– in the House of Commons at 12:40 pm on 3rd November 2022.
[R]: I beg to move,
That this House
has considered the recommendations of the Khan review: Making smoking obsolete, the independent review into smokefree 2030 policies, by Dr Javed Khan, published on
I thank the Backbench Business Committee, on which I have the honour to serve, for enabling us to have the debate this afternoon. On behalf of the all-party parliamentary group on smoking and health, which I chair, I welcome the Under-Secretary of State for Health and Social Care, my hon. Friend Neil O'Brien, to his new role as public health and primary care Minister. The all-party group has a long track record of acting as a critical friend to the Government on this agenda and I am confident that that collaborative and constructive approach will continue.
May I take the opportunity to commend Mary Kelly Foy, who co-sponsored the debate application with me but is not able to be here today? She is currently recuperating from a stay in hospital. I am sure that the whole House wishes her a speedy recovery.
The all-party group originally proposed the debate before the summer recess to ensure that Parliament had the opportunity to scrutinise the independent review by Javed Khan OBE, “Making smoking obsolete”. When the Secretary of State—well, the then Secretary of State, my right hon. Friend Sajid Javid—announced the Khan review in February, he said that it would
“assess the options to be taken forward in the new Tobacco Control Plan, which will be published later this year.”
We have since had several changes of Health Ministers and Secretaries of State, but it should not be forgotten that a new tobacco control plan was first promised in 2021.
Achieving the Government’s smokefree 2030 ambition and making smoking obsolete is vital to the health and wellbeing of our entire population. It will also help to deliver economic growth, because smoking increases sickness, absenteeism and disability. The total public finance cost of smoking is twice that of the excise taxes that tobacco brings into the Exchequer. Each year, many tens of thousands of people die prematurely from smoking, and 30 times as many as those who die are suffering from serious illnesses caused by smoking, which cost the NHS and our social care system billions of pounds every single year.
Javed Khan’s review, which was published in June, concluded that, to achieve the smokefree 2030 ambition, the Government would need to go further and faster. He made four recommendations that he said were critical must-dos for the Government, underpinned by a number of more detailed interventions. I will concentrate on the four main recommendations, given time.
The four must-dos were: increasing investment by £125 million a year to fund the measures needed to deliver smokefree 2030; raising the age of sale to stop young people from starting to smoke; promoting vaping as an effective tool to help people to quit smoking tobacco, while strengthening regulation to prevent children and young people from taking up vaping; and prevention to become part of the NHS’s DNA and the NHS committing to invest to save. Since then, we have had conflicting reports about whether the Government intend to publish a new plan at all. That has been deeply concerning to me and others who support the ambition and want to see it realised. To abandon, delay or water down our tobacco strategy would be hugely counterproductive when the Government are trying to reduce NHS waiting lists, grow the economy and level up society.
As well as increasing funding, Khan recommended enhanced regulation. Both of those are supported by the majority of voters for all political parties, and the results of a survey published just this week show that tobacco retailers share that view as well. I therefore commend the “Regulation is not a dirty word” report by ASH—Action on Smoking and Health—to the Minister. It shows that most shopkeepers support existing tobacco laws and want the Government to go further in protecting people’s health. Retailers want tougher regulations—that is what they think will be good for business—and not deregulation.
There is no time to be lost. When the ambition was announced, we had 11 years to deliver it. Now, we have less than eight years, and we are nowhere near achieving our ambition, particularly for our more disadvantaged communities with the highest rates of smoking. Research cited in the Khan review estimates that it will take until 2047 for the smoking rates in disadvantaged communities to reach the smokefree ambition of 5% or less. Will the Minister put on record his commitment that the Government, having considered the Khan review recommendations, will publish a new tobacco control plan by the end of 2022 to deliver the smokefree 2030 ambition?
As Javed Khan made clear with his leading recommendation, smokefree 2030 cannot be delivered on the cheap. However, public health interventions such as smoking cessation cost three to four times less than NHS treatment for each additional year of good health achieved in the population. Yet that is where the cuts have fallen to date. The public health grant fell by a quarter in real terms between 2015 and 2021, and funding for tobacco control fell by a third, while NHS spending continues to grow in real terms.
Last week, London launched its tobacco alliance with a vision to deliver the smokefree 2030 ambition across London. Cabinet members for health and wellbeing from across London are writing to the new Secretary of State to make clear their commitment to achieve the ambition and pleading for the funding they need to deliver it. Before I became the MP for Harrow East, I was a councillor in the London Borough of Brent for 24 years, so I am well aware of what local authorities want to do on tobacco, but they lack the resources they need so to do.
Javed Khan called on the Government to urgently invest an additional £125 million a year in a comprehensive programme, including funding for regional activity such as that proposed in the capital. His recommendation was that, if the Government could not find the funding from existing resources, they should look at alternatives such as a corporation tax surcharge—a windfall tax—and a “polluter pays” tax. Banks and energy companies have been made subject to windfall taxes, so why not the tobacco manufacturers, who make eye-wateringly high profits from products that kill many tens of thousands of people every year? Four manufacturers, who are collectively known as “big tobacco”—British American Tobacco, Imperial Brands, Japan Tobacco International and Philip Morris International—are responsible for 95% of UK tobacco sales and the same proportion of deaths. For every person their products kill, it is estimated that 30 times as many suffer from serious smoking-related diseases, cancers, and cardiovascular and lung diseases caused directly by smoking.
A windfall tax could be implemented immediately through the Finance Bill. Experts on tobacco industry finances from the University of Bath have estimated that that could raise about £74 million annually from big tobacco. However, that is much less than the hundreds of millions in profits that big tobacco makes annually, because it would be a surcharge on corporation tax paid in the UK and tobacco manufacturers, just like the oil companies, are very good at minimising corporation taxes paid in the UK. For example, Imperial Tobacco, which is responsible for a third of the UK tobacco market, received £35 million more in corporation tax refunds than it actually paid in tax between 2009 and 2016. In contrast, a polluter pays levy would take a bit longer to implement, but it could be designed to prevent big tobacco from gaming the system as it currently does with corporation tax.
The polluter pays model we propose enables the Government to limit the ability of manufacturers to profit from smokers while protecting Government excise tax revenues, so it is a win-win for the Government and for smokers. Unlike corporation taxes, which are based on reported profits and can be—and indeed are—evaded, the levy would be based on sales volumes, as is the case in America, where a similar scheme already operates. Sales volumes are much easier for the Government to monitor and much harder for companies to misrepresent.
The scheme is modelled on the pharmaceutical price regulation scheme—the PPRS—which has been in operation for over 40 years and is overseen by the Department of Health and Social Care. The Department already has teams of analysts with the skills to administer a scheme for cigarettes, which would be a much simpler product to administer than pharmaceutical medicines. Implementing a levy would not require a new quango to be set up, as the Department has all the expertise needed to both supervise the scheme and allocate the funds.
Despite paying little corporation tax, the big four tobacco companies make around 50% operating profit margins in the UK, far more than any other consumer industry. Imperial Tobacco is the most profitable, with around a 40% market share in the UK. It made an operating profit margin of over 70% in 2021. Why should an industry, whose products kill when used as intended, be allowed to make such excessive profits, when 10% is the average return for business? The polluter pays model caps manufacturers’ profits on sales and could raise £700 million per year, which is nearly 10 times as much as a windfall tax.
Amendments to the Health and Social Care Bill calling for a consultation on such a levy were passed in the other place. Health Ministers were sympathetic, but the Treasury was opposed so they were reversed when the Bill came back to this place to be considered. However, that was before the Government knew they had a fiscal hole of around £40 billion that had to be filled. The £700 million from tobacco manufacturers would more than provide the £125 million additional funding that Khan estimated was needed for tobacco control. That would leave £575 million a year that could be used for other purposes, perhaps even for other prevention and public health measures which otherwise in the present economic climate are unlikely to secure funding.
The polluter pays principle has been accepted by Conservative Governments in areas such as the landfill levy, the tax on sugar in soft drinks and requiring developers to pay for the costs of remediating building safety defects. The Government promised to consider a polluter pays approach to funding tobacco control in the prevention Green Paper in 2019. Surely, we can now put it into practice.
The hon. Gentleman will know that in the north-east smoking remains the leading cause of death, as well as of inequalities in healthy life expectancy. The all-party group has come forward with the polluter pays model, which is really important, and I ask the Government to consider it again as a means of funding the essential work on stopping smoking.
I thank the hon. Lady for her intervention. Clearly, there is a difference in smoking rates across the country, and we need to ensure that that is addressed. I will come on to that in my speech in a few moments.
We need the levy to be introduced, so will the Minister commit to investigating the feasibility of a windfall tax, backed up by a polluter pays levy, to provide the funding needed to deliver smokefree 2030?
I want to talk about the need to protect generations to come. The Government are set to miss the ambition, set in the 2017 tobacco control plan, to reduce SATOD— smoking status at time of delivery—rates to 6% by 2022. Currently, 9.1% of women, or about 50,000 women a year, smoke during pregnancy. Smoking during pregnancy is the leading modifiable risk factor for poor birth outcomes, including stillbirth, miscarriage and pre-term birth. Children born to parents who smoke are more likely to develop health problems, including respiratory conditions, learning difficulties and diabetes, and they are more likely to grow up to be smokers. Reducing rates of maternal smoking would contribute directly to the national ambition to halve stillbirth and neonatal mortality by 2025.
Younger women from the most deprived backgrounds are the most likely to smoke and be exposed to second-hand smoke during pregnancy. Rates of smoking in early pregnancy are five times higher among the most deprived areas than the least deprived. That contributes to this group having very significantly higher rates of infant mortality than the general population. As such, if we can drive down rates of smoking in younger, more deprived groups we will then have a rapid impact on rates of smoking in pregnancy. Two thirds of those who try smoking go on to become regular smokers, only a third of whom succeed in quitting during their lifetime. Experimentation is very rare after the age of 21, so the more we can do to prevent exposure and access to tobacco before this age, the more young people we can stop from being locked into a deadly addiction.
If England is to be smoke free by 2030 we need to stop people from starting smoking at the most susceptible ages, when they are adolescents and young adults, and not just help them quit once they are addicted. The all-party group, which I chair, has called on the Government to consult on raising the age of sale for tobacco to 21, which, when implemented in the US, reduced smoking in young adults by 30%. This is a radical measure, but one that is supported by the evidence and by the majority of voters for all political parties, retailers and young people themselves. It would have a huge impact on reducing smoking rates among young mothers, who are more likely than older women to smoke. It would also reduce rates among young men, so reducing the exposure of young pregnant women to second-hand smoke throughout their pregnancy. If men smoke it makes it harder for pregnant women and new mums to quit smoking, and makes it more likely that mother and baby will be exposed to harmful second-hand smoke. Will the Minister consider committing to a consultation on raising the age of sale for tobacco, as supported by both the public and tobacco retailers?
Finally, I want to warn the Minister about the Institute of Economic Affairs’ alternative smokefree 2030 plan, which popped into my inbox yesterday. The IEA’s plan is an alternative that is entirely in the interests of the industry, which is hardly surprising given the funding the IEA has received from big tobacco. The IEA itself refuses to be transparent about its funding, but through leaked documents it has been exposed as being funded by the tobacco industry for many years. I am sure the Minister is aware that the UK Government are required, under article 5.3 of the international tobacco treaty, the World Health Organisation framework convention on tobacco control, to protect public health from the
“commercial and other vested interests of the tobacco industry”.
The guidelines to article 5.3, which the UK has adopted, spell out that that includes organisations and individuals that work to further the interests of the tobacco industry, which includes industry funded organisations such as the IEA and the UK Vaping Industry Association.
I look forward to hearing contributions from across the House. I hope my hon. Friend the Minister will echo the words of his predecessors in his new role and restate for the record on the Floor of the House the Government’s commitment to complying with article 5.3. I hope he will state that on his watch the Government will continue to prevent the tobacco industry-funded organisations from influencing tobacco control policy.
I draw the attention of the House to my interests as a vice-chair of the all-party parliamentary group on smoking and health. I, too, welcome the Minister to his place and wish him well. I look forward to working with him. I congratulate Bob Blackman on an excellent and measured speech. I could make my shortest speech ever by simply saying, “I agree with Bob.” I won’t. [Laughter.] I will reiterate some of the points he made.
When I wander through parts of my constituency, particularly the areas of greater deprivation, I am struck by the number of people who still smoke, including children on their way home from school in school uniform. I know that in recent times rates of smoking have come down across the borough of Stockton-on-Tees, thanks to initiatives by the council, health staff and Fresh, the north-east charity that helped drive a reduction. Although the incidence of smoking has come down overall, it is still a major issue in areas such as the town centre ward, where it remains high, as does the number of young women smoking in pregnancy.
Sadly, public health is in a dire state after 12 years of Conservative rule and, in recent times, the promise to act on smoking does not align with what is being delivered. Time and again, Members from across the House have asked for the long-overdue tobacco control plan, but despite making commitments to introduce the necessary measures to further reduce tobacco harm in this country, the Government have not done so. We will never meet the Government’s targets if we do not have a plan, so I hope that the Minister will today give us a date for the plan and promise to make available the resources to make it work.
I want to be a little parochial and make it clear again why I have always focused on this health issue, in particular, during my 12 years in Parliament. In my patch of Stockton, 13.2% of adults smoked in 2019 compared with 13.9% in England. That rises to 19.1% among those in routine and manual occupations. When we look at the proportion of women who smoked during pregnancy in 2021, it is worrying that the figure for Stockton was 14.1% compared with 9.6% nationally. The fact that one in 10 expectant mothers smoke across the country is bad enough, but the proportion is 50% higher in my patch and much higher, again, in deprived communities. Smoking can be a family issue. Any expectant mother committed to quitting will struggle if their partner or others in their household smoke. We need a plan to work with whole families to discourage smoking and end the dangers to the unborn child.
There is, of course, an economic argument to invest in smoking cessation. At the local level, smoking costs £62.3 million every year. That includes £47.2 million in lost productivity and costs of £9.2 million to the NHS and £5 million to social care. It is particularly distressing that 7.4% of our Stockton North population suffer from asthma—higher than the 6.5% across England. Furthermore, the level of COPD—chronic obstructive pulmonary disease—in my constituency is 3.1%, which again, is 50% higher than the rate of 1.9% across England. In England, 14.1% of people have high blood pressure, but the proportion is 16.2% in my constituency. It is therefore no surprise that 75% of adults in the north-east support the ambition to reduce smoking prevalence to less than 5%—fewer than one in 20 people—by 2030, with just 9% opposed. Along those lines, 76% of adults in the north-east support activities to limit smoking or think that the Government should do more.
We can all celebrate the fact that, in the past five years, the fastest decline in smoking rates in England has been in the north-east, although that was from a very high starting point. That is due to highly effective regional collaboration between local authorities and the NHS, supported by Fresh, to which I referred earlier, but they cannot do that alone. Government action could have a fast impact if they were to bring in legislation introducing the further regulation of tobacco products, as the hon. Member for Harrow East mentioned.
My hon. Friend is speaking powerfully about the experience in the north-east and nationally. He will be aware that, between 2007 and 2019, when the Government led the way in introducing tough new regulations, our smoking rates declined far faster than in the rest of Europe and most of the world, but that has dropped off, so we need to take further action. Is he aware of this recent research into smoking habits? University College London’s smoking toolkit study has surveyed smokers’ behaviour monthly since 2006. After years of steady decline in adult smoking—the proportion went from 24.1% in 2006, as he said, to 14.8% in 2020—smoking rates have stagnated, standing at 14.9% as we reach the end of 2022. Worse still, although the uptake of smoking among young adults declined year on year from 2007, that started rising again after 2019.
I am grateful to my hon. Friend; I was not aware of some of the research to which she referred. However, the reduction in smoking has plateaued in recent times, and that is lamentable. I have a big enough heart to say that the Conservative Government have done much over the years to reduce smoking, building on much of what the Labour Government did between 1997 and 2010, but we cannot allow ourselves to stop there. We need to do so much more.
There are often arguments—many of which are put forward by front organisations funded by the tobacco industry—that further smoking regulation would be the “nail in the coffin” for small businesses, but that is not so. As the hon. Member for Harrow East mentioned, a recent survey commissioned by Action on Smoking and Health found that small tobacco retailers in the UK support further measures to reduce the harm of tobacco, including increasing the age of sale from 18 to 21, mandating a licence to sell tobacco and requiring tobacco companies to pay for services to help smokers to quit. John McClurey, a retired local retailer from Newcastle said, “Tobacco is a burden” to small businesses. The Government could help to lift that burden and charge the tobacco companies to do so.
In my last speech on smoking in Westminster Hall, I again stressed the need for a levy on the tobacco companies, but Ministers were reluctant. The new Minister will want to take action in this space. As we all know, cash will be tight and the Budget in two weeks’ time will be difficult, so he can earn himself brownie points by requiring the industry that makes billions in profits while killing our people to pay up instead. It needs to pay, because more than 4,000 people died prematurely from smoking in the north-east alone last year, with 30 times as many suffering disease and disability caused by smoking.
Going hand in hand with the personal suffering caused by smoking is the economic cost to our already disadvantaged communities. In their election manifesto, the Government claimed:
“We are committed to reducing health inequality.”
Why, then, are there such pronounced inequalities? In the north-east, 42% of smoking households are in poverty and tobacco spending accounts for a higher share of gross disposable household income per head than in any other UK region or nation. Please do not give me the argument that if people are poor, they should give up their fags. Smoking is an addiction and they need help to quit. Ending smoking in such communities would not just benefit the health and wellbeing of individuals but inject money into local economies that was previously going up in smoke.
The Minister will know that, at the current rate of decline, poorer communities risk being left behind as we move towards the hoped-for smokefree 2030. It will not happen in the communities to which I have referred without robust action. Most of the quitting has been done by people from better-off communities, and the benefits have largely accrued to those communities. In 2019, fewer than one in 10 professional and managerial workers smoked—well on the way to the smoke-free target of less than 5%—compared with nearly one in four workers in routine and manual occupations.
Half the difference in life expectancy between rich and poor is due to smoking, which means that the scope for reducing health inequalities related to social position is limited, unless the many smokers in lower social positions can succeed in stopping smoking. Smoking is linked to almost every indicator of disadvantage. Those overlap different communities, so smokers in routine and manual occupations, or who are unemployed, are also more likely to be living in social housing and to be diagnosed with mental health conditions.
There is a clear need for a new tobacco control plan that targets investment and enhanced support at disadvantaged smokers, wherever they are. As long as smoking remains the norm in some communities, not only will it be harder for smokers to quit, but smoking will continue to be transmitted from one generation to the next. The evidence shows that most people who smoke started as children. Prevention is key, so what will the Government do to reduce the appeal of cigarettes?
Does my hon. Friend agree that raising the age of sale, as the APPG proposes, would reduce youth uptake? According to the UCL modelling that I spoke about, it would reduce smoking among 18 to 20-year-olds by a third. It would narrow the inequalities in uptake: as my hon. Friend has powerfully explained, children from more disadvantaged backgrounds are more likely to take up smoking.
I have no doubt that everything my hon. Friend says is totally on the money. We can take action, and it need not cost the Government a fortune either. My hon. Friend raises the issue of age. Some parts of the UK have a Check 25 policy—would it not be wonderful if we could introduce such a check on the sales of cigarettes? It might help to put an end to smoking among younger people.
High smoking rates among people with mental health conditions are a leading cause of premature death and disease. Smoking accounts for two thirds of the reduction in life expectancy for people with a serious mental illness. The smoking rate among people with serious mental illnesses is more than three times that of the general population. The rate among people with depression and anxiety is just under twice that of the general population, but they account for 1.6 million smokers. There is now good evidence that smoking exacerbates levels of poor mental health, whereas stopping smoking contributes to improvements in mental health. Tobacco remains the biggest cause of cancer and death in the UK, so Cancer Research would like to see the ambition to make England smoke free by 2030 implemented. I ask the Minister whether we can expect to see that ambition realised.
I would like to say a little about “The Alternative Smoke-Free 2030 Plan” published by the Institute of Economic Affairs, which the hon. Member for Harrow East has also received. After the disastrous free-market policies promoted by the IEA and adopted by the last Prime Minister and Chancellor, I find it hard to believe that any current Minister would give any credence to the IEA’s recommendations on anything. However, the hon. Member makes an important point: as a party to the World Health Organisation framework convention on tobacco control, the Government and all public authorities are required to protect
“their public health policies…from commercial and other vested interests of the tobacco industry”.
If the Minister is in any doubt about the role played by the IEA, he should take note of the leaked documents that show that during the passage of the tobacco products directive, Philip Morris International described the IEA as a “media messenger” on its behalf, able to assist in “policy outreach” to “pro-actively relay our positions”, while British American Tobacco described it as a “vehicle for delivery” of its UK reputation initiatives. I would like the Minister to restate for the record, on the Floor of the House, the Government’s commitment to complying with paragraph 3 of article 5 of the convention and to preventing tobacco industry-funded organisations from influencing tobacco control policy.
The arguments for bringing tobacco regulation forward are multifaceted and can no longer be ignored. As a member of the APPG, I look forward to working with a new Minister who can do the maths to realise the cash value of a tobacco control plan, especially if we make the polluters pay, and—better still—who can help us to ensure that we have healthier people in all our communities.
It is a pleasure to follow Alex Cunningham. Like him, I could tear up my speech after listening to that of my hon. Friend Bob Blackman. I congratulate my hon. Friend and Mary Kelly Foy on securing this important debate, which I have been eagerly awaiting for some time. I wish the hon. Member for City of Durham a speedy recovery.
I thank the all-party parliamentary group on smoking and health, which is so excellently chaired by my hon. Friend the Member for Harrow East, for all its work on this important area. It has undoubtedly been instrumental in changing the Government’s policy on smoking and their perception of the issue. I am sure that its work has contributed to saving many lives. I thank my hon. Friend for his invitation to become a member of the APPG; I am delighted to accept.
The reasons why we need to tackle smoking and become smoke free by 2030 have been well rehearsed in previous debates in Westminster Hall and this Chamber and repeated today, but I make no apology for highlighting the key reasons again. Smoking remains the single biggest cause of preventable illness and death. Surely we have a duty to do everything in our power to prevent ill health and death. Shockingly, cigarettes are the only legal consumer product that will kill most users: two out of three smokers will die from smoking unless they quit. More than 60,000 people are killed by smoking each year, which is approximately twice the number of people who died from covid-19 between March 2021 and March 2022, yet it does not make headline news. In 2019, a quarter of deaths from all cancers were connected to smoking.
The annual cost of smoking to society has been estimated at £17 billion, with a cost of approximately £2.4 billion to the NHS alone and with more than £13 billion lost through the productivity costs of tobacco-related lost earnings, unemployment and premature death. That dwarfs the estimated £10 billion income from taxes on tobacco products. People often tell me that we cannot afford for people to stop smoking because of the revenue generated by the sale of tobacco, but I argue that as a society, and for the good of our nation’s health, we cannot afford for people to smoke.
Achieving smoke-free status by 2030 will not only save the NHS money but, more importantly, save lives. If we are determined to bring down the NHS backlog, we need to prevent people from getting ill in the first place. If we want to achieve our goal of improving productivity, we need a healthy workforce. It takes a brave and bold Government to implement policies whose rewards will mainly be reaped by the next generation, but that is the right thing to do.
I want to focus on just one of the well-researched and well-received recommendations in the Khan review: the age of sale. The fact that retailers use the Challenge 21 and Challenge 25 schemes indicates just how hard it is to determine a young person’s age. Age of sale policies are partly about preventing young people from gaining access to age-restricted products such as cigarettes and alcohol. More importantly, as Dr Khan states, they are about stopping the start. Dr Khan recommends
“increasing the age of sale from 18, by one year, every year until no one can buy a tobacco product in this country… This will create a smokefree generation.”
That may seem pretty drastic, but so are the consequences of smoking. If we ask smokers when they started, the majority will say that it was when they were in their teens. The longer we delay the ability to legally take up smoking, the fewer people will take it up, and the fewer will therefore become addicted. Let’s face it: never starting to smoke is much easier than trying to quit.
We have already proved in the UK that raising the age of sale leads to a reduction in smoking prevalence. Increasing the age of sale from 16 to 18 in 2007 led to a 30% reduction in smoking prevalence for 16 and 17-year-olds in England. Other hon. Members have mentioned the change in America. I would argue that increasing the age of sale by one year every year is more acceptable than raising it in one go from 18 to 21, for example, or even to 25.
Dr Khan has also called for additional investment in the stop smoking services currently provided by local authorities. However, I am a great believer in making every contact count—every contact that someone makes with a GP, as an out-patient, as an in-patient or on a visit to a pharmacy. Every time a smoker sees a healthcare professional, it should be seen as part of the healthcare professional’s duty to better the health of their patient.
I was honoured to share the stage with Dr Javed Khan at the launch of his review in June, and I was pleasantly surprised by the virtually universal welcome that his recommendations received. Indeed, polling carried out by YouGov backs that up: 76% of respondents support Government activities to limit smoking, or think that the Government should do even more; just 6% say that they were doing too much; 76% support a requirement for tobacco manufacturers to pay a levy or fee, to finance measures to help smokers quit and prevent young people from smoking; 63% support an increase in the age of sale; and, for the benefit of those on the Government side of the Chamber, 73% of those who voted Conservative in 2019 support the Government’s smoke free 2030 ambition.
In our 2019 manifesto we committed ourselves to levelling up, and that commitment has been reiterated by our new Prime Minister. Levelling up is not just about infrastructure; it is also about levelling up our health and life chances. That is particularly important for my constituents, because 16.6% of adults in Erewash are currently smokers, which is above the national average. With average annual spending on cigarettes estimated to be around £2,000, it is not just the health of smokers that is being affected, but their pockets as well. Becoming smoke free by 2030 would lift about 2.6 million adults and 1 million children out of poverty, and so would aid our levelling-up agenda.
Before I end my speech, I want to raise the issue of e-cigarettes, or vaping. The Khan review contains a specific recommendation on this, and I want to explain why it is so important. As with cigarettes, the age of sale is 18, but time after time I see young people at the end of the school day using vapes—and that is outside schools without sixth forms. It is illegal for a retailer, whether online or on the high street, to sell vaping products to anyone under the age of 18, so I am not sure how under- age users are obtaining the devices. The manufacturers are obviously aiming some of their marketing at this age range through the use of cartoon characters, a rainbow of colours, and flavours to match. The function of e-cigarettes should be solely as an aid to quit smoking, and not, as I fear, as a fashion accessory and, potentially, the first step towards taking up smoking.
The proliferation of vape shops in our high streets and online proves that vapes have become an industry in their own right, and are now being used by tobacco companies to maintain their profits as restrictions on tobacco increase. I therefore ask the Minister to work with his colleagues in the Home Office, the Department for Levelling Up, Housing and Communities and the Department for Education to see what more can be done to clamp down on the illegal supply of vapes to those under the age of 18. I also ask him for an update on progress in getting a vaping device authorised through the Medicines and Healthcare products Regulatory Agency—a step that would send the strong message that vapes are an aid to quitting smoking and not an alternative to smoking.
Finally, let me ask a question that has already been asked by other Members today: will the Minister provide a date on which we can expect the tobacco control plan to be published?
It is a pleasure to speak in this important debate. It has been a small but, I think, perfectly formed debate, in which there has been a large degree of consensus throughout the House on our ambition for England to be smokefree by 2030.
I commend Bob Blackman not just for the work he has done on this subject over a long period, particularly in the all-party parliamentary group, but for the way in which he introduced the motion, which, as my hon. Friend Alex Cunningham observed, enabled us to say, “We agree with Bob.” I congratulate my hon. Friend for his own work on the subject. I thank Maggie Throup for her contribution, and also thank her for her time as the public health Minister: I used to enjoy our debates across the Dispatch Box, and I wish her well in whatever comes next.
The Health and Social Care Front Bench is a bit like a whirling dervish at the moment. We had the hon. Member for Erewash a few months ago, then Dr Johnson—she was in post for just six weeks, and I want to thank her as well for the work she did in that short time—and now we have the new Under-Secretary of State for Health and Social Care, Neil O’Brien, whom I welcome. Let me also echo the words of the hon. Member for Harrow East in wishing my hon. Friend—indeed, my friend—Mary Kelly Foy a speedy recovery after her hospital treatment.
It is now nearly five months since the release of the Khan review. Both the hon. Member for Erewash and I spoke at the launch, and I think the review was universally welcomed. It was generally agreed that we must move apace in ensuring that we meet the ambition of a smokefree 2030. In those five months we have had three different Health Secretaries, and we are now on our third Prime Minister. I do not blame the current Minister for all this chopping and changing, but it is little wonder that the Government have failed to find time to respond to the Khan review amid the endless changes. I hope that when the Minister responds to the debate, we will finally be given some clarity. I hope he will set out a timetable for when the Government will respond to the Khan review, and will outline which measures in the review itself the Government are currently considering. I also hope he will be able to reassure Members on both sides of the House that the Government stand by their commitment to create a smokefree England by 2030.
The importance of that smokefree 2030 cannot be overstated. Tobacco is the primary driver of health inequalities throughout the United Kingdom. In 2019-20, there were more than half a million hospital admissions and more than 74,000 deaths attributed to smoking. My constituency of Denton and Reddish straddles two local authorities, Tameside and Stockport in Greater Manchester. The public health charity Action on Smoking and Health—ASH—estimates that smoking costs those two local authorities about £172 million in lost productivity and health and social care costs. That is unsustainable.
Behind those stark economic figures, however, are individual lives that are being harmed or lost as a direct result of smoking. We know that more than 50% of people over the age of 16 who smoke say they want to quit—in fact, many say that they wish they had never started in the first place—and it is therefore imperative that the Government support them in their efforts to do so. Unfortunately, stop smoking services have suffered a 33% real-terms cut in their budgets since 2015-16. There is a drastic need for that to be reversed.
The Government have made a commitment to a smoke- free 2030, which is commendable. We support them, and we want them to succeed. However, a commitment alone is not enough: we want to see action to get there, and we need to see that action fast. The former Secretary of State had an interesting relationship with the tobacco industry, to put it mildly. She had previously accepted hospitality from the industry, and had voted against several sensible public health tobacco measures. During her brief but eventful tenure, it was reported that she had scrapped the Government’s proposals to publish a tobacco control plan, as well as the health disparities White Paper. I asked the Minister about the White Paper earlier this week during Health questions, and received something of a non-answer. I will therefore ask my questions again today, in the hope of getting some clarity. Are the Government planning to scrap the health disparities White Paper—yes or no? Are they planning to scrap the tobacco control plan—yes or no? We need transparency, as there seems to be an information vacuum in the Department of Health and Social Care. If the Government are indeed rowing back on their public health responsibilities, they should have the guts to say so, and face scrutiny for that decision.
By doing everything from inviting tobacco lobbyists into the heart of No. 10 to accepting gifts from the big four tobacco firms, the Government have shown themselves too willing to ally themselves to an industry that is damaging the health of the nation. However, the damage done by the tobacco industry is not confined to public health. Recent analysis conducted by The Daily Telegraph has revealed that the Russian Government have received almost £7 billion from tobacco companies in taxes since Putin’s invasion of Ukraine. That is despite several tobacco companies pledging to cut ties with Russia. I would be interested to know what the Minister makes of this revelation. Will the Government make it crystal clear to tobacco companies that they are expected to follow the lead of those companies that have ceased trading with Putin’s tyrannical regime?
Labour Members believe that if we want to ease pressure on our NHS and improve public health, we need to get serious about prevention. That means ensuring equitable access to smoking cessation services, and taking on tobacco companies that profit at the expense of public health. Smoking prevalence is not a problem that the Government can ignore and hope will magically go away. As a Greater Manchester MP, I have been really encouraged by Greater Manchester’s “Make Smoking History” strategy. If the Minister has not looked at that, I encourage him to do so, because it really is best practice. Indeed, it is cited as best practice in a case study in the Khan review.
Greater Manchester’s comprehensive approach to tobacco control means that smokers in Greater Manchester have more offers of support in quitting than ever before. Thanks to the scheme, smoking rates among people in routine and manual jobs have reduced faster in Greater Manchester than in any other region of England. If these strategies can work regionally, they can, with the political willpower, be scaled up to national level.
I urge the Minister to take the brave decisions. They are sometimes tough and often very unpopular with a significant vocal minority of people, but taking those decisions is the right thing to do, as history often shows. Smoking has gone up among young adults aged 18 to 24 in the past three years. To put that in context, in 2007, around 41% of young people said that they had smoked. By 2019, that had fallen to just a quarter, but in the short space from 2019 to 2022, that increased to a third. That is going in the wrong direction. Between 2007 and 2020, smoking fell, as successive Governments really ratcheted up the regulation of smoking and introduced smoke-free laws. They increased the age of sale from 16 to 18; banned the display of tobacco products; introduced standardised packaging and large, graphic health warnings; banned smoking in cars with children; and, lastly, banned menthol in 2020. Those measures worked, but they have to continue, as does the pace of change, if we are to meet the goals of Smokefree 2030.
The last Labour Government implemented one of the biggest and most significant public health interventions in modern political history. I am most proud of it, but it was not popular in all quarters; I was almost banned from holding surgeries at Denton Labour club. It was the ban on indoor smoking. When we go abroad to countries that still have smoking indoors in public places—in bars, restaurants and cafes—we wonder how on earth we put up with that in our country until fairly recently. Absolutely nobody with a modicum of common sense would want to reverse that legislation.
When we were in government, we supported taking the bold steps necessary to protect public health, and many thousands of lives were saved as a result. That is why we want the Government to commit to Smokefree 2030. They will miss that target unless they up the pace of change, accept the recommendations of the Khan review, and legislate to put measures in place. For far too long, public health has been an afterthought, or a battleground on which to have ideological arguments. We have had obesity strategies scrapped, tobacco strategies binned, and health inequalities widened. This neglect cannot continue. We will support the Government in being brave on public health. We will give the Minister the majority he needs, if he does not have one, to pass the right measures in this House. Labour Members will do right by Britain, and encourage the Government to do the same. Be brave, and build a healthier, happier and fairer Britain; we will support you.
I thank my hon. Friend Bob Blackman and Mary Kelly Foy for securing this important debate. I add my voice to the voices of those who have wished the hon. Member for City of Durham a speedy recovery. A lot of the people who contributed to this debate, including the hon. Members for Stockton North (Alex Cunningham), and for Blaydon (Liz Twist), and my hon. Friend Maggie Throup, who all spoke eloquently, have personal experience on this subject, and a real passion for and dedication to achieving a smoke-free England by 2030—a goal to which the Government are completely committed.
I am pleased to update the House on the Government’s work on the Khan review—the independent review of Smokefree 2030 published in June. Tragically, smoking remains the single biggest cause of preventable illness and death across the country. There are still six million smokers in England, and up to two out of three of them will die from smoking unless they quit. Smoking causes seven out of 10 cases of lung cancer, and most people diagnosed with lung cancer die within a year. One in five deaths from all cancers in the UK was connected to smoking in 2019. Smoking substantially increases the risk of heart disease, heart attack and stroke. Smoking is responsible for around 3.7% of all hospital admissions, and so costs the NHS a staggering £2.4 billion each year.
People who start smoking as a young adult lose an average of 10 years of life expectancy, or around one year for every four years of smoking after the age of 30. As many hon. Members have said, action is vital if we are to meet the Government’s manifesto commitment of extending healthy life expectancy by five years by 2035. The Government are committed to levelling up society and extending the same chances in life to all people across the country. As various Members have said, smoking is one of the largest drivers of health inequalities, and rates vary substantially across the country; we heard about that from the hon. Member for Stockton North. As Dr Khan stated in his independent review, smoking prevalence is four and a half times higher in Burnley than in Exeter, so there is huge variation around the country.
Smoking is a huge drain on the household finances of the most disadvantaged families. In Halton in Cheshire, smokers spend an estimated £3,551 a year on tobacco—nearly 15% of their income. That is a shocking statistic. Reducing smoking presents a huge economic opportunity to increase productivity and people’s incomes. Smoking is very high in certain populations, and as my hon. Friend the Member for Erewash said, a third of all cigarettes smoked in England are smoked by people with a mental health condition—an incredible fact.
Behind all these statistics are individuals, families and communities who are suffering from the harms of tobacco. That is why we are so committed to our goal to be smoke free by 2030. We have committed to doing more to help smokers quit and to stop people taking up this deadly addiction in the first place, because we know that most smokers want to quit and many wish they had never started.
The UK is considered a global leader on tobacco control, and investment in evidence-based stop smoking interventions, a strong regulatory framework, local authority stop smoking services and the NHS has ensured that we now have the lowest smoking rate on record: 13.5% in England, down from 21% in 2010 and 45% in 1974. That is a huge change in our society.
In the 2017 tobacco control plan, we set a bold ambition to reduce smoking prevalence among 15-year-olds from 8% to 3% or less by the end of 2022. I am pleased to say we are well on track to meet that target. The Government have also committed to an escalator that increases duties by more than two percentage points above inflation until the end of the current Parliament. In 2010, the average price of a packet of cigarettes was £5.70; and in 2022 the average price is £12.72. Since 2010, duty on cigarettes has more than doubled, and a minimum excise tax has been introduced to increase the price of the very cheapest cigarettes, because we know that one of the most effective ways of stopping people smoking is making it more expensive.
On top of that, we continue to fund a range of comprehensive tobacco control interventions. We have provided £72.7 million to local authority stop smoking services through the public health grant, and more than 100,000 people have quit with the support of a stop smoking service in 2020-21. This year alone, we have provided £35 million to the long-term NHS commitment on smoking, which means that by the end of 2023-24 all smokers admitted to hospital, whether an acute hospital or a mental health hospital, will be offered NHS-funded tobacco treatment services. We will be using those regular touch points, as my hon. Friend the Member for Erewash suggested, to drive down smoking.
My hon. Friend the Member for Harrow East asked about maternal smoking, and the same model is being provided for expectant mothers through the new smokefree pregnancy pathway, including focused sessions and treatments. A new universal tobacco treatment offer is being piloted as part of specialist community mental health services for long-term users of specialist mental health and learning disability services, to help the most vulnerable populations.
The change in treatment for women who smoke in pregnancy is remarkable. Women now routinely get a carbon monoxide test. People will be offered support. In some cases, there are exciting experiments with vouchers and financial incentives that can help, particularly in some poorer communities, people to stop smoking. There is a lot of work on maternal smoking.
Since leaving the EU, we have implemented a new UK-wide system of track and trace for cigarettes and hand-rolled tobacco to deter illicit sales. I have talked about how we have increased duties to drive up prices and to deter smoking, which would of course be undermined if illicit products were circulating.
We have limited the number of cigarettes that people can bring into the country via duty free to 200, making it much harder for those who want to illegally evade excise duties on tobacco. That will help to prevent the sale of cheap cigarettes, further reducing the illicit market.
Although smoking rates have fallen, we recognise that they are not falling fast enough. That is why we asked Dr Khan to undertake the independent review to help the Government to reduce the devastation that smoking causes. The review makes a number of bold recommendations.
Stop smoking services run by local authorities and funded through the public health grant continue to offer smokers the best chance of quitting, and people who get help from local stop smoking services are three times more likely to quit successfully than those who try to quit unaided. I pay tribute to the work of those services, and I assure them that they remain a key part of the Government’s smokefree 2030 ambition.
The Minister knows as well as I do that local authorities have been under tremendous financial constraints in recent times. How can we ensure that local authority public health continues to be funded so that these services can continue? At the moment the services are quite inadequate.
The hon. Gentleman is right that these services are hugely important. All authorities saw an increase last year and there is a 2.8% increase this year, with funding heavily weighted towards more deprived areas, but there is much more we need to do, and we keep it under active review.
We are also building investment in anti-smoking marketing campaigns. It was heartening to see the number of people who joined the annual Stoptober campaign last month. This well-known initiative encourages smokers to abstain for 28 days each October, as we know that smokers who manage to quit for 28 days are five times more likely to quit permanently. In England, the Stoptober campaign has now helped more than 2.1 million people quit since its inception in 2012.
Dr Khan also called for the NHS to prioritise further action to stop people smoking. The long-term NHS plan commitments are a huge step towards preventing smoking-related illness, and they are making significant progress towards reducing preventable ill health and reducing the burden of smoking on the NHS. I have talked about using touch points in hospitals to offer people help to stop smoking.
We have discussed vaping as a substitute for smoking. We recognise that vaping is far less harmful than smoking and can be an effective quitting device. We also recognise that there is more the Government can do to tackle the myths and misconceptions that surround vaping. Our recently published “Nicotine vaping in England” report set out the most up-to-date evidence on vaping, providing an even more compelling case for supporting smokers to switch. However, in recognition of the recent increase in vaping rates among children, which my hon. Friend the Member for Erewash mentioned, we are doing more to prevent children from vaping. We have updated our online materials, and we are working closely with the Department for Education to communicate with schools on how best to set policies around vaping.
My hon. Friend asked a specific question about the MHRA and medical licensing. We are working closely with the MHRA to support a future medically licensed vaping product, which would carry many benefits, including tackling scepticism of e-cigarettes among healthcare professionals. We understand that several products are applying for medical licences early next year. I pay tribute to my hon. Friend for all the work she has done on public health.
As a world leader in tobacco control, the Government continue to support lower and middle-income countries to implement effective tobacco control strategies, and through official development assistance funding to the World Health Organisation-led framework convention on tobacco control 2030, we are supporting a further nine countries to protect their populations from the harms of tobacco.
Both my hon. Friend Andrew Gwynne mentioned article 5.3 of the tobacco control treaty, to which I can confirm the Government are absolutely committed. I consider myself forewarned about the report mentioned by my hon. Friend the Member for Harrow East.
The Government are determined to address the challenges raised by the independent review and to meet our bold smokefree 2030 target. I understand the compelling arguments made by the Khan review and the very strong evidence in the recent “Nicotine vaping in England” report. Over the coming weeks, we will be quickly taking stock on whether a refreshed tobacco control plan is the best way to respond, and on how and when to take forward all the suggestions made by that review.
The Government recognise that more action needs to be taken to protect our people from this dangerous addiction. We know that the action we take must be comprehensive, bold and ambitious. The prize of reaching a smokefree 2030 will be huge for this country, particularly for our most disadvantaged citizens. I thank all hon. Members who have taken part in this debate.
With the leave of the House, I thank my hon. Friend the Minister, who is new in post, for answering this debate. I am grateful for the extremely welcome support from the shadow Minister, which demonstrates the will on both sides of the House to deliver a smokefree 2030.
I thank all colleagues who have contributed, including the hon. Members for Stockton North (Alex Cunningham) and for Blaydon (Liz Twist), and my hon. Friend Maggie Throup.
Achieving a smoke-free England is key, and it is a major part of the levelling-up White Paper’s mission to increase life expectancy by five years by 2035. I know this is close to the Minister’s heart, because he was previously the Minister for Levelling Up. I remind him that in that role he said:
“ultimately on public health and on prevention, we need to think extremely radically and really floor it, because otherwise the NHS will just be under humongous pressure for the rest of our lifetimes because of an ageing population.”
I think we all agree with those statements. He needs to act radically and immediately on the Khan review and bring forward those proposals. I think he has the commitment of the whole House to deliver them, if legislation is required, but he could do much of what is in the Khan review just by regulation.
We need a tobacco control plan that will end smoking, increasing healthy life expectancy and narrowing inequalities, but without funding, a plan will not deliver. That is why we are proposing the polluter pays levy, which is popular, feasible and supported by voters of all political persuasions and by tobacco retailers. The idea has come to pass and we must now implement it.
Question put and agreed to.
That this House
has considered the recommendations of the Khan review: Making smoking obsolete, the independent review into smokefree 2030 policies, by Dr Javed Khan, published on