We’ll move on to item 7, which is the debate on the general principles of the Public Health (Wales) Bill, and I call on the Minister for Social Services and Public Health to move the motion—Rebecca Evans.

Motion NDM6241 Rebecca Evans

To propose that the National Assembly for Wales in accordance with Standing Order 26.11:

Agrees to the general principles of the Public Health (Wales) Bill.

Motion moved.

Thank you, Deputy Presiding Officer. I formally move the motion.

I’m pleased to open this debate on the general principles of the Public Health (Wales) Bill. I’m grateful to Dai Lloyd, Huw Irranca-Davies and Simon Thomas and their respective committees for the scrutiny of the Bill so far. I’d also like to acknowledge the valuable contribution of stakeholders, who have engaged with the process by providing written and oral evidence.

When I introduced the Bill last November, I spoke about the proven role of legislation in improving and protecting the health of the population of Wales. I also emphasised that legislation forms one important part of a broader public health agenda aimed at preventing avoidable harm and moving closer to our aspirations for a healthy and active Wales. This Bill makes an important contribution to that agenda by taking action in specific areas for the benefit both of particular groups and communities as a whole. I’ve been encouraged during the scrutiny process to see the strong general support from stakeholders and committees for what the Bill seeks to achieve.

Each proposal in the Bill seeks to deliver real benefits for the people of Wales. For example, extending the smoke-free regime to outdoor settings of school grounds, hospital grounds and public playgrounds, as well as the other actions on tobacco, will break important new ground and build on the significant progress we’ve made over many years in protecting children from the harmful effects of smoking. Elsewhere in the Bill, the special procedures licensing system will have a number of direct benefits, from helping prevent avoidable harm to those individuals choosing to have a special procedure, to helping people to become better informed when thinking about a special procedure, and working with the sector so that the standards of best practice become the standards of all.

While the Bill focuses rightly on meeting the needs of specific groups, it also takes important steps to benefit whole communities. The requirement for public bodies to carry out health impact assessments in certain circumstances will benefit communities by helping ensure major decisions taken in Wales are informed by an assessment of their likely impact on both physical and mental health. The changes to the way pharmaceutical services are planned will enable the system to better meet the needs of local communities and better reflect the crucial public health role of community pharmacies. The requirement for local authorities to prepare local toilet strategies will encourage new and creative ways of addressing a complex public health issue.

While the Bill has already benefited from rigorous scrutiny during the fourth Assembly, this National Assembly is also, rightly, taking a very thorough approach to scrutiny during Stage 1, as demonstrated by the detailed analysis provided in the three committee reports. I intend to reply formally to those reports, but I am pleased today to outline my initial reflections on them.

Of the 19 recommendations of the Health, Social Care and Sport Committee, I’m pleased to indicate that I’m likely to be able to respond positively to the majority in a variety of ways. I intend to bring forward amendments at Stage 2 that will directly respond to some of the recommendations. These will include amendments to respond to the committee’s recommendation about offences that local authorities will be able to take into account when considering applications for special procedures licences. This will be a tangible example of how the scrutiny process and the input of stakeholders will have directly and materially strengthened the Bill. I envisage there will also be other areas where I’m able to positively respond to committees’ suggestions in ways other than amendments to the Bill. For example, I will work with partners to produce information that assists the public to locate toilet facilities available for their use locally.

However, there will be a limited number of instances where, although I don’t disagree with the intention lying behind the recommendations, I’ll be unable to respond in exactly the way the committee’s report recommends. For example, I am unable to add laser treatments to the special procedures licensing system at this stage due to a number of issues, including the potential risks of regulatory duplication. However, the Bill allows for this issue to be explored further in due course, allowing for appropriate consultation with Healthcare Inspectorate Wales, local authorities and the public.

Some of the recommendations in the committee’s report raise complex issues, which require thorough consideration. I’m particularly aware of the detailed thought the committee has given to the most appropriate age restriction for intimate piercings, for example. I’ve previously indicated I was revisiting this issue in detail in view of the evidence provided during Stage 1 and that I hoped to be able to outline my position today. Unfortunately, due to the complex considerations involved, the detailed work required, although nearing completion, is still ongoing. However, I am keen to assure Members that I’m giving very active and thorough consideration to this issue, and I will update Members as soon as I am able to do so.

Another complex issue raised by the committee concerns extending smoke-free requirements to additional settings. While I recognise the intention behind the committee’s recommendation on this point, such issues are inherently complex. I would emphasise that the Bill’s provisions that, for the very first time, seek to extend smoke-free requirements to three open spaces, already display the Welsh Government’s strong commitment to the principle of extending smoke-free areas with the aim of preventing children from seeing smoking as a normal and everyday activity. As a further indication of our commitment to this principle, I can confirm today that I’m giving active consideration to a fourth setting, namely early years settings, directly in response to the committee’s deliberations. However, due to the detailed work required, I am unable to commit to bringing forward amendments at Stage 2, but envisage that this work can be completed to enable me to bring forward amendments before the Assembly at Stage 3.

Turning briefly to the recommendations of the other committees, there are also areas where I am minded to make positive responses. These include making good on my previous commitment to bring forward amendments relating to enforcement authorities, which will help allay the concerns underpinning the recommendation of the Constitutional and Legislative Affairs Committee. I’m also able to indicate, in response to the recommendation of the Finance Committee, that I’m willing to consider the potential for identifying additional funding for local authorities to support early implementation of the Bill, recognising the crucial role of the sector in implementing this legislation, and building on the significant ways in which the Bill has already been designed to assist local authorities in meeting the obligations that the Bill will place on them.

Today marks an important milestone in the journey of this Bill. I believe the scrutiny process so far has been of significant assistance, and I look forward to Members’ contribution to that ongoing process during today’s debate.

Thank you. I call on the Chair of the Health, Social Care and Sport Committee, Dai Lloyd.

Thank you very much, Deputy Presiding Officer. I’m very pleased to contribute to this debate today as Chair of the Health, Social Care and Sport Committee. I’d like to start by thanking my fellow members of the committee. The collegiate way in which we work has enabled robust scrutiny and, I believe, has led us to develop clear conclusions and recommendations for the Minister. I should also take this opportunity to say that we are extremely grateful to everyone who took the time to write to us and present evidence to us at one of our formal meetings, and there were many of those.

Now, naturally, public health is crucially important, and we’re all aware of the appalling statistics in terms of the population’s health—19 per cent of the population in Wales still smoke, 40 per cent drink more alcohol than they should, and over half of the population are overweight and don’t exercise regularly. As we’ve heard, this is the second time a Public Health (Wales) Bill has come before the Assembly. We all know that the motion to approve the previous Bill was not agreed by the fourth Assembly, and therefore it did not become an Act. The Bill before us now contains the original proposals considered by the previous Assembly, without the provisions restricting the use of nicotine inhaling devices—more commonly known as e-cigarettes—in some public places. The health committee has heard disappointment from some that these provisions have been removed. However, the overwhelming view of witnesses was that this Bill will help those working in the field to drive forward the public health agenda in Wales, and it must be allowed to proceed this time.

Turning now to the conclusions and recommendations of the committee, we’ve made a number that will strengthen the legislation, in our view, as we’ve already heard, and I will focus my comments on just a few of those, because of time restrictions. We welcome the proposed restrictions on smoking in school grounds, hospital grounds and public playgrounds. We believe that this will play an important part in protecting people from the harm of second-hand smoke, as well as providing fewer opportunities to see people smoking. It’s not a normal activity. However, we believe that the opportunities to offer this level of protection should be maximised, and so we recommend that the Minister, as a matter of priority, undertake the necessary work to enable the smoking restrictions to be extended to early years childcare and education settings—and we’ve heard that that has been agreed—school gates and the perimeter areas of public playgrounds. I would urge the Minister particularly. That is our recommendation 3.

The next comments relate to the issue of intimate piercing. The Bill, as currently drafted, proposes that the age of consent for an intimate piercing should be 16. We listened to the rationale for setting the age limit at 16, and we know it is the age of consent for sexual activity, and, as a committee, we acknowledge that children and young people have the right to decide what to do with their own bodies. However, we then considered this against the weight of evidence from medical and environmental health professionals who have seen at first hand the impact that an intimate piercing can have on a still developing body. We were told that ‘significant damage’ can be caused as a result of such piercings.

We also heard suggestions of a potential link between the intimate piercing of a 16 to 17-year-old and child sexual exploitation. We also learned during the course of our evidence gathering that genital piercing in under 18-year-olds could be considered to be a type of female genital mutilation under the World Health Organization’s definition, and is therefore a criminally reportable event.

On this basis, we do not believe that the correct balance has been struck between young people’s right to have a say and the rights that every young person under 18 in Wales should have to be protected by the articles of the United Nations Convention on the Rights of the Child. We are therefore absolutely convinced as a committee that the age of consent should be set at 18, and we have made a recommendation that section 92 of the Bill be amended to prohibit performing, or making arrangements to perform, an intimate piercing on a person who is under the age of 18. That’s recommendation 14.

We were also surprised and concerned to learn that the offences listed in section 63(3) of the Bill that would prevent a practitioner from being granted a licence to undertake special procedures, which includes intimate piercings, do not include sexual offences. I’ve heard the Minister’s comments today. This is, in our view, a very significant and a relevant concern, given that any one of the procedures named in the Bill are capable of being performed on an intimate part of the body. We as a committee do not accept that this is solely a ‘public health Bill’ rather than a ‘safeguarding’ Bill. Indeed, the explanatory memorandum that accompanies the Bill talks about the need to avoid circumstances where children and young people are placed in a potentially vulnerable situation. We are therefore firmly of the view that the offences listed in section 63(3) should be amended to include ‘sexual offences’. That is recommendation 13.

Finally, we can’t talk about public health without mentioning what is probably the single biggest problem facing public health, namely obesity. The latest Welsh health survey showed that 59 per cent of adults in Wales are classified as overweight or obese, including 21 per cent as obese. Obesity is such a serious threat to population health that it must not be shied away from, no matter how difficult or complex a challenge it is.

We agree with the Minister that no one piece of legislation can address all the determinants of obesity—it will require a multi-faceted approach—but we share the concerns of stakeholders that the Bill lacks any explicit measures to tackle the issue. In fact, it came to our attention as we gathered evidence that there are already steps that the Welsh Government could take, but that the powers in this area aren’t being used to their full advantage. We have therefore urged the Minister to consider our recommendation 2 and examine the potential, through this legislation and under existing powers, to introduce measures to tackle obesity and other priority public health issues, such as extending nutrition standards that are already in existence in our schools to residential care homes and hospitals. But, overall, we welcome the proposals in the Bill and believe that it will have a positive impact on public health. For this reason, we recommend, as a committee, that the Assembly agrees the general principles today. Thank you very much.

Thank you. I call on the Chair of the Finance Committee, Simon Thomas.

Thank you Deputy Presiding Officer. I’m sure it’s a sign of how important public health is that three committees are to report on this Bill as we discuss it this afternoon.

I think it’s important for me to say initially that the committee welcomed the fact that there had been a general improvement in the presentation of this Bill as compared to the previous Bill in terms of the way the cost and benefit figures were presented in the regulatory impact assessment. The committee has reported in the past how important it is that this information is as clear as possible in order to avoid confusion, and it’s good therefore to welcome the fact that this Bill makes that more explicit than the last Bill presented to the Assembly.

We also welcome the Minister’s assurance that the Welsh Government is working with the Wales Audit Office to improve the financial information provided in RIAs. This is an issue we as a committee will continue to monitor as we scrutinise the financial implications of legislation introduced into this Assembly.

The main area of concern, regarding finance in the Bill, highlighted in our report is the fact that a financial burden is placed on public bodies, particularly local authorities, in implementing the provisions of the Bill. We of course realise that the Bill covers a broad range of issues allowing local authorities to raise funds through fees, particularly through nicotine registrations, special procedures licensing applications, and fixed penalty notices. Of course, local authorities in their turn can re-invest those funds in order to deliver their inspection obligations.

However, we were concerned that the up-front investment required from local government to implement the Bill is a disproportionate burden, given that they won’t benefit for some time. So, I do welcome the fact that the Minister, in opening this debate, has said that the Welsh Government is reviewing this aspect and considering how at least the start-up costs of the Bill could be funded and assist public authorities, particularly local authorities, who will have to implement the Bill, if enacted, before they have any means of seeking revenue through the provisions of the Bill.

It does raise a broader question, Deputy Presiding Officer, as to whether the Welsh Government expects local government to shoulder the burden of new responsibilities, and the Finance Committee is very aware that in the past there has been an agreement between the Welsh Government and the WLGA to fund new responsibilities before they are passed to local government in introducing legislation. That might be an issue for the Cabinet Secretary for Finance and Local Government to return to.

We also note that the financial information provided doesn’t provide details as to whether the amount of revenue collected from fixed penalty notices would be sufficient to cover the costs borne by local authorities to enforce provisions, particularly relating to the nicotine register. The fact that this information isn’t available is a cause for concern for us, because such details could assist local authorities in assessing the financial implications that could be entailed in enacting this Bill. We think it’s important, therefore, that the Welsh Government commits to publishing how much money is raised by each local authority from fixed penalty notice income to cover their enforcement costs—that is, that we do keep a close eye and monitor this, and the costs borne by local authorities in enforcing these policies in their own communities.

Local authorities would also face costs from producing local toilets strategies for their areas. Whilst these costs shouldn’t be significant, we do question whether the production of strategies alone would lead to improved public access to toilets, and therefore whether the investment would represent value for money. We therefore recommend that the Welsh Government should review the effectiveness of the provisions relating to public toilets—something that was given a fair bit of attention in scrutinising this Bill, I know.

Finally, I would like to re-iterate our recommendations relating to the costs of implementing the secondary legislation provisions. Whilst we realise that RIAs will be produced to show the costs and benefits when the various pieces of subordinate legislation are introduced. However, information of this kind isn’t included in the costs and benefits set out for the Bill. We believe that this information is important to enable the Assembly to fully understand the costs and benefits. We recommend, therefore, that the Welsh Government should develop a more consistent approach across Bills to provide costs associated with secondary legislation to enable better scrutiny of the full costs and benefits of all Bills.

Diolch. I call on the Chair of the Constitutional and Legislative Affairs Committee, Huw Irranca-Davies.

Thank you, Deputy Presiding Officer. I don’t think anybody will criticise this Bill for suffering from a lack of scrutiny as I step forward as the third in a triumvirate of committee Chairs.

I do want to thank my fellow committee members for their assiduous scrutiny of this and their consistent assiduity in scrutinising the various Bills that come in front of us. We reported on this Bill on 10 February, and I’d like to briefly outline our findings just with a few remarks. But, before I do, I think it would be sensible just to reflect back on the work undertaken by our predecessor committee on a similar Bill in the fourth Assembly under our previous Chair, who’s here with us today.

When that predecessor committee reported on the Bill, it made nine recommendations to the then Minister for Health and Social Services, of which seven were accepted. The then Minister subsequently tabled amendments to give effect to those seven recommendations at Stage 2 and these were agreed by the fourth Assembly’s Health and Social Care Committee.

As the Minister has laid out, one of the principal differences between the Bill before us today and the one agreed at Stage 3 in the fourth Assembly is, of course, the removal of the restriction on the use of e-cigarettes in places such as hospitals, schools, shops, food establishments and on school and public transport, and the Minister has also referred to other changes within the Bill.

In our view, on the Constitutional and Legislative Affairs Committee, it may have been helpful and, indeed, more transparent if the explanatory memorandum had actually compared the two Bills and the differences that have come along simply for ease of understanding, not only for legislators but for members of the public as well. It may be something that we will want to look at in future, as well—it’s simple to achieve; it would have helped members and stakeholders, as well as lay people, understand how thinking had moved on, and facilitated the scrutiny process for the benefit of Welsh citizens.

One of our predecessor committee’s recommendations to the Welsh Government was to require on the face of the legislation that public authorities would be the enforcement authorities. That recommendation was not accepted, and, in our scrutiny, we noted that the new Bill continued with the same approach. However, we are very pleased that, as a result of further work by the Government, the Minister told us it was indeed her intention to bring forward an amendment at Stage 2 to meet the recommendation of our predecessor committee. We very much welcome the Minister’s decision and consider that this will strengthen the Bill by providing greater clarity.

If I could turn now to the recommendation in our current report that relates to those enforcement authorities, we recommended that the Minister should table an amendment to the Bill to ensure that enforcement authorities are fully aware of their human rights obligations when, for example, entering people’s homes. In particular, we suggested that this might be achieved through the issuing of guidance. We do believe that this would highlight the importance of human rights in discharging particularly the enforcement duties in a more effective way than could be achieved by a simple communications campaign. So, I wonder whether the Minister could perhaps further clarify her intentions on this recommendation.

But, we do welcome the comments of the Minister today and also her active engagement—her positive engagement—with the work of the committee. She has engaged very positively and she’s responded positively to the scrutiny of this committee and that of our predecessor committee, and we thank her for this—this is all good for the quality of the scrutiny within this institution.

I’m delighted to be able to stand here and speak on the Public Health (Wales) Bill. Minister, I’d like to say that the Welsh Conservatives will be supporting the general principles of the Bill. As we go forward over the next few stages, we will be seeking to bring further amendments to the Bill and we will be seeking to ensure that the financial assessment of the cost of this Bill keeps pace with the amendments as and when they are posted to it.

There are a number of areas that I would like to try to briefly touch upon. I was very pleased to hear your comment that you intend to extend the smoke-free zones to early-years settings. That chimes with our desire and we are very pleased with the overall thrust of the Bill in terms of tobacco and nicotine products. We do have a slight concern, though, that the proposed register will not achieve the desired outcome in terms of stopping the black market trade in cigarettes and tobacco products, because, of course, that is the area we are trying to get to, and if we’re not careful we could have a cumbersome system that targets those who we know about, rather than a slightly faster system that gets to the people we don’t know about and we want to stop

I’d like to turn to the next area, which is the area of special procedures. I am sad that you’re not going to be accepting the committee’s recommendation on laser treatments. That gives us pause for thought—the Welsh Conservatives—because we were in two minds as to whether or not we would like to go down the overarching description of treatments or whether we should accept your view that we should just add them one at a time, as and when the proven harm came. So, I would like to understand your thinking behind the refusal of the committee’s recommendation, because here we are at the very first step when we might ask you to consider adding something on and the Government is saying ‘no’. Therefore, does that mean that if we’re looking at other areas in future—complete body hair removal, for example—or if we’re looking at cupping and other areas that are now beginning to come forward—tongue splitting—as potentially harmful treatments, will that automatically mean a ‘no’? So, I’d like to have a clear understanding of the process that you went through and your rationale behind it, because otherwise we will need to consider how we think we can strengthen the face of this Bill.

Protecting the public from harm is absolutely key to what we’re trying to do and I would like clarification on your official’s evidence that said the purpose of the legislation was to ensure that procedures were undertaken in a safe and hygienic way and that it wasn’t a safeguarding issue, because, again, whilst I’m still on intimate piercings and the area of special procedures, I have to say that this directly contradicts the evidence the committee received. It’s not just about the infections you might get; it’s also about the competency of the decision-making process, the protection of vulnerable people, the prevention of sexual exploitation and the prevention of coercive control. Earlier on today, we had an excellent question being asked by Joyce Watson on female genital mutilation and it was made very clear to us in some of the evidence that we took that some of these procedures are not reversible. Some of these procedures are considered to be substantial or—and I’m going to quote—‘very major reconfigurations of the genital anatomy’. Something you do at 16, if you’ve fallen into company who is exercising coercive control over you, could be something you live to regret when you’re 25, 26, or 27. Also, if we look at Operation Seren, we can see that many of the people who were affected in Operation Seren were young people. Many of them were looked-after children. They were very vulnerable and so I would urge you, Minister, to be really explicit and clear in your analysis of the age of consent for intimate piercings and for all of these procedures. The Welsh Conservatives are seeking 18. The Health and Social Care Committee is seeking 18. I’d really like to see you come towards us on that one.

I would like to very briefly turn to just one further subject, given the time, and that is the subject of obesity. Minister, this is a public health Bill and it is the one subject that is simply not touched upon at all and it is predicted to be one of the major killers of people in Wales over the forthcoming decades. We would urge you to take further evidence and to see how this Bill might be tailored in a way that will enable local health authorities, local councils and the Government to really try to promote an anti-obesity strategy, because with over 59 per cent of people in Wales overweight and the effect it has on other medical conditions, it is, to be frank, a missed opportunity to have a public health Bill that does not touch upon this one crucial subject. Thank you.

First of all, I would want to echo all of the comments made by the Chair of the committee. I do truly believe that there is value to this legislation. We will certainly agree with taking it to the next stage, where hopefully it can be strengthened and amended. But I think it is very important that we, at this point, are highly aware of the limitations of this Bill, in case we raise people’s expectations excessively. There are very important elements within it, without doubt, but there is a great deal that has been omitted, and we will need more robust legislation if we are to ensure that the public can be healthier in Wales, despite how important the steps proposed in this Bill are in terms of piercing and tattooing and, very importantly, on extending the restrictions on smoking in public places, and so on.

As we’ve just heard, tackling obesity is the main public health challenge of our time. We all know the statistics on the financial impact that obesity has and will have on the NHS, and of the human impact that it has on people in our communities. But the question is: what can we and what should we do about it? We in Plaid Cymru certainly believe that there are a number of lessons we can learn from efforts to tackle smoking over the past decades, and that those are just as relevant in the fight against obesity. I did want a Bill here that would seek to address the greatest crisis facing us in terms of public health, and I would appeal to the Government to continue to seek solutions, through this Bill, to take specific steps. But, unfortunately, it’s been a frustrating process in committee to date. We have seen that the limitations on the powers available, perhaps, to the Welsh Government preclude some of the steps that we in Plaid Cymru would certainly want to see taken—the ban on advertising certain foods, taxing certain foods and drinks and so on.

Of course, it’s important to bear in mind that there is much that the Government can do in this area without legislating. We need far better communication with people and with health professionals, too, on the importance of a healthy diet and exercise and so on. The Government needs to think in a more integrated way. It’s not a good thing to limit leisure centre opening hours or to close leisure centres during an obesity crisis. We need to invest, somehow, in resources that allow and encourage healthy lifestyles, just as we invest in our health service. We don’t need legislation on all occasions, but I do think that we will need legislation in the future, and I look forward to the point when we are able to legislate further. This certainly won’t be the last public health Bill, but it’s not just obesity—we could look at issues such as prevention of pollution, for example, as other important areas.

I’d also like to draw attention to the importance of post-legislative scrutiny, and that it should happen to a greater extent than it has been done in the past, if this bill should be passed. We’ve seen time and time again, when a Bill is given Royal Assent, that our attention can actually be drawn away from the real aims, and that we fail to monitor progress made as a result of a Bill.

This brings me to my final point, which is on health impact assessments. We as a party were certainly eager to see these impact assessments contained within the original Bill. That pressure succeeded. This was laid, and we were grateful to the previous Government for putting that on the face of that Bill, although the Bill did ultimately fail. And that is relevant this time, too. We all support and understand the rationale as to why we want organisations to undertake health impact assessments, but I would warn the Minister at this point that it’s in the action that those benefits will truly be felt. Too often, I think, over the past few years, we have seen equality impact assessments or environmental impact assessments being undertaken, but then being ignored. By the way, I support thee adding of the word ‘well-being’—health and well-being impact assessments. That’s what’s important, but we can’t let those assessments become a box-ticking exercise.

So, generally speaking, my message in closing is that we shouldn’t look at passing this legislation as the end of the journey—the aim is to get a healthier population. There are important measures here, certainly, in terms of creating a safer population, but let us go through the process now—make amendments and find ways of strengthening what we have before us now, whilst bearing in mind what we should be aiming for in the future.

The Welsh NHS Confederation has called this Bill a

‘once in a lifetime opportunity to raise the profile of public health’, reduce health inequalities and reduce demand on the NHS. Several speakers have already mentioned the importance of tackling obesity and its absence from this Bill, but I want to raise a further issue that is linked to obesity but is, I think, an even bigger public health issue in terms of the harm it does, and that is the control of pricing of alcohol.

Drink is the biggest killer of people aged between 15 and 50, and we also know that 40 per cent of all adults in Wales report consuming alcohol above the recommended daily limit on at least one day in the past week. Those are pretty shocking statistics, and I would have thought we have an obligation to do something to address the fact that alcohol is far too cheap and people are therefore able to consume vast quantities of it, even if they’re on very low incomes.

Alcohol misuse directly leads to over 1,500 deaths in Wales and the number of hospital admissions due to alcohol misuse costs the NHS in Wales nearly £110 million a year. We also know that there are many, many people clogging up the accident and emergency system, despite the deviation we endeavour to implement here in Cardiff to keep people safely contained in the city centre and not have to send them off to hospital. But, unfortunately, all too many of them turn up in hospital and they are clogging up the system and we absolutely have to do something about this.

So, I’m really disappointed that we haven’t yet got anything on alcohol in this Bill, particularly as I think it does meet support across the Chamber. Indeed, when I asked the First Minister about this at the end of January, he did confirm that the Government supports the introduction of minimum unit pricing as part of a package of measures aimed at reducing the impact of alcohol misuse on individuals, communities and our public services. So, I would be very keen to know what consideration the Government has given to including minimal alcohol pricing in this Bill, because at the moment we have the situation where alcohol is being sold effectively cheaper than water.

We know that minimum alcohol pricing saves lives because in parts of Canada, where minimum pricing has been implemented, it has resulted in a noticeable reduction in the amount people drink, with fewer hospital admissions and fewer alcohol-related deaths. So, I think we have an obligation to do something about this. We know that minimum alcohol pricing enables us to tackle the cheap, strong alcohol sold in supermarkets and off-licences: drinks like own-brand vodka or gin, strong white cider and super-strength lager, mostly produced in the UK. The people who benefit most from this are those who are drinking at harmful levels, particularly those on the lowest incomes who can least afford to lose days off work.

Unfortunately, we cannot rely on the UK Government to take the action required, because the coalition Government sold the pass on this in 2013, on the basis that there wasn’t enough concrete evidence. Well, I would say there is ample evidence that this works. The alcohol industry—we know they will stop at nothing to resist responsible pricing, as we have seen in Scotland, where the Scottish Parliament passed legislation on this as early as 2012, but it’s all been held up in the courts because the Scotch Whisky Association is challenging it in the UK Supreme Court. We cannot wait another 30 years to tackle alcohol in the way that we had to spend 30 years combating the harm of smoking. So, I would hope that we would be able to include this in the Bill, and that some of the money raised could enable us to keep our leisure centres et cetera open. It would raise useful sums of money to help treat people with alcohol disease and go some way to attempting to combat the huge millions of pounds that are spent by the drinks industry in encouraging people to drink far more than is good for them.

As a member of the health committee, I would like to thank our Chair and other members of the committee for the collegiate way we’ve worked together on this Bill. Also, a thank you to health officials and outside agencies for providing us with their evidence.

UKIP will be supporting the general principles of the Public Health (Wales) Bill. There is much about this Bill that is to be commended. We welcome the steps taken to strengthen restrictions on the sale of tobacco and nicotine products to young people. We welcome the intention to prevent smoking in places where children are present. We welcome moves taken to improve the health and safety surrounding tattooing and piercing, as well as ensuring that people carrying out these procedures are licensed and registered. The age of 16 for intimate piercing, it is felt, needs further consideration. We also greatly welcome the introduction of health impact assessments.

However, in many areas, the Bill doesn’t go far enough. As many others have said, this so-called public health Bill doesn’t address the biggest public health challenge of our time: the obesity epidemic that is facing our nation. Many of those who gave evidence to us on the health committee expressed their disappointment that the Bill did nothing to address obesity, alcohol misuse, poor air quality or loneliness and isolation. I share their disappointment and hope we can address these shortcomings during the passage of the Bill though the health committee.

One of my biggest disappointments with the Bill as it stands relates to public toilet provision. The Welsh Government’s own explanatory memorandum for the Bill recognises the inconsistencies that exist in the provision of public toilets across Wales and the fact that there is no legal duty for local authorities to provide public toilets. While it’s the Minister’s intention to improve toilet provision for everybody, many of those who gave evidence to the health committee felt that the Bill was a huge let down and wouldn’t result in any major improvements. Unfortunately, for many in our society, the lack of accessible public toilets is a prison sentence. People with a range of medical conditions are essentially trapped in their own homes because of the lack public toilets across Wales. The fact that the Bill simply requires councils to prepare a public toilet strategy will do nothing to improve provision or allay the concerns of those affected by the lack of provision. These concerns were shared not only by the patient groups and the older people’s commissioner, but also by the NHS Confederation, the Association of Directors of Public Health and Public Health Wales, which told the health committee that financial pressures on councils will mean that a strategy will not improve provision.

The majority of stakeholders who gave evidence to us in the health committee felt that there should be a statutory duty placed upon local authorities to implement the public toilet strategies. The Minister has said that she feels that, given the financial pressures upon local authorities, it would not be possible to place this statutory duty upon them. I feel that we are letting the people of Wales down by not having enforceable toilet strategies and hope that we can strengthen the enforcement of these strategies by other means. Perhaps the Welsh Government should have the ultimate duty for ensuring that local strategies make adequate provision for public toilets. We need to explore all options and I look forward to working with the Welsh Government to strengthen the Bill as it progresses through the Assembly. Thank you very much.

I’m a member of the committee and I found the scrutiny process productive and collegiate, as other members of the committee have said today. I’d like to concentrate my remarks on two areas: smoking and the provision of public toilets. I welcome the extension of protection from smoking, particularly for children, that is in the Bill. I think those are absolutely crucial steps forward, and other Members have already referred to recommendation 3, which is absolutely key to enable smoking restrictions to be extended to early years childcare educational settings. It’s very pleasing that the Minister has said that that is something that she intends to do.

I’d also like to draw attention to recommendation 5, which recommends

‘that the Minister works with Local Health Boards to ensure smoking cessation support and advice is promoted extensively in healthcare settings’ and, this should be particularly emphasised, in

‘external smoking areas where these are provided.’

I do think that that is the opportunity, when people are in health service settings, to very strongly promote advice and help for smoking cessation. I think that we felt in the discussions in the committee that this is something that could be done to a much greater extent.

There is also the issue, of course, of staff who are in healthcare settings, because we do know a considerable number of healthcare staff do smoke, and so I think every effort should be made to offer opportunities to them.

I think that, in the Bill, it leaves it up to the local health boards to decide, or the local hospitals to decide, whether they do have smoking shelters on their grounds, and it is quite a difficult decision, this, for the hospitals to make. Certainly, in my own constituency, Velindre hospital has no smoking at all in the hospital or in the grounds and doesn’t have a shelter. I understand absolutely why that is the case, because it is a cancer hospital, it sees the terrible danger that smoking causes and it is saying ‘no’ to smoking on its grounds.

But it does cause a problem for people who are living beyond the hospital grounds. For example, a constituent has contacted me saying,

‘On a daily basis, as a result of the smoking ban there is a steady and continuous stream of hospital staff, visitors and patients who congregate outside our house…to smoke.

‘Cigarette butts are consistently discarded in our garden which is distressing. There is also a fire risk….On a number of occasions…patients and visitors have even sat on the wall of my garden and smoked. For my children therefore, smoking is very much a ‘normal’ part of everyday life.’

So, although I do support the decision of Velindre hospital, which has tried very hard to stop patients, visitors and staff from going outside and smoking on people’s grounds, we have to look at the consequences of this. Where hospitals do provide an area for people to smoke in the grounds, I think the committee felt that we should make absolutely every effort to give advice in those shelters about where help can be obtained and that it is a place where people are there as a captive audience. So, I think this is something we’ve got to look at very carefully.

I also want to raise concerns about the provision of public toilets. I’ve recently campaigned on this issue with an 82 year-old constituent after the last public toilet in Whitchurch was closed. I think we’ve already heard how important public toilets are for the public. But I do feel that this is a step forward, and I do think that there are suggestions in this public health Bill that will improve the situation for access to public toilets for the general public. Obviously, if money was no object, we could go a lot further, we could build public toilets and we could make sure that they were well maintained. I think that would be the ideal, but we’re just not in that situation.

So, I think it’s a bit churlish, really, to say that there’s absolute disappointment that this Bill is not doing anything, because I do think it is making some very sensible suggestions. For example, the proposal that public toilets in all public buildings could be accessible for the public—I think that is a very positive step forward, because, in most areas, there is one public building or another. I went, at lunchtime, to the opening of the new Llandaff North hub, which is the old library and the day centre coming together to provide a hub of facilities for the area, and they’ve got toilets in the hub, and I think that we need to have a notice on the door, which I’m sure we will have, to say these toilets are available for the public, regardless of whether you’re going in to use the hub in any other way or not.

Will the Member give way?

Of course.

In some countries, they encourage private enterprises as well to offer facilities, and it can revolutionise the availability of effective and pleasant-to-use public lavatories.

Yes. I think that is another way that this can be progressed, but one of the points—. Just one slight caution on that is that some elderly people in particular have said that they don’t want to go into cafes just to use the toilet, because they feel very conspicuous.

So, I think it is a step forward on the public toilets in this Bill.

I just wanted to speak very briefly, if I can, in this important debate. Can I welcome the fact that the Welsh Government brought back a Bill without any proposals for significant restrictions on e-cigarettes? We know that we’ve had some success in bringing down smoking rates here in Wales in recent years, and that’s gone hand in hand with people choosing to have an e-cigarette rather than smoking tobacco, which is obviously much more beneficial to their health.

Can I also put on record how much I wholeheartedly agree with Jenny Rathbone, who made a powerful case, I thought, for minimum alcohol pricing here in Wales? I can remember, when I first took on the shadow health brief a number of years back, having a conversation with Alcohol Concern Cymru about this. I was very resistant at all to having any sort of minimum alcohol pricing, but when I looked at the statistics, they were very stark indeed in terms of the significant affordability of alcohol compared to the situation back in the 1970s and 1980s from when the price of alcohol, in relative terms, has gone down significantly as a proportion of people’s income. I think that it is time that we stepped up to the plate and brought forward some proposals on minimum alcohol pricing in order to deal with the harms that alcohol is causing society and the significant costs that alcohol is putting on taxpayers in terms of mopping up the cost of treating alcohol-related diseases, and the crime consequences, of course, of alcohol, which Jenny didn’t actually touch on.

In terms of the smoke-free requirements, I welcome some of the extensions that have been brought forward by the Government, but the Minister will know that I have raised with her a proposal from schoolchildren in my own constituency in Ysgol Pen y Bryn in Colwyn Bay, who’ve actually said that one of the things that they really detest is hanging around at bus stops when people are puffing away on cigarettes. I think, particularly between the hours that children are travelling to and from school, there might be something that you could consider perhaps around restricting smoking at bus stops, because it is a place where children congregate on a regular basis. I think that your intentions are absolutely right in terms of the drive to discourage people from smoking in areas where children congregate, but that, I think, is an easy win and it’s difficult to see why you haven’t been able to put it on the face of the Bill at the moment. I wonder, Minister, whether you could say whether that is something that you’re prepared to consider at Stage 2.

Just in terms of public lavatories, obviously, one of the things that we proposed in Stage 3 when the previous Bill was up for debate in the last Assembly, was the need for not just local strategies on public conveniences, but also, of course, for a national strategy to be developed. Because the Government seems to be saying that local authorities should produce their local strategies and, if they fall short, then the electorate can dump them at the next election. That’s absolutely fine for locally important toilets, but the problem is that there are some nationally strategically important toilets that are not important to local electorates. So, for example, we famously quoted, on many an occasion—and Kirsty Williams will be pleased that I’m raising this point—toilets along the A470 trunk road that are, frankly, not well used by locals, but used a lot by people who are passing through on the trunk road, or people who’re vising that locality. Of course, those individuals will not have a vote locally, in Powys, to ditch the local councillors who refuse to acknowledge the importance of those conveniences.

This is something that the Government, to be fair, has recognised as an issue, and that’s why the Government has put funding in to maintaining some of those public toilets. Yet, there is no provision whatsoever for a public convenience strategy on a national basis in order to make sure that those gaps in provision are actually accounted for. And let me tell you, the fact that there are no public conveniences in some parts of Wales does prohibit people, particularly those with medical conditions, from being able to get out of the house and to make long-distance journeys. That, I think, is unacceptable and that’s why I want to see the Bill strengthened. I wonder, Minister, whether you will consider strengthening the Bill through the provision of some sort of national strategy, an overarching strategy that looks at the provision across Wales, that the Welsh Government takes some responsibility for actually implementing.

Thank you very much. Finally, Gareth Bennett.

Thank you, Deputy Presiding Officer, and thanks to the Minister and the various committees for bringing the Bill forward to the current stage. I was going to talk about obesity, but I feel several other people have spoken on that so I don’t want to labour that point.

I think the public toilets issue is a moot point, not just for people with medical conditions but people in general. I was interested in Julie Morgan’s observations, because there was a pub in her constituency, the New Inn in Birchgrove, which I used to frequent, and occasionally people would go in who weren’t using the pub and they were directed to the toilets. I seem to recall the landlady telling me that they were part of a scheme, which may be similar to the sort of scheme that David Melding was talking about. Unfortunately, the pub then closed for refurbishment and that landlady is no longer there. It would be interesting, nevertheless, to find out what kind of scheme they were running and whether that could be more widely applicable.

The only other point I would like to make is to echo and amplify what Angela said about the issue of piercing and the age of consent that we should have for body piercing. Angela compared it to female genital mutilation, with the possibility of someone of 16 or 17 being involved in a coercive relationship, which was interesting. I hadn’t thought of that before, but I had previously thought that, in some cases, it may be a manifestation of self-harming among the young. I do agree with the desire expressed by several people that perhaps you could look at raising the age limit to 18. I think that is important on that point. Thanks very much.

Thank you very much. I call on the Minister for Social Services and Public Health to reply to the debate—Rebecca.

Thank you, Deputy Presiding Officer, and I’m very grateful to all Members who’ve contributed in this debate this afternoon, and also for the indication of the support for the general principles of the Bill. Obviously, I’ll be responding formally to each of the three committees and all of their recommendations, but I’ll take this opportunity to address what I think are some of the key issues that have been raised by Members this afternoon.

With regard to the smoking provisions in the Bill, I’m very pleased to see that these have been welcomed by Members. They’ll have all heard my commitments to extending to early years settings. In my evidence to committee, I spoke about the complexity of banning what is essentially a legal activity in a public place. The Bill does allow for other settings to be added in due course, and that would have to happen after due consultation and with the Assembly’s agreement. Any setting that we do add to the Bill or to the Act in due course will have to be good law. So, the public concerned will have to reasonably understand that they are committing an offence, and people enforcing the legislation will have to have a good understanding of it as well. So, that does make areas such as perimeters, for example, bus stops and other areas especially complex. But, as I say, there’ll be opportunities in due course within the Bill to look at extending to other settings. It is worth recognising as well that, when the Bill was initially tabled before the Assembly in the fourth Assembly, there were no places named on the face of the Bill. So, we already have three and we’re looking at introducing a fourth as well. So, I do think that we’ve come a long way with regard to the outdoor settings for smoking.

There was some concern raised in the debate about illegal tobacco, and I do agree that offences relating to illegal tobacco need to be considered alongside others when adding new offences to the restricted premises order regime. I know this has been an issue of concern to the committee. I think the best approach to doing this would be to use the regulation-making powers that are provided by the Bill. As I indicated in the statement of policy intent, which I published alongside the Bill, work will be undertaken with stakeholders to identify the offences that need to be included.

In addition, full consultation will need to take place before the regulations can be made, and they will also be subject to the affirmative process in the Assembly as well. I would just say that I do consider this piece of work to be a priority, but the proper channels will have to be followed for that. This will ensure that we have a strong enforcement regime for people who do continue to sell tobacco and nicotine irresponsibly, and particularly so to young people.

Members will have heard my comments on intimate piercing. I know this is something that Members are particularly concerned about, and I just would reiterate that I am giving very active consideration to this, taking advice and looking again at the evidence that has been received by committee, and beyond the committee as well.

Sexual offences, lasers and body modification were all mentioned by Members as well. The committee recommended that the offences listed in section 63(3) of the Bill be amended to include sexual offences. And in response to the expert witness evidence provided to the committee, I have asked my officials to revisit the relevant offences listed under this section of the Bill. I do therefore intend to bring forward Government amendments on this issue. I am persuaded that enabling local authorities to take account of information such as unspent sexual offences is justified on the grounds of public protection, particularly as some procedures require an element of intimacy, such as genital piercings, and clients are often alone with the practitioner whilst that procedure is being performed.

There were question relating to lasers and intense pulsed light use, which is already regulated by Healthcare Inspectorate Wales. So, if they were to be listed alongside the special procedures on the face of the Bill at this stage, there would be a regulatory duplication there.

I do acknowledge that some establishments provide tattoos as well as laser tattoo removal, so I do accept that this results in them having to obtain both local authority registration for services such as tattooing, and also HIW registration for lasers and IPLs. The role and function, though, of HIW is subject to ongoing discussion following responses to the Green Paper, ‘Our Health, Our Health Service’. So, I would therefore like to explore whether or not it would be appropriate in due course to add lasers and IPLs for non-surgical purposes to the list of special procedures, but after appropriate consultation with HIW, local authorities and the public.

Regarding body modification, I know that the committee has been keen that there’s extra work undertaken to understand the scale at which procedures are carried out in Wales, and the risk it poses to public health. During the development of the Bill, we did consult with local authorities and practitioners who provided evidence that suggests that body modifications are actually quite infrequently performed in Wales. But I do agree that more evidence is needed to fully understand the range and the scale.

Will you take an intervention? Thank you very much, Minister. Whilst I accept the veracity of the evidence that you’ve heard from public bodies, there was also talk in the committee evidence that we took that there’s a large underground movement that involves things like body modifications. So, they’re not necessarily going to be picked up by public authorities.

I do accept that, and the previous Minister for Health and Social Services did make a commitment that if the Bill did succeed in becoming law, he intended to consult on the principle of adding additional procedures to the list covered by the Bill shortly after the Bill’s enactment, and I’d be happy to stand by that commitment.

I think it’s important, though, that we don’t regulate procedures that are considered in law to be assaults, and currently there’s a case in Wolverhampton where police are prosecuting a man who was performing body modifications such as ear removal, nipple removal and tongue splitting. And he has been charged with three counts of causing grievous bodily harm with intent, and for the alternative counts of wounding without intent. So, we’re monitoring the progress of that case to understand where that line lies between body modification and assault.

Should sufficient evidence be provided through the consultation process in due course to suggest that body modifications are carried out frequently in Wales and that they are a significant risk to human health, further work would then need to be undertaken to understand the legal and ethical complexities of procedures before we could consider adding them to the list of special procedures, by way of affirmative regulations. But, as I say, I stand by the commitment made by the previous Minister in this regard.

Several Members referred to the fact that the Bill doesn’t have any explicit actions within it to tackle obesity, and when I gave evidence to the committee I was keen to stress that, actually, the Bill is only one part of a wider suite of measures. And I understand the frustrations that the committee has actually had in terms of being able to explore with people giving evidence what kinds of actions could be taken forward on this basis. I do thank the committee for the suggestions that it’s made, and emphasise that we are fully committed to tackling this important public health agenda. It won’t always be through legislation; for example, we already have nutritional standards in schools and hospitals, and there’s ongoing discussion with hospitals in terms of how we can extend healthy food to staff members and visitors to hospitals. We’ve got our healthy workplace work, the national exercise referral scheme, healthy eating programmes, and we are also putting pressure on the UK Government on the issue of the advertising of unhealthy foods, particularly to children as well.

I’m content to accept the principle of the committee’s recommendations that it makes in this regard, insofar as considering issues raised under existing powers and other legislative avenues. The committee will be aware that work is already progressing on the issue of nutritional standards in early years settings and care home settings. I’m also happy to discuss the issue of added sugar in school settings further with the Cabinet Secretary for Education, although, again, perhaps amending regulations would be the way in which we would address that rather than necessarily on the face of this Bill. Any changes there would have to be consulted on appropriately as well.

I know that the health committee has made a number of recommendations with regard to accessing toilets, and I would just like to confirm that local authorities will be expected to think about tourists and events and so on—so not just the local population—and wider equality issues as well when they are preparing their approach locally. So, I’m content to accept the recommendation that we work in partnership to develop a national map and I can tell Members that my officials are currently working with their IT counterparts to consider the necessary infrastructure required to collect the appropriate data from local authorities and incorporate those into existing mapping tools. Those data, then, could also be made available to third parties who’d be able to develop other maps and apps, for example, as well—I know there was keenness to develop apps. In consideration of the views of both the committee and expert witnesses, I’ve also asked officials to explore options for the development of an easily recognisable logo that could be displayed at publicly accessible toilet facilities across Wales as well.

With regard to minimum unit pricing, we do absolutely recognise the seriousness of the challenges that alcohol poses for our society, both for individuals and for communities more widely. It still remains our aspiration to take action on this issue, particularly, of minimum unit pricing. But Jenny Rathbone referred to the fact that efforts in Scotland have been referred to the Supreme Court, so we are watching what happens there very closely and as and when I’m able to say more to the Assembly on this issue, I will do.

And finally, I just want to confirm that I also believe that loneliness and isolation is an important public health issue as well, and we have a commitment in our programme for government to develop a cross-government strategy to address loneliness and isolation. As I say, and as Members have recognised, this public health Bill before us today is an extremely important piece of legislation and it remains one of many ways in which we’re trying to address the public health challenges facing the people of Wales.

Thank you very much. The proposal is to agree the motion. Does any Member object? No. Therefore the motion is agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.