Let me begin by thanking Mr Speaker for allowing me to hold this debate, and thanking the Government and all those who contributed to the previous debate for enabling us to have a long Adjournment debate to which other Members can contribute. I trust that you will be able to recognise them when they rise, Madam Deputy Speaker.
The United Kingdom has been a world leader in tobacco control for many years, and we have made great progress in reducing smoking rates. The latest figures show that adult smoking has declined to a low of 14.4% in England and 14.7% in the UK as a whole. However, as we celebrate International Women’s Day on Sunday, it is fair to say that the one target on which we have been extremely challenged is persuading pregnant women to stop smoking. I trust that my hon. Friend the Minister will be able to enlighten us on other measures that the Government will take to encourage that. It is equally fair to say that the health inequalities that exist across the UK are exacerbated by the number of people on low incomes who continue to smoke.
The Government have consistently implemented a comprehensive approach to tobacco control, from the point of sale display ban and the prohibition on smoking in cars with children to standardised tobacco packaging. All those measures have helped to drive down smoking rates and discourage young people from starting to smoke. Last month, yet again, the UK was rated best in Europe for our comprehensive tobacco control strategy, and as we have now left the European Union, we want no backsliding from that performance. The welcome ambition set in last year’s prevention Green Paper is to end smoking in England by 2030. It requires us to build on that comprehensive strategy, and to go further in reducing smoking prevalence. At this point, I must declare my interest as chairman of the all-party parliamentary group on smoking and health.
Last week it was revealed that the tobacco industry is attempting to undermine this comprehensive approach. Leaked documents that appeared in The Guardian—not a publication that I normally read—and in the “Dispatches” programme showed that Philip Morris International, the maker of Marlboro cigarettes, is attempting to buy influence by offering no less than £1 billion over 10 years in return for a relaxing of the current advertising ban on its heated tobacco products, enabling it to market its new IQOS tobacco product in cinemas, online, and at the point of sale.
This latest cynical attempt by Philip Morris International to influence UK health policies follows attempts that it made in 2018 to partner with NHS trusts. On that occasion, the then Public Health Minister, my hon. Friend Steve Brine, said:
“Our aim to make our NHS—and our next generation—smoke-free must be completely separate from the commercial and vested interests of the tobacco industry.”
He went on to say:
“Philip Morris International will be well aware that its actions are entirely inappropriate and we will be contacting all NHS trusts to remind them of their obligations.”
I hope that my hon. Friend the Minister will echo our hon. Friend’s words and restate the Government’s commitment to protecting public health from
“commercial and other vested interests of tobacco companies”,
in line with the UK’s obligation under article 5.3 of the framework convention on tobacco control.
Last week it was also announced in new projections from Cancer Research UK, which does such brilliant work in not only combating the evils of cancer but highlighting ways in which people can avoid it, that unless we speed up the rate of change, we will not hit the Government’s smoke-free ambition by 2030 but in 2037—seven years later—which will mean many more avoidable deaths. Funding is needed to deliver the further action that will help to ensure that we achieve a smoke-free 2030, and the APPG on smoking and health has said in its last two reports that that funding should come from legislation forcing the tobacco industry to pay for the damage that its products do, in line with our obligations under the framework convention on tobacco control. This “polluter pays” approach is used by the United States, which raises a fixed sum from tobacco manufacturers to fund its tobacco control activity. I hope that proposal will be included in the Government’s response to consultation on the prevention Green Paper, “Advancing our health: prevention in the 2020s”, which we keenly anticipate.
The tobacco industry has a long history of subverting regulations design to protect public health. To prevent this, the World Health Organisation’s framework convention on tobacco control 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.”
This includes rejecting all partnerships and non-binding or non-enforceable agreements with the tobacco industry. However, leaked papers revealed last week show yet another attempt by Philip Morris International to subvert public health policies. It proposes setting up a tobacco transition fund, which would provide £1 billion over 10 years in return for the lifting of laws restricting e-cigarette advertising and a loosening of the ban on advertising of its heated tobacco products. This deal is an attempt by Philip Morris to ensure that it is able to promote its new heated tobacco product, IQOS, in countries where the cigarette market is shrinking, such as the UK.
Philip Morris insists that IQOS is aimed at adult smokers, but the US Food and Drug Administration has concluded that it is just as addictive as smoking. In other words, it will be as easy to get addicted to, and just as difficult to quit, IQOS as smoking. The evidence is that more than two thirds of those who try smoking go on to become daily smokers, and on average, smokers try to quit 30 times before succeeding. Relaxing the advertising restrictions on heated tobacco products, as proposed by Philip Morris, would enable advertising of IQOS to reach children and young people, ensuring future consumers of its products even while smoking rates decline.
It is not only Philip Morris International that is attempting to buy influence with Governments; other tobacco companies are doing so. In 2018, The Observer revealed that British American Tobacco, despite being aware that article 5.3 of the WHO framework convention applies to local authorities, had been attempting to partner with councils. The UK Government have been independently assessed as being the Government who are most successful in resisting tobacco industry interference and living up to their article 5.3 obligations, yet the industry continues to try to find new ways to get a seat at the table, and the tobacco transition fund is just the latest attempt, with a bribe of £1 billion attached.
Will the Minister restate the Government’s commitment to protecting our public health policies from the interests of tobacco companies, in line with our legal obligations as a party to the WHO’s tobacco control policy? Will she further ensure that her colleagues in Government are aware of the UK’s legal obligations not to partner or enter into agreements with the tobacco industry?
The prevention Green Paper acknowledges, on tobacco control, that reaching the smoke-free 2030 target will be “extremely challenging”. This was highlighted last week, in projections published by Cancer Research UK, which showed that at the current rate of progress, we will not meet our 5% smoke-free ambition until 2037. That is largely due to inequalities, as I mentioned. While the least deprived communities in England will reach the 5% target by 2025, the most deprived communities are not projected to reach smoke-free until the mid-2040s—a 20-year difference, and of course, a great number of lives unnecessarily lost. I am sure that Alex Cunningham will mention that in his contribution.
That difference in smoking prevalence translates into substantial health inequalities, with smoking being the leading cause of the nine-year gap in life expectancy between rich and poor. Reducing smoking rates will make the single largest contribution to achieving the Government’s ageing society grand challenge, and further action is desperately needed to address this inequalities gap. Reducing the uptake and prevalence of smoking among young people will be key to achieving a smoke-free generation. Smoking rates among young people have declined rapidly in recent years, but there is no guarantee that this will continue to be the case without further action from the Government. The sad reality is that 280 children take up smoking every day in England. This provides a strong case for further action. Interventions such as public education campaigns, enforcement of age-of-sale regulations and greater tax rises—yes, a Tory is calling for extra tax rises—are effective in reducing youth uptake, but sustainable funding is needed to achieve this.
The Government were due to respond to the prevention Green Paper consultation on
The range of measures that I hope the Government are considering are set out in a wonderful document named “Roadmap to a Smokefree 2030”, which was endorsed by the all-party parliamentary group on smoking and health and by 68 other organisations. We will be launching the document in Parliament on
If tobacco manufacturers are offering to give the Government £1 billion as part of a corporate social responsibility public relations exercise, the industry clearly has the money to pay for the tobacco control measures that are needed to mitigate the harm that it causes. The all-party parliamentary group on smoking and health has advocated for the application of the “polluter pays” principle, making the industry pay for the damage that its products do. As the Green Paper highlighted, the US and France have both adopted this approach to funding tobacco control. The mechanism to raise revenue from tobacco manufacturers could be established based on the powers set out in the National Health Service Act 2006 that are already used for the pharmaceutical price regulation scheme.
Such a fund could pay for the evidence-based measures needed to achieve a smoke-free 2030. Those measures could include—this list is not exclusive—public education campaigns. Funding for these campaigns has consistently decreased. In 2019, for example, there was no TV advertising for the Stoptober campaign, and this year there was no January health harms campaign to encourage smokers to make a new year’s resolution to attempt to quit smoking. Providing a source of revenue for local tobacco control measures, including enforcement activity and the provision of support to smokers seeking to quit, would also definitely help. Funding for trading standards has fallen substantially in recent years, from £213 million in 2010 to £124 million in 2016. The National Audit Office estimates that the number of full-time equivalent trading standards staff has decreased by 56% in seven years.
We could also have regional tobacco control programmes. In the five years from 2012 to 2017, areas with a regional programme had an average percentage point decline of 5.1, compared with 4 in the rest of the country, yet funding for those programmes has been cut as the public health grant allocations to local authorities have reduced. Establishing an initiative such as a smoke-free 2030 fund is also popular, with 72% of the public supporting making tobacco manufacturers pay a levy or licence fee to the Government for measures to help smokers to quit and to prevent youth uptake.
Given the urgent need to increase the rate of decline in smoking prevalence and the further measures needed to achieve that, will the Government commit to consult on legislation to create a smoke-free 2030 fund? Given that we have the Budget next week, will the Minister lobby our right hon. Friend the Chancellor to introduce such a fund?
Further measurers could be taken. The prevention Green Paper made the commitment:
“Further proposals for moving towards a smoke-free 2030 will be set out at a later date.”
In the absence of a response to the Green Paper consultation, I hope that the Minister will reassure the House that her Department is working on the proposals and that they include the measures set out in the APPG’s report “Delivering the vision of a ‘Smokefree Generation’”, which I am sure she has read.
Reducing the affordability of tobacco is highly effective in reducing smoking rates and can be achieved through a combination of tax increases and enforcement activity to reduce the size of the illicit market. We know that affordability has the most impact on those who are the most price sensitive: young people and poorer smokers—cheap and illicit tobacco is disproportionately bought by poorer smokers. Reducing affordability will encourage people to quit smoking.
Next week my right hon. Friend the Chancellor of the Exchequer will set out his first Budget. I hope to hear that the tax escalator on manufactured cigarettes will be reintroduced for this Parliament. The escalator should be increased from 2% to 5% above inflation, to help pay for the measures to combat smoking. I also hope to see a further increase for hand-rolled tobacco, because the price differential between manufactured cigarettes and hand-rolled tobacco means that people, particularly those on lower incomes, are more likely to hand-roll, and obviously they would continue to do so rather than quit. An additional tax increase above inflation would avoid that.
Since 2000, Her Majesty’s Revenue and Customs has implemented a well-funded and effective strategy that has reduced the size of the illicit market, but the UK has now ratified the illicit trade protocol of the framework convention on tobacco control and implemented tracking and tracing of cigarettes under the requirements of the tobacco products directive. I am sure that Ministers agree that, now that we have left the European Union, it is an appropriate time for HMRC to review and refresh that strategy, and I hope that the Minister will comment on that in her response.
As I said at the start of my speech, the ambition to end smoking in England by 2030 is laudable and I strongly endorse it—as, I trust, do the majority of Members—but there are clear risks that we will not achieve that without further action and sustained funding. The latest attempts by Philip Morris International to influence Government health policies and to roll back current regulation show once again that the industry cannot be trusted, and the Government must continue to uphold our strong commitment to article 5.3.
Philip Morris International’s proposal to provide £1 billion over 10 years shows that the tobacco industry clearly has the money to pay for the harm it causes. The public support making the industry pay through legislation to create a fund that would be used to support existing smokers to quit and to prevent uptake among young people. There is clearly an urgent need for the Government to set out further proposals to help us reach a smoke-free England by 2030, and I hope that today the Minister will confirm that we can expect the imminent publication of the Government’s response to the prevention Green Paper consultation.
I am pleased to have this unexpected opportunity to speak in this important debate, and I congratulate Bob Blackman on securing it. My politics and his are far apart, but we are brothers in the cause of eradicating smoking. I pay tribute to his work as chair of the APPG and am pleased to serve as his vice-chair.
There are around 23,000 smokers in my Stockton North constituency, and 60% of them want to quit. Sadly, due to cuts to Stockton Council’s budget and to budgets across the north-east, councils in the area have cut stop smoking services by 10% in just two years. I will come back to that later.
Requiring tobacco manufacturers to pay into the smoke-free 2030 fund mentioned by the hon. Gentleman would provide sustainable funding to motivate the smokers in my constituency who want to quit, or who want to give quitting a go, and would fund the specialist support for those who need it. That would be the correct way forward, and it would provide the necessary transparency without the likes of PMI being given free rein to dictate or influence public policy.
I pay tribute to successive Governments for making tremendous progress. We had the smoke-free pubs and restaurants under Labour, and of course we have had the point-of-sale stuff under recent Conservative Governments. That all plays a part, but the extent to which smoking is reducing has continually slowed down and we need to accelerate it again.
Although this is a national issue, I will be parochial this afternoon and outline the challenge we face in my part of the world. In Stockton-on-Tees, 16.4% of the population smoke, compared with 16% across the north-east and an English average of 14.4%. Some 17.7% of women are smokers when their babies are delivered, compared with a national average of 10.6%, and that has significant implications for stillbirths, neonatal deaths and birth weight.
Those statistics hide the reality of what is happening in my constituency. In my inner-city wards, the prevalence of smoking, including during pregnancy, is much higher. Our leafy suburbs and nicer areas—perhaps I should say more affluent areas—bring down the average to that lower level of 16.4%. I do not know of many households in the town centre ward of my constituency in which people do not smoke, which is a terrible situation. We need targeted support for them.
The prevalence of smoking among adults in my area with serious mental health illnesses is 40%, which is actually slightly below the English average of 40.5%, but it still needs to be tackled. In 2018-19, there were 2,780 smoking-attributable hospital admissions in Stockton-on-Tees, which is a rate of 2,474 per 100,000 of population, notably above the English average of 1,612.
From 2016 to 2018, 1,013 deaths in Stockton-on-Tees were attributable to smoking, which is also significantly above the English average. There were 398 deaths from lung cancer and 325 deaths from chronic obstructive pulmonary disease, and over 80% of those disease cases are caused by smoking. Again, from 2016 to 2018 there were 23 smoking-attributable stillbirths in Stockton-on-Tees, which is above the per population average.
I have talked about the more affluent areas of Stockton-on-Tees, and the smoking rate among people in managerial and professional occupations is 9.3%. The rate rises to 11.7% among people in intermediate-level occupations and to 23.1% among people in routine and manual occupations. Men are more likely to smoke than women, with a smoking rate of 17% compared with 13%.
We have much to do if we are to do this, and we have to do it right, without allowing tobacco companies to play the sort of role proposed by PMI, because this is an issue of health inequality. A smoking rate of 16.4% in my constituency compares with 8.3% in mid-Suffolk, where the Minister’s constituency is located.
Like the hon. Member for Harrow East, I was concerned to hear least week that England is not on track to reach the 5% ambition by 2030. The 20-year difference between when the richest and poorest communities are expected to be smoke free shows that we are failing to support the most vulnerable in our constituencies. So does the Minister agree that the smoke-free 2030 ambition must be more than a headline target and that the Government must ensure that they will also deliver a smoke-free generation for communities such as mine in Stockton?
The hon. Gentleman mentioned illegal tobacco, so I wish to say just a few words about that. During the general election, I was on the Hardwick estate in my constituency, where a woman was standing at a door. I was walking up the path and then I realised that money was changing hands. The money changed hands and the door closed. When it reopened, someone had a package in their hand. I know what it was, but the woman saw me and said, “Just wait a few minutes.” She then said, “How can I help you?” I nearly said, “You could help by not operating an illegal tobacco operation”, but I was looking for their vote, so perhaps I prejudiced my principles on that occasion.
These things are happening day in, day out. My wife was a school nurse and she went to schools to talk about smoking. She used to deploy the economic argument, saying to the kids, “If you have so many cigarettes a week, it will cost you £10. Over a year that works out at £520 and that would take the family on a short holiday.” One day, a child put up his hand and said, “Miss, you’ve got the price wrong. They are only £3 a packet from—”. He named a person around the corner from where he lived. So it is clear that we still have a problem to solve and we have an education problem to deal with as well.
Finally, I know that PMI’s proposals for a “tobacco transition fund" in partnership with the industry have already been put to Parliament in a ten-minute rule Bill tabled by my former colleague Kevin Barron in the last Parliament. Kevin is a long-standing supporter of tobacco control, but he admitted to The Guardian that he had had discussions with PMI before tabling the Bill, that he now supported partnering with the industry and that he had spoken to Ministers about the proposals. Kevin was probably the greatest parliamentary campaigner, perhaps even better than the hon. Member for Harrow East, against the tobacco industry for nearly all his 36 years as an MP, so I was really concerned that he was prepared to work with a tobacco company, albeit with the best of intentions, to change the law. Although some people may have been convinced that PMI has been reborn as a public health champion, that is certainly not the case for the all-party group on smoking and health, and I hope the Minister will confirm that the Government agree on that. PMI’s attempts to whitewash its reputation are nauseating, in a company that continues to promote its deadly cigarettes to children and young people whenever and wherever it can get away with it.
So there is still much yet to be done, and I will be interested to near what the Minister has to say. I want her not just to rule out any sort of relationship with PMI, except perhaps taxing it a bit more, with no recognition of its bid to influence public policy; I also want to hear what the Government are now going to do, perhaps in replying to the Green Paper, to get us the resources we need into public health and elsewhere to start again and accelerate the number of people who quit.
I thank my hon. Friend Bob Blackman for securing this important debate on the World Health Organisation framework convention on tobacco control. His passionate work on tobacco harms, including through his chairmanship of the all-party group, and the work of his worthy sidekick as co-chair, continues to keep us focused on what we have to do and on our goal of being smoke-free by 2030. I thank them for that. I agree with both of them that smoking is one of the most significant public health challenges that we face today and that, sadly, it is one that disproportionately affects disadvantaged groups, with the resultant impact on their health and their finances.
This year, the WHO framework convention is celebrating its 15th anniversary. Over those 15 years, the parties to the convention have worked towards a tobacco-free world. We have seen encouraging improvements in tobacco control worldwide, but there is still much more work to be done to protect the world’s population from the harms of a tobacco epidemic.
As a recognised world leader in tobacco control, the UK is firmly committed to the World Health Organisation’s framework convention on tobacco control—which I will now abbreviate to FCTC for all our sakes—and we will remain an active member. I thank my hon. Friend for continuing to remind us how important the obligations under the convention are. In answer to his direct question, we will remain fully committed to the convention and, importantly, to article 5.3 during the transition period and beyond. I can assure him, as my predecessor did, that we write to NHS trusts and local authorities to remind them of their obligations under article 5.3 to protect public health interests from tobacco industry interference. I am proud that, in the first global tobacco industry interference index, published last year, we were rated No. 1 for the work we do to protect health policy from tobacco companies, but I take on board the fact that we need to make sure we continue on that path.
It is estimated that at least 8 million deaths around the world every year are linked to tobacco—more than for AIDS, tuberculosis and malaria combined. Some 80% of the 1 billion smokers live in low and middle-income countries. That puts a huge strain on the development of those countries and their achievement of the sustainable development goals. There is high demand from such countries for help to implement tobacco control measures. That is why, as a global leader, the UK is providing support, via official development assistance, to the FCTC 2030 project, working with low and middle-income countries to support its implementation, with the ultimate aim of reducing the burden of tobacco-related deaths and diseases.
The project has received praise from countries participating, as well as from the global public health and development communities. It has also helped to raise the UK’s profile as a global leader in tobacco control, and is strengthening its global reach. Building on that success, we are increasing capacity within the existing budget to include several more countries to support over years four and five.
In the UK, smoking prevalence is at the lowest ever rate on record and is falling, but we are not complacent—as has been pointed out, the rate of decline is slowing. Around 78,000 people die every year in this country from smoking-related illnesses. As I said yesterday during the debate on health inequalities, and as my hon. Friend pointed out so eloquently, we know that the smoking habit particularly affects disadvantaged communities. We must end that, and our prevention Green Paper sets out the ambition to be smoke-free by 2030. That is undoubtedly a challenging ambition. The public consultation that closed in October had 1,600 responses—more than double the number we usually get—and it is taking some time to go through the analysis. We are analysing the proposals and developing our own response, which will be with Members shortly.
I appreciate everything the Minister is saying. It is the 2030 target I am really interested in. The estimate a couple of weeks ago was that, with current programming, we are 20 years behind where we need to be. Will she tell us how we are going to achieve that target instead?
I thank the hon. Gentleman, and, yes, I will. There is a need to be smarter with what we do. As was stated, we will achieve the target in some communities, but not in others, so refocusing on where we have the problem must be part of the strategy. However, as I am sure my hon. Friend and the hon. Gentleman appreciate, I do not want to pre-empt what we publish in the Green Paper.
I acknowledge and thank my hon. Friend and the hon. Gentleman for the report by the all-party parliamentary group on smoking and health, which I have read and which sets out the group’s recommendations, including on the smoke-free 2030 fund. I assure them that the Department will speak to Her Majesty’s Treasury to discuss possible financial levers to support our smoke-free ambitions. However, I also expect that both of them—and particularly my hon. Friend, who is indefatigable in his lobbying on this matter—will lobby the Chancellor themselves.
Across the country, people are tackling the harms of tobacco every single day. During a recent visit to Tameside Hospital, I witnessed at first hand the commitment and dedication of healthcare professionals involved in the delivery of an innovative approach to reducing smoking in pregnancy. While Alex Cunningham was speaking, I was reflecting on the fact that many of the things that he was saying about his own constituency were very similar to those in this particular project. The prevalence within their local community to start with was much higher than average, and the people who were starting to smoke as a habit were of a much younger age. Therefore, by the time these young women were pregnant, they had been smoking for a longer period of time, making cessation more difficult. The project was thoughtful and holistic in terms of the agencies that it used, and the way that it wrapped around the young pregnant women. It actually reached out into their families, encouraging partners, mothers and other family members to support them. That gave the young women a great deal of motivation. I spoke to one young father who had not yet managed to quit his habit, but he had taken many of the messages on board, was not smoking in their home, and was actually attempting to change his behaviour for the long-term benefit of his future’s baby’s health.
This is a particular passion of mine. I believe that we give both people a much better, healthy start if we can tackle pregnant mums as a particular cohort, because, obviously, we not only help the mother, but, as my hon. Friend has said, help the future health of the baby and ensure that a health compromised by smoking in pregnancy is not something that then follows them through their lifetime. I spoke to those mums and partners about how using a joined-up approach could work and I would be delighted if my hon. Friend and the hon. Gentleman would talk to me further about the matter.
I thank my hon. Friend for her commitment to this undoubted health challenge and also for what she said about pregnant young women. It is not the case that these young women who are found to be pregnant are automatically routed to smoking cessation services yet—neither are their partners. It is, in the long-term, an NHS plan to do that. Given what my hon. Friend has said and that she has seen the success of the trials, will she try to bring that plan forward so that we actually give every pregnant woman who smokes the opportunity to be seen by smoking cessation services? In that way they can not only understand what they should do and how they can quit, but see the damage that they are causing to their unborn child as a result of continuing to smoke.
I can certainly assure my hon. Friend that I am speaking with my officials all the time about how we can make programmes such as this more effective and ensure that they reach out, but they have to be part of a comprehensive programme. We have to understand how we can best help communities most challenged by smoking, who fall outside the 2025 target; we need to pay attention to the detail if we are to address their 20-year trajectory. I would be delighted to have a further conversation on that matter with my hon. Friend at some point in the future.
I wish to assure my hon. Friend that we are determined to build on the success of work so far to sustain our global efforts to tackle the tobacco epidemic and work towards England becoming smoke-free by 2030. I can also assure him that I am committed to seeing more individuals receive help so that they can successfully quit the habit.
Before the Minister sits down, let me counsel her that one of her predecessors, my hon. Friend Steve Brine, was asked during his first outing at the Dispatch Box in Health questions when the prevention Green Paper would be published, and—to the consternation of his officials—he announced, “This month”. Therefore, if the Minister would do us the honour of saying when we will get the response to the Green Paper, I am sure—to the consternation of her officials—we would get some urgent action.
I will resist the temptation to name a date, as I am sure my hon. Friend appreciates that I have one or two other things on my desk at the moment, but we will make sure that the document is with him as soon as possible.
Question put and agreed to.