Tobacco Control Plan

– in the House of Commons at 3:00 pm on 19th July 2018.

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Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care 3:00 pm, 19th July 2018

I beg to move,

That this House
considered the Tobacco Control Plan.

Last year—how time flies!—in response to a question from my shadow on the Opposition Front Bench, Mrs Hodgson, I confirmed my intention to publish a tobacco control plan for England. I published it and then we debated its lofty ambitions in this House. Today, on its first birthday, I hope that we can reaffirm the importance of the plan and welcome the progress that has been made, while recognising—as I always do at the Dispatch Box—there is much more to do.

Last year we announced an ambition to reduce the prevalence of adult smokers from 15.5% to 12%, of pregnant smokers from 10.7% to 6%, and of 15-year-old smokers from 8% to 3%. We also pledged to reduce the inequality gap in smoking prevalence between those in routine and manual occupations and the general population. Furthermore, we set out a long-term goal of a smoke-free generation, reducing adult prevalence to below 5%. We were very clear, however, that now—then or now—is not the time for more legislation. I am still of that view because there is quite enough for us to do in this House.

The UK has some of the toughest tobacco control laws in the world, and we are consistently considered by independent experts to have the best tobacco control measures in the whole of Europe. The plan recognised that smoking in certain groups is stubbornly high, although masked by the overall declines in prevalence. To achieve our ambitions, we need to recognise that smoking is increasingly focused on particular groups in society, and in particular areas. We need to shift the emphasis from action at the national level—hence no need for more legislation—to focused local action in support of smokers.

Pregnant smokers are one critical group. People with mental illness are also much more likely to smoke: a little more than 40% of people with serious mental health conditions smoke, which is more than twice the national average. I repeat: smoking among those with mental health conditions is more than twice the national average. We need to work across the system, as we are, to ensure that everyone is making their full contribution to deliver for those groups.

Earlier this year I was fortunate enough to visit the Maudsley Hospital, which has done an awful lot of very good and fruitful work in this area. I place on record my thanks to the team at the Maudsley for their dedication and hard work. It was good to meet them—staff and patients—and to thank them in person.

When I talk about working across the system to ensure that everyone is making their full contribution, that is what we are doing. Last month we published the tobacco control delivery plan, which sets out detailed commitments made by various organisations in central Government and the arm’s length bodies to help deliver on our 66 recommendations. We will be tracking delivery of those commitments, and adding to them, as we move through the lifetime of the plan.

Let me touch on the work that is under way. The Prison Service is making the whole prison estate in England smoke free—no ifs, and definitely no butts. Do you see what I did there, Madam Deputy Speaker? This is a huge achievement, and I would like to pay tribute to the hard work that has made it possible. Her Majesty’s Revenue and Customs has supported the UK Government’s ratification of the protocol on illicit tobacco under the World Health Organisation’s framework convention on tobacco control. This new treaty aims to eliminate all forms of illicit trade in tobacco products throughout the supply chain. The protocol has now been ratified by the necessary 40 countries and is in force.

Photo of Kevin Barron Kevin Barron Chair, Committee on Standards, Chair, Committee on Privileges

When the Health Committee looked at the issue of smoking in public places and took evidence from different institutions, the Prison Service felt at the time that it would be impossible for it ever to get to a situation in which it was smoke free. We should all look back and thank it for what it has done, which it told us years ago was impossible.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

I agree with the right hon. Gentleman. Those of us who have secure estates in our constituencies and go in and visit them regularly will be aware of just how much of a challenge this is, given how ingrained smoking is within the cohort. That relates to the point I made about specific groups. I think that the Prison Service deserves great credit. Suffice it to say that it has a lot of pressures on it, and in some ways it probably felt that this was the least of its worries and the last thing it could deal with, but it is actually very important. That is why I say we are working well across the Government, and the Prison Service is really pulling out the stops in its area. I thank him for that intervention.

To finish on the protocol, HMRC will continue to lead on it on behalf of the Government, working with my officials at the Department of Health and Social Care. Through the protocol, we are sharing our expertise as a leading tobacco control nation; this is not just about what we are doing domestically. We are funding the FCTC secretariat with £15 million over the spending review period to support tobacco control in 15 low and middle-income countries. I am very proud of that work, and I am pleased to say that we are already having an impact. Georgia introduced smoke-free legislation and a ban on advertising on 1 May. It seems strange to talk about banning advertising as a new measure, given how long a ban has been in place in our country, but it shows that other parts of the world have a long way to go to catch up. I am very proud that we are using our experience and our evidence-based experience to help countries such as Georgia to do so. I want to place on the record my congratulations to Georgia.

Domestically, Her Majesty’s Treasury continues to maintain high duty rates for tobacco products to make tobacco less affordable, which is absolutely right. Public Health England, for which I am responsible, and NHS England are working on a joint action plan to reduce smoking in pregnancy. A key part of this is helping midwives to identify women who smoke and help them to quit and to support the implementation of National Institute for Health and Care Excellence guidance on reducing smoking during pregnancy and immediately following childbirth.

PHE has been encouraging the use of e-cigarettes to help people quit. As part of this, the most recent Stoptober campaign for the first time highlighted the role of e-cigarettes in quitting. The best evidence suggests that e-cigarettes are helping thousands of people to quit and that they are particularly effective in the context of a smoking cessation clinic. PHE’s data website, “Local tobacco control profiles for England”—another snappy title I dreamed up—is helping local commissioners and service planners to identify where they are succeeding, where they face the greatest challenges and how they compare with their neighbours and the rest of England.

Photo of Alex Cunningham Alex Cunningham Labour, Stockton North

I very much welcome the Minister’s comments in The Guardian newspaper this morning about the activities of one tobacco manufacturer that has been contacting or at least trying to ingratiate itself with NHS staff by helping them to quit smoking. Will he write to all trusts and clinical commissioning groups telling them that they should have nothing at all to do with this initiative?

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

I already have and NHS England already has: we have already done so. We think that Philip Morris International’s move is totally inappropriate and totally contrary to the protocol. I do not think I could have been clearer either in the press or at the Dispatch Box today, and I thank the hon. Gentleman for giving me the chance to say so again.

All our local activity has the overall goal of helping people to quit smoking and stopping others starting in the first place, so how are we doing? Here is the score card. Publications by the Office for National Statistics and NHS Digital earlier this month show that we are making progress. Since 2011, the number of adult smokers has dropped by a fifth to the lowest level since records began, and we are fully on track to achieve our 2022 ambition for adults. Among 15-year-old smokers, there is good progress, and figures published last year showed that the prevalence of smoking has reduced by a further percentage point from 8% to 7% since the publication of the plan. The number of e-cigarette users in that group is also falling. Latest figures from the ONS annual population survey reveal that smoking rates among 18 to 25-year-olds are falling faster than in any other age group. Considering that that age is when most smokers start smoking, I am particularly pleased with that.

We are also making progress on inequality. Although routine and manual workers continue to have higher smoking rates compared with the rest of the population, the gap has narrowed slightly, from 26.5% at the publication of the plan to 25.7% as reported by the ONS earlier this month. Those are achievements to celebrate. Nevertheless, I must be honest with the House and say that progress on tackling smoking in pregnancy is disappointing, and in truth the figures have barely moved in the past year.

What shall we do in year 2 of the plan? First and foremost, I am determined to redouble our efforts to support pregnant smokers to quit. That will be best for them and for their babies, and we need people to understand that. Secondly, we will use the opportunity of the Government’s investment in the NHS, which the Prime Minister announced last month, to embed prevention and cessation more firmly into the culture of the NHS. Last month, the Royal College of Physicians, which has a proud record of groundbreaking reports on tobacco, published “Hiding in Plain Sight: Treating tobacco dependence in the NHS”. That weighty report calculated that the cost of current smokers needing in-patient care is £890 million a year. It points out that smokers are 36% more likely to be admitted to hospital at some point than non-smokers, and it makes the powerful argument that smoking cessation repays the cost from year 1. I welcome that report, and I will be making that case loud and clear as we engage with NHS England on the content of the 10-year plan that the Prime Minister has asked it to produce.

Thirdly, we will continue to engage with local authorities —they are now top-tier public health authorities up and down the land in England—on promoting smoking cessation as the best evidence-based means of quitting smoking. Encouraging the NHS to do more on cessation is emphatically not about removing responsibilities from local authorities. This is about creating a whole-system approach in which addicted smokers can access the support they need to quit. Public Health England will continue to provide local councils up and down the land with facts and advice on tackling smoking—for example, it will work with sustainability and transformation partnerships, which should be leading that whole-system approach in the constituencies of all English Members.

Fourthly, as I have mentioned, we will continue to raise tobacco duty to make tobacco less affordable, while also taking action to tackle the illicit trade in tobacco. Fifthly, we will maintain a careful watch on so-called novel tobacco products. The Government are keen to use the opportunity of newer products, such as e-cigarettes, to help smokers to quit, without undermining the key message that the best thing someone can do for their health is quit completely. As I said in the Science and Technology Committee’s inquiry into this subject, we will continue to keep the harms of products such as heated tobacco products under review and continue to hold the industry to account. We have been explicit that the promotion of tobacco products is unlawful, as my recent letter to Philip Morris International makes abundantly clear—that letter was written before the one I mentioned in response to Alex Cunningham.

Last but not least, we will continue to make the case for tobacco control internationally, building on our reputation as a leading tobacco control nation with credibility in that space. We have such credibility because our consistent work in this area goes back to the coalition Government, the previous Labour Government and the Conservative Government before them, and such consistency means that we are highly credible around the world. More than 7 million people a year across the globe die from smoking-related disease, and the UK Government can help make a dent in that toll by sharing knowledge and skills.

Photo of Bob Blackman Bob Blackman Conservative, Harrow East

I pay tribute to the Minister’s brilliant work both since he became a Health Minister and before then. Will he comment on some of the scientific issues raised about addiction to nicotine, compared with the very harmful by-products that are a part of cigarettes, cigars and other tobacco products? Will he comment on whether it is nicotine or the by-products that are harming people’s health and causing the most damage?

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

I think cigarettes cause the most damage, because of the tobacco and the nicotine. The carcinogenic properties of the former are lethal. That link was proven with the lung cancer study that started the ball rolling. I pay tribute to my hon. Friend as the chair of the all-party group for the work he has done in this area. There are a lot of things that we know and there are a lot of things that we still do not know. Some people say that I do not go far enough to promote e-cigarettes and novel products, and some people say that maybe we go too far—I mentioned Stoptober. That generally suggests to me that we are in the right place. What I would say—I think that I said it earlier—is that an awful lot of research is still needed on e-cigarettes. One Member once told me that we should make e-cigarettes free on prescription to all pregnant women. The reason I did not say, “Yes, I think that’s a good idea” is that I still think there are risks to that product. I still think that the best thing people can do is to stop chuffing on anything, whether traditional cigarettes or so-called novel products. I thank him for his intervention, and I look forward to hearing what he has to say during the debate.

Photo of Alex Cunningham Alex Cunningham Labour, Stockton North

I thank the Minister for giving way a second time. I join the tributes to both the Minister and the chair of the all-party group. There has been tremendous cross-party work on this issue—that has always been the case. The Minister mentions the role local authorities have to play. We all know the pressure they have been under in recent times. I wonder whether he could see a mechanism that would provide and ring-fence the funds to enable local authorities to fulfil their role. Currently, they are struggling to do so.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

I thank the hon. Gentleman for that intervention. On providing support to help smokers quit, as I said, we have moved from the national context of legislative work to local application. The challenge is that adult smoking rates vary considerably across the country—for example, they are 8% in Wokingham and 23% in Kingston upon Hull—so it is right that local councils have the flexibility to spend that money. There is some £16 billion in the ring-fenced public health grant during the spending review period, so there is a lot of money in the system. But am I happy with patchy services in areas where smoking rates are too high? No, I am not. That is why I have said that the Government have not made a decision on full business rate retention. I would be concerned about the impact that that might have. I would want all sorts of reassurances from local councils if I were to make that change. Do I think it right that local authorities can design services for their local area? Yes, I do.

The new Secretary of State and I have already discussed prevention, which is one of the three main pillars he wants to focus on. I have told him that the new investment of £20 billion that we are putting into the NHS is fantastic. Bluntly, we could have the money on the side of the bus three or four times over, but unless we get serious about prevention, in this space as much as any other, the NHS will continue to be under enormous pressure. Local authorities are a key partner for us.

I would also say, not least because the chair of the all-party group on community pharmacy is sitting behind the hon. Gentleman, that community pharmacists and pharmacies have a key role to play. They are an NHS centre on street corners up and down our land. Some of them provide really good work. The healthy living pharmacies I have seen help people to access the services they need. They provide a little bit of mentoring and support, using their experience to say, “Yes, you can beat this,” and signposting them to services, whether through the public sector or the third sector.

There is an awful lot that we can still do. That is why the 10-year plan will have prevention embedded at its heart, as the five year forward view said it would—and it did, but I do not think that it lived up enough to the ambition on that. Perhaps people would expect the Minister responsible for prevention to say that, but I am nothing if not consistent.

Tobacco remains the single biggest avoidable killer in our country today, causing a third of preventable cancers. It contributes to around half of health inequalities between rich and poor in our society and is a potent symbol of the burning injustices that the Prime Minister spoke about, which I think affect the life chances of poorer people up and down our land. The tobacco control plan represents the Government’s continuing commitment to tackling this epidemic. It was never presented as a panacea and it is still not a panacea, but it is a cracking good start.

Over the past year, we have seen some impressive progress, but I am absolutely not complacent. In World cup terms, I would suggest that we have made it through to the knockout stages, but nothing more. I hope to be able to demonstrate further progress in a year’s time, and no doubt we will discuss that again in the House. I look forward to hearing hon. Members’ contributions, and I am happy to introduce this important debate.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 3:21 pm, 19th July 2018

It is a pleasure to be here to speak about the tobacco control plan, which celebrated its first anniversary only yesterday, as the Minister said. We are here to discuss the progress of the plan so far in reaching the Government’s goal of a smoke-free generation by 2022. I start by thanking the Government for allowing time for this debate to take place after all the drama and commotion of this week. As the Minister said, my first outing as shadow Minister for public health was in a debate on this issue, and thanks to him, we have the new, updated tobacco control plan that we are debating today. I know that it holds a very special place in both our hearts and, like him, I look forward to the debate.

The Opposition welcomed the plan and its ambitious goals, but we remain concerned about how they will be achieved by 2022. It is true that smoking is now thankfully at an all-time low, but the Government must not be complacent—I know that the Minister is not—and must not quit when it comes to measures that reduce smoking rates.

There are still 7.3 million adult smokers in the UK but, shockingly, smoking is an addiction of childhood, with the vast majority of smokers starting to smoke before the age of 18. Between 2014 and 2016, more than 127,000 children aged between just 11 and 15 started to smoke in the UK. According to a recent study by the Society for Research on Nicotine & Tobacco, this amounts to 350 young people starting smoking each day. That is equivalent to 17 classrooms of secondary school children starting to smoke every day. The Government therefore have a huge challenge on their hands—as we all do in Parliament—to tackle smoking in childhood and to reduce the rate of children smoking to 3% or less.

Between 2013 and 2016, the rate of decline in smoking among young people slowed down and the proportion of 15-year-old regular smokers had fallen from 8% to 7% but, at this rate, we will fail to achieve the ambition for England of 3% by 2022. The Minister mentioned in his opening remarks that we really will need to accelerate our progress when it comes to the number of children taking up smoking. Tackling this issue will be the first step to achieving a generation that is not only smoke-free, but healthier.

Smoking remains the leading cause of preventable premature death, such as from cancer or lung disease, and accounts for around 100,000 deaths each year in the UK. Each of those deaths could have been prevented. In 2015-16, there were approximately 474,000 smoking-related hospital admissions, with smokers also seeing their GPs 35% more often than non-smokers. In 2017, 22% of hospital admissions for respiratory problems were directly attributed to smoking. In 2015-16, smoking-related respiratory diseases cost NHS England £167.4 million in adult secondary care costs. I am sure that the Minister agrees with me that an ounce of prevention is better than a pound of cure.

The National Institute for Health and Care Excellence estimates that every £1 invested in smoking cessation generates £2.37 in benefits. However, according to the King’s Fund, spending on smoking cessation services in 2017-18 was reduced by almost £16 million compared with figures for 2013-14. Furthermore, the Health Foundation has found that next year just £95 million will be spent on smoking and tobacco control services, which is 45% less than in 2014-15. Has the Minister made any assessment of the impact that those cuts will have on local smoking cessation services?

A study conducted by Action on Smoking and HealthASH—and Cancer Research UK found that in 2017 budgets for stop smoking services were reduced in half of the local authorities in England, following reductions in 59% of authorities in 2016 and 39% in 2015. It is a wonder that there are any smoking cessation services left at all. What that means on the ground is that smokers who want to quit do not have access to the services that they need, and smokers who may need an extra push to seek help to quit are not getting that push.

Given that local smoking cessation services are on their knees, how does the Minister’s Department expect to reach the goal of reducing smoking rates to 12% by 2022? The Government’s own plan acknowledges that

“local stop smoking services continue to offer smokers the best chance of quitting”, but cuts in local authorities’ funding have led to unacceptable variations in the quality and quantity of services available to the public. In my region of the north-east, the current smoking rate is 16.2%, which is down from 17.2% in 2016. That represents the biggest fall in smoking in England. It means that smoking rates in the north-east have fallen by more than 44% since 2005, when 29% of adults in the region smoked, and that there are about a quarter of a million fewer smokers.

It has to be said that that decline in smoking rates is due to the excellent programme Fresh north-east. I know that the Minister has commended the programme before, and no doubt he will take the opportunity to do so again. Its vision is to make smoking history and to reduce smoking prevalence in the north-east to 5% by 2025.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

I am happy to place on record my thanks for the work of Fresh north-east, whose representatives I have met. It is a good example of what I was talking about—local systems working together. It is not just about what local authorities commission and the state provides. Fresh north-east is a coalition consisting of the public sector and the third sector.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health)

That is important, especially when, as the Minister has acknowledged, we are in such straitened times when it comes to local authority budgets. I am sure that Fresh north-east will be very grateful for what he has said.

Sadly, other areas are not as lucky. They do not have a Fresh north-east; if only they did. Stop smoking services are roughly 300% more effective than quitting by going cold turkey, but in some places the specialist services are being decommissioned altogether. For example, in Blackpool, smoking prevalence is 22.5%, while the average for England is 15.5%, yet Blackpool Council recently decommissioned its specialist smoking cessation service, citing a number of factors including public sector budget cuts.

That example leads me to my next point. Between 2012 and 2014, the healthy life expectancy for newborn baby boys in England was the lowest in Blackpool at 55 years. Again, the shortest life expectancy among men was in Blackpool too, at 74.7 years. Interestingly, in 2014, Blackpool had the highest smoking prevalence at 26.9%. Wokingham had the lowest smoking prevalence at 9.8%, but the highest healthy life expectancy of 70.5 years. That is a 15.5 year difference between healthy life expectancies, and while there will be several factors in play in these figures, it is clear that smoking is one of the largest causes of health inequalities in England.

Some 26% of routine and manual workers now smoke, compared with 10% of those in managerial and professional jobs. This has slightly increased rather than decreased the inequality from 2016. Some 28% of adults with no formal qualifications are current smokers compared with only 8% of those with a degree. It is these people—manual workers or those from low socioeconomic backgrounds—who suffer the most when the Government cut spending to public health services. I therefore ask the Minister what steps his Department is taking to ensure that these people are reached by local smoking cessation services. What assessment has the Minister made of the impact that smoking rates have on widening health inequalities, and how does he intend to address them?

Finally, I move on to smoking in pregnancy. The Government’s ambition to reduce smoking in pregnancy to 6% or less by 2022 is laudable. In 2015-16 the rate was 10.6%. However, new data published recently showed that the rate of smoking during pregnancy in 2017-18 had increased slightly, to 10.8%. It is therefore deeply concerning that the Smoking in Pregnancy Challenge Group, which I recently met, has warned that this ambition is unlikely to be met unless urgent action is taken.

In 2010, 19,000 babies were born with a low birth weight because their mothers had smoked during pregnancy. Up to 5,000 miscarriages, 300 perinatal deaths and around 2,200 premature births each year have been attributed to smoking during pregnancy. In addition, many other children will be three times more likely to take up smoking in later life because they live in smoking households. If we are going to have a smoke-free generation in the future, the Government must take urgent action to ensure that rates of smoking in pregnancy fall. We must not forget that it will be those very babies who will become the smoke-free generation that we all hope to see.

The current target is to reduce smoking in pregnancy to 6% or less by 2022. If that is achieved, it could mean around 30,000 fewer women smoking during pregnancy, leading to between 45 and 73 fewer stillborn babies, 11 to 25 fewer neonatal deaths, seven to 11 fewer sudden infant deaths, 482 to 796 fewer pre-term babies, and 1,455 to 2,407 fewer babies born at a low birth weight. That is something to aim for, but it will only happen if the Government take urgent steps to reduce the number of women smoking during pregnancy.

Photo of Bob Blackman Bob Blackman Conservative, Harrow East

On behalf of the all-party group on smoking and health, I thank the hon. Lady for speaking at the launch of our recent report. Does she agree that we must encourage not only pregnant women to give up, but their partners, too, so that pregnant women no longer have to face the challenge of not only being deprived of smoking, but of seeing their partner smoke in front of them? This should be a partnership for both parties.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health)

That is a very pertinent point. We all know the damage of passive smoking. It is all well and good if the mother gives up smoking—that will definitely help her and the baby during pregnancy—but if smoking is still going on in the household, the children will still be growing up in an environment of passive smoking. I thank the hon. Gentleman for making that important point and for his excellent work as chair of the all-party group.

I welcomed what the Minister said about tackling smoking in pregnancy, but will he also tell us how he will target work to encourage younger women and women from more disadvantaged backgrounds to give up smoking during pregnancy? Teenage mothers are nearly four times as likely to smoke before or during pregnancy than those aged 35 and over. Young mothers are less likely to quit before or during pregnancy, and only 38% of mothers under the age of 20 did so, compared with 58% of mothers aged 35 or above. It is clear that the Government need to tackle smoking in pregnancy, and smoking in childhood, as a matter of urgency to achieve their ambition of a smoke-free generation.

The Minister and his Department have a huge challenge on their hands if they are to meet the ambitious targets set out in the tobacco control plan. I still welcome the plan as the right thing to do, as I am sure the Minister does. Anything that is worth doing is going to be hard. We have four years to go before the target date, and the Minister must now look at how the Government can properly fund smoking cessation services to drive down smoking rates and support those who need extra help to stop smoking. I look forward to the remainder of the debate and the Minister’s closing remarks.

Photo of Bob Blackman Bob Blackman Conservative, Harrow East 3:36 pm, 19th July 2018

It is a pleasure to follow Mrs Hodgson, who has done excellent work already in her shadowing role. I know that she was also at the forefront of this debate before shadowing these matters. Equally, I pay tribute once again to the Under-Secretary of State for Health and Social Care, my hon. Friend Steve Brine, who set a precedent for future public health Ministers when, at his first outing at the Dispatch Box, he agreed to publish the long-awaited tobacco control plan. We should remember that it had been delayed for a year before it was published last year at the behest of my hon. Friend, probably much to the consternation of his officials.

I also want to pay tribute to the Minister’s predecessors, particularly the former Member for Battersea, Jane Ellison, who did a brilliant job of advancing many of the controls on tobacco that we now have in such a way as to ensure that they were delivered. I remember taking on the first debate on this subject in Westminster Hall, at which many of my colleagues were present. I think it was in September 2013, and it was the first debate after we came back from the summer recess. It took place at 9.30 in the morning, and I feared that I would have an hour and a half to fill by explaining why we should have standardised packaging for tobacco products. I have to say that both major parties were opposed to that idea at the time, but we were able to convince them otherwise and we changed the policy. That measure has now been enacted, which demonstrates the power that we on the Back Benches can have to change policy in a good way.

I must gently chide the Government, however, for taking over our Back-Bench debate. This means that we cannot pass the resolution that we wanted to pass today to encourage the Government not only to adopt smoking cessation policies but to resource them properly, to ensure that the plan is delivered. We understand that we are now having this general debate, however.

I declare my interest as chair of the all-party parliamentary group on smoking and health. We could go through the history of the progress that has been made, and the speeches from the Front Benches have shown us where we are today. I want to take us back to 1974, when I was sitting my A-levels. My late parents were both very heavy smokers. In those days, half the men in this country smoked, as did more than 40% of the women. It is hard to imagine, but in many ways it was considered healthy to smoke; it was somehow considered to be good for our lungs. Sadly, both my parents died five years later of cancer, so for me this is not only a health issue but a personal one. I do not want to see other people going through what my family had to go through as a result of using tobacco products in the way that they are intended to be used.

Smoking rates have dropped remarkably. As has been mentioned, the number of adult smokers has dropped from 7.7 million in 2011 to 6.1 million in 2017. The difficulty with figures, however, is that, as the population increases, we have to go harder and further to reduce the number of people smoking. Smoking-related diseases are the leading cause of preventable death, with 80,000 people a year dying as a result of tobacco products. In Harrow, part of which I have the honour of representing, we still have 14,000 smokers, which is difficult to understand given the encouragement to quit and all the health issues, and the cost to public services is estimated to be £37.9 million a year in just one London borough, out of 32, that has about 250,000 adults. It is clear that we need further action.

The good news is that the UK is one of the leading countries in the implementation of tobacco control policies. We are recognised as a leader in the implementation of the World Health Organisation’s framework convention on tobacco control, and I want to remind the House of article 5.3, which states:

“In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.”

The guidelines on implementing article 5.3 have been agreed by the UK and advise Governments not to enter into any partnerships, whether they be non-binding or non-enforceable, or agreements with the tobacco industry, not to accept voluntary contributions from the tobacco industry, not to accept tobacco-industry-drafted legislation or policy or voluntary codes for legally enforceable measures, not to participate in corporate social responsibility or related schemes funded by the tobacco industry, and not to permit tobacco industry representation on Government tobacco control bodies.

Former MP Paul Burstow, my predecessor as chair of the all-party parliamentary group on smoking and health, is now the chair of the Tavistock and Portman NHS Foundation Trust and co-chair of the Mental Health and Smoking Partnership. He wrote to the Minister about the letter sent by Philip Morris International, and I am pleased that the Minister has taken up the issue straight away. The company, which manufactures Marlboro cigarettes, wrote to say that it is

“keen to work with NHS Trusts and Foundations to see if we can support the NHS in helping its employees to stop smoking”.

I do not usually promote this publication, but an article in The Guardian today quotes me, Paul Burstow and the Minister making it clear that we do not want any interference from Philip Morris and that that company should not avoid its responsibilities under the code. I am delighted that the Minister has completely rejected the position of Philip Morris, which also states that it has

“written to the heads of all the NHS Foundations and Trusts in England, all Clinical Commissioning Groups, Simon Stevens, and the Secretary of State for Health and Social Care” about the issue.

Most local authorities in England have signed up to the local government declaration on tobacco control, which is a public statement of the councils’ commitment to reduce the harm caused by tobacco. The declaration commits signatories to

“protect our tobacco control work from the commercial and vested interests of the tobacco industry by not accepting any partnerships” and so on. However, local government officers have reported continuing efforts by the tobacco industry to engage with local authorities over tobacco control issues including, but not limited to, the illicit trade. We must be clear that the industry’s involvement is not required and not welcome.

I am delighted that, on 1 November 2017, the Minister made a clear statement in this House on the Government’s position, and I am delighted that will continue. I welcome his comments, both in his opening speech and in his letter. What else can he do to make sure that local authorities, the NHS and any other interested parties do not get sucked into this offer from Philip Morris?

On the risks we run, as the hon. Member for Washington and Sunderland West said, one of the problems is that the plan and the targets might not be met. We have to encourage everyone to get to that point. The reality is that smoking rates among young people have started to level out. There is a risk that we will not hit those targets. The target to get smoking rates down to 5% or less by 2022 is good, but I would like to see it at 0%—no one smoking. We could then say that we have achieved what we wished to achieve.

We clearly have to encourage young people not to start smoking. As has been said, more than 350 young people a day take up smoking, and 60% of them go on to smoke for the rest of their life. The huge risk is that those people will fuel the tobacco industry for the future.

There is therefore a case for further control measures, including increased funding for the initiatives, and new legislation. Although it is not appropriate to allow the tobacco manufacturers to make voluntary contributions, if they are offering to give money to the NHS and to local authorities as part of so-called corporate social responsibility, the industry clearly has money to pay for the measures we need to control tobacco and to mitigate the harm it causes, so let us make the tobacco manufacturers pay.

At a time when public sector budgets are under pressure both at national and local level, the tobacco manufacturers, if they have money, should pay an increasing share of the cost of control, as an application of the “polluter pays” principle. That is the clear recommendation of the all-party parliamentary group, and I trust my hon. Friend the Minister will therefore advance that recommendation to the Chancellor.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

Consider it advanced. Time will be limited for the wind-ups, so I will address the point about young people. Earlier this week, I held a roundtable in the Department of Health with a number of charities working on drug policy and with reformed drug takers. One gentleman said to me, “The trouble was that I really enjoyed taking drugs. What I didn’t enjoy was the outcome of taking drugs.”

I have heard young people say that they really enjoy smoking but that they do not enjoy the outcome. We should welcome today’s statement by the Secretary of State for Education on the new work that will be done in schools on health and relationships education. Specifically, health education can help young people to understand the health consequences of smoking, even if they might enjoy the process of smoking.

Photo of Bob Blackman Bob Blackman Conservative, Harrow East

I thank my hon. Friend for his intervention, and I completely agree that health education is an appropriate way to consider the issue.

There is a model in the United States that we could introduce. The Family Smoking Prevention and Tobacco Control Act of 2009 gives the US Food and Drug Administration the power to regulate the tobacco industry, funded through what is called a user fee on manufacturers. The total amount to be raised is set out in legislation and apportioned to manufacturers on the basis of their share of the US tobacco product market. I ask the Minister to look at that US legislation as a way of introducing such a model.

The major recurring costs of tobacco control, and they are important, are mass media campaigns to discourage uptake and to encourage quitting. An approach such as the one in the US would: raise hundreds of millions of pounds a year from the tobacco industry; help to protect the business of legitimate retailers who obey the tobacco control legislation; help to protect Government tax revenues—at the moment, the excise tax raised £9.9 billion in 2016-17, but the loss on illicit tobacco was estimated to be £2.4 billion; pay for the mass media campaigns to discourage smoking, which we desperately need; and provide a source of revenue to local authorities, which could help to fund local tobacco control measures, including enforcement activity and the provision of support to smokers seeking to quit. Funding for trading standards has fallen substantially in recent years, from £213 million in 2010 to only £124 million in 2016, and the National Audit Office estimates that the number of full-time staff has reduced by 56% in seven years. So there are fewer people to enforce the rules that we want to see enforced. Such an approach could also support regional partnerships working to tackle illicit tobacco. The success of that has been shown in the north-east and north-west, which have concerted multi-agency enforcement activity and effective, evidence-based measures to reduce demand. So it is clear that we can deliver on this.

Polling conducted for ASHAction on Smoking and Health—asked respondents how strongly they would support measures requiring tobacco manufacturers to pay a levy or licence fee to help encourage people to quit and prevent young people from starting to smoke. The net support for that was 71%, with only 9% opposing. So the Minister should impress on Chancellor the need for this and the benefit of doing it.

One key issue that I wish to emphasise above all else is the need for mass media campaigns to shock people into realising how desperate smoking is and how damaging it is to health. There is nothing like seeing those sorts of mass campaigns for encouraging people to realise that they are responsible for their health. The analysis of these campaigns has shown that they are very effective but that they have declined in recent years. Public spending on such campaigns in the UK peaked in 2008-09 at £23.38 million, but now that has fallen dramatically, to only £1.5 million in 2016-17. Clearly, we need to encourage local authorities and the Department of Health and Social Care to use the opportunity to shock people so that they understand the damage they are doing. I therefore ask the Minister to look at mass media campaigns and ensure that they are used as part of the strategy.

Finally, let me say that my area now has a large number of people from the European Union who have chosen to come here to live in this country. If we go to many eastern European countries, we see people smoking everywhere; these places do not have the tobacco control that we have in this country. Those people need to be reached to encourage them to give up smoking and ensure they look after their own health. It is those people we have to reach out to fully. I look forward to other contributions from right hon. and hon. Members, and I am sure that the Minister will reply in suitable fashion.

Photo of Martyn Day Martyn Day Scottish National Party, Linlithgow and East Falkirk 3:53 pm, 19th July 2018

It is a pleasure to take part in today’s debate, and I welcome the one-year anniversary of the tobacco control policy for England. A great deal of progress has been made in reducing smoking prevalence across the UK. As has been pointed out, whereas in 1974 more than half of adult males and more than two in five women smoked, the latest figures from NHS Digital suggest that smoking rates in the UK are now 15.1%. So I say congratulations on that achievement.

The figures on smoking prevalence in Scotland, where I come from, vary as between sources, but the Office for National Statistics has suggested a prevalence rate of 16.3% in 2017. Since 2010, Scotland has seen the largest decline in the proportion of smokers of the four UK jurisdictions, with a reduction of more than eight percentage points. That said, there are still about 10,000 smoking-related deaths per year and 128,000 smoking-related hospital admissions in Scotland.

The Scottish Government published their new five-year tobacco control plan in June. It goes a little further than the tobacco control plan for England, in that it not only puts forward a vision of a smoke-free generation but sets a date, 2034, by which we wish to achieve that vision. If Scotland is to achieve its vision, it requires action by the Westminster Government on issues that are not devolved, such as tax, illicit trade and smoking in the entertainment media. Page 14 of the tobacco control plan for Scotland commits the Scottish Government to

“continue to work with the UK Government to address the representation of tobacco use in the media.”

That is not something that the Scottish Government can do on their own.

A clear causal link has been established between exposure to smoking on screen in the entertainment media and smoking initiation in young people. The greater the exposure, the greater the risk of smoking uptake; yet smoking remains common in entertainment media viewed on screen by young people, including prime-time TV, videos, and films. A recent survey for ASH found that in all media for which questions were asked—TV, films, music videos, computer games and online—the 11 to 18-year-olds who had tried smoking were significantly more likely than those who had never smoked to report exposure to smoking imagery. The highest level of young people’s exposure to smoking imagery was in films, with 81% of 11 to 15-year-olds and 88% of 16 to 18-year-olds reporting seeing smoking. An analysis of UK TV programmes broadcast between 6 and 10 pm in 2015 found that 12% of all programmes featured tobacco use, which was the same proportion as in 2010. In both 2010 and 2015 the frequency before and after the 9 o’clock watershed was roughly similar. Only a very small minority of the content could be justifiable on historical accuracy or other grounds.

The relevant regulators are Ofcom and the British Board of Film Classification. Ofcom, which has a statutory responsibility to protect the under-18s, has much more stringent rules than the BBFC. However, both regulators appear to be more concerned about how smoking is depicted than the overall amount of the exposure taking place. Will the Minister endorse the following recommendations and ask his colleagues in the Department for Digital, Culture, Media and Sport to work with the Department of Health and Social Care to put them into effect through revised Ofcom and BBFC codes? First, Ofcom and the BBFC should monitor youth exposure to depictions of tobacco use on screen on the channels that they regulate and publish the data in their annual reviews; secondly, Ofcom and the BBFC should revise their guidelines with respect to smoking on screen in entertainment media viewed by under-18s, to discourage any depictions of tobacco use and require action to mitigate any remaining exposure; and thirdly, if smoking features in any programme or film likely to be widely seen, heard or accessed by under-18s, an anti-tobacco advertisement must be displayed at the beginning and in any advertising breaks.

When I spoke in the debate on the tobacco control plan in October last year, I focused heavily on the illicit trade, which the Minister will remember, and encouraged him to ensure that the UK ratified the illicit trade protocol in time for the meeting in October this year, so I am absolutely delighted that the UK did indeed ratify it. In fact, we were the 40th country to do so and thereby triggered the entering into force of the treaty. I congratulate the Government on that.

However, the UK Government still need to do more to tackle the illicit trade. In 2016-17, the size of the illicit market for cigarettes had remained roughly stable since around 2010, although as smoking prevalence has declined significantly, it has made up a higher proportion of the total market. Because taxes have increased over the years, the total tax revenue lost as a result of illicit trade has grown from £1.9 billion in 2010 to roughly £2.5 billion today.

Articles 15 and 16 of the tobacco products directive 2014/40/EU provide for EU-wide systems of traceability and security features for tobacco products, to address the issue of illicit trade. There are a lot of good suggestions and lots of good work in that directive. Under the traceability system, all unit packets of tobacco products are required to be marked with a unique identifier, and relevant economic operators involved in the tobacco trade are required to record the movements of tobacco products throughout the supply chain and transmit the related information to an independent provider, with data storage contracts to be approved by the Commission. The data will then be made accessible for enforcement purposes to the authorities of EU countries and to the Commission. Under the security features system, all unit packets of tobacco products placed on the EU market will be required to carry a tamper-proof security feature, composed of visible and invisible elements, enabling authorities and consumers to verify their authenticity. It is therefore, in my opinion, essential to the control of the illicit tobacco trade that the UK should continue to participate in the EU tracking and tracing system after Brexit and that any such system implemented in the UK is independent of tobacco manufacturers as required by the illicit trade protocol.

A study for the tobacco control research group at the University of Bath, published just last month, exposes evidence that the big tobacco companies are still facilitating tobacco smuggling. The protocol explicitly requires Governments to take responsibility for control measures, rather than relying on industry self-regulation, which has failed so miserably to date. The industry must not be allowed to control the traceability system, either directly or indirectly through proxies.

In conclusion, will the Minister commit to the UK remaining in the EU tracking and traceability system for tobacco products after Brexit? Will he report on the UK’s progress in implementing the requirements of the EU tracking and traceability system, and will he confirm that the system of tracking and tracing of tobacco products, which will be adopted by the UK, will comply with the independence requirements set out in the WHO illicit trade protocol?

Photo of Alex Cunningham Alex Cunningham Labour, Stockton North 4:00 pm, 19th July 2018

I appreciate being called at this stage of the debate. I declare my role as a vice-chair of the all-party group on smoking and health. This was going to be a Backbench Business debate on a motion that I put forward to consider further action necessary to deliver the vision set out in the tobacco control plan for England 2017 of a smoke-free generation by 2022.

I am grateful to colleagues across the party groups for working with me to secure the original debate. I am also grateful to ASH and other organisations for assisting with my preparation today. I will read the original Backbench Business motion into the record so that the Minister can take it on board. It reads:

“That this House
welcomes the Government’s Tobacco Control Plan published in July 2017;
notes its ambition to create a smokefree generation and to reduce the prevalence of 15 year olds who regularly smoke from 8% to 3% or less;
notes the slowing rate of decline in youth smoking prevalence and risk to progress;
and calls on the Government to develop new strategies to ensure that it allocates the resources and the funding necessary to deliver on that ambition.”

I very much welcome what the Minister had to say today and the 66 recommendations that are coming forward to move things along. I want to summarise the key points that I had originally hoped to make in much more detail.

This is an important issue for me in relation to my home area, the borough of Stockton-on-Tees. The smoking rate has come down considerably: 15% of the adult population in Stockton are currently smokers. Some 31% of the households that have a smoker are below the poverty line. If they quit, 1,991 households would be lifted out of poverty, and residents of those households include 1,342 dependent children. Smoking costs Stockton-on-Tees approximately £37.4 million, it costs the NHS £8.5 million, and £24.1 million in lost productivity. Some 15.3% of pregnant women in our area smoked at the time of their baby’s delivery.

Furthermore, the analysis of the most recent youth smoking data by Cancer Research UK finds that more than 350 young people started smoking every day. That is the equivalent of 17 secondary school classrooms. At the current rate of decline in smoking cessation, we will fail to achieve the ambition for England that, by 2022, 3% or less of 15 year olds are regular smokers.

Health inequalities are growing: one in four people in routine and manual occupation smokes compared with one in 10 in professional and managerial occupations, and that gap is widening. The key points of the Backbench Business proposal were the need to do more to reduce smoking initiation in young people and to encourage quitting among adults. We must reduce young people’s exposure to smoking in film, television and other media. That issue was raised by Martyn Day a few minutes ago.

There is substantial peer-reviewed evidence that shows a causal link between exposure to smoking in the media and starting to smoke and that young people are being exposed to smoking on screen in the UK. Government have a role to play in encouraging media regulators to take smoking seriously and to act in this area. The Government need to urge Ofcom and the BBFC to revise their guidelines with respect to smoking on screen in entertainment media viewed by under-18s to discourage any depictions of tobacco use and to require action to mitigate any remaining exposure. We can make it more difficult for young people to obtain cigarettes by increasing the age of sale to 21, introducing retail licensing for the sale of tobacco and properly funding regional activity to support enforcement.

In the UK in 2014, 77% of smokers aged 16 to 24 began smoking before the age of 18. Evidence from the US shows that raising the legal purchase age to 21 reduces the number of young people who start smoking, reduces smoking-caused deaths and immediately improves the health of young people. More than one third of under-age smokers buy their cigarettes from shops without a licence, which can be revoked if they continue selling—so tobacco retailers can continue to sell tobacco to minors or to sell illicit tobacco. A retail licensing scheme covering all levels of the supply chain from manufacturer to retailer would also help to protect the business of legitimate retailers who obey tobacco control legislation.

As others have said, Government need to do much more to support and enhance enforcement where there is illegal activity, but funding cuts have led to significant reductions in the capacity of trading standards departments, which are responsible for seizures of illicit tobacco and prosecutions for tobacco fraud. From personal experience, I know that the capacity simply does not exist. Time and again, I have alerted Her Majesty’s Revenue and Customs to tab houses selling tobacco illegally in Stockton, but those very same tab houses continue to sell. HMRC is the beneficiary of enforcement activity, as it protects tax revenues, so surely it should be required to fund the activity, which could be organised at the regional level, which is the most cost-effective way of doing it.

One of my principal concerns is the much higher incidence of smoking in disadvantaged communities and how we de-normalise it and tackle health inequalities by funding mass media campaigns, which Bob Blackman talked about in detail. Some 83% of children who smoke regularly have family members who smoke, and this is magnified in disadvantaged communities, such as the town centre ward in Stockton. Public spending on these campaigns, however, has fallen from a peak of £23.38 million in 2008-09 to only £2 million last year. We need to reverse those cuts, as such campaigns are highly effective and can be targeted at poorer and more disadvantaged groups, which have the highest rates of smoking.

The “polluter pays” levy on tobacco manufacturers, which the all-party group on smoking and health supports, could help to fund mass media campaigns as well as other important tobacco control measures. It is time to consider the greater role for social media to amplify the impact of mass media campaigns. There is now the capability to target individual postcode districts with specific messages using, among other things, the promote tool on Facebook. We could help the 60% of smokers who say they want to quit smoking by funding stop smoking treatment and including inserts in tobacco packets encouraging quit attempts.

In 2017, the budget for stop smoking services was cut in half by local authorities in England. The NHS and local authorities need to collaborate more effectively to ensure that smokers, particularly vulnerable groups who tend to be more addicted and have greater difficulty quitting, have access to the help they need. I think the Minister alluded to that in detail—if one can allude to anything in detail—in his speech. Simon Stevens told the Health Select Committee a couple of weeks ago that local authority stop smoking services were not sufficient and that NHS England needed to do more to treat vulnerable groups of smokers under its care. He said:

“It is pretty clear that we will have to keep pushing harder on smoking, and smoking cessation is part of that. That cannot all be done through local authority commissioned services;
we are going to have to look at whether the NHS can embed smoking cessation in more of the routine contacts that we have with vulnerable groups who are still smoking. ASH and the Royal College of Physicians have put out an important set of proposals in the last 10 days, which we will take a very careful look at.”

I very much welcome that, and I hope the Minister does too.

On the subject of pack inserts, research from Stirling University has shown that smokers of a variety of ages, gender and social grade support their use as an aid to encourage them to quit. The Minister said earlier that we did not need more legislation. Well, perhaps we do. We need legislation mandating pack inserts, which would provide an inexpensive and highly targeted means of supplementing on-pack warnings.

People with mental health conditions are being left behind in all this. Approximately 40% of people with a mental health condition smoke. Smoking is the main reason that people with mental health conditions die 10 to 20 years earlier on average than the general population. They tend to smoke more heavily, be more heavily addicted and find it harder to quit. It is not that they do not want to quit, but that they need more help to succeed. The Minister mentioned this in his opening remarks, but I hope that he will say a little more when he winds up the debate. I can help a wee bit—at least the people who are briefing me can.

To reduce smoking among people with a mental health condition, we need to ensure that all mental health trusts treat tobacco dependency alongside implementing smoke-free grounds; to have improved data on smoking rates and service provision for people with a mental health condition who smoke; and to empower and inform people with a mental health condition to take control of their smoking and to include them in the development of services. We need specific national targets for reducing smoking rates in people with mental health conditions, and shared plans between local authorities and the NHS to ensure that smokers get support and help in the community as well as when they are being treated as in-patients. We need to train all mental health staff in smoking cessation and to offer a range of alternative nicotine-containing products, including e-cigarettes, to those struggling to quit. Furthermore, as called for by the Royal College of Physicians and ASH, we need treatment for tobacco dependency to be embedded throughout the NHS, not just in NHS mental health trusts. This would improve treatment outcomes. The Minister knows all this.

Smoking exacerbates as well as causes disease, and helping smokers to quit can reduce NHS treatment costs and improve quality of life for patients. This includes pregnancy, chronic obstructive pulmonary disease and other respiratory diseases, cardiovascular disease, mental health, surgery, diabetes and HIV/AIDS, not to mention 16 different types of cancer. Advice and treatment can increase patients’ chances of quitting up to fourfold. It is about the cheapest and most effective healthcare intervention around, costing hundreds of pounds per successful quitter. But despite these impressive results, only 24% of patients diagnosed with lung cancer are offered advice to quit by their GPs, and only 13% are prescribed stop smoking treatment. The RCP has calculated that if all smokers were provided with help to quit, the NHS could save £60 million annually in hospital readmission costs and A&E attendances alone from year one onwards, once the cost of the treatment is taken into account.

There are many other aspects to this issue. My hon. Friend the Member for Harrow East—I call him my hon. Friend, despite the fact that he sits on the Government Benches—talked about other nationalities living in the UK. We could talk in great detail about people from eastern Europe and the extremely high levels of smoking in those communities, but I want to finish with just two simple questions for the Minister. Will the Government seriously consider all the recommendations that I have outlined in the debate today? Will he commit to asking Simon Stevens, as chief executive of the NHS, to confirm that tobacco dependency treatment for all smokers, as recommended by the RCP and ASH, will be included in the plan for the NHS to be published in November? He knows, as we all do, that lives depend on it.

Photo of Kevin Barron Kevin Barron Chair, Committee on Standards, Chair, Committee on Privileges 4:13 pm, 19th July 2018

I speak as an honorary fellow of the Royal College of Physicians and as a vice-chair of the all-party parliamentary group on smoking and health, to which, as everybody knows, the secretariat is Action on Smoking and Health, which I have been involved in for over two and a half decades now.

Smoking continues to be one of the most pressing health issues in my constituency, despite decades of progress in this country. Most importantly, it remains an enduring cause of unequal life expectancy for my constituents—something that it is extremely welcome to see the Government acknowledge in the tobacco control plan. Different Governments over the years have not always acknowledged these stark issues, which have been around for decades.

In Rotherham, which is partly in my constituency, 16.2% of the population smoke, which is above the English average of 14.9%. In 2016-17, 17.1% of women were smokers at the time of delivery, compared with the regional value of 14.4% and the national value of 10.7%, so we have higher rates of smoking in pregnancy than elsewhere. In 2014-15, of the estimated deaths attributed to smoking per 1,000 of the population aged 35-plus, 1,487 were in Rotherham. If anything else was killing that number of the population in our constituencies, we would rightly be taking action, and more action than we currently do.

In 2016, there were 3,620 smoking-attributable hospital admissions in Rotherham. In 2017, 22.8% of routine workers smoked compared with 13.1% of those in managerial professions. Among people who have never worked, the smoking rate rises further, up to 24.8%. Each year, smoking in Rotherham costs society approximately £64.2 million. This cost is accrued in a range of social domains, including healthcare, productivity, social care and house fires. It used to be chip pans that caused more house fires in constituencies such as mine, but cigarettes have now taken over.

The total annual cost of smoking to the NHS across Rotherham is estimated at about £12.7 million, with £3.7 million of this due to 3,244 hospital admissions for smoking-related conditions and £9 million due to treating smoking-related illness via primary and ambulatory care services. In 2015, there were 24,924 households in Rotherham with at least one smoker. When net income and smoking expenditure is taken into account, 34% of households with a smoker fell below the poverty line. If those smokers were to quit, 2,173 households in Rotherham would be elevated above the poverty line. These are the stakes for people with this addiction in constituencies such as mine.

I have long supported a strong approach to tobacco harm reduction as an important plank in the strategy to reduce health inequalities. Smokers who are disadvantaged face many more barriers to quitting, including high levels of addiction. A properly implemented tobacco harm reduction strategy can address this, and obviously has been doing so in the recent past. The commitment in the tobacco control plan to support innovation is welcome. Since the plan was published, Public Health England has published an updated evidence review of e-cigarettes showing the growing evidence that vaping is less harmful than smoking and has the potential to support thousands more people to become smoke free.

As I said in the debate on this subject in Westminster Hall, this is the first tobacco control plan that has ever mentioned e-cigarettes. The recent report by the Royal College of Physicians on smoking and the NHS reiterated the RCP’s support for the use of e-cigarettes and encouraged wider use of these products within the NHS. However, smokers’ appetite for trying e-cigarettes seems to have slowed somewhat. Since 2013, there has been a tailing off in the rapid growth in the market. This coincides with a deterioration of public understanding about the relative safety of e-cigarettes compared with smoking.

Action on Smoking and Health has recently provided evidence to the Science and Technology Committee inquiry on e-cigarettes. ASH reported a moderate improvement in accurate understanding of the harms from e-cigarettes between 2017 and 2018, but 22% of current smokers still think that e-cigarettes are as harmful or more harmful than smoking. Yet Public Health England has said that they are now at least 95% safer than cigarettes. Clearly, more needs to be done to promote better health understanding of the relative safety of e-cigarettes. This should include addressing the lack of understanding also among health professionals, in addition to engaging smokers more in this.

I want to give a couple of brief examples of how e-cigarettes interact with smoking rates. The Minister has heard me say before that meeting the targets in the last plan and reducing adult smoking to its current levels was probably very much helped by smokers voluntarily taking up e-cigarettes. Some 2.9 million adults in the UK use e-cigarettes, more than half of whom have stopped smoking completely, so about 1.5 million people have stopped smoking because of e-cigarettes. ASH produced those figures for 2017. Likewise, 18% of smokers used e-cigarettes in 2017, and 23% of ex-smokers reported that they use or used to use an e-cigarette. One person in the UK switches to e-cigarettes every three minutes, allegedly.

I want to give a comparator and to refer back to my intervention on the Minister. I chaired the Health Committee in 2005, after we had fought an election on a manifesto commitment by the Labour party to introduce a ban on smoking in public places. I stood on that manifesto, but the ban proposed was not a comprehensive one. The Health Committee, of which I became the Chair, investigated smoking in public places. We went to Ireland to take evidence, because it had had such a ban for about two years.

I will now demonstrate the effectiveness of e-cigarettes by comparing smoking rates in the UK versus those in Ireland, where every other approach to tobacco control is identical to those in the UK, such as plain packaging, retail display bans and marketing promotions all stopped. In recent years in the UK, smoking rates have dropped by almost a quarter—according to the Office for National Statistics, 24.4% of UK adults smoked in 2012 and 15.8% in 2016—and the UK now has the second lowest smoking rate in Europe. In Ireland, which has exactly the same tobacco control as we put through this place over many years, smoking rates have stagnated: 23% of adults smoked in 2015 and 2016, dropping to 22% in 2017, according to Healthy Ireland stats. That shows how the use of e-cigarettes has been good in reducing smoking in this country.

According to Public Health England, e-cigarette use is associated with improved quitting success rates over the past year and an accelerated drop in smoking rates across the country. It said that e-cigarettes contribute to at least 20,000 successful new quits per year and possibly many more—we are not measuring them in those terms, although that is something that clearly needs to be done.

I will finish soon, but as much as I support the tobacco plan in all its targets and everything else, we still need to look at what is happening on the ground, as several other Members have said. I think that we would all accept that the availability of smoking cessation programmes is patchy to say the least.

ONS stats on smoking prevalence identify for us the five local authorities with the highest rates: Redditch, Thanet—so this is not necessarily a north-south thing as a result of deprivation, or there is clearly deprivation in Thanet as well, down on the south coast—the City of Kingston upon Hull, which I think was mentioned earlier in this debate, Glasgow City and Sunderland. The five local authorities with the lowest smoking prevalence rates are Christchurch, West Devon, Maldon, North Warwickshire and the Orkney Islands. In my view, we need to recognise those differences to get to the meat of the targets. We need to look beyond saying that this is a matter for local authorities.

Feeling the Heat: The Decline of Stop Smoking Services in England” was a Cancer Research UK survey and report done in 2017. Its conclusions were that budgets for local authority cessation services ranged from nil to £1.7 million, or an average of £436,000 per local authority, and that 61% of local authorities offered specialist cessation services, with advisers offering one-to-one or group support and access to medication. Some have been replaced with a more general lifestyle service. Tobacco control was said to be a high priority by 57% of the local authorities—they say that, but have they the ability to do anything?—while 75% of local authority cessation services supported use of e-cigarettes, but only 50% of primary care providers did so. We need a consistent approach in line with public health and NICE recommendations. The last figure I will give from the report was that a third of local authorities had no budget for wider tobacco control activity, dealing with issues such as illicit and under-age trade.

I will finish with this point for the Minister. Given that we know the areas where there is evidence of high levels of smoking and therefore a high number of premature deaths from smoking, we need something more—in the current situation of austerity and everything else—than just saying that we want local authorities to get on with this. Having identified where such needs have to be met—this should definitely be ring-fenced—perhaps the national Government, or the Department of Health and Social Care, will find a way to look at this and make sure that we get the services where the need is greatest. I will leave that with the Minister. I thank him again for all he has done since he has been in office, and I hope that the success we want from this tobacco plan will take place.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 4:25 pm, 19th July 2018

First, I thank the Minister for bringing forward the plan. As always, he is very active in health matters, and he certainly has a passion for this. I also thank right hon. and hon. Members who have spoken. Their information and evidence-based contributions have added greatly to the debate. Their knowledge is certainly greater than mine, but I must say that Alex Cunningham and Sir Kevin Barron have made significant contributions.

I am my party’s health spokesperson in this House, and I want to provide a bit of background about Northern Ireland. The right hon. Gentleman referred to some of the facts from Ireland, and I will look at this from a Northern Ireland perspective. We in the Democratic Unionist party set out our health policies in “Our plan for a world class health service”. When we had a functioning Assembly, that was one of the things we were very proud of; I hope we will get back to those days very soon. One of the aims was to improve the health service, and one of the pillars and listed successful health outcomes over the past few years was a decrease in smoking.

We have clearly had a policy and a strategy to address this issue. In 2012, the Northern Ireland Public Health Agency published its public health strategy “Making Life Better” for 2012 to 2023. In 2015, it published “Tobacco Control Northern Ireland”, which stated:

“Smoking has been identified as the single greatest cause of preventable illness and premature death in Northern Ireland”.

The tobacco control paper noted that in 2014, about 16% or one in six of all deaths in Northern Ireland were attributable to smoking. Over the ten years to 2015, smoking caused between 2,300 and 2,400 premature deaths per year. That indicated how important it was to reduce tobacco smoking and its take-up.

Across Northern Ireland, the standardised death rate due to smoking-related causes in the most deprived areas was 54% higher than the overall regional rate and 129% higher than the standardised death rate in the least deprived areas, and relative health inequality was getting worse. A general theme coming through from all those who have made contributions is the take-up of smoking in areas of deprivation across the whole of the United Kingdom of Great Britain and Northern Ireland. There is also a related gender gap. The standardised death rate due to smoking-related causes was highest among males in the 20% most deprived areas, more than twice that of males in the 20% least deprived areas, and almost five times that of females in the 20% least deprived areas. According to the report, smoking cost Northern Ireland some £450 million a year.

We quite clearly had a big issue that we were trying to address, and I believe the strategy implemented through “Tobacco Control Northern Ireland” was a methodology to do just that. Reducing smoking prevalence remains central to Northern Ireland’s public health policy, and we clearly support what the Minister has said, and what other Members have said, because they also recognise that. Although health is a devolved responsibility, many other areas of public policy relevant to reducing smoking prevalence remain the responsibility of the Government in Westminster, and our contribution takes that into consideration.

If I may, I want to comment on e-cigarettes. The right hon. Member for Rother Valley very clearly outlined the advantages of e-cigarettes and vaping. Some of the figures are incredibly important. Vapour particles from e-cigarettes are 73% water, which means that they quickly evaporate into the atmosphere, and the evidence of experts shows that 99% of the nicotine is retained in the vapour. It is very important to appreciate the advantages of e-cigarettes.

According to the UK national health service, there is no evidence of direct harm from passive exposure to e-cigarette vapour, and if we look outside the United Kingdom, evidence from other countries—France is one example—suggests there is no harm from passive vaping, based on current scientific knowledge, facts and figures. In 2016, the UK Government issued advice to employers to encourage workplaces to adopt pro-vaping policies so that it would be as easy and convenient as possible for workers to switch. That was on the basis that international peer-reviewed evidence indicates that the risk to the health of bystanders from exposure to e-cigarette vapour is extremely low. Again, there is an evidential base. Not so long ago I asked the Department of Health and Social Care whether it would consider introducing vaping areas in hospitals. People who are visiting hospitals go outside to smoke, and those who want to vape do not necessarily want to go to those smoking areas. I hope that the Minister will consider that idea.

In Newtownards, the major town of my Strangford constituency, a number of shops sell e-cigarettes. I suggest that those shops function because of the take-up of e-cigarettes—that is why they can pay their bills and why they exist. Very often, someone walking down the high street in Newtownards and elsewhere can see puffs of smoke. They are almost taken aback, and then they get the smell of strawberry, raspberry or cashew nuts, and realise that someone is vaping.

I want to comment on that point because it is important. Bob Blackman mentioned the US, and a survey carried out there suggested that vaping flavours may discourage smokers from returning to cigarettes. It stated:

“The results show that non-tobacco flavours, especially fruit based flavours, are being increasingly preferred to tobacco flavours by adult vapers who have completely switched from combustible cigarettes to vapour products.”

That was a survey of 20,000 adult frequent vapers in the United States, and of those 20,000, 16,000 had completely switched from smoking to vaping, and 5,000 were dual users who smoked and used vaping products—I want to add that point to the debate, because we must consider those results and look at the best ways to tackle this issue.

Hon. Members have asked how we can advance our strategy further. The Tobacco Control Northern Ireland report stated that exposure to smoking behaviour

“continues to occur in films deemed by the British Board of Film Classification as suitable for children and young people…this tobacco imagery extends beyond the film industry into mainstream television broadcasts”.

More than 60% of incidences of tobacco use occur before the 9 pm watershed, thereby providing a possible source of young people’s exposure to tobacco. A clear causal link has been established between smoking initiation among young people and smoking on screen in the entertainment media. The impact is down to the amount of smoking that young people see, not whether it is glamorised or not. The greater the exposure to smoking—however it is depicted—the greater the risk of smoking uptake, and I am sure that the Minister will come back with his thoughts about that.

Will the Minister ask his colleagues who are responsible for the regulation of film and TV in the Department for Digital, Culture, Media and Sport to work with the Department of Health and Social Care, and press Ofcom and the British Board of Film Classification to ensure that their codes effectively tackle the portrayal of smoking in films and television programmes that are likely to be seen by children?

In Northern Ireland, since 6 April 2016, retailers have been obliged to register with the Tobacco Register of Northern Ireland, with a final deadline of 1 July 2016. That built on a similar scheme already in place in Scotland—Martyn Day referred to that—and a scheme is due for implementation in Wales. Lessons can be learned from such schemes, and I believe that we can learn greatly from the other regions of the United Kingdom of Great Britain and Northern Ireland, and bring our thoughts together to do something collectively that will benefit us all. Although registration schemes have the benefit of enabling public health authorities to identify where tobacco is sold, as currently constructed they appear to have had limited impact in preventing the sale of tobacco to underage children, or the sale of illicit tobacco.

I know this point is not the Minister’s responsibility, but I would just like to put it on record. In Northern Ireland, paramilitaries are involved with illegal tobacco smuggling and cheap cigarettes flood the market. The Police Service of Northern Ireland and the customs authorities are involved in trying to address the issue, but if I may I would suggest that Her Majesty’s Revenue and Customs could be more involved across the whole of the United Kingdom.

In conclusion, will the Minister ensure that his officials and their counterparts in HMRC talk to their opposite numbers in Northern Ireland, Scotland and Wales about their experience of the retail register scheme, and the lessons to be learned from the experience of the devolved Administrations? We can live these issues collectively, bringing our knowledge from the regions we represent. Hopefully, out of that we can construct a tobacco control policy that can help us all.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 4:35 pm, 19th July 2018

With the leave of the House, I would like to start my closing remarks by thanking Bob Blackman and my hon. Friend Alex Cunningham, the chair and vice-chair of the very influential and active all-party parliamentary group on smoking and health, for their excellent speeches today and their leadership on this issue. I also thank my right hon. Friend Sir Kevin Barron. As we know, he has campaigned in this House for decades on this issue. I thank Martyn Day, who speaks for the Scottish National party, and, last but by no means least, Jim Shannon. It has been an excellent debate.

I will begin by touching on e-cigarettes, which I mentioned in my opening remarks and several hon. Members mentioned in the debate. For the first time, e-cigarettes were mentioned in the updated tobacco control plan, with the aim of maximising the availability of safer alternatives to smoking. There has been a significant increase in e-cigarette usage since the publication of the previous 2011 strategy. There were 700,000 e-cigarette users in 2012. That figure rose to 2.8 million by 2016. In 2016, Office for National Statistics data found that 470,000 people were using e-cigarettes as an aid to stop smoking, while an estimated 2 million had used the products and had stopped smoking completely. I am therefore pleased that Public Health England’s Stoptober campaign now includes e-cigarettes as a smoking cessation aid and that e-cigarettes have been found to be about 95% less harmful than smoking. We should encourage people to use smoking cessation aids, such as e-cigarettes, to help them to stop smoking, while keeping a watchful eye on any negative health outcomes, if there are any.

Earlier this year, I joined the Minister, Action on Smoking and Health, Fresh North East and a host of NHS professionals to launch the NHS Smokefree Pledge. During my speech at the launch, I said that smoking cessation should become a central theme of healthcare staff’s engagement with patients, making every contact count to help people to quit smoking. Has the Minister made any assessment of the success of this pledge so far and will the Government make any further assessment of how many people have quit smoking because of the NHS Smokefree Pledge?

While the proportion of adults who have never smoked cigarettes has increased over the past 30 years, from 25% of men and 49% of women in 1974 to 56% and 63% respectively in 2016, we must ensure that that steady increase continues. However, the deaths attributable to smoking continue. Of the 115,000 lung disease deaths each year, up to 58,500 are attributable to smoking. This includes 86% of all lung cancer deaths and 77% of all chronic obstructive pulmonary disease deaths. The UK currently has one of the highest premature mortality rates from lung diseases in Europe. Smokers are almost twice as likely to have a heart attack compared with people who have never smoked and about half of all regular smokers will eventually be killed by their habit. This is unacceptable.

The Government have a duty to ensure that their citizens are healthy, which means properly funded public health services and implementing policies that encourage healthier lifestyles. Will the Minister tell the House if further funding will be granted to local authorities to deliver public health services such as smoking cessation? I truly believe that the ambitions in the tobacco control plan cannot be achieved without adequate funding. I know that like me, he is truly passionate about reducing smoking rates and rightly passionate about achieving a smoke-free generation, so I look forward to his response.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care 4:40 pm, 19th July 2018

With the leave of the House, I will also respond to the debate, Mr Deputy Speaker. I am aware that I am standing in the middle of the A14—almost literally—which is tonight’s Adjournment debate, but I will respond to the points that have been raised in this short and small but perfectly formed debate.

The shadow Minister—my good friend, the hon. Member for Washington and Sunderland West—rightly mentioned the issue of pregnant women and smoking, to which I referred in my opening remarks. Public Health England and NHS England are working on a joint strategy at the moment, setting out recommendations for how local areas can work together to achieve our ambition on smoking in pregnancy. In a way, I guess that is given a greater impetus in the light of the flatlining figures—I suppose that is the accurate way of putting it. This work is part of the maternity transformation programme, which started in 2016 and which I know she is aware of. Public Health England will look at how its mass media campaign can more effectively reach young people, especially working-class women of reproductive age and their families and friends. I wanted to put that on the record.

The hon. Lady returned to the subject of smoking services. I repeat what I said during the debate: there are varying rates across the country, so it is right that local councils have the flexibility to respond. I will touch on the point that Sir Kevin Barron mentioned about this being all the responsibility of local authorities. There is a third way, he will pleased to know, as a Blairite—that has finished his career, I apologise. I put on record again that councils will receive £16 billion of the public health funding until the next spending review, when the spending plans will be announced. We expect them to use it wisely.

My hon. Friend Bob Blackman talked about the Back-Bench debate and the general debate. I will leave that matter for the usual channels, but the important thing is that we are having the debate, which is very welcome.

The shadow Minister spoke about smoking cessation training and those services. The success of our plan hinges on all manner of professionals offering help that works, which is why effective training on supporting smokers to quit is central to the tobacco control plan—from doctors and nurses in the NHS to physiotherapists in the community, to pharmacists, who I have mentioned, and to the health professionals who need to equip smokers with the capability, opportunity and motivation to quit for good. It often involves very brief advice and there is a lot of online training out there. Twenty minutes or so of online training can teach a professional how to have a short conversation with somebody with a smoking challenge, with proven results. I wanted to put that on record.

My hon. Friend the Member for Harrow East mentioned Philip Morris International and its kind proposal to help NHS trusts, which has been in the newspapers today. I thought I would place on record for the House that what it talked about in its offer to trusts was “operating a scheme that allows employees who do not quit to trial one of our range of smoke-free alternatives”. We have to give them 10 out of 10 for effort, but it is totally inappropriate and that is why we have written to all trusts to make it clear.

I understand my hon. Friend’s Budget 2018 proposal for the Chancellor of the Exchequer on the need for the money in respect of the polluter pays principle. I know that the Chancellor will have heard that. My hon. Friend talked about the need for hard-hitting campaigns. We do have them, of course, and they are an essential part of tobacco control. In England for several years now, we have sought the balance between hope and harm. Every January, we have the Health Harms campaign and in the autumn, we have our more upbeat Stoptober campaign, and 2018 will be no exception.

Martyn Day, who spoke for the SNP, talked about the illicit tobacco trade protocol, and I thank him for putting on record that we indeed ratified the protocol on 27 June to eliminate the illicit trade in protocols. The first meeting of the members of the protocol will be in Geneva from 8 to 10 October.

The hon. Gentleman talked about track and trace. The tobacco products directive contains a commitment for member states to provide the track and trace system by May 2019 for cigarettes and roll-your-own tobacco. The European Union has published draft recommendations on the track and trace proposals, and we voted in favour of implementing the regulations. I would say that the EU measures go beyond the requirements of the framework convention on tobacco control, but many of its benefits arise from the exchange of information between nations, so it seemed sensible to us for the UK to align with the EU after exit in this respect.

Both Alex Cunningham and the hon. Member for Linlithgow and East Falkirk talked about smoking and the media. The Government do not interfere in editorial decisions. I think it right that content makers decide what to include in their programmes, provided that they comply with the broadcasting code, and I ask them to take their responsibility seriously. Obviously, as Members have said, they are regulated by Ofcom. Last month, it published a note to broadcasters reminding them of the rules in this area, and advising them on the depiction of branding and health warnings. The last time Ofcom found a breach of the broadcasting code related to smoking was in 2015, so I think that broadcasters take the code seriously.

Many Members mentioned the British Board of film Classification, which I know well and which is a well-managed organisation. Its guidelines were last updated four years ago, in 2014. Consultation on the new guidelines began late last year, and they are expected to be published early in 2019.

There was a lot of talk about e-cigarettes, which were partly dealt with at the beginning of the debate. Public Health England will update its evidence report on e-cigarettes and other novel nicotine delivery systems annually until the end of the current Parliament in 2022, and we will include that in our “quit smoking” campaign messages about the relative—I underline “relative”, if Hansard can underline—safety of e-cigarettes. I enjoyed the comparison that the right hon. Member for Rother Valley made with Ireland: I thank him for that.

The right hon. Gentleman also said that not everything could be done by local authorities. We have not said that it should. I have made very clear to Public Health England that where we have more work to do is where they should target their help and support, but there is also a new grant to support the tobacco control plan. The Government have launched a competitive scheme whereby organisations can apply to undertake work to support the plan’s ambitions. The grant is £140,000 a year for three years, from 2018-19: a total of £420,000 is available. Applications are currently being assessed, and we will contact the successful applicants in the autumn. I will find out some more details and send them to the all-party group.

Jim Shannon—as always!—asked whether we would introduce vaping areas in hospitals. Public Health England advises that the smoking of e-cigarettes should not be routinely treated in the same way as smoking tobacco, but it is true that it is for NHS trusts to make their own policies. Some, including the Maudsley, have designated areas both indoors and outdoors.

Photo of Lindsay Hoyle Lindsay Hoyle Deputy Speaker and Chairman of Ways and Means, Chair, Panel of Chairs, Chair, Standing Orders Committee

It was the Minister who suggested that he wanted only one minute in which to sum up. The fact that we are late does not matter to me.

Photo of Alex Cunningham Alex Cunningham Labour, Stockton North

Let me tease the Minister on three matters. One, what are we going to do about the “tab houses”? Two, what is his position on cigarette pack inserts? Three, what is he doing to do about the fact that mass media campaign funding has been cut by 90% in the last 10 years? We need that funding in order to be effective.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

I will write to the hon. Gentleman about his first two points. As for the mass media point, the hard-hitting campaigns that we conduct through the mass media are incredibly powerful. Last year’s campaign showed a gentleman rolling a cigarette with roll-your-own tobacco made of blood and gore. That was very hard-hitting, and it had an incredibly good response mechanism when we tested it and when we rolled it out. In this year’s campaign, “between hope and harm”, I think the hon. Gentleman will see a good balance of that mass media campaign that he talked about.

I realise that that was more than a minute, Mr Deputy Speaker. There is so much to say about this subject! It is so exciting.

Let me end by reaffirming the Government’s commitment. What everyone has said today has been very kind. Yes, I am committed to this subject, but ultimately we will be judged on our record. We are committed to making further sharp reductions in smoking prevalence, not so that we can meet the ambitions of the plan, although that is all very nice, but so that we can make a difference to people’s lives, because as the right hon. Member for Rother Valley said, if our constituents were dying in these numbers in road accidents we would be calling for crossings.

We want to make the smoke-free generation a reality to help people’s lives and to make a difference. Tobacco control is a key priority for us, and it will be a key priority for the 10-year plan that the Secretary of State and I will be working on with NHS England. I was interested to hear the comments of Simon Stevens at the Select Committee, and I agree with Simon, not for the first time.

I thank all Members who have spoken for their contributions—and it is amazing how far a minute can go, Mr Deputy Speaker.

Question put and agreed to.

Resolved,

That this House
has considered the Tobacco Control Plan.