The potential of stem cells for myelin repair in the central nervous system

The potential of stem cells for myelin repair in the central nervous system

Introduction

The policy and its objectives

From 1st July 2007 all public places and workplaces in England have been smoke-free. The smoking ban was introduced in Wales on the 2nd April 2007 and in Scotland in March 2006. The legislation aims to protect employees in all workplaces from the ill-health associated with smoking and to encourage people to give up smoking. In October 2007, the legal age for buying tobacco was raised from 16-18. NHS ‘Stop Smoking Services’ have seen unprecedented levels of demand since the introduction of smoke free legislation. On 16 November 2004 a Public Health white paper proposed a smoking ban in almost all public places in England. Smoking restrictions would be phased in, with a ban on smoking in NHS and government buildings by 2006, in enclosed public places by 2007, and pubs, bars and restaurants (except pubs not serving food) by the end of 2008.

Under the legislation, it is the duty of any person who controls/manager of smoke-free premises to stop people smoking there and if they fail to comply with this duty, they are committing an offence. Employers need to have and maintain a Smoke-free Policy outlining the restrictions on smoking and how non-observance will be dealt with. The ‘Smoke-free’ Policy prohibits smoking in all enclosed and substantially enclosed areas in the workplace, including company vehicles. Members of staff are only permitted to smoke whilst off duty, in official break times only, and in unenclosed designated areas. The policy applies to all visitors, customers and other people who enter the workplace.

The policy on passive smoking has been genuinely concerned only with a reduction in smoking in public places; other issues about the formulation of policy in this area are raised, in addition to any concern that the ban on smoking may represent a disproportionate policy response. One of these issues is whether decision-making in this area has given sufficient attention to alternative policy responses, as required by the Treasury guidelines. The Confederation of British Industry have strongly argued that voluntary smoking bans are already in place in many areas and that business saw the legislation as further evidence of unnecessary intervention by government.

The Smoke-Free Policy Objectives are to save lives over the next decade by reducing exposure to hazardous second hand smoke. The policy also aims to protect and improve the health of staff, patients / clients, visitors and contractors by countering the health risks caused by tobacco smoke. Assist both patients and staff who wish to stop smoking by ensuring smoking cessation support is widely available to staff, patients and clients; set an example of best practice; reduce the risks to health from exposure to second-hand smoke; recognise a person’s right to be protected from harm and to enjoy smoke-free air; and increase the benefits of smoke-free enclosed public places and workplaces for people trying to give up smoking so that they can succeed in an environment where social pressures to smoke are reduced. Whether the policy will directly reduce the incidence of smoking and smoking-related diseases remains to be seen. It has proved that the banning smoking in public places, the policy has been highly effective. She stressed there would be public consultation on how to protect staff in pubs where smoking will still be allowed – possibly giving a second chance for her plan to restrict smoking in exempted pubs to sealed “smoking rooms”. The Health Bill also includes measures to tackle MRSA, new rules on managing controlled drugs, proposals to pave the way for reform of pharmacies, including new roles for pharmacy staff.

The main objective of this policy is to ban smoking in public places in order to reduce the incidence of passive smoking and protect children’s and adults overall health. Groups that are affected by the ban are smokers, owners of pubs and restaurants and also cafes, the general public are also affected. The main aspects of the Health bill is the legislation of the ban of smoking in workplaces and also the new hygiene code of conduct that has been introduced for health providers to help reduce hospital infections and also a ‘shipman safeguard’ which means their will now be a tighter management of controlled drugs after inquiry into the GP’S murders. And finally the last main aspect of the Health bill is a reform to the way chemists work.

When proposed in 2007 it was outlined that three years after the smoking ban was put in place the bill would be reviewed. However, after the 2010 General Election the Conservative Party and the Liberal Democrats which entered the Coalition Government announced that it would no longer be reviewing the smoke free legislation on the 30th June 2010. However, an attempt in October 2010 by Conservative MP David Nuttall to amend the law to exempt private members clubs and pubs from the smoking ban was defeated in the House of Commons on its first reading.

Policy evolution

The House of Lords commented saying that the ban on smoking in pubs was an over reaction to the threat posed by passive smoking and was the MP’s failure to understand the concept of risk. The Lords Economic Affairs Committee cited the smoking ban as an example of policy based on bad science and that it had been sold to the public as necessary because of the dangers of passive smoking. However the Committee members later questioned whether the Government had a scientific basis for the claim after Caroline Flint, the Health Minister, told the committee: “In relation to deaths from smoking and second-hand smoke, the most serious aspect is smoking in the home. Ninety-five per cent of deaths are related to smoking in the home.”

With the main risk of passive smoking was with the concern of children who were exposed to second hand smoke in the home and the bill was not originally designed to address this issue.

Tobacco control policy in England during the years of 1998-2009 was largely guided by the 1998 white paper ‘Smoking Kills‘ and the public Health white paper ‘Choosing Health’ published in November 2004. In 2004 the Department of Health set targets to reduce smoking prevalence in the population with aiming to reduce smoking rates to 21% or less by 2010.

Policy Process

After opposition and debates within the cabinet on the 26th October 2005 the government published that it would continue with the plan of the smoking ban. However, there was still wide criticism with many MPS threatening to overturn the bill. One year later, on the 11th January the government announced that MP’s would gain a free vote on an amendment to the Health bill. On the 14th February 2006 the House of Common voted on the amendment to the original plan and wanted to extend the ban so that all enclosed public places, including private members clubs would also be smoke free. MP’S went on to vote whether all enclosed public places. This amendment gained significant support and the legislation was passed by the House of Lords.

Many campaigners said that the partial ban in 2005 did not go far enough and said that it would still leave workers in private members clubs and pubs not serving food at risk of second hand smoke.

In August 2003, Pizza Hut announced that all 500 of its branches would become non-smoking and in January 2005, the JD Wetherspoons pub chain announced it would be following.

Critics of the ban questioned the claim that passive smoking increases the risk of lung cancer, and organisations representing the tobacco industry and smokers also argued that ventilators could be used to remove smoke from bars and pubs, negating the need for a ban. However, the medical profession claimed that ventilators do not protect the public from the risk of lung cancer.

Eventually the support for a smoking ban was outweighed by the opposition and the government was forced to allow a free vote in parliament where MPs had the chance to back a complete ban on smoking in public places. By February 2006, the House of Commons voted by majority of 200 to introduce a blanket ban on smoking in England and Wales from summer 2007. A ban on smoking in all NHS and government buildings was introduced in January that year. The government later went on to decide and announced that a rise in the age at which people could buy cigarettes went from 16 to 18 from October 2007. The Government also went on to print pictures of cancer on cigarette packets for another way to put off smokers.

It had been argued that it was the opinion of the business’s owners rights to decide what happens in his or hers property and because a person can purchase cigarettes legally a personal should be able to smoke where smoking is allowed. However health officials and individuals such as Lance Armstrong say with a state-wide smoking ban lung cancer and other health problems can be reduced.

A group called ‘Freedom to choose’ launched a campaign for a judicial review of the smoking ban. The freedom to choose campaigners claimed that the smoking ban was in breach of the Human Rights Act 1998 because it doesn’t give the right to privacy of people who wish to smoke in clubs and bars.

After 24 hours after the committee’s report of the harm of smoking, new evidence was brought forward stating that passive smoking can cause a common type of blindness in older people.

To add to ministers’ discomfort, just 24 hours after the committee’s report, new evidence emerged that passive smoking can cause a common type of blindness in older people. Cambridge researchers reported in the British Journal of Ophthalmology that living with a smoker for five years doubled the risk of age related macular degeneration and regular smoking tripled it (2006;90: 75–80).

One change which is based on an overall national health policy statement is that the smoking ban legislation forms part of the Health Act 2006.

101 MPs including 69 Labour backbenchers signed a motion for a free vote. Critics and health experts argued that plans to exempt private clubs and non-fast food pubs from the ban were bad for health and would prove unworkable. However, Mrs Hewitt who is favour of a full ban on smoking in all enclosed public spaces defended the ban and said that ‘Many of us would have liked to have gone further and faster’ and stressed that even with exemptions 99% of workplaces would be smoke-free.

Implementation

It was agreed that 3 years after the ban was put in place a review would be conducted, however in 2010, 3 years after it was put in place the government dropped the planned review of the smoking ban in England. Labour had promised that the ban would be looked at again in the autumn of 2010 however this never happened.

The smoke free policy can be implemented in a range of settings such as schools, workplaces and to facilitate implementation of the policy businesses should prepare workplaces by displaying smoke-free signs and by removing ashtrays and butt bins.

The government assumed success for the policy and the enforcement officers from local authorities work closely with businesses to ensure compliance with the ban. The ban means that it is an offence to smoke in smoke free premises or vehicles and a failure to do so carry a fixed fine of ?50. Failure for those who control smoke free places to make sure others to smoke in these places carries a fine of up to ? 2,500 and with failing to display no smoking signs carries a fixed fine of ?200.

It was rumoured that implementing the smoking ban in England cost taxpayers, restaurant and pub property owners at least ?100 million more than the Government originally budgeted. The Department of Health estimated that the bill for the ban that comes into force in 2007 time would run to ?1.6 billion. It was also estimated that the implementation costs for workplaces would be minimal. However The British Beer and Pub Association say that its members spent at least ?70 million on converting premises

According to the Mental Health Foundation 85% of respondents to a survey that was conducted said that the ban had been implemented wholly effectively and this may be due to the rise in ‘secret smoking’ and also with occasions where staff feel obliged to turn a blind eye especially when a patient is very unwell .

The government’s main aim was to try and get people to stop smoking so to help this they set up specialist stop smoking services widely available across the country. An example of this is a trust wide smoke free group which co-ordinated a stepped up approach towards the implementation of the smoke free society.

The Government allocated funding to support implementation of the smoke free legislation for the financial years 2006-07 and 2007-08.

The Department of Health distributed ?29.5 million to support first-tier local authorities in England to undertake new work associated with the introduction of smoke free legislation on 1 July 2007.

Policy Evaluation

Compliance with the ban will be monitored by enforcement officers employed by the local authorities. It will of course take many years to assess whether the ban has led to a reduction in the number of smokers, and/or improved health outcomes. Given the number of confounding influences, it may never be possible to assess the effectiveness of the plan in these regards.

Two weeks after the ban was introduced, 97% of inspected premises and there had been nearly 90,000 inspections were complying with the ban. That is to say that 97% of premises where prohibiting smoking (98% of smoke free vehicles), although at that point in time, only 79% of premises were displaying the required no-smoking signage at the entrance to buildings (84% of smoke free vehicles). In total, local councils had issued on 142 written warnings (0.2% of the total) to premises that had failed to prevent smoking, adopting a ‘light touch’ rather than draconian measures at this early stage in the policy’s life.

In terms of banning smoking in public places, the policy seems to be highly effective. Whether the policy will directly reduce the incidence of smoking and smoking-related diseases, remains to be seen.

Impact of this policy

In 1965 British government bans cigarette advertising on television. In 1971 Government health warnings to be carried on all cigarette packets sold in the UK. In 1984 Smoking banned on London Underground trains. In 1987 the London Underground smoking ban extended to entire network following the King’s Cross station fire, in which 31 people died.

In May 1997 New Labour government pledges to ban tobacco advertising.

In March 2001 New EU directive requires larger, more prominent health warnings on tobacco packaging.

In March 2002 British parliament passes legislation that began as a Private Member’s Bill, banning tobacco advertising. Deadline for phasing out sponsorship of Formula One motor racing brought forward to comply with EU directive. In December 2002 British Medical Association calls for a ban in smoking in public places because of the threat to non-smokers.

In January 2004 British Heart Foundation uses graphic images to reinforce its government-sponsored anti-smoking campaign. In November 2004 A Public Health White Paper proposes introducing a smoking ban in workplaces by 2008, with pubs which do not serve food and private members clubs exempted. The legislation would apply to England and Wales, but the Welsh Assembly has said it would amend the bill to create a comprehensive ban when it gains Royal Assent in England.

In April 2005 MSPs voted by 83 to 15 to introduce a ban on smoking in public places from April the following year. Smokers who defy the ban are liable to pay a ?1,000 fine.

In October 2006 Northern Ireland agrees a smoking ban in all workplaces and public spaces from April 2007 as discussions over the England smoking ban break down at cabinet level, causing the smoking ban bill to be delayed and leading to doubts over how a ban will be introduced.

In December 2006 the government announces England will get a smoking ban from 1st July2007.

Conclusion

In conclusion the policy does seem to be meeting its short-term objective. The policy enjoys a high level of public support, and therefore, in this instance, the Government does seem to be enacting a policy that the people want.

References

http://webarchive.nationalarchives.gov.uk/20100407191046/opsi.gov.uk/acts/acts2006/pdf/ukpga_20060028_en.pdf

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BBC NEWS. (2005). Smoke ban bill details released . Available: http://news.bbc.co.uk/1/hi/health/4375478.stm. Last accessed 3rd April 2011.

BBC NEWS. (2005). Hewitt defends smoking ban plans . Available: http://news.bbc.co.uk/1/hi/4380978.stm. Last accessed 1st April 2011.

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The Gallup Organisation. (2009). Survey on Tobacco. Available: http://ec.europa.eu/health/ph_determinants/life_style/Tobacco/Documents/eb_253_en.pdf

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http://www.publications.parliament.uk/pa/cm200506/cmselect/cmhealth/485/48506.htm

http://webarchive.nationalarchives.gov.uk/20100407191046/opsi.gov.uk/acts/acts2006/pdf/ukpga_20060028_en.pdf

http://www.publications.parliament.uk/pa/cm200506/cmbills/069/2006069.pdf

http://www.legislation.gov.uk/ukpga/2006/28/contents

http://www.pcs.org.uk/en/resources/health_and_safety/hazardsatoz/smoking.cfm