2,000 jobs in Dublin. 1 However, t hese figures are dubious, as they too are based on subjective interviews with bar managers or owners and not on objective economic information. Mandate Trade Union, the third largest union in the Republic of Ireland, represents almost two thousand bar workers, mainly based in Dublin. The union’s records indicate that job losses in the greater Dublin area have been in the order of a couple of hundred, not the thousands claimed. 23 Levels of visits to pubs and restaurants are thought to have remained constant since legislation was introduced, with 1 in 5 smokers choosing not to smoke at all when out socialising. The rate of smokers visiting pubs has remained steady at 74%, and the frequency of non-smokers visiting pubs has increased from 67% to 70%. 24

b) United States of America

A recent report on the first 12 months since the smoke-free legislation in New York was introduced has documented clear financial benefits to comprehensive legislation; 10,000 new jobs have been created (2,800 seasonally adjusted jobs), air pollution levels have reduced six fold, and business tax receipts in restaurants and bars are up 8.7%. 25

Many hospitality groups have claimed that their business has been detrimentally affected by smoke-free legislation. For example, in Beverly Hills, California, the Restaurant Association said that their businesses had suffered a 30% decline in revenues during the five months after smoke-free regulations were in effect. 26 As a direct result of such opposition, organised by the tobacco industry, Beverly Hills repealed their smoke-free restaurant ordinance. Studies have since shown that, contrary to tobacco industry claims, there was no detectable drop in restaurant sales during the time the ordinances were in effect, nor was the an increase in restaurant sales following reversal of the 100% smoke-free ordinances. In fact, sales increased slightly during the period the smoke-free regulations were first in place. 27

Whilst hospitality groups often claim that smokers will stop visiting pubs and restaurants, hence projected loss in trade, international data in fact shows that once-lost custom from nonsmokers starts to return. For example, it has been reported that, in the State of Massachusetts, there are more non-smokers who avoided smoky restaurants and bars pre-legislation than there were smokers in the State. 28

c) Australia

A recent study has assessed the economic impact of introducing smoke-free policies in Tasmania on sales in bars, licensed clubs, restaurants and cafes. Using seasonally adjusted monthly sales data from January 1990 to September 2002, and statistically controlling for underlying economic trends, unemployment, and population changes, the study concludes that smoke-free legislation has not had any negative impact on sales turnover in restaurants, cafes and pubs, when compared to total monthly retail turnover in Tasmania. 29

Estimated economic impact of smoke-free legislation in Scotland

A recently published international review models the likely impacts of moving from the current voluntary code to comprehensive legislation on smoking in enclosed public places in Scotland. Modelling procedures utilise existing evidence on the economic impacts that have been measured in other countries with comprehensive smoke-free legislation. The report concludes that conservative estimates of savings in the workplace exceed the ‘worst case scenarios’ for losses in the hospitality industry. The effect on the hotel, restaurant and bar sectors in Scotland is centrally estimated at +£110 million (range –£63milion to +£281million). The study also suggests that the most sizeable economic impact is a net gain for society in resource terms, which are centrally estimated at £115 million five years post legislation. 30

The SLTA have criticised this international review, claiming that there is not enough relevant research on which to base estimates of potential economic impact in Scotland. 31 However, despite this claim, they have commissioned research that suggests “the capital cost of compliance with the Bill will be in the region of £85million. The research also suggests that “costs may be well in excess of that, depending on the views of the local regulatory authorities on matters such as the provision of fire escapes and facilities for the disabled”. 32 These estimates were calculated on the basis of information that is available from Ireland, which the SLTA claims concludes that turnover in Ireland is down by more than 7% in value and 10% in volume, and that the number of jobs has reduced by 6%. 33 However, as already outlined on page 1, the latest hard data availablesuggests an increase in sales figures of around 2.3%. 2 The shrinking bar sales market that was previously reported had been in decline since May 2001 2, and the alleged downturn in trade cannot be attributed solely to the introduction of smoke-free legislation.

The SLTA have reported that smoke-free legislation will force more than 140 pubs to close, and lead to the loss of 2,300 jobs, and £59 million in tax revenue in Scotland. 34

The level of turnover in Scotland should be borne in mind when interpreting any future claims of economic loss; there are around 5,000 openings and closures of businesses over a 3-year period, without attributable effects to policy changes. 11

Predictions of a downturn in business are encountered in every country where legislation has been, or is currently being, introduced. However, s moke-free legislation has been passed in every conceivable type of community, from small towns and rural areas to a number of states, and economists have studied the impacts on communities across the spectrum. Anecdotal reports, polls or interviews with business owners concerning economic impacts of smoke-free legislation should be treated with great scepticism. No objective, peer reviewed study ever conducted has found a significant negative economic impact associated with smoke-free legislation.35 Recent research has compared the quality and funding sources of 97 studies concluding either a negative effect, no effect, or positive effect of smoke-free legislation on the hospitality industry. The best designed most rigorous studies consistently report no impact or a positive impact of smoke-free restaurant and bar laws on sales and employment. It is noteworthy that all the studies concluding a negative impact have been funded by the tobacco industry.36

Recently discovered tobacco industry documents demonstrate that second-hand smoke may be even more harmful, volume for volume, than directly inhaled cigarette smoke.37 Yet the tobacco industry continues to place the highest priority on preventing the introduction of restrictions on smoking in public places, and remain equally active in spreading misinformation about the effects of legislation that has already been introduced successfully in other countries.

The Scottish Licensed Trade - Proposed Legislation

The licensed trade umbrella group, Against an Outright Ban (AOB) represents the SLTA, the Scottish Beer and Pub Association, and other pub groups based in Scotland. In May 2004 they outlined proposals for implementation of a 5-point plan, across a 3-year period, as an alternative to the comprehensive legislation that the First Minister outlined in November 2004. The SLTA’s Chief Executive, Paul Waterson, believes that the 5-point plan would provide a “major contribution to improve health prospects in Scotlland”. 38 This alternative approach proposes that:

  1. Smoking be banned at the bar counter in all licensed premises.
  2. Smoking be banned in any area where and when hot food is served.
  3. Smoking be banned in any area from which the public is excluded
  4. Licensed premises must allocate
    1. 30% of total floor space to a non-smoking area in year one
    2. 40% in year two, and
    3. 50% in year three. This would be followed by a further review
  5. Licensed premises mist display a smoking policy at the entrance in order that customers can see the facilities available before they enter.

The option of postponing introduction of new law provides the hospitality trade and tobacco industry with increased time to step up attempts to scupper the introduction of legislation. The tobacco industry and their allies use this in every battle they have fought to try and prevent the introduction of smoke-free legislation. 39

Adopting the proposed 5-point plan would ensure that Scotland’s legislation was aligned to the policies adopted in the rest of the UK, which the SLTA believes is of extreme importance. 13 However, the 5-point plan, like the current Voluntary Charter, would fail to deliver significant protection to hospitality workers in Scotland. Even where designated smoking areas are provided under the current Charter, they often continue to expose people in the vicinity to second-hand smoke, and they increase the exposure to smoke by concentrating smokers in the one place. Neither the current Voluntary Charter, or the proposed five-point plan are based on evidence on how to protect health, either for staff in the leisure industry, or for the public who use these facilities. Voluntary agreements do not provide significantly increased protection from second-hand smoke. 4041

The Impact of Smoke-free Legislation on Tourism

The SLTA suggest that there is a “strong possibility of tourists preferring English destinations rather than Scottish ones as a result of different tobacco policies”. 13 Their concerns are contrary to the evidence available from the Republic of Ireland, where 2004 saw a reported record numbers of visitors and double the growth rate of revenue compared to Northern Ireland, where smoking is still unrestricted. 42 Surveys of tourists in Ireland demonstrate that availability of smoking areas is not a factor for most people when choosing holiday destinations. However, when smoking is an issue, it is because people want smoke-free holiday destinations. 24 Glantz and Charlesworth (1999) identified 3 US states and 6 US cities in which opponents of smoke-free legislation specifically advanced claims that such laws would adversely affect tourism. Contrary to industry claims, the introduction of smoke-free legislation was not associated with significant drops in tourism in any of the locales outlined, and in several cases significant increases in tourism were observed as a result of smoke-free legislation being introduced. 43

The Health Benefits of Comprehensive Smoke-Free Legislation

The SLTA believe that a phased approach to legislation may well achieve improved health results compared to the option of introducing the proposed Smoking, Health and Social Care Bill in Scotland. 13 However, the health benefits of comprehensive smoke-free legislation are tangible and evident in a short space of time when introduced, as outlined below.

A recent review of smoke-free workplaces in the USA, Australia and Canada estimated that comprehensive smoke-free legislation reduces smoking prevalence by 4%, and overall tobacco consumption by 30%. 44 In the six months after legislation was introduced in the Republic of Ireland, an estimated 7000 smokers had given up smoking. 45 These figures have not been matched in the North, where smoking rates remain static. 46A modest reduction in active smoking rates would have major benefits in terms of reducing numbers of deaths among the Scottish population generally.

The hospitality and tobacco industry continue to voice concerns regarding a ‘dramatic escalation a possible rise in smoking in the home ‘ as an immediate consequence of the introduction of smoke-free enclosed public places. 47 The SLTA have recently suggested that approximately six-sevenths of health problems encountered by ETS are derived from domestic situations. 13 However, evidence from countries such as the USA, Canada and Australia suggests that the introduction of legislation for smoke-free workplaces and enclosed public places may have the effect of enhancing protection from SHS in the home. For example, in Australia, the introduction of legislation for smoke-free workplaces during the 1990’s was accompanied by a steep increase in the proportion of adults who avoided exposing children to tobacco smoke at home. Among households with children, the proportion with smoking restrictions increased overall from 25% in 1989 to 59% in 1997. More specifically, in households where one adult smoked, the proportion with smoking restrictions increased from 17% to 53%, and in households where both adults smoked, the proportion with smoking restrictions increased from 2% to 32%. 48 Smoke-free legislation will clearly support current smokers attempting to quit, and denormalise smoking in society, so that future generations do not get addicted to smoking.

Hospitality Industry Representatives and the Tobacco Industry

The SLTA claim that the licensed trade has always been, and will always remain, supportive of the ultimate objective of a smoke-free Scotland. They stress that they are committed to working with the Government to improve Scotland’s health, and that they understand fully the benefits of a reduction in tobacco consumption. 13

Whilst there are many reputable experts with years of experience working in the field of second-hand smoke, t he SLTA chose to invite a scientist from Imperial Tobacco Limited to speak about the health hazards of second-hand smoke at their recent seminar on smoking in enclosed public places. 49 Imperial Tobacco still deny the link between cancer and cigarettes, and unsurprisingly, numerous attempts were made at this seminar to undermine the vast body of established research outlining the heath risks associated with exposure to second-hand smoke.

The SLTA have also widely publicised and quoted results of a recent study that claims to investigate the real effectiveness of ventilation in pubs. The study concludes that simple, low-cost ventilation systems provide an adequate means of reducing the health risks associated with second-hand smoke by significantly improving air quality. 50 This study, although widely publicised and quoted by the Licensed Trade, has not yet been published, and is currently being peer reviewed. Funding for this research was coordinated by Atmosphere Improves Results (AIR) from the SLTA. It is common knowledge that AIR is a tobacco industry funded organisation. 51 T h ere is a substantial body of published work on ventilation, carried out independently of the hospitality and tobacco industry, which shows how second-hand smoke cannot be effectively removed from the air . 525354555657. It is also widely accepted that there are no known safe limits for second-hand smoke exposure. 58

The SLTA are one of the key partners in the Against an Outright Ban (AOB) Group, which represents a consortium of organisations and individuals in the Scottish licensed trade. Their choice of ‘experts’ when engaging in scientific debate, their attempts to criticise the science on second-hand smoke, cast doubt on whether second-hand smoke harms people, and prolong the controversy about the health effects of second-hand smoke, are tactics that are entirely consistent with those used by the tobacco industry to combat smoke-free laws around the world. 59 The SLTA stress that they are committed to working with the Government to improve Scotland’s health, and that they understand fully the benefits of a reduction in tobacco consumption. However, they continue to attempt to fight second-hand smoke issues, and obstruct the introduction of smoke-free legislation in Scotland.

It has been estimated that second-hand smoke (SHS) kills up to 1,000 people every year in the UK 60; with some studies suggesting the figure is even higher than this. 61 Legislation on s moke-free enclosed public places will not harm the economy, and will improve Scotland's appalling rates of cancer, heart and lung disease, by cutting smoking rates, helping workers and customers to quit and by reducing people's exposure to unwanted smoke. Introduction of the new legislation for smoke-free enclosed public places in Scotland is the next and most important measure that can be taken to improve the health of Scotland’s people.

SUBMISSION FROM BRITISH DENTAL ASSOCIATION

QUESTIONNAIRE

Consultation

1. Did you take part in the consultation exercise for the Bill, if applicable, and if so did you comment on the financial assumptions made?

Response: The British Dental Association (BDA) is responding to Part 2 of the Bill. In this regard, we took part in and provided a comprehensive response to “Modernising NHS Dental Services in Scotland” in April of 2004. We also responded to “Towards Better Oral Health in Children” in December 2002.

The BDA still awaits formal responses from the Scottish Executive on both of these consultations.

The BDA noted the current level of expenditure on General Dental Services, outlined in “Modernising NHS Dental Services”. We also noted the level of funding that had been made available for dental practice improvements in the 3 years up to 2003.

In our response to that consultation, the BDA highlighted serious shortfalls in funding in both primary and secondary care dental services. In particular, we believe that the cost of funding the NHS General Dental Services at the current level of provision of service should be in the region of £520m, ie a threefold increase. Our estimation is based upon expenditure figures published by NHS Highland’s “Oral Health Strategy” in 2002, which shows the levels of expenditure across primary care dental services in the area. These figures highlighted a significant under-investment in the independent contractor services (the GDS), compared with the costs of providing a salaried general dental service.

2. Do you believe your comments on the financial assumptions have been accurately reflected in the Financial Memorandum?

Response: We do not believe our comments on the financial assumptions have been reflected in the Bill. For this reason, it is almost impossible for the BDA to comment in more detail. The Bill will enable legislation to take forward “Modernising NHS Dental Services in Scotland” before the Scottish Executive has announced its detailed policy intentions to address the shortcomings of the current system.

3. Did you have sufficient time to contribute to the consultation exercise?

Response: The original deadline of 5 th March 2004 proved very difficult to meet and we welcomed the extension of the consultation to 2 nd April 2004. We would suggest that consultations of this nature should extend over a minimum period of 4 months.

Costs

4. If the bill has any financial implications for your organisation, do you believe that these have been accurately reflected in the Financial memorandum? If not, please provide details.

Response: Not applicable

5. Are you content that your organisation can meet the financial costs associated with the Bill? If not, how do you think these costs should be met?

Response: Not applicable

6. Does the Financial Memorandum accurately reflect the margins of uncertainty associated with the estimates and the timescales over which such costs would be expected to arise?

Response: Not applicable

Wider Issues

7. If the Bill is part of a wider policy initiative, do you believe that these associated costs are accurately reflected in the Financial Memorandum?

Response: With regard to the policy intentions outlined in Part 2 of the Bill, the BDA has serious reservations on two grounds;(a) funding and (b) workforce. For the purposes of this submission to the Finance Committee, our comments and evidence here relate solely to the funding aspects, but includes reference to the funding implications with regard to workforce.

In the BDA’s response to “Modernising NHS Dental Services” we set out our recommendations for a way forward for improving oral health, and a shift towards a preventive based service.

The funding of general dental practices is mostly from item of service fees. This system generates the “treadmill” effect, which the Scottish Executive mentions in the Bill.

The BDA believes that if NHS dental services are to be truly modernised, then financial provision needs to be made to facilitate a preventive approach to dental care. This allows general dental practitioners to spend more time with patients discussing their oral health, their general health and agreeing individual management regimes. This increased time commitment must be recognised and appropriately remunerated. The current range of GDS allowances have been welcomed, however, the eligibility criteria of these are almost totally based on levels of GDS earnings, which is “output” based, rather than “outcomes” based; thus compounding the “treadmill” effect.

As long as the current system does not recognise this time and focuses mainly on funding reparative and restorative work, modern dental services will not be delivered. Examples of where additional support might come from would be direct support for premises and infrastructure that would include things such as equipment and materials, as well as direct reimbursement for some staff costs.

The impact of the current NHS system requires dentist to work at a pace that is increasingly difficult to sustain in order to provide adequate dental care. The result is that many dentists have had to withdraw from the NHS and seek support for running their practice through the provision of dental services on a private basis. In doing so, it also enables them to allocate greater time to their patients, which they are unable to do by working under the current NHS system.

The Scottish Executive has confirmed that since 1999, 93 practices in Scotland have ceased to provide general dental service, ie NHS treatment 62. In many cases, this has been as a result of dentists choosing to retire early. According to the findings of the “Toothousand Project”, a survey of General and Community Dental Practitioners carried out by the Scottish Council for Postgraduate Medical and Dental Education, two thirds of GDPs planned to retire early. Half of this group planned to reduce their clinical hours in the years before retirement. The “piecework” nature of the GDS was cited as one of the main reasons; furthermore, a third of GDPs identified stress as a reason for early retirement.

Many dentists (practice owners) have found it difficult, if not impossible, to sell their practices as “going concerns”. The current criteria of the Scottish Dental Access Initiative does not allow for funding to be allocated towards the purchase of established practices. The BDA believes that if the criteria were expanded in this way, it would help address the problems associated with practice closures, not least continuation of care for patients.

Free Dental Examinations

The funding of this initiative is of major concern to the BDA. In its response to “Modernising NHS Dental Services in Scotland”, the BDA favours the development of a fully funded, comprehensive oral health assessment as part of basic oral healthcare provision. The existing dental examination 1(a) in the Statement of Dental Remuneration is insufficient to identify the needs of patients and to identify and discuss and agree with them the care regimes that they should receive as part of a modern dental service.

Dental workforce shortages in Scotland will also affect the ability to deliver this initiative. Evidence to support this statement is contained in NHS Education for Scotland 4 th Workforce Planning Report “Workforce Planning for Dentistry in Scotland” published in June 2004. The Report states that in 2003 “Potential gaps in service provision may be identified by comparing the supply and utilisation model projections and the principal results suggest a current shortfall of 215 GDPs.”

The Scottish Executive has based its costs for the implementation of this initiative on the current system and “on an increase of up to 25% on the numbers of people who currently pay for dental check-ups.” The BDA finds it difficult to see how this increase in numbers of patients will be realised, more especially with current evidence showing the numbers of patients being de-registered in some areas. Evidence of a downward trend in adult and child registrations is contained in the Scottish Dental Practice Board’s annual report of 2003/2004, figures that the Scottish Executive recently presented to Parliament.

In addressing workforce shortages, the Scottish Executive must also recognise and take action on the funding of under-graduate and post-graduate education and training.

In 2000, a recommendation was made by the Scottish Advisory Committee on the Dental Workforce (SACDW) to standardise the output of the two dental schools in Scotland by setting an output target of 120 dental graduates (70 from Glasgow and 50 from Dundee), over the 5 year period 2000-2005. (Reference: “Workforce Planning for Dentistry in Scotland – A Strategic Review”).

The Scottish Executive Health Department has set a revised output target of 134, which is reflected by an intake target in 2004/2005 of 151.

The BDA believes that without significant investment in the two dental schools in Scotland, then this increase in intake will be difficult to support. The BDA understands that some of the education and training of dental students is likely to take place in a primary care setting (outreach). However, once again, this will require major investment in facilities and staff training and recruitment.

The BDA acknowledges that the proposed increase in Professionals Complementary to Dentistry (PCDs) may help to free up dentists’ time (although it has not been made clear as to how these numbers are to be increased). This is more likely to be the case if PCDs have enhanced roles within the dental team - a trend that will be facilitated under the planned new regulatory regime for PCDs. However, we note that the Section 60 Order (under the Health Act 1999) that is required to amend the Dentists Act 1984 so as to enact this change has been delayed by six months and the GDC now expects the PCD reforms will not be implemented until 2006.

Moreover, an article published in the British Dental Journal ( Vol.198 No 2 Jan 2005 page 105) 63, showed that the majority of registered dental hygienists in Scotland do not work in wholly NHS practices, but in either wholly private practice or in mixed NHS/private private (39% and 41% respectively).

GDS

The Bill is measuring and costing the current system. The BDA is unable to comment on this aspect of the Financial Memorandum, as we do not yet know the Scottish Executive’s plans for “Modernising”.

8. Do you believe that there may be future costs associated with the Bill, for example through subordinate legislation or more developed guidance? If so, is it possible to quantify these costs?

Yes, there will be future costs associated with the Bill. The modernisation of NHS dental services in Scotland cannot take place without significant increase in the level of funding. The BDA has already provided an estimation of the investment required (as outlined above).

SUBMISSION FROM CARE COMMISSION

QUESTIONNAIRE

This questionnaire is being sent to those organisations that have an interest in, or which may be affected by, the Financial Memorandum for the Smoking, Health and Social Care (Scotland) Bill . In addition to the questions below, please add any other comments you may have which would assist the Committee’s scrutiny.

Consultation

1. Did you take part in the consultation exercise for the Bill, if applicable, and if so did you comment on the financial assumptions made?

Did not take part.

2. Do you believe your comments on the financial assumptions have been accurately reflected in the Financial Memorandum?

Not applicable

3. Did you have sufficient time to contribute to the consultation exercise?

Not applicable

Costs

4. If the bill has any financial implications for your organisation, do you believe that these have been accurately reflected in the Financial Memorandum? If not, please provide details.

The financial implications as stated do provide an accurate reflection of the cost implications to the Care Commission.

Services which are excepted by regulations and that are not required to register with the Care commission will not incur regulatory costs in the form of Care Commission fees that are set to recover the full cost of regulation.

5. Are you content that your organisation can meet the financial costs associated with the Bill? If not, how do you think these costs should be met?

There are no material financial costs to the Care Commission associated with the Bill.

6. Does the Financial Memorandum accurately reflect the margins of uncertainty associated with the estimates and the timescales over which such costs would be expected to arise?

Not applicable

Wider Issues

7. If the Bill is part of a wider policy initiative, do you believe that these associated costs are accurately reflected in the Financial Memorandum?

Not applicable

8. Do you believe that there may be future costs associated with the Bill, for example through subordinate legislation or more developed guidance? If so, is it possible to quantify these costs?

No future costs that would impact on the Care Commission can be identied.

SUBMISSION FROM COSLA

Purpose

The purpose of this paper is to provide the Scottish Parliament’s Finance Committee with an outline estimate of the costs associated with the introduction, implementation and continuing enforcement of a ban on smoking in wholly enclosed public spaces as proposed by the Smoking, Health and Social Care (Scotland) Bill. The Committee is asked to note that these are preliminary costs that COSLA will refine with its member councils. The costs will, in addition, be discussed with the Scottish Executive.

Principles

1. COSLA supports the principle of the ban on smoking in enclosed public spaces and regards it as a major step in advancing the health improvement agenda which is one of our member councils’ priorities.

2. Support for the principles and goals of the Bill is dependent on the Scottish Executive providing full funding to allow for the successful implementation of the Act. This is standard COSLA policy and was reiterated as part of our spending review submission in 2004.

The Financial Memorandum

3. As usual, as required by the Parliamentary process, the Financial Memorandum was published with the Bill itself but in the absence of the detailed Regulations that will accompany the new legislation. This has caused practical problems in costing the implementation of the smoking ban and means that, at best, COSLA’s current estimate can only be an estimate. Costing new legislation is an important part of the legislative process, for all parties involved, but it is particularly important to ensure the integrity of any new legislation and its efficacy. Against this background COSLA’s member councils have provided the best estimates possible. The Committee is asked to recognise this and also the fact, that, at this stage, the interpretation of costs will vary between authorities. Any inconsistencies in approach will be addressed as estimates are refined.

4. Work with COSLA member councils has produced an initial first year estimate for the implementation of the ban of smoking in public places. Based on figures available, we believe that the total cost in 2005/6 and 2006/7 is in the region of£6 million.

5. With regard to the other elements of the Bill, the financial memorandum states that no major financial implications have been identified for local government at this stage. However, the cost neutral description of the section relating to Joint Ventures should be treated with some caution. It is felt that, in the long term, this could have implications for local authorities and COSLA would wish to reserve its position on this element of the Bill.

6. The commentary in Executive’s Financial Memorandum on the banning of smoking in public places reflects the uncertainty which all parties feel surrounds the financial elements of the Bill. It rightly states that the implementation costs for local authorities have yet to be determined and will be linked to the detail of the Regulations which have yet to be drafted. It also recognises that additional costs in the early years are likely, an open acknowledgement that is welcome. It is therefore against this background that this evidence has been prepared and the Committee will recognise that the figures used are estimates only. However, experience does indicate that where councils have given detailed estimates, the outturn costs are unlikely to vary significantly.

7. The evidence has been prepared within a short timescale to meet the Committee’s deadline and there has been little opportunity for cross checking, either at Council or COSLA level. When the Regulations are available, it is intended to repeat this exercise against the more detailed background the Regulations will provide and COSLA will be happy to make the information from this available to the Committee.

8. As indicated in the introduction to this paper, COSLA will also be working with the Scottish Executive on these financial estimates.

9. One specific point emanating from the Financial Memorandum that COSLA would like to raise relates to the generally held view that enforcement costs will diminish over time. This is accepted, but there are concerns that it may take longer than anticipated for opposition to the ban to fade. To ensure the success of the ban therefore ongoing commitment is needed from all parties involved. The ban is not a ‘quick fix’ but the beginning of what will be a sustained campaign against the damaging effects of smoking on health. The investment of sufficient resources both initially and on an ongoing basis will be essential.

10. What will not be available with the Regulations and in the next year or so with actual experience of implementation is firm evidence of the financial benefits of the legislation. Some of these benefits to health will be long term and COSLA would prefer to leave it to statisticians to attempt to quantify the cost benefits to employers, the NHS and individuals, of living and working in a smoke free environment. What is clear, however, is that there will be real benefits which must be borne in mind when considering the cost of implementing the legislation.

Individual Issues

11. COSLA would wish to comment on and highlight a number of individual issues with financial implications. These are:

Staff

12. There is already an acknowledged shortage of Environmental Health Officers – a situation likely to be exacerbated given the age profile of the profession. This is an issue the Scottish Executive has already agreed to discuss. It is a fact, however, that the enforcement needs of the smoking ban will create further demands and difficulties on council staff with considerable efforts being required for recruitment. It is recognised that fully qualified EHOs will not necessarily be required for all elements of the resulting workload and enforcement officers will be employed too – typically authorised/technical officers. This will very much be a matter for individual authorities to determine and current staffing arrangements will be a factor.

13. The possibility of combining smoking legislation duties with existing EHO officer work and with enforcement officers to be responsible for liquor license standards work will be considered by individual authorities, but decisions here will be on an individual authority basis. (For example, in one authority it is not envisaged that the Liquor Licence Standard Officer will be involved in the enforcement of the smoking ban in licensed premises. This post is considered to be a liaison and advisory link between the Licensing Board and licensees and accordingly will at most report breaches of licensing conditions to the Board. It is considered that a direct involvement in enforcement would compromise this link.) Discussions are also taking place between COSLA and the HSE regarding respective responsibilities, possible cross over etc but these discussions are at a preliminary stage.

14. There are concerns that the Executive will only fund enforcement for an initial period and that funding will then decrease with revenue consequences for councils.

15. ‘Lone working’ will not be an option given the need for corroboration and the nature of the premises to be visited allied to the police position that they are not able to commit resources to assist in the enforcement of a ban.

16. Much of the work will be of an ‘out of hour’ nature – overtime payments will be the norm.

17. For rural councils, (and notably islands authorities) given the geography of their areas, there will be particular organisational issues to be addressed and extra expenses incurred.

18. The introduction of the new legislation, if the planned timetable is achieved, will more or less co-incide with the introduction of the new EU Food Hygiene Regulations (from 1 January 2006) which will also place significant additional burdens on environmental staff.

Lead in time

19. Assuming the implementation date for the legislation will be 1 April 2006, work will be required prior to that and expenditure incurred in the current financial year. Ideally staff should be in post some months before the legislation goes live. Publicity and consultations with businesses should ideally be allowed a generous timeframe.

Street Cleaning

20. An increase in street cleaning – particularly in city centres – has been identified by elected members as a likely outcome of the ban. At the moment cigarette litter is a particular issue at the entrance to shopping centres and large office complexes and it is a problem that is expected to increase once the legislation is enacted.

21. There are differing views, however, as to the additional burden this will impose on councils and as with many of the issues relating to enforcement of the ban, advance quantification of their impact is not an exact science. Where streets are not swept in the evenings this might need to be reviewed. If cleaning is required in other than city centre areas, any noise caused by the sweepers will be a consideration. Cigarette related litter is difficult to deal with by mechanical sweeping and is labour intensive. What is clear is the view that responsibility for the immediate environs of premises such as pubs, clubs and restaurants should lie with proprietors allied to a licensing condition that licensees provide cigarette disposal facilities and/or local cleaning at licensed premises. Capital costs for the provision of additional litter bins are anticipated by many councils and to this must be added the cost of their installation and servicing.

Training

22. Training will be required not only for all staff involved, but also for elected members. A central training resource (perhaps a bespoke, module-based course) that can be delivered remotely has been suggested.

23. Training should include: enforcement; how to deal with confrontational situations/aggression/assertiveness; court room training; statement taking, record keeping; use of computers and relevant programmes

Publicity materials

24. These will be required on both a national and local basis and, as usual, in minority languages etc. Clarification is awaited as to how the £2M expenditure identified by the Scottish Executive for ‘communication ahead of implementation’ will be used. It is hoped that a proportion at least will be allocated to the central production of materials that can in turn be individually badged by councils.

Income generated from fines

25. It is not anticipated that income generated from fines will be high, but that income should be retained by councils for use, for example, to:- offset the cost of implementing the legislation, for smoking cessation services or for sports grants in keeping with the public health theme.

Start up Costs

26. These will include: advertising and employment of new staff; the development of enforcement strategies; preparation for training for enforcement and front-line staff, elected members and senior management; briefing of administrative and managerial staff and training of existing and new enforcement staff; promotion/publication of the new law and councils’ approach to enforcement, associated management of Freedom of Information and the provision of information to the public and businesses (recognised that the Scottish Executive could provide some materials centrally for badging by individual councils); use of existing EHO staff to provide advice on the ban in the run up to implementation.

27. Inspections will require to be at a higher level initially, but it is anticipated that the need for these will decline to a lower, constant rate over time.

Exemptions

28. Depending on any exemptions agreed later through Regulations, there could be financial implications for councils’ social work and housing services, eg to upgrade premises, the introduction of transitional arrangements as part of a move towards smoke-free status as well as a need for continuing support to protect workforce and client health in them. Private agencies used by councils as care providers could pass on costs to councils as service users.

Practical Experience

29. Councils’ experience of implementing similar legislation – eg dog fouling – is varied. In one council, 20-25% of fines are unpaid. The cost of pursuing these through Sheriff Officers is not cost effective.

Conclusion

30. The financial comment and estimates contained in this paper have been based on the information available to date, in some cases projected scenarios and best estimates. COSLA would welcome the opportunity to return to the Committee with more detailed financial information once its member councils have had the opportunity to consider the full implications of the new legislation in light of the detailed regulations.

February 2005


Council

 

Estimated Costs (2006/07)

+ prep costs

Comments*

Aberdeen City

114,000

Probably 75k in future years; 5000 premises; 2 FT officers; 24k start up

Aberdeenshire

109,100

1 senior officer; 2 authorised officers; admin asst + 10k essential training

Angus

108,000

Includes start up costs in 05/06; for 05/06 - Senior EHO/EHO on out of hours conditions (33k); links with other enforcement teams – 5k; publicity + comms materials – 2k; for 06/07 – 08/09 – Senior EHO – 45k; 2 PT EOs – 20k; publicity, comms – 5k. 22.7k pa estimate after 06/07

Argyll & Bute

145,000

Includes ICT set up costs of 10K + 4K for publicity materials, assuming central provision of some materials

Clackmannanshire

52,000

25k staffing (AP3); 15k street cleaning; training 2k publicity etc 10k; admin – 15k

Comhairle nan Eilean Siar

55,000

Initial recruitment training + indirect costs + possible legal & admin costs

Dumfries & Galloway

159,800

5-6000 premises (includes food premises + other where H & S enforced) 4FT officers (I co-ordinator + 3 tech officers); for first 18-24 months reducing to 2 (co-ordinator + 1 tech officer) in next 18-24 months. + admin backup

Dundee City

95,500

includes1 EHO (37,000); 1 Enforcement Officer – 25,000; Staff, training, overtime, travel, IT, local publicity + 5k initial set up

East Ayrshire

135,000

2 EHOs; Includes oncost; 10k for training + other operational costs + 10K street cleaning, litter bin provision

East Dunbartonshire

143,500

2 EHOs - 72k. accommodation – 13k; elected member training 1k – 2.5k; publicity; 5k additional street cleaning 50k

Edinburgh City

403,000

17,000 premises currently inspected – a further 3,000 expected to fall within the smoking legislation; 173k for staff (1 EHO; 1 EO; 2 Env Wardens; 2 EOs (night team); 230k - other costs (16k recurring overheads; 1k elected member training; 30k staff communication and signing; 10k publicity.

Fife

420,000

2 FT EHOs per area, reducing to 1 FTO per area as legislation beds in – 180kv for years 1 and 2, 90k thereafter; includes costs for mechanical sweepers (i80k) + additional manpower; + additional litter bins

Glasgow

896,000

192k of this for first year only; 404k for initial 3 years. Covers additional EHOs – 1 team leaders + 5 enforcement assts + admin support – 250k for 3 years; legal support; technical & admin support; monitoring; publicity & info materials; additional street cleaning – 144k pa.

Highland

184,000

Staff only costs – 4 additional staff; 4,500 premises, but 1500 estimated to require active regulation. Other costs to be added later - admin, re signage,

Inverclyde

140,000

Includes 40k in 05/06 for preparatory work

Moray

126,500

Covers 4 officers (poss qualified technical officers) – 117k; training for new and existing staff and also Licensing Board members – 4k ; implementation in council premises – 1k; printing of fixed penalty notices + establishment of systems – 3.5k. NOT included, but expected to be substantial – additional street cleaning costs and also publicity materials which it is felt should be produced by the Executive.

North Ayrshire

40,000

1 EHO only costed + training

North Lanarkshire

Using Irish experience as model; 8,600 premises – risk assessment required in some form to determine priority for visits; specialist unit will be required, managed by an EHO and initially staffed by at least 6 technical officers on short term contracts; flexible working patterns and out of hours working.

Orkney

128,000

Based on 2 officers at 30k, including out of hours working, training, mileage and publicity. Pre-implementation costs included cover training, consultations with businesses, training for elected members. NOT included is cost of employing EHOs in lead in period pre-April 06.

Perth & Kinross

312,500

5-6 staff at AP3-4; training; staff time + management costs; equipment – mobile phones, laptop PCs, printer etc; hire equipment (2 vans + running costs); publicity; admin (clerical support; job adverts; accommodation etc). Excludes training, street cleaning costs and miscellaneous additional costs

Scottish Borders

196,000

Includes 1 senior warden + 4 wardens + vehicles, training transport, recruitment – 155k; 1 AP111 officer – 35k; training 3/.5k; signage 1.5k publicity 1k

Shetland

75,100

2 EHOs at higher salary point (36,869) assumed; training £600; mileage costs

South Ayrshire

302,200

Covers additional staff + overtime, additional litter warden, training + publicity – 81k; additional street cleaning – 56k; provision of bins and their servicing – 182k

South Lanarkshire

470,000

Includes 170,000 for lead in work; costs for years 2 + 3 reducing to 230k; anticipated 6965 premises

Stirling

132,500

Senior EHO SCP 39-42); 3 EHOs SCP 31-38 Admin support (SCP 13-15); training; office accommodation

West Dunbartonshire

190,000

76k for start up + 114k in 05/06 covering recruitment, training of 2 EHO + 2 student EHOs, publicity + other misc costs; 113k and 114k in following 2 years; further 20% reduction anticipated in 09/10.

West Lothian

75,000

Includes staff (AP4), training, promotional work; 5000 premises

comments are summaries only extrapolated from detailed submissions. Where councils have provided low and high estimates of staff costs, these have been averaged.

Notes:

‘Start up’ costs typically include: development of enforcement strategy; training of front-line staff, elected members and senior management; briefing admin and managerial staff; promotion/publication costs- eg staff time, postage, officer time for preparing and presenting seminars, press releases, briefings etc; advance advice provision by EHO staff; recruitment costs; accommodation and equipment costs

Enforcement costs typically include: initial high volume of inspections, decreasing over time; out of hours working; provision of advice; responding to complaints; monitoring; technical and admin support.

SUBMISSION FROM HEALTH SCOTLAND

Response to SLTA evidence on Smoking in Public Places

Introduction

In April 2004 Health Scotland commissioned Anne Ludbrook (Health Economic Research Unit) and colleagues from the University of Aberdeen to conduct a study of the health and economic impact of the regulation of smoking in public places. The researchers were advised by a reference group that included experts in the field of epidemiology, respiratory medicine, health economics and tobacco control. The draft report was sent for peer review to four referees with international reputations in the fields of tobacco epidemiology, health economics and tobacco control. Reviewers commented on the high quality and robustness of the research and agreed with the overall conclusions. Indeed a consistent view was expressed that the overall estimates of the health and economic benefits were, if anything, rather conservative.

In their evidence the SLTA were critical of the research. The remainder of this submission is the response of the principal researcher Anne Ludbrook and the research commissioner from Health Scotland, Sally Haw to the issues raised by the SLTA.

Comments

These next comments relate to the first two points in the evidence submitted by the SLTA.

(a) Completeness, relevance and timescale of the ‘Financial Impact Study’.

The SLTA claim that the research was incomplete but fail to identify any studies that the evidence review missed.

All of the evidence reviewed related to the health and economic impacts of the regulation of smoking in public places and was entirely relevant. It is true that there was little evidence relating to impact on bars and this is made clear in the report. We excluded evidence from New York relating to the one year follow up of the comprehensive ban on smoking because it was not published in a peer reviewed source. However, it should be noted that this report showed a positive impact on bars and restaurants but did not show results for the sectors separately. As with all aspects of the research, the authors have been careful not to overstate the case for regulation.

Based on their own research report, the SLTA state that the International Review did not identify evidence that a ban would reduce the number of smokers because the smoking may be displaced elsewhere. However, the review cites specific evidence that both smoking prevalence (number of smokers) and cigarette consumption by continuing smokers are reduced by restrictions and bans and that bans have greater effect than lesser restrictions (such as segregation). Again, this evidence was interpreted cautiously in terms of modelling the results for Scotland.

There is a difference between conducting research efficiently to a short timescale and rushing the research. No evidence is put forward to identify any aspects of the report that were not conducted properly.

(b) CEBR estimates of likely financial impact.

We have not as yet had the opportunity to attempt to replicate the CEBR analysis. However, our examination of the data indicates a number of concerns. The CEBR researchers do not justify the starting date of 1996 and there is no obvious reason to include 8 years data prior to the ban. This start date introduces problems of re-indexing the published data (not discussed by the CEBR researchers). It also takes in a period of growth in the value of the bar sector, relative to the whole retail sector, in the early part of the period, whereas the performance of the bar sector relative to the retail sector has been in decline in the more recent period. This pattern of increase and decline introduces structural problems in the analysis.

Furthermore, the CEBR model does not take into account the impacts of other relevant changes on the bar sector. In particular, restrictions on children being in bars after 9 pm were introduced from September 2003. It is reasonable to hypothesise that these restrictions would have most impact on holiday and tourist business (as this would be the main time at which families might wish to be out together in licensed premises). In this case, there might be an effect in the summer months of 2004, which would confound the analysis of the smoking ban.

The CEBR researchers indicate that the accuracy and reliability of their results are supported by observation of monthly trends. However, extrapolating the seasonally adjusted trend from 2000 (which we believe is a more reasonable starting point) and comparing this with observed monthly data gives a reduction in ratio of the sales value index for bars to the sales value index for all retail business (excluding the motor trade) of 4.4% (rather than 7.3%) and for the ratio of the volume indices of 2.4% (rather than 10.7%). This is without taking into account any possible effect of the restriction on children after 9pm.

Points (c) – (f) are not related to the evidence review.

Comments relating to the Moffat Research Centre Report

Chapter 9 – Review of Aberdeen University Study.

1. The first paragraph states that the Aberdeen study defines its geographic scope by selecting and reviewing studies from other countries. This is incorrect. We reviewed all the studies that met the quality criteria and these happened to be from other countries. We have not excluded evidence from the UK, as this opening paragraph might imply, and the Moffat report does not offer any evidence that has been missed.

2 The Aberdeen study reviewed all of the evidence from all of the sectors. Only one study related to smoking restrictions affecting bars but this reflects the available evidence. We excluded the one-year report from New York City, which has introduced a comprehensive smoking ban, because the report was not a peer reviewed publication. The reported experience in New York of the Smoke Free Air Act was an increase in tax receipts from bars and restaurants but this was not broken down between the two sectors.

3. The Moffat report attempts to argue that because areas where restrictions have increased incrementally have reported no significant effect on business, an outright ban in bars where smoking restrictions have previously been very limited will necessarily have a more adverse effect. This is a logical fallacy and is not supported by any evidence. Most studies have found no significant effect when restrictions are first introduced. Also, the study cited relates to restaurant restrictions, and the author(s) of the Moffat report maintain a position that evidence relating to restaurants and hotels is not relevant to bars.

4. The comments under 9.3 relating to the study by Glantz and Smith 1997 are erroneous. Although this study was undertaken before a State wide ban on smoking in bars took effect in California, the data in this study were taken from 5 cities and 2 counties which had already enacted bans on smoking in bars.

5. The author(s) of the Moffat report then totally misinterpret the use of the term ‘subjective’ in the Aberdeen University report, despite a clear distinction having been made. Subjective is used to describe the type of information contained in certain reports and papers; i.e. opinion survey results. This is in comparison to objective data, such as sales tax receipts. At no time does the Aberdeen University report refer to self-interest or bias. An overview of the subjective research findings is provided in the Aberdeen University report.

6. The author(s) of the Moffat report assert that there are two weaknesses in the Aberdeen University report relating to a lack of evidence on:

  • reduction in smoking following a ban rather than a displacement of smoking from the workplace; and
  • the impact of a no smoking policy on the hospitality sector, particularly bars.

In relation to the first point, the author(s) have either not read, or not understood, the section of the Aberdeen University report relating to changes in smoking behaviour. This provides a clear overview of evidence of a reduction in smoking prevalence (number of smokers) and a reduction in total number of cigarettes smoked by continuing smokers. The only reservations expressed in the Aberdeen University report related to estimating the precise size of the effect, not its direction, and a cautious interpretation was employed in modelling the results for Scotland.

Regarding the second point, the main argument resorted to by the Moffat report is an attack on the background of the authors of two studies cited in the Aberdeen University report (one of which is referred to by the wrong date and was not included in the evidence review). The study that was used in the review, Glantz and Smith 1997, was published in a leading medical journal and subject to rigorous scientific review. These are appropriate considerations in a serious review of evidence; personal attacks on the authors are not. The Moffat report author(s) neglect to comment on the authors of nine other studies cited in the review, all reporting similar findings, one of which was published in a hospitality sector journal (Cornell Hotel and Restaurant Administration Quarterly). As no ‘economists familiar with the hospitality and tourism industry’ appear to have published any analysis of objective data in peer reviewed publications, it is unclear what additional evidence such individuals could bring to the study.

The remainder of this section of the Moffat report largely consists of repeating the caveats included in the Aberdeen University report. We had considered all the potential weaknesses of both the health and economic impact evidence and drew very careful conclusions taking these into account. The author(s) then indicate that the level of analysis of economic impacts has to be similar to that given to the health argument. However, it is almost impossible to replicate the kind of study designs available in medical research. We recommended that research should be undertaken at the level of individual businesses using objective data, such as tax information, although this could be difficult to achieve for reasons of confidentiality relating to such data.

Chapter 10 The counter argument

This chapter provides no new evidence and repeats the argument that there is no reliable evidence for reduction in active smoking despite the evidence put forward in the Aberdeen University report.

Anne Ludbrook
University of Aberdeen

Sally Haw
NHS Health Scotland

February 2005

SUBMISSION FROM OPTOMETRY SCOTLAND

Smoking, Health and Social Care (Scotland) Bill: Financial Memorandum

I am writing as Chairman of Optometry Scotland, the organization that represents the profession which will be charged with the implementation of the Partnership Commitment on “free eye checks”, as provided for in the Smoking, Health and Social Care (Scotland) Bill. We wish to take this early opportunity of advising the Committee that, in our view, the funding estimates contained in the Bill are likely to fall well short of that required to fulfil the Commitment.

We appreciate that the figures in the Bill were produced from the currently available GOS data and that the SEHD have informed the Health Committee that information on any additional costs for Dental and Optometry services will be made available as soon as practicable.

At the request of the Scottish Executive, The Review of Eyecare Services in Scotland is currently considering fundamental changes in the nature of care and responsibility optometrists will have for Eyecare in the community. The Centre for Change and Innovation is designing pathways for Eyecare that will make use of the services of Optometrists at a level far in advance of that for which the current very limited General Ophthalmic Services contract was designed almost 60 years ago. The introduction of Community Health Partnerships and integrated inter-disciplinary working arrangements will reinforce this updated provision of Optometric Eyecare.

Using Optometry, in the way under discussion with the SEHD, will reduce acute referrals to the hospital sector by approximately 40%. There will also be considerable direct patient, carer and social benefits that it is our intention to quantify within the interim Review of Eyecare Services Report.

OS believes that this Bill offers the opportunity to provide Scotland with a primary Eyecare service of which it can be truly proud and which will contribute significantly to a real health gain for the country. This must, however, be accompanied by realistic funding and we will continue to work with SEHD to develop the detail of that.

We would therefore commend the Smoking, Health and Social Care (Scotland) Bill to the Finance Committee and encourage its support bearing the caveats above in mind.

Yours sincerely,

Hal Rollason
Chairman

SUBMISSION FROM SCOTTISH HEALTH ENDOWMENT RESEARCH TRUST

SHERT was involved in discussions with the Chief Scientist Office about the proposed wording for the section of the Bill dealing with the repeal of SHERT’s public body status and was also asked for comments on the financial assumptions which are now included in the Financial Memorandum.

The Financial Memorandum accurately reflects the financial implications for SHERT connected with the repeal of public body status in the way proposed in terms of Section 32 of the Bill.

SHERT can meet the one-off financial cost associated with the Bill.

We would also comment that, in the long term, we do anticipate that the change of status will lead to cost savings for SHERT. These are impossible to quantify and have therefore correctly been reflected in the Financial Memorandum as being “at the most …….. neutral”. Perhaps the likelihood of cost savings could be emphasised to the Finance Committee.

Any comments or queries should be directed to Simon Mackintosh or Alexander Garden at Turcan Connell, SHERT’s Secretaries.

Turcan Connell
Secretaries to SHERT
10th January 2005

SUBMISSION FROM THE SCOTTISH LICENSED TRADE ASSOCIATION

On behalf of the SLTA I am writing to formally respond to your invitation to give a written submission to the Finance Committee on the Financial Memorandum of the Smoking, Health and Social Care (Scotland) Bill. As previously advised both Paul Waterson, Chief Executive, and I will be representing the SLTA at the oral hearing on Tuesday 8 February.

The SLTA represents 1,800 licensees in Scotland who are mainly independent self-employed publicans operating bars and small hotels throughout the length and breadth of the country.

There is a common misconception, perhaps derived from uninformed press reports, that the SLTA has opposed the Government’s plans to increase restrictions on smoking in public places. On the contrary, we have been working with the Scottish Executive for five years as partners in the Voluntary Charter and we proactively approached the Deputy Health Minister in May 2004, asking him to legislate for the introduction of significant restrictions on tobacco smoking in licensed premises with incremental restrictions being introduced on an annual basis.

We would like to present six principal points for your consideration and for further debate at the oral hearing:

(a) The Financial Impact Study carried out by the Scottish Executive (through Aberdeen University’s International Review) has been incomplete, irrelevant and rushed.

(b) Independent research, commissioned by the licensed trade, suggests that the financial impact will be far greater than stated in the Financial Memorandum.

(c) We feel it is extremely important that Scotland’s policy on tobacco restrictions should be aligned to the policies adopted in the rest of the UK. There should be exemptions for licensed premises which do not serve hot food.

(d) The knock on effects of the health and economic impact of a sudden, outright ban have, so far, not been fully considered by the Scottish Executive.

(e) The gradual or phased approach may well achieve improved health results, in comparison to the outright ban approach.

(f) The licensed trade wishes to continue to work with the Government to achieve the common aim of a healthier Scotland.

Can I now elaborate on these six points.

(a) Lack of Relevant Research

The licensed trade has commissioned the Moffat Centre for Travel and Tourism Business Development, Glasgow Caledonian University, to undertake a project to source, review and evaluate existing research which has been undertaken in analogous destinations and countries which have legislated for either an outright or a phased ban on smoking in workplaces. This included the aforementioned International Review undertaken by the University of Aberdeen.

Their report is herewith attached at appendix 1.

The Moffat Centre conclusions include:

The weakness of the International Review is its lack of relevant evidence to:

(a) support the argument that an outright ban in all workplaces will reduce the number of smokers when increases in smoking may be displaced elsewhere eg in the home

and (b) make a claim that a no smoking policy will not harm the hospitality business, particularly bars.

(page 50 refers)

The authors of the International Review add weight to the above argument by freely admitting that “the estimates for Scotland of the impact on the hospitality sector of a smoking ban are not considered to be as robust as the estimates for the health effects”. This was likely to be the case as the authors are from a health background.

(page 50 refers)

We would expect pubs and bars to feel the negative effects of a total ban much more keenly than in the restaurant and hotel sectors. (page 54 refers)

Nearly all the governments in the countries and states reviewed for this work, with the exception of Ireland, have given significant notice of their intention to introduce a total ban on smoking in hospitality establishments. This is only fair given the apparent difference in perception of the public towards smoking in different categories of hospitality premises. The Scottish Executive could take a lead from the experiences of other nations’ legislature. (page 54 refers)

It has been acknowledged as a weakness in the Executive’s commissioned research that the studies reviewed do not include analysis of a total ban situation. This is compounded by the lack of transferability of the cases used in their argument. (page 54 refers)

A government-backed investigation into the effects of the ban in Ireland could be undertaken, using a cross sectoral group that encompasses health experts, industry practitioners and government policy makers. This would surely provide a consensus on the effects of and timescale for introducing a total ban, if that was the conclusion of the group. (page 55 refers)

(b) Likely Financial Impact

The licensed trade in Scotland has been alarmed by the lack of any in depth study of the potential financial impact of the smoking ban. As one of the key partners in the “Against an Outright Ban” Group we commissioned the Centre for Economics and Business Research ( London) to independently review the economic impact on both the licensed trade and the beer industry in Scotland. The CEBR report is attached as appendix 2. Its findings include:

  • The value of annual turnover in the licensed trade will decline by £105m (page 5).
  • Annual profits in licensed premises may decline by £86m (page 5).
  • Employment in the licensed trade can be expected to decline by 2,300 jobs initially (page 5).
  • About 142 average sized licensed premises may close as a result of decreased trade (page 5).
  • The Chancellor of the Exchequer may lose out on a total of £59m in annual tax revenues from Scotland (page 5).

(c) Alignment with the Rest of the UK

The SLTA feels strongly that Scotland should align its general smoking policy with that of the rest of the UK. Tourism is a major contributor to the economic welfare of Scotland and we feel that there is a strong possibility of tourists preferring English destinations rather than Scottish ones as a result of the different tobacco policies. Eighty percent of visitors to Scotland are English based. There is support for this theory from American boundary States (see page 40 of Moffat Centre research) where border-hopping has become an issue.

We would like to make it clear that we do not agree with the exemptions proposed in England for registered clubs. Whatever smoking restrictions are introduced (in any country) it is not fair or reasonable to give preference to clubs (which don’t pay tax on their profits) over business premises (which do pay several different taxes on their income). If clubs are subject to different laws from licensed premises, health problems are not solved – they are merely shifted.

(d) Knock on Effects

Little recognition seems to have been afforded to the ramifications of a downturn in the Scottish leisure industry and the consequences of lower employment. The fear of unemployment affects the mental and physical welfare of all those who work in any industry which is subjected to such sudden cultural change as this.

Moreover, there has been no Scottish Executive research into the potential consequence of smokers ceasing to visit licensed premises and switching their disposable spend into take home drinking. Approximately six-sevenths of health p roblems encountered from ETS are derived from domestic situations and it is quite possible that the outright ban approach will result in greater health p roblems as a consequence. Obviously, this is a crucial point and we strongly contend that the Scottish Executive should conduct independent research into the likelihood of this before any legislation is approved.

(e) The Benefits of the Gradual Approach

The Scottish Executive’s own research, and many other opinion surveys show that the Scottish public favour tobacco restrictions but they also favour a gradual approach to the banning of smoking in licensed premises. It is our contention that the public will support a phased approach to an eventual ban but could well be hugely resistant and rebellious to the outright ban proposition. If the outright ban proposal simply fosters the “couch potato syndrome” the desired effect of moving towards a smoke free Scotland will not be achieved. The legislation will not solve a health p roblem – it will simply shift the health p roblem from ETS experienced in public places to ETS experienced in domestic environments.

(f) Working Together in the Future

We would stress that the Scottish Licensed Trade Association wishes to continue to work with the Government to improve Scotland’s health and we understand fully the benefits of a reduction in tobacco consumption. What we are seeking at this stage is a reappraisal of the best means to achieve the desired outcome. It will be to the benefit of all parties if the Scottish Parliament adopts a phased approach to a smoking ban or the structure proposed by Dr John Reid for England (apart from the matter referred to earlier – there should be the same smoking rules for pubs and clubs).

These are our main points. However, we would further comment on the Financial Memorandum as follows:

1. No attempt seems to have been made to examine the loss of excise duty, VAT, etc to the Exchequer should smoking of tobacco reduce following the implementation of the ban. The most recent figures (2001/2002) calculate excise duty on tobacco to be £9.5bn. Scotland has about 9% of total UK population so it is fair to assume that the tobacco take from Scotland is circa £855m. Section 202 of the Financial Memorandum pontificates that 4% of smokers might quit following the introduction of a workplace ban. If that proves to be the case the tobacco take will decrease by over £34m. Against that, NHS savings due to 4% lower treatment costs would be £8m. Thus, the net cost would be in the region of £26m.

2. The Financial Memorandum makes reference to National Health Service Scotland savings should there be a reduction in the number of smokers over time and therefore a reduction in the treatment of smoking related diseases. However, the Memorandum fails to endeavour to capture the cost of expensive geriatric healthcare and attention if longevity is achieved through the smoking ban.

3. Further, no attempt has been made to calculate the cost to the country of providing pensions for smokers who live longer as a result of the smoking ban. This is a major issue for everyone at present – pensions are not being funded adequately as it is.

We would also make the following observations on the Financial Memorandum:

(a) If the smoking ban is to be enforced effectively by the authorities we estimate that each of Scotland’s 32 licensing boards will require around six additional environmental health officers to cover the geographic territory and the long working day within the licensed trade (including sports and social clubs) which stretches to almost 24 hours. We believe that the cost of this policing could amount to as much as £6 million per annum.

(b) We are baffled by the “international research” which is suggesting that there will be an identified saving from smoking breaks which would no longer be permitted under the terms of the proposed legislation. This is patently a nonsense. If smoking breaks are permitted by employers at the moment then it is clear that the staff involved will require to leave the premises rather than stay within the premises, once the ban is imposed. So there would be no cost implication whatsoever. However, it is our experience that very few employers permit smoking breaks in Scottish industry at present. In most companies if staff want to smoke they must do so in their own time, not in the time of their employers. So it is a “cost neutral” issue.

Conclusions

The licensed trade has always been, and will always remain, supportive of the ultimate objective of a smoke free Scotland. However, we strongly believe that the Scottish Executive has not afforded the time and consideration necessary to identify the best move for public health. As we have stated, there is a significant body of evidence to suggest that an alternative strategy, with the same aim, may further increase the health benefits achievable from restricting the use of tobacco in licensed premises.

Surely what is effectively the most radical move in public health policy this government has seen deserves a greater attention to detail?

We urge the Finance Committee to request more time to conduct research into the financial and health benefits of alternative approaches. In addition, we would urge the government to consider new and innovative ways to tackle smoking. This debate

seems to have been dominated by a ban / no-ban approach. At no point in the process would it seem that anyone has really sat down and looked for the best solution.

Should the Executive decide to give the decision just a bit more thought we would of course be delighted to help in anyway possible.

We look forward to further debating these issues with you at the oral evidence on 8 February.

Yours sincerely

Stuart Ross
Chairman of the Year 2004
The Scottish Licensed Trade Association

SUBMISSION FROM THE SCOTTISH NHS CONFEDERATION

Written submission to the Finance Committee on the financial memorandum of the Smoking, Health and Social Care (Scotland) Bill

January 2005

1. The Scottish NHS Confederation is the independent representative body for NHS Scotland boards and special health boards. We are grateful to the members of the Finance Committee for giving us the opportunity to present evidence on this important bill.

2. We have confined our comments to the sections of the bill where we believe that there are potential significant financial implications for NHS organisations. We have not commented on the implications for NHS National Services Scotland as, although they are one of our member organisations, they are giving their own evidence to the committee.

3. A key point that the committee should bear in mind when considering all new cost commitments for NHS boards is that, despite significant increases to their allocations in recent years, boards have only very limited financial scope available to develop new services or take on new commitments. This is because funding increases have been accompanied by new cost pressures which account for the greater part of boards’ annual allocation uplifts. Chief amongst these is the UK-wide pay modernisation agenda (the new GMS and consultant contracts and Agenda for Change), along with increases in prescribing costs and a revaluation of the NHS estate. Further pressures to come in the future will include the implementation of Modernising Medical Careers, the review of training for doctors. NHS boards increasingly find that their annual allocation uplifts are largely accounted for by the time they reach them, and that they have very little left over to redesign and develop services. Audit Scotland reported that of the additional £2.7 billion allocation uplift (£1.8 billion in real terms) for the whole of NHS Scotland 02/03, £1.4 billion was already accounted for, not including Agenda for Change. 64 This picture was confirmed by the most recent Auditor General’s overview of NHS Scotland financial performance, which concluded:

“Despite significant increases in funding …the NHS in Scotland is facing unprecedented challenges over the coming years…the fixed costs associated with staffing and property will make it difficult for NHS boards to free up money for redesigning services.” 65

4. Prohibition of smoking :

The Confederation fully supports the proposals to prohibit smoking in public places and is confident that, in the long-term, it will result in a considerable reduction of the estimated £200m per annum that smoking-related ill-health currently costs NHS Scotland. It is extremely difficult to predict when these savings will be released and at what level they will be achieved, as the wide range of the Executive’s own estimate (£5.7m – £15.7m) in the Financial Memorandum indicates.

5. In order that the full health benefits of the prohibition of smoking in public places are realised, the policy should be supported by further investment in NHS smoking cessation services. The Executive has already confirmed, in A Breath of Fresh Air – Improving Scotland’s Health: The Challenge, that funding for smoking cessation will rise to £5m across Scotland for 2005/06. This figure is welcome but may need to be supplemented , not only in order to respond to increased demand as a result of prohibition of smoking coming into force, but also in order to allow NHS boards to actively promote their full range of smoking cessation services without fear of staff being overloaded, waiting times building up or prescription costs increasing significantly in the short-term. Several studies (such as Buck and Godfrey 1994 66 and Parrott and Godfrey 2004 67) have found smoking cessation services to be one of the most cost-effective forms of health intervention. It is difficult to say in advance of prohibition being implemented how much extra investment may be required, but the Executive should be prepared to respond if necessary to the evidence presented by NHS boards.

6. Free eye and dental checks

The Confederation has always welcomed the proposal to introduce free eye and dental checks as an important contribution of preventive health care, but we have had some concerns about the impact that the costs of providing free checks would have on existing NHS services. We are pleased therefore that the Executive has committed to provide funding to National Services Scotland to cover the costs of free checks, but stress that this must be additional funding and not drawn from existing NHS allocations.

7. Provision of General Dental Services

Section 13 of the bill provides for NHS boards to provide assistance and support, including financial assistance to general dental practitioners. This could be a useful method of encouraging dentists to contribute more of their time to treating to NHS patients or to move into areas which are currently lacking in dental provision. We believe however that it could also lead to an expectation on the part of practitioners that financial assistance will be provided, and that this burden will fall particularly on boards where there are particular shortages of NHS dentists and/or where issues with the quality and availability of premises have been identified, such as in remote and rural and urban deprived communities. The Executive should, in the interests of ensuring an adequate level of dentistry provision across Scotland, consider providing additional resources for those boards which are likely to find themselves in the position of having to make higher levels of financial assistance available.

8. The estimation in the financial memorandum of a £500,000 increase in administrative costs across NHS Scotland resulting from the new GDS provisions seems reasonable and, if the actual costs turn out to be in this region, they should be found fairly easily from existing allocations. However, it is difficult to predict exactly what administrative costs will be in advance of the new provisions coming into force, and once again it is likely that a larger burden will fall on those NHS boards that currently face particular problems with dental service delivery.

9. Pharmaceutical care services

The Confederation fully supports the Executive’s intentions, set out in Modernising Community Pharmacy, to further integrate community pharmacy into the NHS, to increase the clinical care offered by community pharmacies and to improve access to community pharmacy services across Scotland, as part of the overall strategy to deliver services closer to patients. An important element of this strategy is the new responsibility for NHS boards to secure the provision of adequate pharmaceutical services in their areas, and we support the plan to disburse the existing national ‘global sum’ to NHS boards so that they have more control over the use of that money in response to local needs.

10. We do not believe, however, that the current global sum of £97m for the whole of Scotland will be sufficient to allow boards make the investment that will be required to adequately rectify under-provision of pharmaceutical services over and above the maintenance of existing services. Until boards develop their individual Pharmaceutical Care Services (PCS) Plans, we cannot say exactly what the extent of under-provision is and what it will cost to address, however we do know that there are significant service gaps in many remote and rural and deprived urban areas. Expanding provision to fill these gaps and to ensure that there is equitable access to PCS across Scotland will have significant cost implications. The Financial Memorandum does give some indication of the specific costs that may be involved (£30,000 to £80,000 for fitting small to medium-sized premises), and it can be seen even from this broad estimation how costs could quickly accrue for boards which have significant service gaps to fill. These costs will be extremely difficult for boards to meet from their annual allocations at the present time, for the reasons that we outline in paragraph 3. The Confederation believes that the Executive should give serious consideration to finding additional resources for boards to fulfil their PCS Plans once they have been drawn up. The expansion of community pharmacy will be an important factor in the successful implementation the Executive’s health policy agenda and it should be funded properly.

11. Once again, the estimate of £500,000 across NHS Scotland for additional administrative costs associated with the new PCS provisions does not seem unreasonable, but the true figure will not be quantified until implementation begins to take place.

12. Joint Ventures

The development of a Joint Ventures model would provide NHS boards with another vehicle, if they choose to use it, to invest in and expand community premises and services. Since there is so little flexibility within annual financial allocations for service development, the creation of new options for NHS boards in this respect is welcome. The new arrangements for securing and exploiting intellectual property developed within the NHS are also welcome, and are a source of potential income. Both of these are complex issues and we look forward to seeing the outcomes of the work of the Joint Premises Project Board for further detail on implementation.

13. Finally, we would reiterate that NHS boards currently have very limited capacity within their existing financial allocations for service expansion. One idea that has come from Confederation members is that the Executive should provide boards with financial memorandum-type costings for new health policies, before they reach legislative stage, where this is relevant. We would suggest that this would be extremely useful, not only to aid financial planning at the centre and at board level, but also to assist the Parliament’s committees in their scrutiny of health policy.

SUBMISSION FROM SCOTTISH SOCIAL SERVICES COUNCIL

Smoking, Health and Social Care (Scotland) Bill – Financial Memorandum

Thank you for the opportunity to comment upon the Bill. The Council was aware of the Bill and supports the amendments relating to its functions. (These can be found in the Explanatory Notes, page 19, paragraphs 131-135; page 38, paragraph 259 and in the Policy Memorandum, page 24, paragraph 140). The Council brought to the attention of the Scottish Executive the issues it wished to see addressed relating to its functions. We do not anticipate any additional costs arising out of the sections relevant to the Council’s function and responsibilities.

Yours sincerely

Carole Wilkinson
Chief Executive


Footnotes:

1 Smoking, Health and Social Care (Scotland) Bill: Explanatory Notes page 30

2 Submission from the Scottish Licensed Trade Association

3 Waterson, Official Report, 8 February 2005. Col 2310

4 Waterson, Official Report, 8 February 2005, Col 2312

5 Submission from Health Scotland

6 McKeown, Official Report, 8 February 2005, Col 2318

7 Greenhill, Official Report, 8 February 2005, Cols 2314 and 2315

8 Davidson, Official Report, 1 March 2005, Col 2425

9 Scottish Executive, Draft Regulatory Impact Assessment, published 10 March 2005

10 Davidson, Official Report, 1 March 2005, Col 2422

11 Wilson, Official Report, 1 March 2005, Cols 2432 and 2433

12 Wilson, Official Report, 1 March 2005, Col 2430

13 Wilson, Official Report, 1 March 2005, Col 2430

14 Wilson, Official Report, 1 March 2005, Col 2430

15 Wilson, Official Report, 1 March 2005, Col 2431

16 Wilson, Official Report, 1 March 2005, Col 2432

17 Naldrett, Official Report, 1 March 2005, Col 2439

18 Naldrett, Official Report, 1 March 2005, Col 2439

19 ‘ Ireland’s Smoking Ban Shows Results’. Article in Taipei Times, 23 rd November 2004. Available online at: http://www.taipeitimes.com/News/feat/archives/2004/11/23/2003212287 (Accessed 12/01/05).

20 ‘Retail sales rise of 2.8% marks turnaround – CSO.’ Press article in the Irish Times, 22 nd January 2005.

21 ‘Pub sales dip raises doubt on impact of ban.’ Press article in the Irish Independent, 25 th January 2005.

22 Douglas, J. (2004). ‘The view from behind the bar’. Paper presented at the Scottish Executive ‘Towards a smoke-free environment’ conference, September 2004.

23 Mandate Union Press Release: ‘Irish Barworkers’ Union urges Scottish People to Follow Irish Smoke-Free Workplace Legislation.’ Monday 17 January 2005 .

24 Office of Tobacco Control. Smoke-free Policies: Market Research & Literature Review on Economic Effects on the Hospitality Sector. Clane ( Ireland): Office of Tobacco Control, 2004.

25 The State of Smoke-Free New York City: A One Year Review. Online at http://www.tobacco.freekids.org/pressoffice/NYCReport.pdf (Accessed 22/04/04)

26 “The 30 Percent Myth,” sidebar to the article “Public Interest Pretenders: That group with the do-good name may not be what it seems, Consumer Reports (1994), 59, 316-320.

27 Glantz, S and ? Smith (1994). The effect of ordinances requiring smoke-free restaurants on restaurant sales. American Journal of Public Health, 84, 1081-1085.

28 Biener & Fitzgerald (1999). Smoky Bars and Restaurants: who avoids them and

why? Journal of Public Health Mgt. and Practice 5, 74-78.

29 Lal, A. et al. (2004). The economic impact of smoke-free legislation on sales turnover in restaurants and pubs in Tasmania. Tobacco Control, 13, 454-455.

30 Ludbrook, A., Bird, S and van Teijlingen, E. (2004). International Review of the Health and Economic Impact of the Regulation of Smoking in Public Places. Summary Report. Available online at: http://www.hebs.com/researchcentre/pdf/InternationalReviewShortReport.pdf (Accessed 11/01/05)

31 SLTA submission to the Finance Committee of the Scottish Parliament, F1/S2/05/5/1, 08/02/2005.

32 SLTA response to Stewart Maxwell Bill, page 3, para. 1

33 The Scottish Parliament Finance Committee Official Report, 8 th February 2005. Available online at: http://www.scottish.parliament.uk/business/committees/finance/or-05/fi05-0502.htm (Accessed 17/02/05).

34 ‘Smoking ban will cost 2,300 jobs and 140 pubs, report claims.’ Press article in the Scotsman, 05 February 2005, available online at: http://news.scotsman.com/scotland.cfm?id=141022005 (Accessed 08/02/05)

35 American Lung Association (2004). Fuzzy Math. How the Tobacco Industry Distorts the Truth about the Economic Effects of Smokefree Restaurants and Bars. Available online at: http://www.lungusa.org/atf/cf/{7A8D42C2-FCCA-4604-8ADE-7F5D5E762256}/FUZZYMATH.PDF (Accessed 20/01/05).

36 Scollo, M. and Glantz, S.A. (2003). Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry. Tobacco Control, 12, 13-20.

37 Gugel, H. et al. INBIFO, Institut fur Biolgische Forschung. Intergrating Report A 0500/3047 21-Day Smoke Inhalation Study with Mainstream and Sidestream Cigarette Smoke of Standard Reference Cigarette Type 2R1 on Rats. 29 July 1982. Philip Morris Bates No. 2029190329/0354.

38 Waterson, P. (2005). “The Licensed Trade in Scotland”. The Scottish Licensed Trade Association Pub Smoking Seminar Conference, Edinburgh, 13 January 2005.

39 http://www.tobaccoscam.ucsf.edu/index.cfm (Accessed 09/02/05),

40 Freeth, S. (1997). Smoking Related Behaviour and Attitudes. London: ONS. 1998.

41 The Scottish Executive. Scottish Health Survey 1998: Vol. 1. Edinburgh: The Stationery Office, 2000.

42 Fáilte Ireland news release, 10/01/05: http://www.failteireland.ie/?id=9&MediaID=82

43 Glantz, S.A. and Charlesworth, A. (1999). Tourism and hotel revenues before and after passage of smoke-free restaurant ordinances. Journal of the American Medical Association, 281, No. 20. Available online at: http://www.tcsg.org/sfelp/revenues.htm (Accessed 17 February 2005).

44 Fichtenberg, C.M. and Glantz, S.A. (2002). Effect of smoke-free workplaces on smoking behaviour: systematic review. British Medical Journal, 325, 188.

45 ‘7,000 Fewer Smokers in Ireland.’ Smoke Free at Work Press Release. 26th September 2004. Available online at http://www.smokefreeatwork.ie/news/detail.asp?id=22 (Accessed 08 February 2005).

46 The British Medical Association (2004). “The Human Cost of Tobacco”.

47 Beers, R. ‘One way to increase smoking in the home’. Letter to the Herald, 25 January 2005.

48 Leiss, W. (1999). Risk perception and communication: environmental and child health. Background paper. WHO international Consultation on Second-hand smoke and Child Health: Consultation Report. Geneva: World Health Organisation. WHO/NCD/TFI/99.10. Online at: www.who.int (Accessed 28/07/04)

49 Stotesbury, S. (2005). Smoking in Public Places and Second-hand smoke (SHS). Imperial Tobacco Limited. Paper presented at the SLTA seminar, January 13 th, 2005, Edinburgh.

50 Geens, A. (2005). Can ventilation clear SHS? Paper presented at the Scottish Licensed Trade Association Pub Seminar Conference, Edinburgh, 13 th January 2005.

51 The Tobacco Manufacturer’s Association funding of AIR and Dr Geen's consultancy are documented at http://www.airinitiative.com/press.asp?id=109

52 Repace, J (2004). Respirable Particles and Carcinogens in the Air of Delaware Hospitality Venues Before and After a Smoking Ban. Journal of Occupational and Environmental Medicine, 46, 9, 887-905.

53 Mulcahy, M. (2001). Pubsmoke: Passive smoking in bars. Environmental Health Officers Association Yearbook 2000/2001, pp.38-44. EHOA Ormond House, Ormond Quay, Dublin 7.

54 World Health Organisation Report on International Consultation on Second-hand smoke (SHS) and Child Health. January 1999, Geneva, Switzerland.

55 Smoking Kills – A White Paper on Tobacco. Online at: http://www.archive.official-documents.co.uk/document/cm41/4177/contents.htm (Accessed 19/01/05).

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