The Health and Sport Committee issued a call for written views on the Health (Tobacco, Nicotine etc. and Care)(Scotland) Bill on 3 July 2015.
The Bill was introduced in the Parliament on 4 June 2015 and the Health and Sport Committee has been designated by the Parliament as the lead Committee.
The stated policy objective of the Bill is to make provision about tobacco, nicotine and related products, in particular to make provision about retailing, to amend the prohibition on smoking in certain areas and to control advertising and promotion; to make provision about a duty of candour following serious incidents in the course of providing care; to make provision about offences applying to ill-treatment or neglect where care is provided, and for connected purposes.
There are three key parts to the Bill. These are described briefly below.
1. Nicotine Vapour Products and smoking in hospital grounds – The Bill will introduce restrictions on the sale of nicotine vapour products (NVPs) such as e-cigarettes and shisha pipes. These restrictions will include; a minimum purchase age of 18, prohibiting the sale of NVPs via vending machines, requiring NVP retailers to register on the tobacco retailer register, prohibit ‘proxy-purchasing’ for under 18s, restrict domestic advertising and promotions, implement an age verification policy for the sale of NVPs and ban staff under the age of 18 from selling tobacco and NVPs. The Bill would also make it an offence to smoke in parts of hospital grounds
2. Duty of Candour – The Bill proposes to place a duty of candour on health and social care organisations. This would create a legal requirement for health and social care organisations to inform people (or their carers/families) when they have been harmed as a result of the care or treatment they have received.
3. Ill-treatment and willful neglect – The Bill would establish a new criminal offence of ill-treatment or willful neglect which would apply to individual health and social care workers, managers and supervisors. The offence would also apply to organisations
Organisations and individuals were invited to submit written views to the Committee in relation to the inquiry remit. Those submitting views were asked to feel free to address the issues in whatever manner they preferred, but also to attempt to address the questions set out below—
NVPs and smoking in hospital grounds
1. Do you support the Bill’s provisions in relation to NVPs?
2. Do you support the proposal to ban smoking in hospital grounds?
3. Is there anything you would add/remove/change in the Bill with regards to NVPs or smoking in hospital grounds?
Duty of candour and willful neglect
4. Do you support the proposed duty of candour?
5. Do you support the proposal to make willful neglect or ill-treatment of patients a criminal offence?
6. Is there anything you would add/remove/change in the Bill with regards to these provisions?
Royal College of Physicians of Edinburgh
Health (Tobacco, Nicotine etc. and Care)(Scotland) Bill
Call for written evidence
The Royal College of Physicians of Edinburgh (the College) is pleased to respond to the Scottish Parliament Health and Sport Committee’s call for written evidence on the Health (Tobacco, Nicotine etc. and Care)(Scotland) Bill.
NVPs and smoking in hospital grounds
1. Do you support the Bill’s provisions in relation to NVPs?
Yes, however we would also wish to see action taken on the use of NVPs (nicotine vapour products) in enclosed public places, as the College believes NVPs should be subject to the same restrictions as tobacco.
The College fully supports the provisions in relation to NVPs listed in the Bill, including the introduction of an offence of selling a NVP to a person under the age of 18; the introduction of an age verification policy; making proxy purchase an offence; the requirement to register NVP businesses and the provision of powers to make regulations containing restrictions on advertising; sponsorship and giving away NVPs.
2. Do you support the proposal to ban smoking in hospital grounds?
Yes. The Bill offers the potential to maintain some flexibility in terms of the extent of the ban in hospital grounds, which the College welcomes due to the practical difficulties of enforcement and the need to respect vulnerable people who may be addicted and under stress.
In some cases it may be better for Health Boards to designate large areas of grounds non-smoking, but have discretion to have limited areas, well away from entrances where smoking might be permitted. The great variation in the size and arrangement of NHS grounds make it necessary for the legislation to be flexible according to the local circumstances.
In long-stay facilities, including long-stay mental health care and care of the elderly wards, it may be necessary to provide some facilities for cigarette and e-cigarette use, provided this has no impact on staff or other people in the facility.
3. Is there anything you would add/remove/change in the Bill with regards to NVPs or smoking in hospital grounds?
As mentioned in Question 1, the College would like consideration given to NVPs being subject to the same restrictions as tobacco, unless new evidence of absence of harm comes to light.
A paper published by the American Industrial Hygiene Association “White paper; Electronic Cigarettes in the Indoor Environment”[i] highlights a number of concerns, including the lack of regulation and quality control of the devices; chemical exposures to bystanders, and the lack of good evidence about exposure to many of the flavourings etc, employed in e-cigarettes. The paper concludes that while they may carry lower risks than tobacco cigarettes, there is not enough evidence of their safety.
Duty of candour and wilful neglect
4. Do you support the proposed duty of candour?
Yes. There is a need for the NHS to be recognised by the public as open and transparent about adverse incidents and poor quality, and in this regard the College supports the introduction of an organisational duty of candour.
The College would particularly emphasise that legislation needs to be accompanied by cultural change in organisations to be effective, and that the requirements should help to reinforce an open and transparent culture of learning and improvement where possible.
5. Do you support the proposal to make wilful neglect or ill-treatment of patients a criminal offence?
Yes. The College is supportive of the offence of ill-treatment and wilful neglect being applicable in all formal health and social care settings.
6. Is there anything you would add/remove/change in the Bill with regards to these provisions?
The College notes that “further detailed consultation will take place about extending the provisions to children in both health and social care situations and whether this should be done at Stage 2 in the parliamentary process”[ii].
The College supports the offence of ill-treatment and wilful neglect being extended to health and social care services for children as it seems illogical to exclude certain groups of victims of the acts of wilfully neglecting, or ill-treating due to their age. The focus of the legislation should be on the quality of care and treatment.