The Telegraph
London, UK
24 October, 2007
'Charge smokers for right to buy cigarettes'
Smokers should be forced to apply for an annual £200 licence in order to purchase cigarettes, a Government advisor has suggested.
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The scheme would ensure smokers had to make a conscious decision to continue the habit and require people to become "registered addicts".
Prof Julian le Grand, a former advisor to Tony Blair, floated the idea during a speech this week. He also proposed banning food manufacturers from adding salt to products, an exercise hour for all employees during the working day and free fruit in offices.
The smoking permits were immediately lambasted as an excessive nanny state measure and "political suicide", given that their introduction would alienate the one quarter of British adults who smoke.
A report from the Department of Health yesterday revealed Britons are more likely to die from smoking related diseases than Europeans. They also drink more alcohol and eat less fruit and vegetables and are the fattest on the Continent.
Prof le Grand, who lecturers in social policy at the London School of Economics and advises ministers through his chairmanship of Health England, said the idea was to make healthy choices the norm and force those who object to make a conscious effort to opt out.
Once the scheme was up and running, it could be extended so smokers had to get a doctor's signature that their health was not at "massive risk" by smoking in order to get a licence.
He admitted there could be a problem with an emerging black market where those with permits sold them to those without, and that it could create the impression that as long as one is licensed smoking is not harmful.
Prof le Grand told the Telegraph: "There is nothing evil about smoking as long as you are just hurting yourself. We have to try to help people stop smoking without encroaching on people's liberties."
A simple price rise by increasing tax on tobacco would not have the same effect, he said, because evidence shows this does not stop people from taking up smoking in the first place.
But he said requiring them to fill in forms, have photographs taken in order to apply for a permit would prove a more effective deterrent.
The £200 charge would mostly be spent on administering the system and any surplus would go to the NHS to treat smoking related diseases.
The permits would be renewed every year, giving smokers more opportunities to quit, almost like an official New Year's resolution.
Requiring a doctor's signature could prove problematic because of the liability risk if the smoker was signed off and then developed cancer or heart disease as a result of the habit.
Prof le Grand said: "A doctor's signature adds to the difficulty of getting a permit and makes people think about the health issues but if requiring a doctor's signature made it virtually impossible to get a permit, that would get in the way.
"We'd need to find some sort of cut off point below which doctor's would sign them off an above which they would not."
Dr Chaand Nagpaul, GP representative on the British Medical Association’s public health committee said the idea was a non-starter and completely unworkable.
He said: "I find it extremely worrying that a former Government advisor is making suggestions like this. It doesn’t bode well for the sort of the advice the Government is getting."
Dr Nagpaul said ministers would be better off taking advice from doctors, nurses and patients instead of 'arm-chair policy theorists’.
He also pointed out that for each smoker to see their GP every year to have their permit renewed would take up 25m appointments annually and rob millions of sick people of the chance of seeing their doctor.
He also rubbished the idea that doctors would sign off a smoker as at low risk of health problems related to their habit because it is impossible to tell.
"The biggest problem associated with smoking is heart disease and the damage smoking does in relation to that is invisible until someone has a heart attack," he said. "The idea you could say to one person smoking is unlikely to affect your health and tell someone else it is, is impossible.
"This is a half baked idea that lacks logic and credence."
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'Charge smokers for right to buy cigarettes'
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