Scotland’s landmark legislation on banning smoking in public places, which came into force on 26 March 2006, met with fierce opposition from those who argued it undermined smokers’ personal liberties.
But that argument held little water when placed alongside the right of non-smokers in bars, restaurants and workplaces to live their lives free from inhaling second-hand smoke.
There is a corollary in the current debate about smoking in private cars and in private homes. Public health professionals pushing for new curbs want to protect family members, especially children, from the effects of inhaling other people’s smoke. This concern is well founded: all the credible evidence is that the health of non-smokers can be seriously harmed by second-hand smoke inhalation. When children are part of the equation, that concern is obviously more pertinent and persuasive.
Yet there is an important difference between the current debate and the previous one. Seven years ago, legislators in the Scottish Parliament were looking to control what happened in public spaces. There was some debate at the margins about what “public” actually meant – did it include hotel rooms or prison cells, for example – but, in the main, the focus of the new law was clear. This was a public health matter in the fullest sense of the word “public”.
In this new debate, however, the focus of legislators’ interest has narrowed considerably, and now includes some of the spaces we might naturally regard as our most private – namely the interiors of our homes and cars.
Legislation that determines what we can and cannot do in our own homes simply does not fall into the same category as a law to stop you lighting up a cigarette in a crowded bar. The health lobby might present this new push as simply a natural progression from existing legislation, but the fact is that this crosses a significant line, and is in danger of setting new and unwelcome precedents.
And there are other issues over how this will be policed. Will police have the resources (given the cuts in their budget) to effectively prosecute this; and given the finite resources they have, is this where we want them spent? Look at the number of drivers still seen on their mobile phones. And what if the windows are open? What if the roof is down on a convertible?
Perhaps the biggest concern, however, is precedent. If the state has the right to stop parents smoking in front of their children in the car, why not the living room? Does it also have the right to control what they feed to their offspring at the kitchen table? Does the state have the right to determine what levels of saturated fat children ingest? Or what TV programmes they are permitted to watch?
The urge to protect children is an honourable one, but it cannot be a carte blanche for illiberal laws.
Don’t give up on A&E targets
NURSING staff are at the sharp end of the National Health Service. They are the ones delivering the bulk of patient care, often in the most taxing of circumstances and often in high-stress circumstances. When they have something to say about the way our hospitals are operating we would be wise to listen.
So when the Royal College of Nursing says the four-hour waiting time target for accident and emergency units in Scottish hospitals is unachievable, that is a sobering message that should receive due weight from anyone concerned about improving patient care.
What it should not do, however, is deter hospital administrators and politicians from any further efforts to make the unachievable achievable.
The Scottish Government currently has an action plan in which £50 million is being spent on trying to improve A&E waiting times. The administrators implementing this plan have a significant challenge. The latest statistics show that one in ten patients in Scottish A&E departments now waits longer than four hours to be treated. This is the worst since monitoring began in 2007. Of Scotland’s 14 health boards, only four managed to meet ministers’ target of treating 98 per cent of patients within that four-hour period.
These are not just statistics – these are people who are in pain and discomfort and who have turned to the NHS for help. They have done so in the expectation of being offered the most professional healthcare available.
The action plan is focusing on sensible measures that will release pressure on the front line. It must be given time to prove the Royal College of Nursing wrong.