A smoke-free Britain in which cigarettes would be banned in all enclosed public places was called for yesterday by the Government's chief medical officer.

Sir Liam Donaldson challenged ministers to follow the lead of Canada, Australia, Hong Kong and parts of the United States, in banning smoking. Ireland is the latest country to announce a ban, to take effect from next January, which will include all workplaces, including restaurants, clubs and pubs.

Launching his annual report on the state of public health, Sir Liam said a ban on smoking in public was the most important of five measures he had highlighted to improve the health of the population.

The others were aimed at reducing the threat from obesity, West Nile virus, poorly performing doctors and drug errors in hospitals.

Sir Liam rejected the traditional argument that a ban on smoking in pubs and restaurants would damage their business. In Vancouver, Canada, restaurants saw a 23 per cent rise in business after a ban and a review of 100 published studies showed either no impact or a positive commercial impact.

A ban would see a climate in which "no smoking" was the social norm, protecting non-smokers from the damaging effects of cigarettes, encouraging smokers to give up and making offices and leisure places cleaner and more pleasant to work in and visit. Polls showed a ban would be supported by 85 per cent of the public, and more than 80 per cent of smokers, although support slipped to 50 per cent for a ban in pubs.

Sir Liam commended the Government's for its "excellent record" on smoking control, which included a ban this year on the advertising of tobacco. Eliminating smoking from public places would be the "final brick in the wall", he said.

"Tobacco puts nails in the coffins of 120,000 people a year in this country. Banning the advertising of tobacco has put nails in the coffin of the tobacco industry. Acting on second-hand smoke would put a further nail in that coffin," he added.

Children were especially vulnerable to other people's smoke because their lungs were smaller, meaning that they inhaled faster, and their immune systems were less developed. Passive smoking was a cause of low birthweight, cot death, ear infections, asthma and bronchitis in childhood, as well as lung cancer and heart disease in later life.

"Young children don't have the choice to leave the room," Sir Liam said.

A television advertising campaign warning parents to protect their children from the effects of passive smoking begins on Monday.

Sir Liam said MPs should take the lead by banning smoking in Parliament, and he urged towns and cities in Britain to follow the recent example of New York by acting as champions for smoke- free public places.

Studies showed smoke-free environments led to improved morale and productivity in the workforce, cleaning bills were lower and there was less risk of fires. Smokers had to go for longer periods without nicotine while at work, which also helped them to give up.

"We estimate we could reduce the proportion of adults smoking from [the current] 27 per cent to 22 per cent if we moved forward in a robust way on second-hand smoke. We would need to double the cost of cigarettes to get the same effect," Sir Liam said.

Anti-smoking groups welcomed the report but Simon Clarke, director of the pro-smoking group Forest (Freedom Organisation for the Right to Enjoy Smoking Tobacco), said that children should not be used as a means of gathering support for a smoking ban. He said: "We have no problem with an advertising campaign warning parents to be aware of the effects of smoking, as long as they stick to the facts." Sir Liam had a role to educate people on the effects of smoking, but the effects of passive smoking on children should not be used as a means to get the public to back a ban.

Millions spent on pay for suspended doctors

The National Health Service has spent more than £50m over the past three years paying doctors to do nothing.

The money went on paying the salaries of doctors who were suspended from work while concerns about their performance were investigated, plus associated costs.

A total of 514 doctors were suspended between 1998 and 2002. That doubled in 1999, after the Bristol babies heart surgery disaster, from 15 per quarter, on average, to about 30 per quarter. The costs rose sharply, from almost £13.5m in 2000 to £20m in 2002, but there are now signs of a fall.

Suspensions lasting years were costly and unfair, Sir Liam Donaldson said. In new guidance, he said doctors should be suspended for one month, and that should be reviewed each time it was extended. "That would put pressure on everyone, especially the lawyers."

More than 100,000 doctors practise in the UK and the great majority are of a high standard but, traditionally, the NHS has been poor at dealing with those who are not up to the job, Sir Liam said. The only option was to put them through the disciplinary process, which was often inappropriate.

The National Clinical Assessment Authority was set up last year to deal with the problem. In its first 21 months it received 446 referrals, mainly of surgeons and psychiatrists. The latest figures show there were 29 suspended doctors at the end of last year.

Killer virus may hit UK

West Nile fever was a disease of the Middle East, Africa and India until an outbreak in New York in 1999, spread by black crows, infected 62 people and caused seven deaths

In the four years since then it has swept across the United States, infecting 4,161 people in 44 states and killing 277. Now there is a threat that, with the right climatic conditions, it could come to Britain.

Sir Liam Donaldson said the risk was low but there was a need for vigilance. Studies at Oxford University suggest that the risk of the virus spreading to the UK is highest in the North-west and Wales, where the environment is best for transmission of the disease.

There was a big outbreak among horses in the Camargue region of France in 2000 but on that occasion the disease did not spread to humans.

In the UK, it is most likely that it would be introduced by birds and then spread to humans by mosquitoes. Most people infected with the virus do not become ill but in some it can cause encephalitis, a potentially fatal swelling of the brain. The disease is not infectious and cannot be transmitted from human to human.

Injections that kill

An error in the administration of the cancer drug vincristine has been repeated many times with tragic consequences. The drug is used to treat leukaemia and should be injected into a vein but it has been injected into the spine with disastrous consequences.

At least 23 cases have occurred worldwide in children and young people. The error causes paralysis and death.

Sir Liam set a target for the NHS to eliminate all deaths from wrongly administered spinal injections by 2001, by introducing foolproof systems. But he is "disturbed" by the lack of progress in implementing national guidance. "The clear national guidance must be implemented and the time being taken to achieve full compliance is a source of concern," he says.

The move is part of a wider agenda to improve the safety of patients in the NHS, which is being overseen by the National Patient Safety Agency set up last year. Ensuring the safety of patients "is becoming one of the most important challenges facing health care today", he says.

'Epidemic is possible'

The numbers affected by obesity have tripled in the past 20 years and the first cases of Type 2 diabetes, usually found in adults and weight-related, have been observed in children.

Sir Liam said the data was "chilling", and showed "the prospect of an epidemic of obesity in this country as in the US". A fifth of men and a quarter of women are obese, and 24 million adults in the UK are overweight or obese.

He called on the food industry to cut fat, sugar and salt in processed foods, curb the advertising of junk food to children, and examine ways of improving food labelling.

Obesity causes 9,000 premature deaths each year and cuts life expectancy by an average of nine years.

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