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[Mr Clive Betts in the Chair] — Backbench Business — Tobacco Control Strategy

– in Westminster Hall at 1:30 pm on 17th December 2015.

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Photo of Kevin Barron Kevin Barron Chair, Committee on Standards, Chair, Committee on Privileges 1:30 pm, 17th December 2015

I beg to move,

That this House
has considered a new tobacco control strategy.

I am pleased to speak in this debate with you in the Chair, Mr Betts, because we are not talking about football today—our teams are doing different things in the league at the moment. I ought to declare that I am the vice-chair of the all-party group on smoking and health, and have been an officer of sorts for it for some 20 years. I am sure Members are aware that the group’s secretariat has been the Action on Smoking and Health charity for many years.

My commitment to tobacco control is well known in this House. For the more than 20 years that I have been involved in this issue, I have had great support from Action on Smoking and Health, as I know Governments have from time to time. My commitment was an individual one at one stage, going back a couple of decades, so I am pleased that in recent years we have seen see a growth in cross-party support for tobacco control, as people recognise that it is a key area of public health.

The Minister has played a key leadership role in guiding through the House measures such as standard packaging and the prohibition on smoking in cars with children. She has been helped by the strong support for these measures across Parliament, both here and in the other place. We have moved on in leaps and bounds on this major public health issue in the past decade. Measures to tackle the harm caused by smoking are strongly supported by the public, three quarters of whom supported Government action to limit smoking in a YouGov poll conducted for ASH, and around half of whom think the Government could do more.

In recent years, a great deal has been achieved with the support of the public and all political parties, starting with the Labour Government introducing the first comprehensive tobacco control strategy in 1998; they subsequently introduced comprehensive smoke-free legislation with strong cross-party support. The coalition Government published as their first detailed public health strategy the tobacco control plan for England in 2011. Over the life of the current plan, a great deal has been achieved, and smoking prevalence rates in England have fallen significantly during the five years of the plan from some 20.2% in 2011 to 18% in 2014.

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

I am not sure whether the right hon. Gentleman will cover this, but I am particularly interested in smoking prevalence rates among those who suffer severe and enduring mental ill health. It appears to have been stubbornly more difficult to reduce smoking rates among that group. Given that people with mental ill health die earlier, and that smoking actually damages their mental health, does he agree that it is critical that the NHS ensures that those people get access to support services to help them give up smoking?

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

The right hon. Gentleman is absolutely right; there is a high incidence of smoking among people with mental health conditions, as there is among poorer households. I will go into that in more detail, but he is right to mention it.

Smoking rates have fallen among not only adults but, importantly, young people. Regular smoking among 15-year-olds has fallen even faster under the plan, from 11% in 2011 to just 6% in 2014. That is a great credit to the current plan, but it is about to come to an end, so we need a new strategy.

The reduction ambitions set out in the tobacco control plan for England have been achieved ahead of the end of the strategy. However, a great deal remains to be done. Smoking remains by far the single largest cause of preventable illness and premature deaths in the United Kingdom, causing about 100,000 premature deaths a year and killing more people than the next six causes put together, including obesity, alcohol and illegal drugs. The cost of smoking to the national health service in England is estimated to be about £2 billion a year.

My constituency, Rother Valley, sits in Rotherham borough. Just under one in five people smoke in Rotherham, which is about the same as the national average. That amounts to some 37,391 people. Nearly 500 people in Rotherham die from smoke-related diseases every year—primarily cancer, heart disease and respiratory diseases. An estimated 900 children in Rotherham start smoking every year, and it is important to remember that two thirds of smokers start before the age of 18. Of those who try smoking, between one third and one half will become regular smokers. The best way to prevent children taking up smoking is to encourage their parents to quit, because children are three times more likely to start smoking if their parents smoke.

Smoking rates are much higher among poor people. In 2014, 12% of adults in managerial and professional occupations smoked, compared with some 28% in routine and manual occupations. Almost all groups that experience disadvantage have higher smoking rates than the general population. For example, as Norman Lamb mentioned, people with mental health conditions are much more likely to smoke, and nearly eight out of 10 prisoners and people who are homeless smoke.

Poorer smokers also face financial hardship as a result of smoking. When their expenditure on smoking is taken into account, some 1.4 million households are below the poverty line—that is 27% of all households that include a smoker. In Rotherham alone, smoking is estimated to cost the national health service some £12.2 million. The current and ex-smokers who require social care in later life as a result of smoking-related diseases cost society in Rotherham an additional £5.7 million, £3.3 million of which is funded by the local authority through social care costs, and £2.4 million of which is self-funded.

Quitting smoking surveys show that about two thirds of smokers would like to stop smoking, but only around one third make a quit attempt in any given year. Continued Government and public sector action to cut smoking rates therefore remains necessary, and a new strategy is required to replace the expiring tobacco control plan.

The current Department of Health tobacco control plan will expire at the end of this month, as I understand it. I am delighted that the Minister with responsibility for public health has announced that there will be a new plan, and I look forward to her announcing when it will be published; we may hear something today. It is crucial that a new tobacco control plan be a public health priority, and it has to be comprehensive. The current strategy has been successful because it is comprehensive and, so far, properly funded.

The main elements of successful tobacco control, as implemented in the UK, are well understood and strongly backed by evidence. They are: price rises through taxation, intended to make tobacco less affordable and to help pay for tobacco control interventions; stopping the smuggling of tobacco, which allows children and young people easy access and reduces the incentives for adult smokers to quit; helping smokers to quit through evidence-based services, including support and, where appropriate, the prescription of nicotine replacement products; an end to tobacco advertising, marketing and promotion, including on the pack design; and mass-media campaigns and social marketing of anti-smoking messages. Legislating for smoke-free enclosed public places and vehicles to protect people from the harmful effects of second-hand smoke has been a great success. The new strategy will need to be comprehensive and ambitious, with tough new targets, and it has to be well funded.

I commend to the Minister the comprehensive set of measures set out in the ASH document, “Smoking Still Kills”, which has been endorsed by more than 120 public health-related organisations, including the British Heart Foundation, Cancer Research UK, medical royal colleges and the British Medical Association. The report calls on the Government to impose an annual levy on tobacco companies, proposes new targets for reducing smoking prevalence to make our country effectively tobacco-free by 2035, and makes a comprehensive set of recommendations for a renewed national strategy to accelerate the decline in smoking prevalence over the next decade.

Hon. Members will remember that at the launch of that report in June, the Minister committed the Government to publishing a new strategy to replace the current plan. Sustained funding is essential to the success of any new strategy, as it has been for Government strategies to date. Clear evidence from the UK and overseas shows that a reduction in spending on tobacco control, together with less emphasis on new policies and on enforcement of existing ones, is likely to slow, halt or even reverse the long-term reduction in the smoking prevalence rate.

Some measures, once implemented, either do not need funding—such as standardised packaging, and the ban on advertising, promotion and sponsorship—or are self-funded, such as tax increases and reductions in smuggling. Others continue to need to be properly funded, including mass-media campaigns, stop smoking services and enforcement to prevent children from being able to buy cigarettes.

I am deeply concerned that the cuts in funding to the Department of Health and local authority public health budgets, both in-year and announced in the spending review, threaten to undermine the ability of the planned new tobacco control plan for England, so that, unlike the current plan, it will not be effective. We are already seeing cuts to stop smoking services up and down the country, and to local authority investment in tobacco control, even before the spending review cuts are implemented. Will the Minister confirm that the new tobacco control plan will contain ambitious targets and be sustainably funded?

I want to focus on the importance of mass-media campaigns, which are highly cost-effective in encouraging smokers to quit and in discouraging young people from taking up smoking. When funding was cut to mass-media campaigning in 2010, when the coalition Government came in, there was a noticeable impact on quitting behaviour. There was a decrease of 98% in the amount of quit support packs. Quitline calls fell by 65% and hits on the website fell by 34%, but the evidence shows that such services are only effective if they are sufficiently well funded; in recent years, they have not been.

At the peak in 2009-10, nearly £25 million was spent by the Government on mass-media campaigns. However, last year, in monetary terms, not taking inflation into account, the amount had fallen to less than £7 million, and it is likely to fall again this year. Investment in mass-media campaigns is a crucial part of the mix of tobacco control interventions needed to drive down smoking rates, and the UK is seriously under-investing.

To give an international comparison, in the US, the Centres for Disease Control and Prevention’s best-practice recommendations for mass-reach health communications to reduce smoking is $1.69 per capita. Using 2014 population figures, that means that in England, we should be spending in the region of £57 million a year on mass-media campaigns for that to be evidence-based. We are spending eight times less than that.

The cut in spending is already having an impact. An early indicator of the effects of reductions in spending on tobacco control is given by the smoking toolkit study run by Professor Robert West, from University College London. Results for 2015 show that smoking prevalence has stopped declining and is beginning to go back up again for the first time in many years.

Smoking rates have increased from 18.5%—the lowest ever recorded—to 18.7% in recent months. There has also been a fall in the proportion of smokers who made an attempt to quit, from 37.3% in 2014 to 32.4% in 2015. There are lower success rates for quit attempts, from 19.1% in 2014 to 17.0% in 2015. That is going in the opposite way to how it should be going.

I want to move on to an area on which the public have contrasting views: the role of electronic cigarettes, which are perhaps badly named, and harm reduction. Over the last few decades, it has become increasingly clear that although population smoking rates had been declining, some groups—particularly the poor, the disadvantaged and those with mental health problems—were being left behind. Those are the groups with the highest levels of nicotine addiction, who find it hardest to quit.

At present, the most popular source of nicotine—the cigarette—is far and away the most hazardous and addictive. In response to that, tobacco harm reduction approaches have been developed in the UK to find ways of giving smokers who are unable to quit access to alternative, less harmful forms of nicotine. We are at the forefront in the world in developing such an approach. Current smoking cessation programmes use nicotine replacement therapy, but they also use non-nicotine approaches such as psychotherapy and other pharmaceutical products. Although there has clearly been success with those products, they predate the advent of electronic cigarettes as a major consumer product.

Electronic cigarettes are now widely on sale and have become the most popular tool used by smokers to help them quit. There is growing evidence that they are effective aids to quitting, and they are used by around 2.6 million smokers, primarily to help them quit or prevent them from relapsing back into smoking. Although concerns have been raised about their use by young people and never-smokers, this has not been found to be an issue. Indeed, use by adults who have never been regular smokers is very rare, and although a growing number of young people under 18 have experimented with electronic cigarettes, regular use is limited almost exclusively to young people who are current smokers or who have experimented with smoking in the past.

More worryingly, evidence from ASH indicates that the public increasingly have false perceptions of the harm from electronic cigarettes, and smokers who have not yet tried an electronic cigarette are much more likely than other smokers to believe they are as harmful as conventional cigarettes, or more harmful. That is certainly not the case. A recent groundbreaking review by Public Health England, which was published in August, found that they are 95% safer than smoking tobacco and recommended that health providers and stop smoking services take a more proactive approach in supporting smokers who want to use electronic cigarettes to quit smoking.

For 50 years we have known now that it is not the nicotine in cigarettes that does the damage to people, but the contaminants in the tobacco. However, some people, including in the medical field, are talking electronic cigarettes down as though they were as dangerous as cigarettes. That figure of 95% safer gives us 5% wriggle room, because I do not think that has been tested or proven at this stage. It could be far higher than that, but this product is a way of taking nicotine into the system that does not do the damage that tobacco does.

I believe a large part of the delay in the roll-out of electronic cigarettes has been due to the fact that they were not developed in the UK, or not through traditional methods in national health service labs. I just wish they had been, because then some medical practitioners in the NHS would have had a different attitude to them. The regulatory systems are not used to this sort of organic growth that comes in from outside. However, the Medicines and Healthcare Products Regulatory Agency’s new approach to licensing e-cigarettes is a welcome step. To my knowledge, the MHRA is the only medicines regulator in the world to licence an e-cigarette, as happened earlier this month. They will potentially become a major part of smoking cessation programmes.

Unfortunately, there are high costs to putting e-cigarettes through the MHRA, and from conversations with British suppliers it is clear that the licensing costs are prohibitive for smaller manufacturers if they want them to be a medicinal product. That is obviously a major block, and it is argued that only the tobacco companies are putting those products through the MHRA at the moment. That may be because they have the money to be able to put them through at this stage. I would prefer a tobacco company to spend money on putting these products through the MHRA, so that they can get into smoking cessation clinics, than to sell cigarettes, which prematurely kill 50% of the people who use them. We should take our head out of the sand and look at the potential of these products to get everyone off cigarettes, which are so damaging to their health.

I recently met someone who runs a small business in my constituency and has developed a product called E-Burn, which is an e-cigarette for use in prisons. It is currently used in the prison on Guernsey and is being adopted by the NHS for use in secure hospitals. That innovation is taking place out there. I have not tasted that product and I do not know it from any other, but when I was on the Select Committee on Health in 2005-06 and we did an inquiry on smoking in public places, one of the most difficult things was trying to convince people that those in prisons ought to have smoke-free workplaces as well.

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

It should also be mentioned that in mental health settings and in-patient wards, where no-smoking policies have been introduced and patients have been helped to escape from addiction to tobacco, a significant improvement in their mental wellbeing and mental health has been seen.

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

The product to which I referred comes from China, I understand, but is assembled in Rother Valley, and the person who runs that company wants to expand his business and create jobs. I want to encourage him on the basis that it creates better health if these products are used both in mental health institutions and in prison.

I mentioned the 2005-06 report. The Health Committee, which I chaired at the time, had great difficulty in convincing people who ran institutions that smoke-free workplaces should be as much for people inside prisons and secure hospitals as for anyone else. Various arguments were put to us at the time. The major issue was not just about taking people off cigarettes; it was about control in prisons. I now see that from 1 January we are banning smoking in all Welsh prisons and selected English prisons, which we could loosely call non-traditional environments. That has taken a long time. We were told when we were doing that inquiry in 2005-06 that the Prison Service would bring things forward within three months of our completing it. It has actually taken 10 years to get to this stage. I suspect that if e-cigarettes, no matter which ones they are, go into those institutions for people who are addicted to nicotine and cannot get off that addiction, it will help us get what some of us were arguing for 10 years ago.

Next year, the UK will implement the electronic cigarette provisions in the tobacco products directive, which will provide a regulatory framework for those products, giving users greater assurance about their safety and quality. However, e-cigarette users have raised concerns that the UK Government’s implementation of those provisions will force products that they use off the market and may cause them to revert to conventional smoking.

I accept entirely that it is essential that the directive be implemented proportionately. As I understand it, the MHRA will be responsible for that, although not for making all e-cigarettes medicinal product, which involves high expense. It will bring in a regime whereby it will look at the quality of e-cigarettes, and quite right too. We want to know, if people are buying e-cigarettes in shops on our high streets or wherever, that what the packet says is what is in the product. People should know exactly what they are using. I agree about that, but I hope the Government will ensure that the regulation of electronic cigarettes is proportionate and maximises the benefits to smokers while minimising the risks.

I want to finish by discussing our role in global tobacco policy. As reported by Public Health England, money has been found in the spending review for the Department of Health to support the international implementation of tobacco control. The UK, as a world leader in tobacco control and in supporting development internationally, has a key role to play in that area. I am pleased to see the Minister nodding. The UK is the first G7 country to meet the long-standing commitment to spend 0.7% of gross national income on official development assistance—a commitment that is enshrined in law, I am very pleased to say as a Member of the House. Building economic growth and creating jobs helps developing countries to lift themselves out of poverty, and we can justly be proud of our work in that area.

Key to effective development work going forward will be helping to deliver on the new sustainable development goals. One of those is to accelerate the implementation of the World Health Organisation framework convention on tobacco control. I hope, therefore, that our new tobacco control plan will be cross-Government and will include an ambitious international strategy to help countries with FCTC implementation.

The Addis Ababa declaration on financing for development, which backs up the sustainable development goals, says that parties, such as the UK, should strengthen implementation of the WHO FCTC and support mechanisms to raise awareness and mobilise resources for the convention. The UK, as a world leader both in development and in tobacco control, has a key role to play in helping to support FCTC implementation, particularly in low and middle-income countries.

The financing for development declaration goes further and states that

“price and tax measures on tobacco can be an effective and important means to reduce tobacco consumption and health-care costs, and represent a revenue stream for financing for development in many countries.”

Clearly the UK has expertise in tobacco taxation: we have some of the highest taxes in the world, combined with a comprehensive and effective strategy to tackle illicit trade. A 2014 study found that tripling tobacco taxes around the world could reduce the number of smokers by 433 million and prevent 200 million premature deaths from lung cancer and other smoking-related diseases. That would benefit UK plc, because increased tobacco taxes of necessity go hand in hand with enhanced anti-smuggling strategies, which we now have to deal with daily. Her Majesty’s Treasury, in collaboration with Her Majesty’s Revenue and Customs, is in the process of setting up a cross-departmental ministerial working group to tackle the illicit trade in tobacco and help HMRC to achieve its aims, which include:

“Creating a hostile global environment for tobacco fraud through intelligence sharing and policy change”.

If other Governments increase tobacco taxes and enhance their anti-smuggling strategies, that will help to create precisely that hostile global environment for tobacco fraud. HMRC is working on that at the moment.

Our international strategy also needs to include work to help countries protect their tobacco control public health policies from the commercial and vested interests of the tobacco industry, and to ensure that UK diplomatic posts do not help tobacco companies promote their deadly products around the world. It was rightly considered a scandal earlier this year when the British high commissioner to Pakistan was revealed to have attended a British American Tobacco meeting with the Government of Pakistan, at which BAT lobbied the Government not to implement tougher health warnings on cigarette packs—a campaign that was successful, sadly. In a recent BBC “Panorama” programme, it was alleged that BAT employees and contractors had been involved in making payments to officials and politicians in Africa in return for access to draft tobacco control legislation. Given the UK’s strong domestic record on tobacco control and our leading international role in promoting successful tobacco control policies, we need to remain vigilant and ensure that we all do everything we can to promote successful tobacco control around the world.

I had personal experience of what the tobacco companies do more than 20 years ago, when I was promoting a private Member’s Bill to ban tobacco advertising and promotion. A lot came out years later through the tobacco files about exactly what had taken place and the influence that those companies exerted to try to stop us doing what this country has now done. They tried to stop us putting this country on the map as a major force in tobacco control, as it is now. Will the Minister confirm that the international work to support the implementation of the WHO FCTC will be a key part of the new tobacco control plan, and that it will include supporting Governments in protecting their public health policies from the commercial and vested interests of the tobacco companies, in line with article 5.3 of the FCTC?

I thank you for your indulgence, Mr Betts—you will be pleased to know that I am about to sit down. The tobacco control strategies have been published, in recent history, about once every five years. They have been crucial to this country in saving the lives of many of our fellow citizens and in our getting a good evidence base for the same thing to happen throughout the world. The last thing I want is for this country to stop doing what it has been doing well. I have asked questions about funding and other things, but there is much that we can do that requires not money but good will and determination.

Photo of Bob Blackman Bob Blackman Conservative, Harrow East 2:00 pm, 17th December 2015

It is an honour and a pleasure to serve under your chairmanship, Mr Betts, as I do weekly on the Select Committee on Communities and Local Government. It is also a pleasure to follow Kevin Barron, who has almost a lifetime of experience of dealing with the tobacco industry and ensuring that the country wakes up to the fact that tobacco and the products that the tobacco industry produces will, if they are used in the way that is intended, kill us. They are the only legal product that will achieve that. I declare an interest in that I speak as the chair of the all-party group on smoking and health. I thank the vast plethora of organisations that have contributed to the debate by supplying me with facts, figures and determinations.

I remember in September 2013, on the first Tuesday back after the long summer recess, we held a debate in this place on standardised packaging for tobacco products. The predecessor of the Minister for Public Health was in post, and some 22 Members contributed to the debate. The Government’s position was that they would not introduce standardised packaging, and the Opposition’s view was that it would be the wrong thing to do. Less than two years later, however, it has come to pass. Government policy changed quite radically as a result of pressure from MPs on both sides of the House. I pay tribute to the work that has been done over many years on tobacco control. The key point is that we must continue to bear down on smoking prevalence, so that we see a reduction year on year.

High taxes on tobacco, to prevent people from starting smoking, are part and parcel of that strategy, which has continued for the past 25 years on a progressive and comprehensive basis. Action on stopping smuggling was started in 2000. We are the only country in the world to have smoking cessation services available free at the point of delivery to smokers. We were the first to introduce them, and we are the only country that has continued with them. I think we should be proud of that. We have been at the forefront when it comes to comprehensive laws prohibiting advertising, promotion and sponsorship by the tobacco industry of our sports and activities.

Over the lifetime of the current tobacco control plan, a substantial amount has been achieved, such as the prohibition of point-of-sale tobacco displays in large shops from April 2012 and in small shops from April of this year, and the ending of smoking in cars carrying children. That measure was introduced in the last Parliament, carried through at the behest of Back-Bench MPs and implemented with Government support. Some of the action is still to be implemented, including the introduction of standardised packaging for tobacco products. That, as the Minister is no doubt aware, is the subject of attacks in the courts by the tobacco industry, but it should come into place in May next year. The new tobacco products directive and the illicit trade protocol will also come into effect later next year.

The new measures together have been very effective in driving down the prevalence of smoking. For the first time since records began, fewer than one in five members of the adult population smokes, and we are seen as a world leader in tackling tobacco. Our leadership has been acknowledged internationally since 2007, and the UK has received the highest score and the top ranking in Europe from the European Cancer Leagues. This year, the Department of Health received the prestigious triennial Luther Terry award from the American Cancer Society. I know that the Minister was pleased to receive that award, and we must congratulate her and the Department of Health on it. We were only the second country in the world to pass legislation to implement standardised packaging for tobacco products. The legislation is being challenged in the courts, but we feel sure that the Government will win that challenge, as they have done in many other cases, including on smoke-free laws, advertising and point-of-sale displays.

Having said that, we must recognise that there is a lot more to be done. Almost one in five adults still smokes, and smoking remains the single biggest cause of preventable deaths and premature death. As we have heard, smoking kills almost 80,000 people in England every year. In London alone, more than 8,000 people die prematurely from tobacco-related diseases, and more than 51,000 hospital admissions can be attributed directly to smoking.

Smoking is the leading cause of inequality, and it is responsible for half the difference in life expectancy between the rich and the poor. As a general rule, those who experience disadvantage have smoking rates higher than those of the general population, and that fuels cycles of deprivation. We have heard that nearly eight out of 10 prisoners smoke, and that people who are homeless smoke. Rates of smoking are also much greater among those who live with a long-term condition, such as asthma or diabetes. That, in turn, has an impact on the national health service. We know that health interventions are less successful for smokers than for non-smokers, and non-smokers tend to have much shorter hospital stays and fewer complications as a result.

In my constituency, Harrow East, which is within the London Borough of Harrow, 13.1% of people still smoke. That equates to 24,855 people who still smoke. That is lower than the national average, but in Harrow 209 people still die from smoking-related diseases every year, 1,410 hospital admissions a year are caused by smoking and 80 people die from lung cancer each year. We know that 90% of lung cancer is attributable directly to smoking. Every year, 55 people in Harrow die from chronic obstructive pulmonary disease, which is also known as emphysema, and 60% of those deaths are caused by smoking. Although smoking rates have fallen significantly among children, from 10% in the early 2000s to just 3% last year, we must not become complacent. It has been estimated that 207,000 children—11 to 15-year-olds—start smoking every year. In Harrow, that is 551 young people starting smoking every year.

Government and public sector action to cut smoking rates is still, clearly, necessary. As such, I was delighted to hear the Minister announce earlier in the year that there will be a new tobacco control plan. The current plan runs out in just two weeks, at the end of the month, so we look forward to hearing from the Minister when the new strategy will be in place. For the new strategy to be successful, it needs to be properly funded. In July this year, the Chancellor announced an in-year cut to public health funding of £200 million, which amounts to some 6.2% of the total budget. That has been compounded by further cuts of 3.9% each year to 2021, which were announced in the Treasury’s spending review. That, according to Public Health England, translates into a further cash reduction of 9.6%, in addition to the £200 million of savings this year alone. Those cuts are already having an impact on local authority spending. I am very disappointed that the local authority where my constituency sits is cutting its public health funding by

60% over the next three years. That has had a severe impact on the stop smoking services, for which funding is being cut from £299,000 in the current financial year to just £20,000 in 2017-18. My local authority is not the only one making such reductions and that is deeply concerning because there may be a return to young people starting to smoke and fewer adults taking the opportunity to give up.

According to the National Institute for Health and Care Excellence, stop smoking services are some of the most cost-effective healthcare interventions—far more cost-effective than the drugs needed to treat smoking-related diseases when they start to develop. Stop smoking services are considerably cheaper than treating long-term conditions caused by smoking, such as lung cancer and coronary heart disease. There is considerably stronger evidence for the effectiveness of stop smoking services compared with many prevention interventions such as, for example, NHS health checks.

What is more, smokers are four times more likely to quit successfully with the combination of behavioural support and medication provided by services compared with unsupported quit attempts. In the previous financial year, more than 450,000 people set a quit date with stop smoking services in England and 51% had successfully quit after four weeks. Those figures include nearly 19,000 pregnant smokers, 47% of whom successfully quit. I was pleased to see in the official statistics released yesterday that the Government have reduced their ambition to cut smoking in pregnancy to 11%. If support available to those women is cut, it raises the question of whether such achievements can be sustained and built on in the future.

Services play an important role in reducing health inequalities. Poorer smokers, who find it more difficult to quit as they tend to be more heavily addicted, are more likely to be successful with the support of those services. More people from routine and manual groups use the stop smoking services than any other socio-economic group and, as such, the services can help reduce health inequalities. They also help to prevent the uptake of smoking among children, although assisting adults to quit is their most important element. Children growing up with both parents who smoke are three times more likely to start smoking compared with children whose parents do not smoke. The cuts to public health funding, which I referred to, have been described, unsurprisingly, by the King’s Fund as the “falsest of false economies”. The reductions do not only affect my constituency, but people all over the country. For example, Manchester City Council, which is part of the new devolution deal, has already announced that it will not fund such services in 2015-16, and there are numerous reports of planned reductions in other local authorities—and that was before the announcement of further reductions in the spending review.

As well as reductions in budgets, a great deal of change is taking place in local services, and it is not clear that new approaches are properly evidence-based. A recent survey conducted by ASH for Cancer Research UK found that more than half the respondents—53%—described some form of restructuring of local smoking cessation services. One in five described a shift to an integrated approach, in which smoking cessation is delivered as part of a wider lifestyle package, including, for example, measures to tackle obesity and reduce the harm of alcohol. This has meant the loss of important specialist support.

The changes taking place within services raise questions about their efficacy and outcomes. In particular, the shift to integrated services or lifestyle choices has limited support from the evidence base. An authoritative Cochrane review did not find a significant effect in reducing smoking from those interventions. Will the Minister tell us what steps the Government will take to ensure that smokers continue to have universal access to stop smoking services that meet NICE standards and are free at the point of delivery?

Given the pressure on local budgets, and reductions to funding for local authorities, it is crucial that the NHS picks up the baton and does more to support reductions in smoking prevalence. Not only will this support local authorities, but it is essential for the viability of the NHS and the long-term impact that taking no action against smoking would have.

The NHS five-year forward view rightly states:

“The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

The forward view also notes that this has long been a policy objective, stating:

“Twelve years ago, Derek Wanless’ health review warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. That warning has not been heeded—and the NHS is on the hook for the consequences.”

It is important to note that even after additional Government funding of the NHS, there is still an estimated potential shortfall of £22 billion by 2020. That is likely to be closed through some efficiency savings, but there will still be a funding gap, which will have to be met through reductions in services, longer waits for treatment or reductions in demand for NHS services. Clearly, the latter possibility requires a much more sustained effort to improve public health and to tackle the major causes of illnesses, particularly smoking, but we have seen a reduction in NHS activity to tackle smoking over the last few years.

The number of GPs recommending that smokers quit and directing them to further support has declined markedly. In addition, services to support people to quit smoking in secondary care—already far from universal—are also under threat. For example, the reductions in specialist stop smoking services in Manchester have resulted in the end of funding for smoking cessation services at the city’s world famous cancer hospital, the Christie. The service will now only continue through charitable funding made available by the hospital.

Smoking places a significant burden on the NHS. Getting smokers to quit can prevent diseases from developing but there is also great value in supporting smokers who are already sick to quit. Many diseases are improved if a person quits. For conditions such as cardiovascular disease, smoking can be a major risk factor in further illness or exacerbation. For people who have developed cancers, including lung cancer, quitting improves the effectiveness of treatments, the likelihood of successfully treating the cancer and five-year survival rates. Even when smokers have an illness that is not related to smoking, quitting can improve the outcome of their treatments. Those who have quit have much better surgical outcomes and reduced recovery times in hospital.

About 1,260 hospital admissions a day in England are due to smoking—amounting to one in 20 of all admissions. It is estimated that smoking costs the NHS in England around £2 billion a year. In the local authority where my constituency sits, the NHS spends about £6 million on treating smoking-related diseases every year. Reducing the number of people who smoke delivers immediate as well as long-term savings to the NHS. Evidence suggests that if we could increase the rate at which smoking is declining by an additional further 0.5 percentage points a year above the current rate of decline—0.66 percentage points—the NHS could save at least £117 million a year by 2020. That estimate does not include the contribution that reducing smoking makes to conditions that are made worse, but are not caused by smoking, such as diabetes.

In short, helping patients to quit smoking should be a core part of NHS business as a means to save lives, reduce costs and improve outcomes. What steps are the Government taking to ensure that the NHS does more to help smokers to quit in line with the implementation of the five-year forward view? To ensure that the radical upgrade in prevention and public health called for in the NHS five-year forward view is achieved, our tobacco control strategy needs to be properly funded. We know that tobacco remains the primary cause of preventable and premature death in this country. Despite that, we have already seen mixed services cut, and the impact of such disinvestment is only beginning to be seen. If we are to continue driving down smoking rates and ensuring that people do not die early from smoking having suffered years of disability, we need an ambitious and comprehensive strategy and to ensure that such a strategy is properly and sustainably funded.

We have already heard that public health and stop smoking services budgets are declining. We must conclude that that effect is likely to continue and is likely to be long term. There is clear evidence that reductions in public spending on tobacco control, together with less emphasis on new policies and on enforcement of existing policies, is likely to slow, halt or even reverse the long-term reduction in smoking prevalence rates. In New York, for example, sustained investment from 2002 led to a decline in smoking rates until 2010, when the decline ceased following funding reductions. Investment was reinstated in 2014, and the rates of smoking cessation began to improve again.

An early indicator of the effect of both national and local spending reductions on tobacco control is given by the smoking toolkit produced by Professor Robert West of University College London. The results for 2015 show a small increase in smoking prevalence over 2014, a fall in the proportion of smokers who made an attempt to quit—from 37.3% in 2014 to 32.4% in 2015—and a lower success rate for quit attempts, from 19.1% in 2014 to only 17% this year.

Clearly, the tobacco industry needs to fund the control of tobacco. As we have heard, the gains we have made run the risk of being reversed, so funding for tobacco control is a good investment by the Government. In advance of the spending review, the all-party group that I chair published a proposal to fund tobacco control with an extra £100 million a year to reduce smoking, combined with a 5% tax escalator on tobacco, which could deliver more than £11 for every £1 invested in the NHS. As we have already heard, spending on tobacco control is extremely cost-effective, but national and local resources for tobacco control and stop smoking services are far from secure, so the Government need to find an alternative, sustainable source of funding.

The report published earlier this year, “Smoking Still Kills”, was endorsed by more than 129 public health organisations and recommended the introduction of a new annual levy on tobacco companies to help fund evidence-based tobacco control and stop smoking services in England. In the United States, the principle of charging the industry for the specific costs imposed on the public purse is well established. In the US, the costs of the levy are apportioned to tobacco companies according to their market share in the country. That concept has received broad-based support in Congress because it is understood to be a charge related to a specific cost, rather than general taxation.

The Chancellor said in 2014:

“Smoking imposes costs on society, and the government believes it is therefore fair to ask the tobacco industry to make a greater contribution.”

His decision not to proceed with a levy on the industry in the 2015 Budget was disappointing. Rather, in the 2015 autumn statement, he suggested that future funding for local public health delivery could be met by returning business rates to local authorities. However, one of the primary purposes of public health interventions is to improve ill health and address inequalities. There is a fundamental flaw in his proposal because richer areas, which have higher business rates, have lower rates of smoking than poorer areas with lower yields from business rates.

Applying that principle, the Local Government Chroniclehas highlighted that there will be clear winners and losers from returning the national share of business rates to local authorities. The five areas outside London that are the biggest winners from the proposal have an average smoking rate of 16%, whereas the five biggest losers have an average smoking rate of 20%. In Harrow, 138% of the national share of business rates would need to be returned to the council in order for it not to lose out if the revenue support grant is ended and the council instead has to rely on business rates. If that were to happen, Harrow would be the 35th worst-off authority in the country, out of 125 unitary authorities.

I have two more questions for the Minister. How will the Government ensure that tobacco control is properly funded locally and nationally so that prevalence rates continue to fall, with consequent benefits for the NHS and public health? Equally, what analysis have the Government undertaken to determine that using business rates to fund local public health activity will not further reinforce existing inequalities?

Despite being a lethal drug, tobacco products can be sold by anyone in England almost anywhere—a licence is not required. The sale of tobacco used to require a licence, and signs above pubs and shops from that period still state that they are licensed to sell tobacco and alcohol. Local authorities in England have powers to shut down a tobacco retailer, if necessary. However, that requires the local authority to take legal action against the retailer, which is both time consuming and resource intensive. What is more, reductions in local authority budgets are affecting the work of trading standards departments across the country, which could damage enforcement work on illicit tobacco in future years.

In 2013-14, there were only 34 convictions in England for selling tobacco products to young people, and there were no restricted premises or sales orders, yet 44% of young people who smoked said that they obtained tobacco directly from shops. We were pleased to hear in the autumn statement that, as part of the obligations under the illicit trade protocol, the Government will consult on the introduction of a licensing scheme for tobacco machinery and the possibility of licensing tobacco vendors. Licensing retailers is an important step that was recommended by ASH in the “Smoking Still Kills” report and endorsed by more than 120 public health-related organisations, and it would enable the Government and local authorities to promote higher standards in the retail market and clamp down further on illicit sales. Such a system would also protect legitimate retailers and simplify the action that local enforcement officers can take against those selling illicit tobacco both within and outside the retail setting.

I congratulate the Minister on the Government’s success throughout the last tobacco control plan in taking major steps to drive down smoking rates. Successes have been lauded, not just in the UK but internationally, but the plan has come to an end. We need to build on the achievements that have already been made by implementing another ambitious and comprehensive strategy. We have heard that, in recent months, some local services have been cut and that others are likely to follow. We have also heard about the impact of similar cuts in places such as New York. With that in mind, I urge the Government to think about how the strategy will be not only implemented but sustainably funded to ensure that the UK remains a world leader in tobacco control.

We should be ambitious in our outlook and look forward to a tobacco-free Britain much earlier than 2035 to enable our young people to live much longer and much healthier lives and to encourage people who have unfortunately become addicted to this lethal product to quit smoking much earlier so that they can improve not only their life expectancy but their quality of life.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health) 2:29 pm, 17th December 2015

Bob Blackman gave us a comprehensive summary of the situation, so I will bring us back to a few key points that we need to think about. What are the issues? They are not just the obvious things that people care about, or see mentioned in adverts, such as lung cancer; there is hardly a part of the body that is not affected by smoking. There are many problems that people are not aware of, such as stomach ulcers and bladder cancer. There are also the obvious ones, such as strokes, heart attacks, peripheral vascular disease and dementia—14% of Alzheimer’s is caused by smoking. Amputation is commonly due to peripheral vascular disease. Those are things that put people in a dependent situation and often result in them being in care homes. Not only does that have a direct cost for the NHS, but huge costs in our care world will become an increasing burden.

We have had quite a lot of success, but as was mentioned, 18.7% of people in England smoke. Unfortunately, while there has been a considerable drop in Scotland, the figure there is 20%. We started with the worst heart attack rates, and we still have 10,000 people in Scotland dying from heart disease every year. That number is almost equivalent to the population of Troon, where I live. That is a considerable number of lives lost every year. In England, the figure is 100,000. In addition to the question of the number of people who die, there is the painful journey to dying, and the amount of debilitation and suffering for the person and their family.

We have had success: in March 2006, Scotland was the first United Kingdom country to go for the smoking ban, so next year’s 10-year anniversary is approaching. I expect that there will be a re-evaluation of the ban’s success. We had a 17% drop in admissions for heart attack in the first year. That is a bigger effect than anyone expected. We saw an 18% drop in admissions for acute childhood asthma. Myocardial infarctions had been dropping slowly by 3% a year in the previous decade, but the rate accelerated to 17%. Childhood asthma admissions had been increasing by 5% a year until the smoking ban; there has been a 40% drop in smoking exposure for 11-year-olds. And so it goes on. We saw a much bigger impact in the first year than we could have hoped for. There has been success, and that has been UK-wide. It has all been done separately, but we were very much moving in the same direction.

We think of the debates that we have had here with the Minister with responsibility for public health on other issues, such as obesity. The whole public health agenda involves us taking radical action. It is interesting to hear about the earlier debates on banning sponsorship and banning smoking in public places, and how hard those things were to do, but look at what we and the NHS have recouped from that. We need to look at that going forward.

The impact of the cuts and changes to Public Health England has been covered in great detail. It is right that a lot of public health measures are integrated in local authorities, because they can bring about a more people-centred approach to such things as active transport, and the control of how tobacco is sold and how things are sold near schools. This is about looking at the whole person, because public health cannot always just be campaigns looking at one bit at a time. We need to challenge our whole lifestyle, and local authorities are in the best position to do that.

Unfortunately, Public Health England faced a significant cut of more than 6%, or £200 million, and it has been earmarked for significant ongoing cuts. That is a real problem. We have heard about the cuts to smoking cessation, including Manchester stopping all specialist services, and it being on a charitable or basically ad hoc basis in other places, and that just is not good enough. We need to think about how we go forward, and the lives being lost, the suffering being caused and the burden on the NHS.

In the five-year forward view, a shortfall of £30 billion was identified. Some £22 billion of that is expected to be found by the NHS. When Simon Stevens was in front of the Health Committee, on which I sit, he identified that the NHS was expecting about £5 billion to be saved through prevention, but at exactly the same time, we are talking about cutting public health funding. If that prevention does not come about, that £5 billion saving will not happen and the NHS will hit a brick wall. It is important that we look at all that local authorities do, including to prevent tobacco being sold to under-age people, and to prevent the smuggling of cigarettes and the selling of illicit cigarettes—the whole environment that people are facing.

The hon. Member for Harrow East mentioned the experience in New York, and the stalling of the drop there. That is already being seen here, with the slight increase in the prevalence of smokers, the decrease in quit attempts and the decrease in success. One of the biggest successes is an almost halving of young smokers starting. While the main drive of smoking cessation is helping people to stop, it is important that we do not create future generations who are in the same boat as ours. If we had listened to Wanless 12 years ago and got serious about public health then, we would be in a better place. He said that there would be a sudden surge of preventable and multimorbid diseases hitting the NHS, and that is exactly what we are living through.

It is timely that the debate in the Chamber is about the 1,001 critical days of pregnancy and the first two years of life. We need to invest in our children to try to have healthier, more successful generations in the future. We see odd patterns, such as the connection between smoking and people who end up in prison, and between smoking and those who have mental health problems. There has not been enough research to enable us to say that that is causal, but the fact that mental health patients smoke one third of all tobacco consumed does prompt the question: which one is the chicken, and which the egg? We need to think about our future generations; we need to ensure that pregnant women stop smoking—and do not start again as soon as the child is there, thereby exposing those young children to cigarette smoke. A lot of work has been done on smoking in cars. There has been a big campaign in our neck of the woods to try to get people to go outside the home and not smoke in the presence of children.

We have had a huge amount of success on this issue, due to the work of successive Governments who have ploughed forward, but we cannot afford to take our foot off the gas. We owe it to adults, to those who are approaching the age at which they might take up smoking, to the young, and to those not yet born to aspire to a future generation that is not burdened with the crippling diseases related to smoking. I saw this as a breast surgeon. People ask, “Why do people from deprived areas have poor success from cancer treatment?” Quite simply, I would meet someone aged 70 with breast cancer who had begun to collect morbid diseases from the age of 50. I could see straight away that they would not survive chemotherapy, and might not survive surgery. Treatment for a disease that is not related to smoking is therefore completely inhibited by their underlying disease. Smoking affects every part of people’s bodies. It affects the NHS and our society. We need to ensure that the smoking control policy we have at the moment is quickly replaced by one that is just as determined.

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health) 2:37 pm, 17th December 2015

It is a pleasure to serve under your chairmanship, Mr Betts. I begin by thanking the Backbench Business Committee for granting the debate, and I take the opportunity to wish all hon. and right hon. Members, the Clerks and everyone else sitting in this room a very merry Christmas.

Clearly, it is always a pleasure to follow Dr Whitford, because she speaks about these issues with such passion and a great deal of knowledge. She adds greatly to our debates. The need for a strategy and for funding to make it happen is pressing, and I am glad we have had the chance to discuss it today. I thank my right hon. Friend Kevin Barron. His interest in the issue is, as we are all fully aware, not just passing; he has been championing the issue for a great number of years, and I commend him and Bob Blackman on the work that they have done on it through the all-party group.

I start with the problems with the autumn statement—an issue raised by all Members who have contributed so far. It is clear that the autumn statement brought yet more cuts to the public health grant. As a result of year after year of cuts to public health budgets, there has been a consistent fall in the number of people using local smoking cessation services. It is not the kind of thing that can be done half-heartedly. We can throw a little cash at the problem and suggest we are tackling it, but if we spend too little, the returns will be minimal. We may as well spend a sufficient amount and enjoy much greater returns on the investment in public money. We all know that a smoker may throw themselves into an attempt to stop—usually in the new year period, following a new year’s resolution—but if the support is not there, many of them might fail in their attempts. Even worse, after a failed attempt with insufficient support, they are unlikely to try again; that is just human nature. It is worth getting it right the first time round, and giving people the support that they need. That is why some of the cuts to the public health budget have been short-sighted and are the falsest of false economies.

I fear that most smoking cessation services will not survive a 24% cut to the non-NHS part of the Department of Health’s budget. I want public health bodies to be able to push to make children born today the very first smoke-free generation, but I am worried that their ability to do so will be damaged by the reduction in funds.

Let us consider just one aspect of the cost of smoking that may be overlooked. The general health implications of smoking are well known and documented, but mouth cancer often gets overlooked. Oral cancer kills more people in the United Kingdom than cervical and testicular cancers combined, yet there is still an alarming lack of public awareness about oral cancer. Nine out of 10 oral cancer cases are preventable, and two thirds of cases are a direct result of smoking, so improved awareness of all the possible health problems caused by smoking is one role of local public health services. Awareness as a concept can often be dismissed, but when it comes to deterring people from using tobacco products, it is invaluable, yet such services will be slashed in the upcoming public health bonfire. I call on the Government and the Minister, for whom I have a great deal of respect, to think again and try to reverse some of the cuts to public health services.

I welcome the introduction of standardised packaging for cigarette packets by May next year. There are powerful arguments in favour of it, and I am pleased that the

Minister pushed ahead with the policy, with cross-party support, albeit that there were a few recalcitrant members of Government, and even louder voices against on the Back Benches. Nevertheless, we got that through, and I commend her on the work she did in pushing for that.

This month marks the third birthday of plain packaging. Australia’s Tobacco Plain Packaging Act 2011 came into force on 1 December 2012, which made it the first country to halt the use of figurative trademarks on tobacco products. In the past few months, both France and Canada have taken significant steps forward in introducing a similar ban. France should be introducing a ban in May, at the same time as our standardised packaging laws come into force.

The importance of removing legitimacy from such activities cannot be overstated. Take the example of the ban on smoking in cars, championed by my predecessor as shadow Public Health Minister, my hon. Friend Luciana Berger. The purpose is obviously not to punish every single driver smoking in a car with children; that would be impossible to enforce. The real purpose is to send a very strong message that it is not acceptable to smoke in cars with children, and that it is punishable by law. A similar example is the ban on driving without a seatbelt. There are not many convictions, but the number of people using seatbelts soared after the ban was introduced. Our approach must include encouragement as well as enforcement.

I come on to my main point. The previous tobacco strategy was, on the whole, a success. It has encouraged the introduction of measures such as standardised packaging, which are to be welcomed, but I am concerned that a new strategy has not been developed yet. I welcome the Government’s commitment to establishing a new strategy in the new year, but I have concerns about their ability to implement it fully and comprehensively.

In October last year, the five-year forward view noted that

“The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

As the hon. Member for Central Ayrshire said, Simon Stevens has gone on record to say that as part of the efficiencies that the NHS is looking to implement, £5 billion will come from prevention, but how can we achieve £5 billion in prevention when preventive services are being cut back—or, in some cases, removed altogether? I hope the Minister can give Members of all parties, who want the same outcomes, assurances that cessation and other public health services at a local level will not see the axe fall on them in the way it is suggested they might, and that the £5 billion of efficiencies that Simon Stevens has identified as coming from prevention are achievable through the role and remit of the Minister with responsibility for public health.

I will return to the point that I opened with. A person is four times as likely to quit smoking successfully with the help of specialist support, but those services are under attack. In the autumn statement, the Chancellor announced further cuts in the public health grant, amounting to an average real-terms cut of 3.9% each year to 2020-21. That translates to a further cash reduction of 9.6%, in addition to the £200 million-worth of cuts announced in the summer budget.

Meanwhile, tobacco, as we have heard from other Members, is still the single biggest cause of premature and preventable death, responsible for 100,000 deaths every year in the UK. Some 10 million adults still smoke. More than 200,000 children aged 11 to 15 begin smoking every year. This is an income inequality issue, too. In 2014, 12% of adults in managerial and professional occupations smoked, compared with 28% in routine and manual occupations. People with mental health conditions, prisoners and the homeless are far more likely to smoke than the general population. In my constituency, smoking rates are still far too high and well above the national average. In Tameside, where smoking is prevalent—a quarter of the population smokes—450 deaths a year and 2,500 hospital admissions are attributable to smoking. I know how much this contributes to poor health, which places a huge pressure on health and care services locally, and causes untold misery for the communities and the families of those affected.

I want to touch briefly on the point made by my right hon. Friend the Member for Rother Valley about e-cigarettes, because I have seen them work for people who have smoked for a very long time. The e-cigarette not only helped to wean them off tobacco, but, by reducing nicotine levels over a long time, removed the need for nicotine and got them off cigarettes altogether. I implore the Minister to ensure that any regulations she introduces are proportionate, as my right hon. Friend said.

I ask the Minister to keep a watching brief, though, because I am a little concerned. I am starting to see in my constituency the glamorising and normalising of smoking among young people through the use of e-cigarettes. I fully support them as a product to help people come off smoking, but as a gateway product to smoking, they worry me considerably. I accept that there is probably nothing more than anecdotal evidence at this stage, which is why I urge the Minister to keep a watching brief, but having seen the marketing of some e-cigarette products, I am concerned that it uses precisely the same marketing tactics as we saw used by tobacco companies, which brought about the introduction of the regulations on standardised packaging. Let us make sure that e-cigarettes are used for their correct purpose: to bring people off smoking. If there is evidence that they are starting to become a gateway product to smoking, I hope very much that the Minister will look again at whether action is required.

Health inequality is one of my biggest bugbears, and smoking is one of its most virulent causes. A comprehensive strategy to reduce smoking rates is imperative if we are to tackle the issue. The Opposition will support the Minister with responsibility for public health and the Government in developing such a strategy, building on the achievement of both her Government and the previous Labour Government over a number of years. I hope that she can give some assurances on the issues that Members have raised, and some Christmas cheer to Members looking for a renewed strategy on this very important issue.

Photo of Jane Ellison Jane Ellison The Parliamentary Under-Secretary of State for Health 2:52 pm, 17th December 2015

It is a pleasure to serve under your chairmanship, Mr Betts. What an excellent and extremely well informed debate we have had. I thank Kevin Barron for raising this important issue for debate. In a way, the timing is more helpful for me than for right hon. and hon. Members, inasmuch as this is a piece of work to which we in the Department of Health are turning our minds, so it has been enormously helpful to hear the views of colleagues from across the House on how we go forward. There are some areas of the topic on which I can respond, but some on which Members might have to wait until a little way into the new year.

The Government have a very clear position on tobacco control, recognising that smoking is and remains one of the most significant challenges for public health, with all the devastating social and personal consequences that Members have outlined. The Government have been proactive and, I think, ambitious in their approach to tobacco control. That was reflected in the comments made by both Government and Opposition Members, for which I thank them. It is also reflected by the fact that many other countries approach us for advice on tobacco control matters. Over the time I have been in this post, it has been a pleasure to attend a number of international events at which we were asked to provide a leadership role. I will say a little more about international matters before I finish.

Our efforts are paying off, and have paid off. As the shadow Minister said, they build on the good work done by previous Governments in previous Parliaments, and we continue to see year on year reductions in smoking. Since 2010, its prevalence has decreased by almost 3%, saving thousands of lives and, of course, countless families from the pain and harm caused by smoking. At various events in the past I have been open about discussing my experience of that harm in my own family. I know that I speak for other Members who have seen that as well.

Before I talk about the new strategy, it is worth reflecting on progress against the current tobacco control plan. We have met, or are on track to meet, the three national ambitions. Adult smoking prevalence is now at 18%, which is the lowest rate since records began; only 8% of 15-year-olds smoke, which is also an all-time low; and rates of smoking in pregnancy are falling, with the most recent figures showing a rate of 10.5%, so we have a high degree of confidence that we will meet that national target as well. On 1 October, it became an offence to smoke in a car carrying children and for adults to buy tobacco for those aged under 18. Making the latter—also known as proxy purchasing—an offence has been called for a great deal in the past. As has been noted, we have also passed legislation to introduce standardised packaging and consulted on how we intend to transpose the revised EU tobacco products directive into UK law.

Despite those achievements, smoking is still the leading cause of premature death and health inequality, and Members have rightly focused on that throughout the debate. About 8 million people still smoke, and the resulting number of premature deaths has been recorded. There continues to be enormous regional variation, which weighs heavily on me—I know that the right hon. Member for Rother Valley is very conscious of that as well. In some areas the prevalence rate is as high as 29%. With that backdrop, we can by no means think that the battle is won.

There is similar variation in ill health and death rates associated with smoking, as Dr Whitford eloquently outlined. That variation means that there can be 472 deaths per 100,000 people in one area and fewer than 200 deaths in the same population in others. Throughout the country, we see variation in rates of smoking by pregnant women from more than 25% to about 2%. I know that some areas are working really hard to address that variation. I pay tribute to the people working in places that, despite the high rates that they battle, have seen encouraging results, such as the public health and NHS teams in Blackpool. They are bearing down on their high rates with some success and have done very well.

While we are discussing the ill health caused by smoking, perhaps this is a useful moment to give the shadow Minister a little reassurance in two regards. He made a good point about oral cancer, and I can confirm that one of the pictures in the new library of photographs being introduced with the tobacco products directive will feature throat cancer, so that will draw attention to it. Also, we received welcome information today from the British Dental Association setting out how dentists can help with smoking reduction and the identification of oral cancer. We will consider that further as we develop the strategy. That is welcome and timely news.

As we are talking about the work that people have done in different areas, such as the efforts to bear down on smoking in pregnancy, which have seen some welcome drops, I want to mention the role of health professionals. Their role has run as a thread through the debate, and I suppose it will be ever more relevant as some services look to integrate more with health professionals in the NHS and elsewhere. The movement of health visiting into local government in October—it is now commissioned through local government, as are public health services—offers a welcome opportunity to get some really close working between those two functions in local government right across the board.

As we look at the new tobacco strategy, we are working with Health Education England to identify how NHS health professionals can be further supported to act on smoking. Nevertheless, progress has been made, and I congratulate the midwives and health visitors who have done such good work to identify women who smoke during pregnancy. We have seen their work reflected in the ongoing reductions in the level of smoking during pregnancy, but there is more to do, so we are looking to build on that success.

As I have said, the Government remain committed to tobacco control, and our goal is to drive down the prevalence of smoking in England. At this point, I should say that we are working very closely and constructively with colleagues in the devolved Administrations on that shared objective. Our officials speak to each other regularly, and we are always interested to look at what measures are introduced. As always, it was good to hear the contribution from the hon. Member for Central Ayrshire. Tobacco-related deaths are avoidable, so we want to do more to avoid them.

Although I have said this in an event in the Palace of Westminster, I have not yet confirmed it in the Chamber, but I can confirm that the Government will publish a new tobacco control strategy for England next summer, which I think is a sensible timetable. I hope Members agree that, given the significant measures coming into force in the spring and the fact that we want a little time to reflect on the current strategy, that strikes the right balance. The work is under way already, which is why this debate is a timely opportunity to hear Members’ thoughts. I will ensure, throughout the timetable for developing and producing a new strategy, that there are ample opportunities for Members on both sides of the House to contribute to the strategy development. Important stakeholders, such as those who contributed through Members’ speeches today and supplied useful briefing materials ahead of the debate, will have important and regular opportunities to influence the strategy and have input into it.

In developing the strategy, we will review the current national ambitions, and we will further empower local areas and support action within them, particularly where tobacco control strategies can be tailored to the unique needs of local populations. We cannot ignore the stark differences in the results of different areas across our country, so the new strategy has to focus on those discrepancies. Robust activity at that level is vital if we are to tackle the impact of health inequalities in England and ensure that smoking prevalence continues to decline in all communities. We will, of course, need to support local authorities in pursuing collaborative partnerships and securing a high return on investment as they prioritise and streamline their budgets.

A number of questions were asked about funding, and we will give careful attention to it. I am not in a position to comment in detail on the funding of the strategy itself, about which hon. Members made a number of points and expressed concerns. It was made clear in the spending review that the public health budgets are to be ring-fenced for the next couple of years and protected, with conditions stipulating that the whole budget must be spent on public health duties.

If any right hon. or hon. Members are concerned about what is happening in a particular area, I ask them to please speak to me. The chief executive of Public Health England remains the accounting officer for how the ring-fenced public health grant is spent, and I am always extremely happy to ask him to speak to Members about their concerns about what is happening in their own areas. Manchester was mentioned specifically. I can confirm that we are aware of Manchester City Council’s decision, and Public Health England is currently working with it to identify how it can provide cost-effective support to local people who want to stop smoking. The new control strategy has not been finalised, so we cannot commit to the level of funding that will be needed, but Members have made their views on that extremely clear.

I gently say to my hon. Friend Bob Blackman in particular that we have championed the way in which, over the past five years, local government has done extremely well in providing excellent services for less cost. It has focused far more on outcomes than on the money spent. It is relevant to bear that in mind, given that Members have expressed reasonable concerns about the local government spending landscape.

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

I entirely accept that there are regional variations. We must all accept that, but the mass media—the news and the national media—cut across all regions. Will an evidence-based mass media campaign be part of the strategy that will be published in the summer?

Photo of Jane Ellison Jane Ellison The Parliamentary Under-Secretary of State for Health

I can give the right hon. Gentleman a broader assurance than that. Our approach to the subject has at all times been evidence-led, so the new tobacco strategy will clearly encompass a range of evidence-led activities. I hope that reassures him more broadly than just on that point. We must at all times be led by the evidence, as those who contributed today highlighted.

The new strategy is an opportunity to shine a spotlight on what local councils are doing locally, and to learn from innovative work. We cannot stand still in that regard. We must be open to evolving the way we do things, and that is already happening. The new devolution deals are an opportunity to focus on the exciting new ways in which local areas are reimagining the way they do things, and we have seen councils of all colours doing that. We must be optimistic in that regard and pay tribute to the innovation of local government across a range of areas. I have seen that in a host of different public health areas in the two-plus years that I have been doing this job.

But the picture in some communities and areas is not positive. Smoking rates vary across social groups—those from poorer communities and backgrounds experience higher tobacco use and much greater health burdens, as the right hon. Member for Rother Valley and others said in their speeches. Although Norman Lamb has left, I want to put it on the record—I am sure he will follow this up after the debate—that a particular focus of the new strategy will be on reducing health inequalities and their impact on people who suffer from a mental health condition. We are conscious of the great differences in smoking rates, so that will be a focus of what we do. A quarter of cigarettes are smoked by people with mental health conditions, so I can confirm that that group will be a key priority for the new strategy. We seek to embed the importance of tackling health inequalities both in the new strategy and locally, to cement the national gains that we have made.

We have introduced a significant tranche of legislation, some of which is still to come into force, so we are unlikely to commit in the strategy to a package of legislative interventions. I think colleagues appreciate the reasons for that. Rather, we will set out what we must do to identify and develop new and more effective measures for reducing smoking and smoking harm.

It might be useful to update the House on prisons, which hon. Members mentioned. We are conscious of the great differences in the rates for prisoners and non-prisoners. The Ministry of Justice has announced a programme to make prisons smoke-free, which will be implemented in stages, and prisoners will be given support to stop smoking. Public Health England continues to improve the support that it offers to prisoners who quit in prison to stay smoke-free when they leave.

Of course, tobacco control is not a matter just for legislation or for the Department for Health. There are a range of measures that can choke off the supply of new smokers and help those already addicted to quit. We will work with Her Majesty’s Treasury on tax, as

Members would expect; with Her Majesty’s Revenue and Customs on the illicit trade; with local authorities, as I have already said; and, of course, with the NHS on smoking cessation services. I am conscious, as we look at the preventive landscape, that there has rightly been a focus on the five-year forward view. I am looking at several strands of that key piece of work, and this strategy is part of it. Our colleagues in trading standards, who do so much great work on enforcement, are also part of the solution. We will work with academia, the Royal Colleges and the wider tobacco control community to look at what works and how the Government can play their part.

Next year, in addition to publishing the new tobacco control strategy, we will introduce the stricter packaging requirements, and the revised EU tobacco products directive will come into force. The directive sets out harmonised rules on the composition and labelling of tobacco products that will apply from May 2016, and it will strengthen the functioning of the EU internal market. We look forward to its helping to improve public health. Examples of the impact of the directive are that the minimum pack size for cigarettes will increase to 20, and all flavours, including menthol, will be banned by 2020.

I will come to e-cigarettes in a moment, as I want to respond to the right hon. Member for Rother Valley and others and hopefully give them some helpful updates. First, on the international element, which was rightly raised, I can confirm that the UK has a significant role to play. The UK Government have signed the framework convention on tobacco control, and are now working in the UK and with the Commission to ensure that everything is in place to ratify that protocol. That is something we are committed to doing. The Department for Health has been awarded an overseas development assistance fund to assist other countries with developing their tobacco control policies. That funding will be used to protect people from the harms of tobacco internationally and to tackle the problem of health inequalities globally. A dedicated team will be established to deliver that work. I look forward to updating the House on that in due course.

I turn to e-cigarettes. Of course, the best thing a smoker can do for their health is to quit smoking, and to quit for good. There are now more than 1 million ex-smokers who have used e-cigarettes to help them to quit smoking completely. The evidence indicates that e-cigarettes are significantly less harmful to health than smoking tobacco. I thank Public Health England for the important piece of work it provided to advise us in the summer.

However, the quality of products on the market remains variable. It is therefore important that we have regulation that is proportionate—that is exactly the right word, and I echo that view—to ensure that we have minimum safety requirements and that the information provided to consumers allows them to make informed choices. That is exactly the aim of the regulatory framework set out in the revised directive.

In implementing the new EU rules, we intend to work towards regulation that will permit a range of products, which people want to use, to remain on the market, but with those products positioned as alternatives to smoking, not as products that introduce children to vaping or smoking.

I join the right hon. Member for Rother Valley in welcoming the arrival of licensed products that can be prescribed alongside existing nicotine replacement therapies. The Government had full support from both sides of the House when we took through precautionary legislative measures on the issue of children and e-cigarettes; indeed, most parts of the industry welcomed and supported the uncontentious approach of adopting the precautionary principle with regard to children.

We will continue to take a pragmatic approach to e-cigarettes, and we will be guided by the evidence. The right hon. Gentleman was right that, in a fast-evolving marketplace, we must be guided by the evidence. To that end, we have commissioned a comprehensive review of the impact of e-cigarettes to ensure that future policy decisions continue to be supported by a robust and published evidence base. That will build on the PHE review of evidence on e-cigarettes, which was published in August.

It might be helpful if I update right hon. and hon. Members on some relevant research projects. The National Institute for Health Research is funding a randomised controlled trial to examine the efficacy of e-cigarettes, compared with that of nicotine replacement therapy, when they are used in the UK stop smoking service. I spoke earlier of the evolving world of smoking cessation services and of understanding what works, and that will be an important piece of research. The report of the trial is expected to be published in 2018.

The Department—I hope this speaks to the watching brief that the shadow Minister asked that we keep—is commissioning work through the Public Health Research Consortium to identify whether there are any early signals of e-cigarettes having the potential to renormalise use of tobacco products. That work is expected to report in summer 2016. Again, we will look to update the House when we have the results—I know there will be interest in them on both sides.

I congratulate the right hon. Gentleman on securing a debate on this important issue. As I said, it comes at a really timely moment. When I come back in the new year, I and my officials will certainly turn considerable attention to this important strategy. As I hope I have made clear, none of us can rest on our laurels. We have made some good progress, but the Government will continue to develop support and new measures to reduce the prevalence of smoking further and faster in England. We will, I hope, continue to work constructively with colleagues in the devolved Administrations, with the objective of preventing more people—more of our constituents—from dying prematurely as a result of smoking.

I am acutely conscious of the fact that the burden of disease and harm associated with smoking falls most heavily on the most disadvantaged. Addressing that will be right at the heart of our new strategy. Like all those who have contributed to this excellent debate, I look forward to our first smoke-free generation.

In closing, I echo the words of the shadow Public Health Minister. I wish colleagues and the staff of the House a very happy Christmas, and I thank all those who have contributed to this excellent debate.

Photo of Kevin Barron Kevin Barron Chair, Committee on Standards, Chair, Committee on Privileges 3:13 pm, 17th December 2015

May I also echo those comments? I wish everybody a happy Christmas and a peaceful new year as well.

The debate shows just how far the House, as a legislative body, has travelled over the past two decades, taking on these major issues on the basis of their effect on people, as opposed to their potential effect on political parties. That is greatly to the House’s credit, and I thank everybody who has spoken this afternoon.

I thank the Minister for leaving the door open in terms of what will be in the strategy next summer. Things may come forward that test us—such as what happens in the e-cigarette market and how we deal with that—and I am sure we will watch the issue with great interest. I thank everybody who has contributed.

Photo of Clive Betts Clive Betts Chair, Housing, Communities and Local Government Committee

May I also take this opportunity to wish everyone here a very happy Christmas? I look forward to seeing you all again in the new year.

Question put and agreed to.

Resolved,

That this House has considered a new tobacco control strategy.

Sitting adjourned.