I beg to move,
That this House
has considered the tobacco control plan.
It is a pleasure to serve under you chairmanship, Mr Brady. I am grateful to the Backbench Business Committee for granting us the opportunity to debate this issue in the depth and detail required. The subject has an impact on all of us, and it is right that time is allocated for a meaningful and thorough debate. I am also grateful to my colleagues from across the House who helped to secure the debate and who will, I am sure, make some incisive and insightful contributions.
I am pleased to have been part of the team that has consistently advocated tobacco control, and I am proud of the achievements we have made. The great thing about those achievements is that they have been built on strong cross-party commitment in both Chambers, with the devoted support and drive of external organisations and charities across the country that are determined to keep the harm caused by tobacco very much in the minds of the public and, of course, Ministers. Those organisations have succeeded.
A recent Action on Smoking and Health survey of more than 12,000 people found overwhelming public support for Government action to limit smoking and strong support for the Government to go further and do more. That is no surprise, really, as tobacco control is an area where Government action is highly effective.
Let me start with a parochial statistic. Back in Stockton, 250 miles up the road, smoking prevalence was estimated at 27.5%—more than one in four people—as recently as a decade ago. However, by last year various policies and interventions had seen that figure fall to 18.4%, which is a decrease of about a third. That means that some 14,000 fewer adults in Stockton now smoke than in 2005. I, for one, am very proud of that achievement.
I speak not only as a member of the all-party parliamentary group on smoking and health, the secretariat for which is provided by ASH, but as an MP who, as a humble Back Bencher, successfully pressed for the legal changes around smoking in cars when young children are present, with the support of groups including the British Lung Foundation, Cancer Research UK and the British Heart Foundation. That is on top of the principled and unwavering support I have received from north-east organisation Fresh, which covers my patch in Stockton North and whose joint conference on the harms of tobacco and alcohol I was pleased to address just a fortnight ago.
The dedication to improving public health and promoting tobacco control runs deep not only in my own psyche but in that of colleagues across the House. Back in 1998, the Labour Government introduced the country’s first comprehensive tobacco control strategy. Legislation has moved on since then to prohibit tobacco advertising, smoking in public places and smoking in cars carrying children, and to implement controls on point-of-sale displays. I welcomed all those measures, but I am only too aware that there is much more to be done.
The most recent measure was the introduction of standardised tobacco packaging, which I repeatedly called for and supported. Although the original form of the Children and Families Act 2014 contained no measures at all to protect children from the dangers of smoking or to avert uptake, the amendment on standardised packaging tabled in the House of Lords by Baronesses Finlay and Tyler and Lords Faulkner and McColl was swiftly taken up by the Government and brought to fruition.
In the spirit of debating the issues and the evidence base rather than the politics of any decision, I thank the previous public health Minister and current Financial Secretary to the Treasury, Jane Ellison, for her consistent support for tobacco control and, in particular, standardised packaging. That was duly recognised by her receipt of the prestigious World Health Organisation director general’s special award to mark World No Tobacco Day earlier this year.
A great deal was achieved under the previous plan, “Healthy Lives, Healthy People: A Tobacco Control Plan for England”. Progressive tobacco control legislation was introduced, and the three key ambitions of the plan have been achieved. Smoking rates among adults and children have fallen below the target levels, and rates of smoking during pregnancy reached the 11% target earlier this year. That illustrates perfectly why Britain is a world leader in tobacco control, with the UK coming top in a European survey measuring the implementation of key tobacco control policies and passing legislation that goes further than the requirements set out in European Union directives—perhaps that is one area in which we can expect no negative impact from Brexit. Yet there is still much to be done.
Smoking is responsible for approximately 78,000 preventable and premature deaths each year in England alone, and nearly 100,000 across the UK. In the north-east, the number of deaths from smoking-related diseases is some 30% higher than the English average. Despite the fact that we have hit the national targets on smoking prevalence laid out in the previous plan, stark variations in prevalence persist regionally and among different groups. A national tobacco control strategy should therefore be introduced without delay.
“fighting against the burning injustice that if you’re born poor you will die on average nine years earlier than others”.
Half of that difference in life expectancy is solely due to higher rates of smoking among the least affluent members of our society, with smoking rates among those with multiple complex needs reaching as high as 80%. I am clear that we should all share that commitment.
In Stockton, just under 30,000 people smoke—that is just over 18% of the population. However, it has been estimated that 539 children between the ages of 11 and 15 start smoking in Stockton-on-Tees every year, with 964 people dying from smoking-attributable causes from 2012 to 2014. Shockingly, that is the equivalent of almost 5,000 years of life lost due to smoking. That death and disease is disproportionately borne by the poorest people in my area.
Although smoking rates among the adult population fell throughout the life of the previous tobacco control plan, health inequalities have remained stubbornly high. In 2013, for instance, smoking prevalence among people in the routine and manual socioeconomic group was more than twice that among the professional managerial group—28.6% compared with 12.9%. The picture is even worse for those who are unemployed, with smoking rates of approximately 35%. People earning under £10,000 a year are more than twice as likely to smoke as those earning more than £40,000 a year. The higher rates of smoking place a significant financial burden on poorer members of society. If the costs of smoking were returned to households, 1.1 million people, including more than 300,000 children, would be lifted out of poverty.
In Stockton-on-Tees, when tobacco expenditure is taken into account, almost 6,000 smokers fall below the poverty line, including more than 1,300 dependent children. Those innocent children not only suffer from the financial burden of their parents’ smoking but are more likely to be exposed to second-hand smoke and to try smoking themselves. We all know that those who grow up in a household where parents or siblings smoke are far more likely to become smokers themselves.
Those children may experience considerable peer pressure to start smoking, and tobacco is often more accessible to them in the community and at home, thus creating a cycle of inequality and leading to the life expectancy gap noted by the Prime Minister. Perhaps worse still is that when poorer smokers attempt to quit smoking, they are less likely to succeed than their more affluent peers.
To tackle inequalities, support to stop smoking needs to be specifically tailored to meet the needs of those in lower socioeconomic groups. Although the ambitions in the previous plan have been met and smoking rates continue to decline, they remain stubbornly high in disadvantaged sections of society. Further action is needed from the Government and the public sector to reduce smoking rates and associated health inequalities, and the new strategy is necessary to drive that action forward.
With that in mind, and given that the policy development work for a new tobacco control plan was in place for publication this summer, I would welcome the Minister telling us when the new plan will be published. I say to her that there is a standard to live up to, because the last time there was a debate about the plan in this room, the then Minister confirmed the timing of its publication. I hope we will hear about that in depth today.
Perhaps the Minister will also oblige the British Lung Foundation and outline the Government’s plans to prioritise lung health as an area for health improvement. Will she tell the House whether an assessment of respiratory health could be included in the NHS health check?
I am grateful to the hon. Gentleman for giving way, and I very much agree with what he is saying. He has talked a lot about inequality, which of course spreads beyond this country. I understand that some 80% of smoking deaths, which will rise to 8 million by 2030, are in lower and middle-income countries. Does he share my desire to see the Government publish the plan before the meeting in India in November? We could then see what the special fund for developing countries will be used for, because we need to have an impact there, too.
I agree. With the huge proportion of deaths in lower-income countries, which are suffering even more than we are in this country, it is imperative that the report is published so that we can show a lead. We are a leading country, if not the leading country, on smoking control, and we must continue to demonstrate that.
As colleagues will be aware, stop smoking services are one of the most effective healthcare interventions. Smokers are four times more likely to quit successfully with the combination of behavioural support and medication provided by those local services. Significantly, smokers from routine and manual socioeconomic groups are more likely to access the support of stop smoking services, which have real potential and are an effective way of beginning to address health inequalities. In 2014-15, for example, more than twice as many smokers from routine and manual groups set a quit date with a stop smoking service compared with those in professional and managerial occupations. Such services are not only effective in supporting efforts to quit but can prevent the disability and distress caused by smoking-related diseases without the side effects of many of the drugs used to treat such diseases. Indeed, the National Institute for Health and Care Excellence considers smoking cessation treatment to be among the most cost-effective healthcare interventions.
Smoking cessation treatment is also cost-effective for those who already have smoke-related diseases. Take chronic obstructive pulmonary disease, for instance. Some 900,000 people in England have been diagnosed with smoking-related COPD, out of about 3 million sufferers. Some 25,000 people a year die from the disease, and the NHS spent £720 million on treatments in 2010-11. The British Lung Foundation estimates that in my constituency, people are as much as 60% more likely to be admitted to hospital with COPD than the UK average. We also discovered recently that the rate of lung disease in my constituency is the second worst in the country.
Yet COPD is a disease that is almost entirely preventable. Smoke is the cause of more than three quarters of COPD cases, and in this country exposure to such smoke is primarily through smoking. Although it is clearly better to prevent COPD through the provision of smoking cessation treatment to help smokers quit before the disease develops, that treatment can help improve quality of life even after the onset of COPD and is highly cost-effective compared with other treatments. Indeed, it is the only treatment that can prevent the disease from progressing in smokers. The cost of smoking cessation treatment for people with COPD is estimated to be £2,000 per quality-adjusted life year, whereas the cost of drug treatment for those with the disease ranges from £5,000 per QALY at the bottom end of the scale to £187,000 per QALY for triple therapy.
I am mindful that this is a co-operative debate with cross-party support, but I believe it is fair to highlight the impact of some of the Government’s economic measures on smoking cessation programmes. In 2014-15, despite all the evidence of their cost-effectiveness, approximately 40% of local authorities cut the budgets of their stop smoking services, with half of all services being reconfigured or recommissioned. It is not just local authority cuts that are happening; we are now hearing that clinical commissioning groups are also cutting funding for prescriptions to stop smoking medications and refusing to fund smoking cessation services.
Local authorities faced with huge cuts to their budgets are reducing investment not only in stop smoking services but in other areas essential to effective tobacco control. Trading standards staff, who are crucial to tackling illicit tobacco and under-age sales, are increasingly under threat. During the past six years, the total national spend on trading standards has fallen from £213 million in 2010 to £124 million today. Teams have been cut to the bone, with a 12% drop in staff working in trading standards since 2014, on top of the 45% drop over the previous five years identified by an earlier survey.
The importance of trading standards, working in partnership to deliver concerted multi-agency enforcement activity, is shown in my region, the north-east. After setting up a regional illicit tobacco partnership, the region has seen a significantly greater fall in the illicit tobacco trade than has been seen at national level, to the benefit of both public health and Government revenues. Between 2009 and 2015 the illicit market declined by more than a third in the north-east, from 15% to 9%, whereas the decline at national level was less than a fifth, from 12% to 10%.
Without sustained funding, such services are simply unable to continue to operate effectively. The new tobacco control plan therefore needs to prioritise cutting health inequalities rather than budgets, and in so doing must protect public health funding for tobacco control. I hope the Minister will confirm today that the Government will take steps to sustain protected funding for tobacco control, and will outline what those steps will look like.
I would similarly welcome hearing the Minister commit to bringing mass media spending in line with best practice evidence. Research has shown mass media campaigns to be highly effective in promoting quit attempts and discouraging uptake. In the UK, however, we are currently falling far below best practice spending on such campaigns. When funding was cut back in 2010 there was a noticeably negative impact on quitting, with a whopping 98% decrease in requests for quit support packs, a fall of almost two thirds in quit-line calls and more than a third fewer website hits. That should hardly come as a surprise, with year-on-year cuts seeing only £5.3 million spent on mass media in 2015, which is less than a quarter of the amount spent in 2009. Spending has actually declined further this year to £4 million. To make matters worse, it is not even clear how much, if any, of that budget is reserved for televised mass media campaigns.
This year’s annual Stoptober campaign, for instance, is being run without any televised advertising. Yet the evidence confirms that it is precisely such mass media campaigns that are essential to motivate quitting and to inform smokers of the useful resources provided by Public Health England to help smokers quit. Those campaigns, which discourage smoking and encourage quitting, are most effective when they are sustained and sufficient, with the best results being achieved when people are exposed to televised anti-smoking adverts around four times a month.
Again, I draw attention to my own patch and the “Quit 16” mass media campaign co-ordinated by Fresh and Smokefree Yorkshire and Humber, which focused on the damage smoking does to health. Some 16% of those exposed to the campaign, or roughly 53,300 people, cut down on their smoking. A further 8.4% made a quit attempt, and 4% switched to electronic cigarettes. That shows the clear impact that mass media campaigns have on triggering quit attempts and changes in behaviour, and the Government need to take such evidence seriously and commit to investing in mass marketing campaigns without delay.
Members will be aware that the decline in smoking prevalence in the UK since the first comprehensive strategy was published in 1998 has been comparable to that in Canada and Australia, both of which have consistently addressed the harms caused by smoking through comprehensive and sustained tobacco control strategies. Smoking prevalence has declined rapidly among adults and children in England since the Government first implemented such strategies from 1998. The latest figures show that adult smoking prevalence in England has declined by more than a third, falling from 27% in 1998 to 16.9% last year. The proportion of 15-year-olds in England who are regular smokers fell by two thirds between 1998 and 2014, hitting 8%, and the proportion of 11 to 15-year-olds who have ever smoked fell from 47% to 18% over the same period. Those are the lowest figures ever recorded for both adults and children.
None the less, smoking remains the leading cause of preventable premature death and the major reason for differences in life expectancy between the richest and poorest in society. Experience elsewhere shows what can happen if we do not review and renew our tobacco control strategy and ensure that it is properly funded. While the UK has seen a significant decline in smoking because of its comprehensive approach, the prevalence of smoking in France and Germany, which have not had any such strategies in place, has barely shifted over the last 20 years. We cannot rest on our laurels and assume that the long-term declines we have achieved will continue unabated if we do not take decisive action to review and renew our strategy.
It is a pleasure to serve under your chairmanship, Mr Brady. I commend Alex Cunningham for his tireless campaign on tobacco control and for introducing the debate.
In 1974, 46% of adults smoked, but that figure has now fallen to 16.9%. That is not an accident; it has been because of the concerted action of campaigners, cross-party working and Government support over the years. It has all been about price, marketing, availability, smoke-free environments, education, targeted support to help people to cut down and quit, and the availability of less harmful alternatives.
I also commend the Government and the Conservative-led coalition Government for their action over the past six years. We have seen an end to point-of-sale displays—the last refuge of advertising and marketing—and, finally, the introduction of standardised or what we might call “truth” packaging, which allows people to see the product and what it does to them. We have also seen further protection for children, with bans on proxy sales and on smoking in cars with children present.
The evidence shows that intervention saves lives, and in the case of smoking it saves lives very quickly. It can have a real effect in the same year on foetal, maternal and child health and on reducing cardiovascular disease and complications in surgery. It is definitely worth doing, both in the short and the long term. It should set a template for other public health measures, because it shows that they really make a difference and are definitely worthwhile.
As the hon. Member for Stockton North so clearly stated, however, these improvements do not mean we should be complacent. There are still 76,000 preventable and premature deaths a year as a result of smoking. Not only does that have a devastating impact on individuals and their families, it has other implications, not just for mortality but for the disease burden and the lives lived in very poor health. In my 24 years on the frontline in the NHS I saw that at first hand. Living with COPD and end-stage COPD is a dreadful burden on individuals.
There is also the cost to the NHS and the issue of health inequality, which we have heard about already. The cost to the NHS is about £2 billion a year. If we are to look at the long-term sustainability of our NHS, we must tackle that. Things can be done. Almost a quarter of hospital admissions for lung disease are attributable to smoking; we can do better on that.
As the hon. Member for Stockton North pointed out, the Prime Minister spoke in her first speech on the steps of Downing Street about the “burning injustice” of the life expectancy gap between rich and poor. I absolutely support her determination to tackle that; we also need to tackle the gap between rich and poor in healthy lives lived, which is also very important. The stark reality is that those who earn less than £10,000 a year are twice as likely to smoke as those who earn more than £40,000 a year. If the Government are serious about tackling health inequality, they have to have an effective tobacco control plan.
Of course, health inequality is a multi-factor problem. It is not just about issues such as smoking and obesity—there are many other important issues, such as education, poverty and housing—but we can make a difference both quickly and in the long term by continuing to tackle smoking. I really hope the Minister will acknowledge that it is about preventing new smokers from coming on board, helping existing smokers to cut down and quit, and imposing greater responsibility and accountability on the industry. The five year forward view rightly calls for a radical upgrade in prevention and public health, which is essential for the long-term sustainability of the NHS. Now is not the time to cut back on the services that deliver prevention and help for people to cut down and quit, but sadly that is what is happening.
I am afraid a lot comes down to budgets. In 2015, we saw a £200 million in-year cut to public health budgets, and that is set to continue. The Health Committee’s recent inquiry into public health, which has now reported, found that there will be a real-terms reduction in public health budgets from £3.47 billion in 2015 to £3 billion by 2021. That will hit front-line services. Around 4.1% of total health spending is currently in public health, and that percentage is definitely set to decline, which is absolutely a false economy. We should be investing now to make the savings we need for the future—not just for individuals, though of course they should be the priority, but for the long-term sustainability of the NHS. That would be cost-effective.
We are already seeing the impact on front-line services: local authority stop smoking services have been decommissioned in Manchester, for example, and in Worcestershire they are now available only to pregnant women. We also need to look at how CCGs are withdrawing their support for GPs to prescribe nicotine replacement therapy. That is worrying, because there is a very clear evidence base for such services, as we have heard—I will not repeat what the hon. Member for Stockton North set out so eloquently. Cutting them is the worst example of poor value for money and letting people down. I really hope that when devising an effective strategy the Minister will look at that and make sure that those services are available, both within local authorities and at the frontline of NHS services.
As a former GP, I know the role GPs can play in persuading those who are in the most danger, because they see people when they are suffering the complications of smoking and their intervention at that point is often the trigger for people to quit effectively. But GPs are now left in a position where they cannot prescribe the products that we know might help patients. We absolutely must not abandon one of the most cost-effective measures in healthcare, and we must not add extra cost to the future.
Members in the main Chamber of the House of Commons are discussing baby loss this afternoon, and I am sorry that none of us can be in two places at once. However, it is essential to remember that if the Government are to succeed in their aim to reduce neonatal stillbirths and maternal deaths by 50% by 2030, we have to consider maternal smoking. Sadly, around 300 perinatal deaths every year are attributable to smoking. There are very important reasons across the board for tackling this.
Finally, I will touch on the issue of e-cigarettes, because there is some controversy around them. Some people fear that the industry will take over and that e-cigarettes will become a gateway into smoking, but the evidence so far does not support that. Of course we need to be vigilant and make sure that these products are not being marketed to children to push nicotine addiction, which then steps on to smoking, but so far the evidence is not there. Nevertheless, we need to watch the marketing side of things.
There is no doubt that for many people e-cigarettes are a gateway out of smoking or a way to reduce the amount that they use. It is estimated that in 2015 around 18,000 long-term smokers were helped to cut down and quit by such products. We should be encouraging their use, because the evidence supports that. We are currently members of the European Union and so subject to the tobacco directive, which will mean further restrictions on the use of e-cigarettes. Will the Minister confirm that she will look carefully at the emerging evidence to see where we want to fit in with and adopt that directive and, perhaps, where we feel that it might not be appropriate for the UK? It is an emerging picture, but the overall message should be that we should encourage the use of e-cigarettes and make them available to people when they need to use them.
I know that other Members wish to speak, so I shall not detain the House any further, other than to say that, like the hon. Member for Stockton North, I hope the Minister will be able to confirm today the timetable for the introduction of the tobacco control plan. I know that she will be personally determined to ensure it is effective.
I declare an interest: I speak as a vice-chairman of the all-party group on smoking and health, the secretariat of which is supported by Action on Smoking and Health, a national charity.
I echo the thanks expressed by my hon. Friend Alex Cunningham to the previous public health Minister, Jane Ellison, for all the work she did and her commitment to support for tobacco control. I welcome the Under-Secretary of State for Health, Nicola Blackwood, to her new post; I hope that we can work together on this important issue. The previous four public health Ministers, under either the current Administration or the coalition Government, have worked very well with the all-party group and other Members who want to see progress on this issue. I also welcome my hon. Friend Mrs Hodgson to her new role as shadow public health Minister. She is going to have to get used to seeing us, as she is going to be in here quite regularly.
It was in December that I last spoke in Westminster Hall on tobacco control. I was highlighting the fact that the tobacco control plan for England, “Healthy Lives, Healthy People”, was soon to expire, and that a new plan to ensure sustained funding for tobacco control was needed. I rise today for the same purpose. England has now gone 10 months without a comprehensive strategy on tobacco control. The House was assured that a new plan would be published in the summer. I know that some political summers lapse into the autumn, but I stand here in October wondering whether this summer is going to lapse into the spring. I hope that is not the case. The Government have since stated that a publication date will be decided in due course.
I am proud that tobacco control is no longer a partisan issue but enjoys the benefits of support from all parties in this House and in the other place. However, Parliament cannot act alone. We need a Government strategy to ensure that in this period of austerity tobacco control does not slip off the agenda and that local authorities continue to see it as a crucial part of their work. Dr Wollaston referred to Manchester in her speech. It was deeply worrying to hear what she said, because I have no doubt that, although Manchester is a much bigger place, its socioeconomic profile will be like that of my own borough of Rotherham, where, sadly, a lot of people participate in smoking.
My hon. Friend the Member for Stockton North commented on the impact of smoking in his constituency; my constituency, Rother Valley, is similarly hit by the burden of smoking. Approximately 13,660 people in Rother Valley smoke, and across the three borough constituencies of Rotherham nearly 1,500 people died prematurely from smoking between 2012 and 2014. We know the national figure and I have to say, as I have always said in similar debates, that if we were losing our fellow citizens on such a scale from any other cause—whether it was an intervention in a war or anything else—we would be much more concerned than we seem to be about people tragically dying so prematurely.
Smoking has such a dreadful impact on communities. Surveys of smokers show that around two thirds want to quit smoking and that that desire to quit is the same across population groups. However, only around a third of smokers make a quit attempt each year, and the number of people accessing NHS stop smoking services is declining. A new plan is needed to set out continued support for those people by encouraging them to make quit attempts and to access services that can offer support. Smokers are four times more likely to quit with the help of the expert support provided by stop smoking services, but a new plan is needed to guarantee funding for such services, which are currently under threat.
I have been contacted on this issue by Teresa Roche, Rotherham’s director of public health, and Councillor David Roche, Rotherham Council’s cabinet member responsible for this subject. I do not think they are related, but somebody in my office once asked whether they were. I am not too sure at this stage, but the next time I meet them I shall find out. They are part of the ambitious plan in Yorkshire and the Humber to inspire a generation free from tobacco by 2025. However, their work requires funding. I ask that that be addressed in the strategy, when it is published. The percentage of adults who smoke is falling, but the fall has been even better among teenagers and young children. Back in 1993-94, I introduced a private Member’s Bill against the advertising and promotion of tobacco. At that time, the levels of smoking among both the adult and teenage populations were far higher. Work to discourage smoking is working, and it is saving lives.
International evidence shows that funding for tobacco control activities is crucial. Members who attended the debate in December may recall me describing the situation in New York, where smoking rates declined consistently until 2010, when funding for tobacco control was cut. Smoking prevalence then began to increase until 2014, when funding was reinstated and smoking rates began to decline once more. That is one example of the well-known fact that tobacco control needs sustained funding in order to be effective. As was said earlier, after the change of Government in 2010, the removal of social marketing in the national media was clearly followed by a decline in the number of people stopping smoking. There is a direct correlation.
Funding is needed not only to secure the future of stop smoking services, but for mass media campaigns to encourage smokers to quit. We must keep them up. I understand that this year the Stoptober campaign has moved online, utilising resources such as Facebook Messenger—something on which I have to say I am no expert—to support people who are attempting to quit.
It is all very well having online services, but people need to have access to those services. I know that everybody thinks every kid from a poor home has a smartphone, but that is not true. If they do not have access to IT services, they cannot benefit from the services my right hon. Friend is describing.
I accept that entirely. We hear all the time about people getting online to claim their benefits or whatever else, but it is quite clear that not everybody has access. Nevertheless, we are in the 21st century now and we have moved on a little. We can now sit in this Chamber using our phones for things that would have required an office 20 years ago, so we must remember that things are moving on. I do agree with my hon. Friend, though.
The Stoptober campaign will be delivered at a fraction of the cost by using new media. I await with anticipation the evaluation of its effectiveness compared with previous campaigns that have used a broader range of outlets, including TV and print media. Effective tobacco control needs to be comprehensive, encompassing all these activities to support smokers and to promote systems-wide action to dissuade people from taking up smoking.
Quitting smoking is incredibly difficult. As we have heard, electronic cigarettes are now used by over 2.5 million people in the UK; some people estimate that the figure is 2.8 million. They give smokers access to a significantly less harmful source of nicotine and help individuals to give up tobacco. Evidence from the Royal College of Physicians—I should say here that I am an honorary fellow of that body, before it gets into the newspapers. There is no payment for that. None the less, I ought to say that I use my personal experience in these matters. Evidence from the royal college and from Public Health England shows that vaping is around 95% less harmful than smoking cigarettes.
Two new publications have further supported the argument that electronic cigarettes can make it easier to quit smoking without posing significant health risks. The first is a systematic review of the evidence from the Cochrane Tobacco Addiction Group. Such reviews are generally considered to be authoritative summaries of the current scientific evidence. The results show that electronic cigarettes containing nicotine significantly increased the chance of quitting smoking, while not showing any adverse health effects within two years of use. I know that there are some people outside who say, “We’ve got to see what this is like over decades to make sure they are perfectly safe”. I am afraid that we would have to wait decades to be able to see that. What we should concentrate on is the scientific evidence that we have available since the introduction of electronic cigarettes and make judgments on that.
The second publication has already been mentioned by Dr Wollaston. A number of newspapers have picked up on the researchers’ estimate that in 2015 electronic cigarettes helped an additional 18,000 people to quit smoking. That illustrates how electronic cigarettes have the potential to be a huge public health innovation. There is growing consensus, including charities such as the British Lung Foundation, Cancer Research UK and the Royal College of Physicians, that electronic cigarettes are a very useful tool for smoking cessation.
We all know that smoking is responsible for approximately 96,000 premature deaths across the UK, which is more than the number of deaths caused by the next six biggest causes of preventable deaths in the UK, including obesity, alcohol and illegal drugs. Electronic cigarettes have amazing potential to reduce that burden of death and disease. The Tobacco and Related Products Regulations 2016, which came into effect in May, aim to maximise the benefits from these products within a properly regulated framework. There is a clear role for electronic cigarettes as a form of tobacco harm reduction, but regulation is needed to ensure manufacturing quality and to dissuade non-smokers, including young people and children, from taking up vaping. In the UK, there is no significant evidence that non-smokers are taking up vaping, or that electronic cigarettes are acting as a gateway to smoking. However, it is proportionate to the risks posed by nicotine in any form that these products are regulated.
I wish that people would get over the fact that some of the owners of the companies that make these products happen to be tobacco companies. I do not think anyone has battled more against tobacco in this House than I have for two decades now. However, tobacco companies grow tobacco; tobacco contains nicotine; and nicotine is addictive. It is 90% safer to take nicotine through vaping than through a cigarette, and I wish that people out there who listen to these debates would recognise that fact and stop knocking on about who owns the companies that make these products. The quality of people’s lives is improving in taking people off this drug, which prematurely ends the life of 50% of people who smoke cigarettes. That is what we should concentrate on.
Before the summer recess, on
Lord Prior also committed to commissioning Public Health England to update its evidence report on e-cigarettes annually until the end of this Parliament, and to include within that its quit smoking campaign’s consistent messaging about the safety of e-cigarettes. Can the Minister tell us when Public Health England’s review and updating of the evidence for 2016 will be published, and what message about electronic cigarettes has been included in the Stoptober campaign? The one that was published by Public Health England and others in August 2015 about e-cigarettes was truly ground-breaking in showing how people with a nicotine addiction can help to save themselves from dying prematurely by using these products. Do not get me wrong, Minister and Members of this House—I would like to see people off nicotine all together, but that is a difficult thing to achieve, as we all know. We have been debating this issue for years and years, but more than 2.5 million people have voluntarily gone on to this safer system of dealing with their addiction. If we can use that to get them off the addiction all together, we should do so.
We all know that quitting smoking is one of the hardest things a person can do and we have a duty to support these people in any way we can, not only for their own personal health and well-being but for the health and economic well-being of society as a whole. A new tobacco control plan is urgently needed to make sure there is the funding and momentum to ensure that we are successful in making smoking history for our children.
Thank you, Mr Brady, for calling me to speak; it is a pleasure to serve under your chairmanship.
It is also a pleasure to follow the speech made my right hon. Friend Kevin Barron, as I will call him in this context. I thought that it was thoughtful and, as always, well argued in its treatment of the data.
I place on the record my congratulations to Alex Cunningham on securing this debate, and I also congratulate my colleagues on the Backbench Business Committee on allowing it to take place. No doubt the Health Department considers itself extremely challenged by having to respond to a debate in Westminster Hall and to two debates in the main Chamber on the same day.
I also put on the record my congratulations to the Financial Secretary to the Treasury, my hon. Friend Jane Ellison, on all the work she did for public health. Indeed, a lot of the reforms that have been made and that we are talking about today came under her stewardship.
I also congratulate the Under-Secretary of State for Health, my hon. Friend Nicola Blackwood, on securing her ministerial position. We are all looking forward to hearing her speak later on. As she is a former chairman of the Science and Technology Committee, I suspect that she will examine the scientific data and the important evidence before moving on; we look forward to that taking place.
On that subject, I echo what has already been said, namely that smoking is the No.1 public health challenge in the UK. As has been mentioned, there are almost 100,000 premature deaths every year across the whole country as a result of smoking. The fact that adding together the number of deaths caused by the next six biggest causes of preventable deaths would still not exceed the number of deaths caused by the No.1 cause of preventable death suggests that we have to address this matter. However, there is a risk that, because of the success of the tobacco control programme over the last five years, people will think the job is done. Well, I have to say that it is most certainly not done.
I declare my interest as the chairman of the all-party group on smoking and health and, as someone who has been an avowed anti-smoker all my life, I will continue to oppose smoking. I take the view that there are two categories of people here. We have to help people to stop smoking, but even more importantly we have to prevent people from starting to smoke, because we know that once people are addicted it is a very difficult job for them to give up their addiction.
As Dr Wollaston said, we have been very successful. In the 1970s, more than 50% of the adult population smoked; that figure is now down to below 20%. That is good news. However, it still means that there is a stubborn minority and we have to get across to them how damaging it is to their health to continue smoking.
Success in this area has not happened by accident. Governments of all persuasion— including the current Government, the coalition Government before that and the Labour Government before that—have done enormous amounts of work to reduce the prevalence of smoking. Health professionals have also contributed to that, as have civil society organisations.
The position now is that the tobacco control programme finished at the end of last year. That is the reality and we need to see the new programme as soon as possible.
On this side of the House it is not unusual to hear people argue that the smoking habit is none of the Government’s business. Of course, it is an important source of tax revenue, but some people say—they are not necessarily employed or funded by the tobacco industry—that those who choose to smoke understand the risks, and have exercised their free consumer choice. I would say that informed choice and people understanding the damage they are doing to themselves is up to them, but that does not mean that we should not increase the pressure on those individuals to understand the damage they are doing to themselves and to others by continuing to smoke. I seek to make sure that we continue with the regulations and ramp up the tobacco control programme. We will soon see a situation where all cigarettes and hand-rolled tobacco are sold in standardised packaging, which has been a huge advance. We should take credit for that. Together in this Chamber, we changed Government policy through the force of our argument and the data that we provided in evidence.
I am sure that my right hon. Friend the Prime Minister is among the group that understands that the state and the Government have to interfere in this process. In her recent speech, she said that
“government can and should be a force for good…the state exists to provide what individual people, communities and markets cannot;
and…we should employ the power of government for the good of the people.”
I say that she is absolutely right, and that, on tobacco control, the position is quite clear. In her very first speech as party leader, she promised to fight the
“the burning injustice that, if you’re born poor, you will die on average 9 years earlier than others.”
That injustice is a clear issue for tobacco.
It would be very hard to find a more dysfunctional market than the one controlled by four of the most profitable companies in the world, who make their money selling products that they know will kill half of their lifetime customers—products that have been carefully designed to deliver a highly addictive drug, as fast as possible, to the brains of their users. If anyone were attempting to invent such a drug today, they would not get away with it, but these companies are quite clear in what they set out to do. The estimates by the US National Center on Addiction and Substance Abuse of capture rates for both legal and illegal drugs demonstrate that point powerfully. Capture rates are the percentage of users who report that they have become dependent on the drug at some point. Tobacco has a capture rate of almost a third, more than for heroin, cocaine, alcohol and cannabis. It is clear that the tobacco companies deliberately set out to ensure that their customers are addicted to the drug.
Dependency is a combination of physical and psychological factors. Social and economic factors, such as the relative availability of different drugs, when and where they can be used in a socially acceptable way, and how affordable they are, all have an impact and smoking is therefore a major contributor to poverty and health inequality. As the Marmot review concluded in 2010, smoking in the UK accounts for about half the difference in life expectancy between different social classes, and so the important commitment that the Prime Minister has made to tackling what she rightly calls this “burning injustice” cannot be met without further action on reducing smoking rates.
In my borough, Harrow, analysis based on the 2015 integrated household survey shows that about 13% of the working age population smoke, which is above the UK average, and equates to about 25,000 people. Of the roughly 15,700 households in Harrow that include a smoker, 2,700 fall below the poverty line. About 1,000 would rise above that line if all smokers in poor households were to quit. A lot of people refer to my borough as a nice, leafy borough, but it is important to understand that there are levels of deprivation all across the country—with respect to the hon. Members opposite, it is not confined to the north and the industrial cities.
Despite that fact, I am displeased that Harrow Council has decided to consult on stopping the smoking cessation services in an attempt to save money, but I am pleased that a large petition has been initiated by consultants at Northwick Park hospital with the aim of combating that and preventing it from happening. As my hon. Friend the Member for Totnes noted, stopping smoking cessation services would be a stupid move and would increase pressure on the health service and on individuals.
I would also add that, whatever one’s views on Brexit, the reality is that over the last five years more than 10,000 adults from eastern Europe have come to live in my constituency and almost all those of adult age smoke. The tobacco control programme needs to include encouraging people to give up by reaching parts that have not been reached previously.
One important lesson that we have learned from previous control programmes is that efforts to reduce smoking must be sustained and progressive. Sustained because, as I have said, nicotine is a powerful drug, it increases dependency and requires powerful interventions to persuade people to quit. Progressive because people who continue to use tobacco after the control programmes are in place can be said to have discounted their effect. For example, many smokers quit after the introduction of the workplace ban in 2006, but most did not. The need for progressive steps is particularly important when it comes to tax and price policy, because the economic impacts of tax rises on reducing demand for tobacco products depend not simply on absolute price levels, but on affordability. If taxes rise more slowly than incomes, tobacco will become more, not less, affordable and consumption will tend to rise, not fall.
That point is well understood by the four major tobacco companies, who routinely use what they call “overshifting” as a pricing device. When the Government put up taxes, the companies raise the price of their so-called luxury brands by more than the amount required by the tax increase, while raising the price of the economy brands by less than the tax increase, or in some cases not at all, so that as many low-income smokers as possible are encouraged to continue with their habit or to start smoking in the first place. That has resulted in increasing brand segmentation in the tobacco market, and was cheerfully admitted by the companies in written evidence in their recent unsuccessful court challenge against standardised packaging. One of the most important secondary benefits of standardised packaging, over and above the removal of the last permitted form of advertising and marketing of tobacco products, is likely to be the gradual collapse of this approach to marketing. The brand value of a luxury packet of cigarettes is likely to be greatly reduced when it can no longer be highly designed, but instead must consist of drab, olive colours and large photos of diseased lungs and eyeballs. It is likely to mean that future tobacco tax prices are more effective in encouraging smokers to quit, as the different brand values and prices collapse towards a middle price. If we increased tobacco prices above the escalators and ensured that the money was given to public health for prevention and cessation measures, it would be welcome.
Tobacco control policies work best in combination and should not be planned and assessed in isolation. For example, standardised packaging will no doubt encourage many smokers to try to quit, but most quit attempts fail. Smokers who try to quit have a much greater chance of success if they can get help from stop smoking services and a prescription for nicotine replacement products, whether that is patches, gum or electronic cigarettes. That will all help towards people quitting, and so it is extremely disturbing to see the results from Action on Smoking and Health’s latest survey of tobacco control work in local authorities.
ASH asked control experts from 126 local authorities about their smoking policies and budgets. Its evidence shows that funding is being cut back in two out of five areas and that half of all services are being reconfigured or commissioned, which largely seems to be with the intention of saving money, not saving people’s lives and improving their health. I completely understand the need to control public expenditure, and I know that that often requires local authorities around the country to make difficult decisions, but if that leads to closures and reductions in this vital area of public health work, there is definitely a need for some very urgent rethinking.
Colleagues in clinical commissioning groups in my area tell me that they would love to spend much more money on preventative services, but they are too busy spending money on treating and curing people to invest in the longer term. Does the hon. Gentleman think there is a case for providing ring-fenced funding for public health and saying, “Let’s spend this great tranche of money now and do the preventative stuff, and get the benefits 20 years down the road”?
We should remember that when public health was devolved to local authorities, the money was ring-fenced. I pointed out to Ministers at the time that removing that ring-fence would put at risk all public health expenditure, which can be squeezed. I think that is precisely what is happening. We are in danger of undoing all the good work that local authorities have done on public health by allowing that to happen. I, too, would welcome a ring-fencing of money for purposes such as this. We can see clearly that this is a particularly good, important service.
I am also concerned about the progressive reductions in the money spent on mass-media campaigns. As has already been mentioned, the money is going down. In 2015, we spent less than a quarter of the amount that was spent in 2009, and it looks like the spending is going to fall again this year. As has been mentioned, the Stoptober campaign is now only going to be online, with no television advertising. The benefit of large-scale television advertising is that it reaches people who are likely to smoke, so we need to look at that again.
Given the appalling damage that the tobacco industry causes, and given that those major companies are vastly profitable, I cannot see why they should not be asked to make a greater financial contribution to help solve the public health disaster that they worked so hard to create. I cannot imagine a more obvious application of the principle that the polluter should pay. I would very much like to see that commitment included in the new, overdue control plan for England.
Colleagues will remember that last December, when we had a Backbench Business debate on this subject, the previous Health Minister, my hon. Friend the Member for Battersea, announced that the tobacco control programme would be published this summer. I know that spring extends as far as November in some Government quarters, but in this case summer seems to be extending into next year. I am seriously worried, because we have reached the autumn and there is no plan in place and no date for publication. The previous plan was an excellent means of combating the appalling diseases, including cancer, pulmonary diseases, vascular diseases and various other things that are caused by smoking. It helped to improve matters and added many years to the lives of thousands of people across the UK.
Some colleagues may think that an intervention in the market is not required, but I think one is needed more than ever before. Since the programme was first published in 1998, the fall in our smoking rates has been similar to that of Canada and Australia, as has been mentioned. In France and Germany, which do not have comprehensive strategies, the rates have hardly changed in 20 years. The evidence shows that these programmes work, and that where there is no programme there is no movement forward.
The UK has an excellent record on tobacco control. The Department of Health was rightly given the prestigious Luther L Terry award last year by the American Cancer Society for its global leadership on the issue, and the UK was ranked as the world’s most successful country on tobacco control by the Association of European Cancer Leagues. We should never forget that two of the biggest tobacco firms in the world, British American Tobacco and Imperial, are based in the UK, along with Gallaher, which is now an important part of Japan Tobacco International. We simply cannot sit back and watch smoking rates fall in the UK while the tobacco industry puts more time and money into increasing consumption in developing countries.
The next conference of parties of the World Health Organisation Framework Convention on Tobacco Control takes place in India in November—next month. We are in an Indian summer, and the tobacco programme will be published in the summer, so what would be better than publishing the plan in advance of the conference in India? That would set the UK, once again, on the world leadership level.
I hope that my hon. Friend the Minister, in her response, will give a firm and early date for publication. I hope that the plan will set ambitious targets to cut heath inequalities, deal with the funding crisis affecting tobacco control work in local authorities and set specific targets to reduce smoking among vulnerable groups including, as my hon. Friend the Member for Totnes said, pregnant women and people with mental health problems. The targets for the past five years of the programme seemed difficult, but they have all been achieved, so we should set challenging targets now that will lead to a smoke-free Britain. That has got to be our ultimate aim.
I strongly believe that tobacco control is an essential part of policy. It will enable the Prime Minister to achieve her commitments on good government and reducing health inequality. I pay tribute to the work of colleagues from all parties and in both Houses, who pressed the need for tobacco control legislation on sometimes reluctant Governments, which I consider to be one of the most important political and social advances during my time in Parliament. I hope that that work will continue until the death, disease and misery caused by smoking is finally consigned to the past. I look forward to hearing positive news from my hon. Friend the Minister about when we are going to set out the new challenges for the industry and the Department.
It is a pleasure to serve under your chairmanship, Mr Brady, and to follow Bob Blackman. I find myself in agreement with everything he said. Anyone who has come here hoping to see violent disagreement and robust debate will be disappointed, because we all agree about the importance of this issue.
The hon. Gentleman talked clearly about the nature of this lethal product, which, as we have heard, kills 96,000 people a year across the UK. He also touched on the issue of the developing world. It is anticipated that 8 million people across our world will die from smoking in 2030, and that 80% of them will be in low or middle-income countries that do not have strategies to tackle the problem. Companies based in this country are selling this lethal product to the developing world and killing so many people. We need to be clear that that is shameful.
Many hon. Members, including Dr Wollaston and Alex Cunningham—I congratulate him on all the work he has done and on leading this debate—have talked about the inequalities that are associated with smoking tobacco, including wealth and income inequalities. Smoking hits people from low-income communities much harder than others. As Members have said, smoking is about half of the reason for the difference in life expectancy between the richest and the poorest in our country.
I want to talk about another inequality, which the hon. Member for Harrow East touched on at the end of his contribution: the impact on people with mental ill health. A substantial part of the reason why such people, particularly those with severe and enduring mental ill health, die 15 to 20 years earlier than others is higher smoking rates. Here’s the thing: we have been very successful in this country—I will come back to this in a moment—at reducing the smoking rate. Public health strategies have worked effectively, although we all recognise that there is much further to go. But as the smoking rate has come down in the population as a whole, it has remained stubbornly high among those with severe and enduring mental ill health; there has been hardly any shift at all. That has been a failure of public health strategies.
Back in 2013, when the smoking rate across the population was 21%, it was 40% among those with severe and enduring mental ill health, 60% among those with psychosis, and 70% among people in in-patient care. We can start to see why those people end up dying so much earlier than everyone else. That amounts to a neglect of those people’s need for support in combating this highly addictive product, and it makes me absolutely driven—as is everyone else in the Chamber—to do more to combat the problem.
Let me come back to the successes of smoking cessation strategies. I join other hon. Members in congratulating Jane Ellison on her work. The hon. Member for Harrow East was right; there are Government Members who take a different view. I remember hearing the hon. Member for Battersea speaking and wanting to tell her to watch her back, because there were quite a few Members behind her who took a different view. She was brave in standing her ground, particularly in pursuing the plain packaging policy. Kevin Barron has a plain packet in his pocket. The previous Government was in my view a coalition Government, not a Conservative-led Government; the Liberal Democrats played our part in important strategies such as plain packaging and ending smoking in cars with children on board, which will have a big impact on saving people’s lives.
It is imperative that the new strategy is published and becomes operational. Given the leadership role that we have played for so many years, it is important that we go to the meeting in India in November and demonstrate our continued leadership. If there is any way for the strategy to be published before that meeting, and for it to include a focus on how we will use the fund that has been established for combating smoking in developing countries, I urge the Minister to do everything possible to ensure that that happens.
Let me speak a little more about what the tobacco control plan needs to include. I come back to what I said about mental health, which the plan needs to address directly. I do not know whether the Minister has seen the iterations of the plan, which we hope will be published soon, but I hope very much that it will address directly the failure of public health strategies to reduce smoking among people with mental ill health. The plan needs to focus on the recommendations of the report “The Stolen Years”, which was published by ASH and produced in collaboration with the Royal College of Psychiatrists, and its ambitious targets for reducing smoking among people with mental ill health. We can no longer fail to confront the failure of past strategies in that respect. Interestingly, that report highlights the therapeutic benefits of stopping smoking for people with mental ill health, not only for their physical health but for their mental health. Ironically, many people with mental ill health smoke because they see it as an escape from the pain that they are suffering and a way of coping with stress, yet smoking increases stress and the risk of aggression, particularly in in-patient services.
I went to the launch of that report. Some 70% of people who are discharged from mental health secure units smoke, yet we have in our midst a product—e-cigarettes—that could have been designed to be put into such institutions, some of which are now putting e-cigarettes on their shopping lists. That would allow people to satisfy their addiction without creating secondary smoke and the many ailments that occur when people smoke. Does the right hon. Gentleman agree that we need more leadership to ensure that e-cigarettes can be used in institutions where, for control reasons, it is difficult to keep the customer satisfied, as it were?
I completely agree. If we want to focus effort where it is most needed and where smoking rates are highest, we should focus on those very mental health institutions. As well as making vaping available for people who need help to give up smoking, we need to do much more to focus on training staff in such institutions so that they know the importance of smoking cessation being one of the objectives in the care of individuals there, because of its potential therapeutic benefit.
I should also mention the move towards smoke-free in-patient settings, a strategy that I supported as Minister and that I am pleased is continuing. Guidance was published by Public Health England and NHS England in June 2015, and that strategy is having a beneficial effect on the environment in in-patient settings by reducing aggression and stress and improving physical and mental health. I encourage the Government to keep pursuing that objective.
On electronic cigarettes and vaping, although I was a committed remainer in the EU referendum debate, the tobacco products directive is flawed, because it takes an inappropriately tough approach to electronic cigarettes. I therefore hope that the Government will review that directive regularly. One of the potential benefits of leaving the EU—there are not many, in my view—is that we will gain the ability to differentiate more between the effective regulation on tobacco in that directive and the regulation on electronic cigarettes, and do much more to recognise the evidence that already exists, as the right hon. Gentleman has made clear, on the benefits of electronic cigarettes.
I will end by saying something about public health funding. The hon. Member for Totnes made the point clearly, and I totally share her view. The Health Committee has pointed out that the £8 billion or £10 billion that we keep being told will be given to the NHS by 2020 is actually nearer £4.5 billion. Extra money is being found for front-line NHS services partly by cutting other parts of the Department of Health budget, including, distressingly, public health and health education. As she said, that is completely counterproductive. When NHS finances get tight, crisis management takes over. The hon. Member for Stockton North made the point that CCGs are focusing on propping up established traditional services—the repair services, as it were—and in so doing, tragically, are cutting the prevention services that prevent people from ending up needing care in the first place. That is so counterproductive. A new settlement for the NHS and the care system, which I keep calling for, must recognise the imperative to invest more in prevention and public health, particularly given that there is so much evidence that that has a beneficial effect.
It is a pleasure to serve under your chairmanship, Mr Brady. I thank Alex Cunningham for bringing forward this interesting debate. I should say that I have never smoked a cigarette in my life, so if I start coughing, as I have been doing throughout the week, that is purely down to a bug that I have picked up.
When the Scottish Parliament brought in its smoking ban in 2006, I thought it was a birthday present, because it was brought in on
The Scottish Government have implemented and overseen a number of progressive actions on smoking: increasing the age for tobacco sales from 16 to 18 in 2007; the overhaul of tobacco sale and display law, including legislation to ban automatic tobacco vending machines and a ban on the display of tobacco and smoking-related products in shops; the establishment of the first tobacco retail register in the UK in 2011; and the passing of a Bill in December 2015 to ban smoking in cars when children are present. Record investment in NHS smoking cessation services has helped hundreds of thousands of people to attempt to quit smoking.
This year, the Scottish Parliament celebrated the 10th anniversary of the ban on smoking in public and welcomed comments from the World Health Organisation, which praised the Scottish Government’s
“excellent example of global public health leadership” for implementing its framework convention on tobacco control. In 2013, the Scottish Government published a tobacco control strategy setting out bold new actions that will work towards creating a tobacco-free generation of Scots by 2034. I hear that in the Humber there are more plans in advance of that, although I think our problem may be slightly larger. Key actions in the plan include setting the target date of 2034 for reducing smoking prevalence to 5% and eliminating it in children; a pilot of the schools-based programme ASSIST—“A Stop Smoking in Schools Trial”; and a national marketing campaign on the dangers of second-hand smoke in cars and other enclosed spaces. I echo the comments on the need for a UK-wide national campaign and media advertising.
Although the Scottish Government have long made clear their aspiration for a tobacco-free Scotland, the strategy sets the date by which we hope to realise the ambition. It is not about banning tobacco in Scotland, though if we were to discover it today we would never licence it. I remember as a child listening to the Bob Newhart radio sketches—some may remember them—and he had one about Nutty Walt and the discovery of tobacco. That was only about the crazy tobacco scene and did not even go into the ludicrous health aspects. Nor is the strategy about stigmatising those who wish to smoke. The focus is on doing all we can to encourage children and young people to choose not to smoke.
In September, the Scottish Government welcomed figures that showed that children’s exposure to second-hand smoke in the home reduced from 11% to 6% from 2014 to 2015, which I think sets us in the right direction. Health inequality is a key theme running through the SNP’s tobacco control strategy, with explicit recognition that current smoking patterns have a hugely disproportionate impact on Scotland’s most deprived communities. That is no different from anywhere else in the UK or, as we have heard from so many speakers, throughout the world.
Scotland has a proud record on tobacco control. We believe the UK Government need to get their finger out and commit to publishing their promised new tobacco control plan for England. I am a great believer that we can learn from each other and pinch good practice whenever we see it, so a good tobacco control plan for England may well help us in Scotland by exposing a few other ideas and strategies that perhaps we have not considered or pushed as firmly.
[Ms Karen Buck in the Chair]
The hon. Gentleman has outlined a great catalogue of activities north of the border, in my own homeland. I appreciate that, but what new, big ideas are there north of the border that could contribute to the plan of colleagues in England?
I thank the hon. Gentleman for that question. I have mentioned some of the key points that we are targeting, and stopping children smoking is the key aspect. The title of the strategy we are working on is “Creating a Tobacco-Free Generation”. That is important. The point has been alluded to by other speakers that stopping people smoking is more important than reducing it, although reduction is important for those who smoke because of the impact on deaths and on the health service.
We encourage the UK Government not to keep the House waiting but to fulfil their promise to publish their new plan. If they are stuck for ideas, they are welcome to look at Scotland’s 2013 plan.
It is a pleasure to serve under your chairmanship again, Ms Buck. I start by paying tribute to my hon. Friend Alex Cunningham and to the Backbench Business Committee for allowing him and others to secure this important debate. As we all know, he has done much during his time in Parliament to address the sale and use of tobacco products, not only in his own constituency just up the road from my own but across the country. That includes his excellent work with my hon. Friend Luciana Berger to bring forward the ban on smoking in cars with children. I commend him for his tireless campaigning and commitment to this hugely important area of public health policy.
I thank right hon. and hon. Members who have taken part in the debate. I pay tribute in particular to Dr Wollaston, the Chair of the Health Committee, for the support and expertise she brings to the debate. Her predecessor plus one or two, my right hon. Friend Kevin Barron, also has a huge wealth of expertise and knowledge across the whole health brief. In my new role, I will certainly be calling on him a fair bit—I hope that he is prepared and willing for that to happen. I also want to commend the other right hon. and hon. Members who spoke today: Bob Blackman, Norman Lamb and Martyn Day, who spoke on behalf of the SNP.
I wish to say a few words to the public health Minister. This is our second outing together and I have had this role for only four days, so I think this will be a regular thing. I am definitely looking forward to keeping a close eye on her work at the Department of Health and to debating across the Chamber. I am sure we will do that on many important issues facing our country’s health. If the tireless work of my predecessor, Andrew Gwynne, is anything to go by, that will be often—surely he has his own seat in here with his name on it because he was in here so much. That is a daunting prospect.
Today we are debating the important topic of tobacco products. It is crucial that the message is put across to the Government that more can and should be done to ensure that we all lead healthier lives. The control of the sale and use of tobacco is an important public health matter not only for those individuals who use it but for all around them.
During Labour’s time in office, we recognised that fact, which is why we did a lot to address smoking in society, most famously with the introduction of the ban on smoking in public places. The ban brought in a culture change in our society. When we used to walk into any indoor public space, it was the norm to be met with a cloud of stale tobacco smoke, whereas now all of us—especially children and families—can enjoy ourselves freely without having to breathe in second-hand smoke or have the overhang of smoke in the air.
The Tory-led coalition Government came into power and brought in their own tobacco control plan, and it was welcome that it achieved so much over its lifetime, including the prohibition of point-of-sale displays in shops; the introduction of standardised packaging for tobacco products; and the national ambitions on reducing smoking, which were all met. However, when the plan ceased at the end of last year, it was vital that the Government published a new plan in a timely manner to build on the work of previous Governments. Sadly, nearly a year on, the Government have failed to come forth with such a plan, despite the promise and a commitment to do so last December.
Last month, the Health Minister in the House of Lords failed to commit to a final date for publication. We were expecting to have sight of that plan over the summer; we are now hopeful that we will see it during the Indian summer. Changes in Government meant the plan was put on hold. The delay is not too dissimilar in some ways to the constant delay to the childhood obesity plan—although at least that was rushed out over the summer.
A change in ministerial personnel should not be an excuse for delaying such an important intervention in the health of our society, especially when the new Prime Minister stood on the steps of No. 10 Downing Street in the summer and committed her Government to
“fighting against the burning injustice that, if you’re born poor, you will die on average 9 years earlier than others.”
We were led to assume that was going to be the driving force of the Prime Minister’s Government, and I hope it is, but the rhetoric has not yet translated into reality when it comes to this serious public health issue facing our country.
The Government have faced a vocal chorus from charities and organisations, including the British Medical Association, Action on Smoking and Health and the British Lung Foundation, which have all called on the Government to get their act together and publish the new plan. In that regard I also commend the work of Fresh, which my hon. Friend the Member for Stockton North mentioned, which does such sterling work in the region with the highest smoking rates and some of the worst health outcomes.
The Minister and her officials at the Department of Health are being told loud and clear to get on with the job at hand and to answer the crucial question that has come out of today’s debate: what is the delay? I hope she will shed some light on that important question in her response and—finally—tell us when we can expect the new tobacco control plan.
I want to set the scene on why it is so important we have a new plan, on top of what has already been said today, by looking at the facts and figures on smoking, including the variation of smoking habits among certain groups of society—especially children, young people and pregnant women. The smoking rate in England is 19%, but that varies from region to region. It is highest in the north-east, where it reaches 19.9%, and lowest, at 16.6%, in the south-east. Those are regional figures. When looking at the figures borough by borough, my local authority of Sunderland does not fare well at all, with 23% of the population smoking. That is much higher than even the highest of the regional averages.
Looking at smokers based on their socioeconomic status, it is clear the less well-off in society are more likely to smoke. I am not going to go into all of the reasons for that. We just have to accept it is where we are—but what can we do about it? Smoking rates among those in the professional and managerial socioeconomic group are less than half the rate of those in routine and manual socioeconomic groups, at 12% and 28% respectively. When the net income of a family and their smoking expenditure are both taken into consideration across England, 1.4 million, or 27%, of the households with a smoker fall below the poverty line. If those costs were returned to the families, it is estimated that approximately 769,900 adults and 324,550 dependent children would be lifted out of poverty.
That is a striking statistic, especially given the study published only a few weeks ago that showed that 250,000 children will be pushed into poverty during the lifetime of this Parliament due to the Government’s policies. Getting it right on smoking could totally negate that impact, so it is definitely something worth looking it. The stats show we must do more to address the cycle of health inequality, which spans generations and continues the awful situation in which there are huge life expectancy gaps between the rich and poor, as we have clearly heard today. If the Government want to change that, one way would be to step up and continue the work of reducing smoking in society.
If those figures do not spur the Minister on to bring forward the new tobacco control plan, hopefully looking at the issue of smoking among our children and young people will. It is welcome that smoking among children and young people fell to an all-time low of 6% under the last tobacco control plan, as we have heard, but it remains an issue when two thirds of adult smokers report taking up the habit before the age of 18, with 80% saying it was before 20. That is compounded when children who live with parents or siblings who smoke are three times more likely to take up the habit than children from non-smoking households. It is also estimated that 23,000 young people in England and Wales start smoking by the age of 15 due to exposure to smoking in the home.
They certainly do. The situation on children smoking is quite stark. The earlier children start smoking, the more serious the consequences are for their health. Children who take up smoking are two to six times more susceptible to coughs and increased phlegm, wheeziness and shortness of breath than those who do not smoke. It can also impact their lung growth, which can impair lung function and increase the risk of chronic obstructive pulmonary disease in later life. As we heard from my hon. Friend the Member for Stockton North, 25,000 people a year die from COPD. Surely we do not want any child in this country to die in that way. The prevalence of these conditions among smokers shows it is paramount that we seriously tackle smoking among our children and young people. We do not want to see the children of today being the COPD sufferers of the future, as well as having those other conditions.
I am really pleased my hon. Friend is framing the issue specifically around children. My wife, Evaline, worked as a school nurse and used to hold classes talking to young people about this. She would put forward the economic argument—“If you smoke so many cigarettes over so many days over so many months it costs £2,000, which could buy you a summer holiday.” She was then told, “No, Miss, you’ve got it wrong; it is only £3.20 a packet from Mrs Bloggs down the road.” Do we not also need to ensure we tackle illicit tobacco and ensure children understand the dangers of that as well?
My hon. Friend raises a very good point. The danger and quality of illicit tobacco can often be far worse for health than just long-term smoking. The substances used in those cigarettes can be life threatening.
I will move on to the dangers of smoking during pregnancy, which was raised by the hon. Member for Totnes. While we know the harms of living in a household with a smoker, for some that harm starts before birth as 10.6% of women are smokers at the time of delivery. That equates to 67,000 infants born to smoking mothers each year, while up to 5,000 miscarriages, 300 perinatal deaths and around 2,200 premature births each year have been attributed to smoking during pregnancy.
Smoking during pregnancy has been identified as the No. 1 risk factor for babies to die unexpectedly. According to research by the British Medical Association, if parents stop smoking, that could reduce the number of sudden infant deaths by 30%. Those are shocking figures that show the heartache and pain a mother and the family around her will go through from the horrific events of losing a baby through, for example, miscarriage, stillbirth or sudden infant death. That is especially pertinent this week as it is baby loss awareness week, which I know some of us are wearing little pins to commemorate. There is a debate currently going on in the main Chamber —there was; it has just finished—in which many colleagues gave heartbreaking accounts of their personal experiences or those of their constituents who have suffered the loss of a baby. I was able to intervene and give a personal account of my own experience.
Baby loss due to smoking is preventable if Government action is taken as soon as possible. Important work has been implemented on smoking during pregnancy that has seen the number of pregnant women smoking fall to its lowest-ever levels, but I welcome the calls from the Smoking in Pregnancy Challenge Group to see a commitment from the Minister today to work to reduce the percentage of women smoking during pregnancy to 6% or lower by 2020. It may be an aspirational figure, but it can be achieved as long as a comprehensive plan is put in place to control the use and sale of tobacco.
Regional variations, including those I mentioned earlier, must be addressed; other colleagues have mentioned them, too. We are seeing 16% of women in the north-east and Cumbria smoking at the point of delivery, compared with only 4.9% in London. This stark figure shows that more regional action and support must be offered by the Department of Health to ensure that regional inequalities are addressed. The regional variations and the other variations mentioned show that the slashing of the public health grants is a false economy when it comes to seriously driving forward the agenda on public health, especially in relation to smoking.
In last year’s autumn statement, the then Chancellor announced further cuts in the public health grant, which amounted to an average real-terms cut of 3.9% each year to 2020-21, and translates to a further cash reduction of 9.6% in addition to the £200 million worth of cuts announced in the 2015 Budget. As we know, specialist support and stop smoking services help to get people off cigarettes and to lead a far healthier lifestyle. However, cuts to public health funding have meant that it has proven far more difficult for local authorities to provide that much needed specialist support.
In a survey of local tobacco control leads conducted by Action on Smoking and Health and commissioned by Cancer Research UK, a total of 40% of local stop smoking services were being reconfigured or decommissioned in 2014-15. In Manchester, we have seen a complete decommissioning of stop smoking services. This is even more concerning when the initial results of the 2015-16 survey show that the rate of decommissioning and reconfiguring is increasing. Therefore, I hope that the Minister will be able to commit to ensuring that we have a substantial source of funding for specialist services that help to support in particular those in lower social economic groups as well as pregnant women to quit smoking. We must end the intergenerational cycle of health inequality that I have spoken about.
It is important that we have a plan and that we have it now—a plan that continues the work of previous Governments to reduce smoking in our society. We have seen inroads into creating a healthier society, but we all recognise we have a long way to go, as the facts and figures show. The Government’s delayed plan must be published now, and it must have measures in place that will address the many variations, from geographical variation to deprivation and socioeconomic background variation.
We must see further work to address the take-up of smoking by children and young people if we are to ever achieve our goal of the next generation being healthier than the last. We need to address smoking among young people head on. Achieving a smoke-free society is within our reach, but what we do not need is further delay and hesitation by the Government. What we need is bold action.
I hope that the Minister can give us that bold action today and that she does so by finally giving us the date when the new tobacco control plan will be published. The longer we wait, the more children will take up smoking, the more people will get ill and, sadly, the more people will die. The time for waiting is over. We now need bold action.
It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate Alex Cunningham, my hon. Friend Mrs Drummond and Norman Lamb on securing the debate, and the Backbench Business Committee on allowing it. The importance of the debate is shown by the fact that we have the Chair and former Chair of the Health Committee and a former Health Minister present, as well as our newly appointed shadow Minister, whom I welcome here today; there was not much chance to do so in Health Question Time.
As hon. Members have made clear, despite the continuing decline in prevalence, smoking remains the largest single cause of preventable and premature death in this country, with approximately 17% of deaths annually caused by smoking. I want to be clear from the outset that the Government remain committed to reducing the number of people who smoke by stopping them before they start. We have a clear track record in reducing the harms caused by tobacco, which has already been mentioned.
We have made good progress through a comprehensive package of measures, many of which were brought about by my predecessor, my hon. Friend Jane Ellison, with a lot of support from the all-party group on smoking and health; I thank its many members who are here today. We have introduced standardised packaging and the ban on displaying tobacco in small shops. We have maintained a high duty rate on cigarettes and hand-rolled tobacco, and we have ended smoking in cars with children in them. Such measures have played a part in ensuring that the public are protected from the harms of tobacco. We now see that 80% of people support the smoke-free places legislation, which shows a change in culture and attitude.
We have also continued to support people to quit smoking, with Public Health England running media campaigns such as Stoptober. As the Minister responsible for public health and innovation, I am pleased to see the innovative use of digital tools such as the Stoptober app and social media messaging, which have allowed campaigns to reach out to groups in which smoking rates remain high and target them more effectively. That approach has proved extremely successful and was responsible for 130,000 people successfully quitting for 28 days in Stoptober in 2015.
I have heard the concerns about the lack of use of mass media, and I will look at the evaluation of Stoptober and see whether there has been any impact. That strategy has been used so that we can have a more focused targeting of high prevalence areas and groups by using the most efficient social media channels, but we will examine the evidence to see how effective that has been. As today is so close to the halfway mark for those attempting to quit during the campaign, I take this opportunity to wish them all the best in reaching 28 days smoke-free. I want to tell them not to give up.
As the former Chair of the Health Committee, Kevin Barron, said, it is notable that one of the most significant disruptions to smoking in recent years has had nothing to do with Government intervention. We have seen considerable take-up of e-cigarettes in the UK, and we know that almost half of the 2.8 million current users are no longer smoking tobacco. We need to continue to embrace developments that have the potential to reduce the burden of disease caused by tobacco use. However, we need to recognise that the use of such products is not risk-free. We need a regulatory framework that minimises risks to users and targets the promotion of products at existing smokers and not at children. I have heard the comments made today about e-cigarettes.
I am looking closely at PHE’s expert independent review. I have asked officials to examine that closely, and they are updating the review of the evidence each year. I do not have a date for this year—I know the right hon. Gentleman asked for it—but I will write to him when I find out exactly when that will come forward.
Our approach has been comprehensive and has seen smoking prevalence fall in all age groups for both men and women. As various Members have said, adult smoking prevalence in England is now just under 17%, the lowest rate since records began, and we should take a moment to be proud of that. However, as others have said, we cannot be complacent. Smoking continues to be one of the largest causes of social and health inequalities in this country. It accounts for approximately half of the difference in life expectancy whereby, as the Prime Minister said, those on the lowest incomes die an average of nine years earlier than others. The Chair of the Health Committee, my hon. Friend Dr Wollaston, said it so well: it has an even greater impact on healthy life expectancy, which we also need to focus on.
At national level, smoking prevalence is declining year on year. There remain significant regional and demographic variations—an issue raised by the hon. Member for Stockton North, the shadow Minister and others—with the prevalence in some population groups, such as those with mental health conditions, at more than twice the national average. That point was particularly raised by my hon. Friend Bob Blackman and the former Health Minister, the right hon. Member for North Norfolk. I shall certainly look at the report that was mentioned, “The Stolen Years”.
Regional variation means that rates of smoking during pregnancy can range from anywhere between 2% in some areas to 27% in others. That is another issue that we must focus on. Given the wide variation in smoking rates across the UK, it remains crucial that local councils have the flexibility to consider how best to respond to the unique needs of their local population and tackle groups in which prevalence remains high.
Ring-fencing is a highly political question, but I recognise that some difficult decisions have been made right across Government to reduce the deficit and ensure sustainability. Councils have been given £16 billion of public health funding across this Parliament, on top of further NHS prevention funding. The big question is whether that is being targeted at the right public health priorities.
We have been looking at that issue closely in my office. Local PHE centres are working with local commissioners to try to ensure that evidence-based service provision remains a priority. Nationally, PHE has been putting together a range of tools to support local commissioning decisions and has convened a round-table of experts to review the situation and propose a range of actions. However, I recognise that ensuring that the right services are prioritised will require more than just providing data about cost-effectiveness and smoking prevalence. The sustainability and transformation plans are supposed to be part of the answer.
On the adequacy of public health budgets, does the Minister think it is rational in any way to increase in real terms the budget for the NHS while reducing in real terms the budget for public health?
Prevention is a core part of the NHS five year forward view and should be embedded in NHS funding, public health funding and social care funding, as the right hon. Gentleman has stated. We are looking for the STPs to show a joined-up plan for how prevention, acute delivery services and social care will work together. PHE can and does advise and support local councils to tailor their services effectively, but we need to see how we can improve that. The local tobacco control profiles are one way in which we are doing that, but we must ensure that we see some of that work implemented.
At national level, to help drive a reduction in variation, the Government are committed to publishing the new tobacco control plan that all Members have mentioned, which has tackling inequalities at its heart. The plan will build on our success so far and will include renewed national ambitions. We have to maintain the proactive, comprehensive and non-partisan approach we have seen so far. The UK is recognised as a world leader in tobacco control strategy, and we intend to maintain that. However, I am afraid that on this occasion I will not be able to match my predecessor by announcing the date of publication. [Hon. Members: “Oh!”] I know; I feel inadequate.
My hon. Friend the Member for Harrow East is right in identifying my desire to ensure that the plan is evidence-led. It is reasonable for a new Government to want to check that the plan offers the best possible strategy, based on evidence. On something as important as a tobacco control plan, which is a golden moment, we have to ensure that we do not publish the plan until we get it right. It has been valuable to have the opportunity to listen to and engage with this debate, so that I can hear from colleagues as expert and engaged as those present before going forward. I assure all Members that the Government see the issue as a matter of urgency and are pressing forward with the plan as quickly as possible. I will certainly take away the suggestion from the hon. Member for Stockton North about incorporating respiratory health monitoring into the NHS health check.
I would like to go through a few of the points that we have discussed before I finish. As I have highlighted, it is right to turn our focus to population groups in which smoking prevalence remains higher than elsewhere. In particular, we must turn our attention to reducing health inequalities in populations who already suffer from poorer health and social outcomes, such as those in routine or manual occupations or those who suffer from mental health conditions.
As my hon. Friend the Member for Totnes said, improving maternity outcomes and giving children the best start in life is an important priority for this Government, and supporting pregnant women to quit smoking will be an important factor in working towards that. We all know that smoking during pregnancy increases the risk of stillbirth, as the shadow Minister said, and of problems for a child after birth. We also know that babies born to mothers who smoke are more likely to be born underdeveloped and in poor health. Tackling that was a priority under the previous tobacco control plan, during the period of which smoking prevalence among that group fell by three percentage points, but more can be done to reduce it further and, most importantly, to tackle the variation I mentioned. We will look at that.
Alongside limiting babies’ exposure to smoke during and after pregnancy, we must continue to work to end the cycle of children taking up smoking in the first place. As the percentage of 15-year-olds who regularly smoke has fallen to 8% and continues to fall, we must press our advantage and work towards our first smokeless generation. That would be something that we could genuinely be proud of. Restricting access to tobacco remains key, and we will want to maintain the enforcement of measures mentioned today, such as age of sale laws. Evidence shows that children who have a parent who smokes are two to three times more likely to be smokers themselves. Continuing to support adults to quit is therefore vital to ending the cycle of children taking up smoking and must remain a key part of tobacco control in the future.
In order to achieve our ambitions for the population groups I have mentioned, and to reduce smoking prevalence across all populations to even lower rates, we have to continue to draw on the things that we know work. This is an area in which have a strong evidence base, and that work will include continuing a programme of evidence-based marketing campaigns such as Stoptober and monitoring the evidence base for e-cigarettes.
Finally, the right hon. Member for North Norfolk is right to say that tobacco use is a global issue and an international priority. Our new tobacco control plan will need to reflect that. As a world leader on tobacco control, the UK will continue to work closely with others to reduce the burden that smoking places on individuals, families and economies across the globe. As he said, we are investing official development assistance funds over five years to strengthen the implementation of the WHO’s framework convention on tobacco control. The project will be delivered by the WHO, and through it, we will share the UK’s experience in tobacco control to support low and middle-income countries to put effective measures in place to stop people using tobacco. That will happen through capacity sharing. We will carefully monitor the progress of that initiative to ensure that it delivers results, using very effective evaluation measures. I am happy to have further discussions about that with the right hon. Gentleman, if he would find that helpful.
We can be proud of the progress that successive Governments have made on helping people to quit smoking, preventing them from starting in the first place and creating an environment that de-normalises smoking. With prevalence rates at an all-time low, there is no question that good work has been done, but as the issues raised in this debate clearly show, there is more work to be done. The Government are committed to doing that work as a matter of urgency. I will take away the comments made today, which are incredibly helpful to me as a new Minister, and I will ensure that as we finalise the new tobacco control plan—
The hon. Lady will have to wait and see.
In conclusion, the Government recognise this area as a top priority and will continue to work on it as such.
I welcome you to the Chair, Ms Buck.
I hope we have not bored people—many have passed through the Chamber this afternoon, and I am sure others are watching online—because consensus has broken out, at least on most issues. We have had an excellent debate, with the expected comprehensive contributions from colleagues across the House. I thank everyone who has taken part.
Many questions have been posed to the Minister on tobacco control and e-cigarettes, ranging from constituency-level issues all the way through to worldwide issues. I am sure she has much to reflect on. I am disappointed that she has not lived up to her predecessor’s reputation by giving us a date this afternoon. We had a bit of a laugh a few moments ago, but I am a wee bit worried that it may not happen this year. I hope she will go back to her Department and think on that.
As the Minister said, she must get the matter right, and that means focusing on the socioeconomic groups that do not have the benefits the rest of us have. There are also health inequalities to consider.
The Minister can be in no doubt that tobacco control remains very much a focus for many of us in the House and will continue to be in the forefront of our minds. I assure her, as others have, that she will have the full support of the all-party group, and of us as individual Members of Parliament, when she introduces the new plan. I just hope that will be sooner rather than later.
Question put and agreed to.
That the House has considered the tobacco control plan.