I beg to move,
That this House
has considered the Seventh Report of the Science and Technology Committee, Session 2017-19, E-cigarettes, HC 505, and the Government Response, Cm 9738.
It is a pleasure to serve under your chairmanship for the very first time, Sir Henry, in my last appearance in this Chamber, and it has been a pleasure to have you as my constituency next-door neighbour for the last 18 years. I am pleased to have secured a debate on this important work undertaken by my Committee before this Parliament draws to a close. It is great that we have been able to hold the debate in the month of Stoptober, the big anti-smoking initiative, which I think has been successful, and which I remember launching in my time as a Minister, back in the day.
Statistics released by the Office for National Statistics show that in 2018 in England, 14.4% of adults smoked. That represents a significant advance in reducing the prevalence of smoking in our country; ONS figures show that smoking rates in England have fallen every year since 2011. It is important to say that there is one exception to that advance, and it relates to mental ill health—something I care a lot about. People with severe and enduring mental ill health tend to die much younger than others, by as many as 20 years, one key reason being the prevalence of smoking among that group, around 40% of whom smoke. Although we have been very successful in reducing smoking rates in the population as a whole, we have not been successful in doing so for those with mental ill health. I will return to that.
In Great Britain in 2018, there were approximately 3.2 million vapers—6.3% of the population—which marks a significant increase since 2014, when the figure was 3.7%. Why does that matter? The tobacco control plan stated:
“Tobacco is the deadliest commercially available product in England”— it is important to hold on to those words from the Government—
“with tobacco regulations serving to safeguard people, particularly children and young people from the avoidable disease and premature death it causes.”
The recent prevention Green Paper clearly articulated that some people are disproportionately likely to smoke, which we should all be deeply uncomfortable with:
“Smokers are disproportionately located in areas of high deprivation. In Blackpool, 1 in 4 pregnant women smoke. In Westminster, it’s 1 in 50.”
What an extraordinary contrast! Deprivation causes that significant risk to the health of mothers and babies.
According to Public Health England, vaping is at least 95% less harmful than smoking. That does not mean that vaping is safe, and it certainly does not mean that we should encourage non-smokers to start vaping, but based on all the evidence we have, vaping is considerably less harmful than smoking.
I put on record my thanks to the right hon. Gentleman for his time chairing the Select Committee on Science and Technology. It has been an interesting period, in which we have gone into great detail—effectively, I think—on many subjects. I was annoyed that NHS England, which has the time to put out often crass and obvious statements on health, did not have the time to come and give us advice on e-cigarettes, the use of which, as he says, is one way get people to stop smoking.
I thank the hon. Gentleman for that. I will call him my hon. Friend, because I am demob-happy and I do not care about the normal rules. It has been a great pleasure to work with him on the Committee. I share his concern. Given that the Government’s own tobacco control plan describes tobacco as
“the deadliest commercially available product in England”, one would have hoped that the body that runs the NHS in England would show a strong commitment to confronting that clear risk. Despite it being very clear from all the available evidence that vaping is significantly less harmful than smoking, I none the less absolutely encourage continued research in this area. We should always be alert to anything that indicates a potential risk; that is exactly what our Committee recommends.
E-cigarettes are not only less harmful than smoking, but appear to be an effective tool for stopping smoking, as the hon. Gentleman made clear. A study published earlier this year in the New England Journal of Medicine randomly assigned adults attending UK NHS stop smoking services either nicotine replacement products of their choice, including product combinations, for up to three months, or an e-cigarette starter pack. That study of 886 participants found that the one-year abstinence rate was 18% in the e-cigarette group, compared with 9.9% in the nicotine replacement group. That is a significant difference, and we need to make sure that we act on that difference now that we have knowledge of the effectiveness of e-cigarettes as a stop smoking tool.
“the three main reasons for vaping remain as an aid to quitting (22%)…preventing relapse (16%) and to save money (14%)”, because people who vape spend much less money than people who smoke. That demonstrates that users perceive e-cigarettes as a stop smoking tool. E-cigarettes are therefore likely to help the Government to meet their ambition, announced in the prevention Green Paper, for England to be smoke-free by 2030. None the less, I accept that further research is needed on the effectiveness of e-cigarettes as a stop smoking tool. Will the Government or one of their agencies request further independent research on the effectiveness of e-cigarettes as a stop smoking tool?
Our report highlights the issue of what the NHS does on smoking cessation. Cancer Research UK recently pointed out that primary care clinicians face barriers to discussing e-cigarettes with patients who smoke; one in three clinicians is unsure whether e-cigarettes are safe enough to recommend. Given the death toll from smoking, it is extraordinary that it appears that clinicians are unaware of the clear advice from Public Health England in that regard.
I agree with everything that the right hon. Gentleman has said. Does he agree that the Government could reach their ambitious target, which he alluded to, by embracing vaping, getting more information out there to those clinicians and working through the law, particularly post Brexit, to ensure that people who want to give up smoking have all the information they require in order to take up vaping instead?
I totally agree. The statistics that I am citing make the point about raising awareness, even among clinicians. We thought that it was just the general public who needed to understand better the relative risks, but clearly clinicians also need to understand the relative risks so that they can advise their patients more effectively.
Two in five clinicians feel uncomfortable recommending e-cigarettes to their patients who smoke. Again, that is an extraordinary finding. Fewer than three in 10 agree that their current knowledge is enough for advising patients about e-cigarettes. That extraordinary data reveals a clear need for the awareness raising to which Gareth Johnson has just referred.
What assessment has the Minister made of the number of smoking cessation services in the NHS that are actively promoting e-cigarettes as alternatives to conventional cigarettes? It ought to be every single one throughout the country, but are they actually doing it? Do we know? Can the Minister tell us what work the Government are doing with NHS England on increasing knowledge among clinicians of the uses, benefits and risks of e-cigarettes for current smokers?
Our report recommended that NHS England should create a post for someone who is responsible for implementing the Government’s tobacco control plan. The response said:
“The Government broadly accepts this recommendation.”
However, no specific steps to implement our recommendation were set out. We pursued that with NHS England, which in January told me:
“It is our intention to appoint an individual with lead responsibility for this role. This will be an important part of our delivery programme for the NHS Long Term Plan.”
We would all assume that that person was appointed long ago and that active work is now underway to pursue this vital agenda, which will save lives, but can the Minister confirm that NHS England has created that post and, if so, is someone actually in post and doing the job?
The Government say that, in their long-term plan, provision is made for
“all smokers who are admitted to hospital being offered support to stop smoking”.
That is not due to be fully implemented until 2023-24. Again, given the extraordinary health benefits of stopping people smoking, I would have hoped for a tighter timescale than ’23-24 to implement that. Will the Minister tell us how implementation of that proposal is going and whether consideration is being given to implementing it fully before 2023-24?
Our report recommended that the NHS should have a clear policy on e-cigarettes in mental health facilities that establishes a default of allowing e-cigarette use by patients. This comes back to my point that approximately 40% of those with severe and enduring mental ill health still smoke. The attitude and culture within mental health trusts is critical if we are to enable and help people with severe and enduring mental ill health to give up smoking. We said that should be the default that and e-cigarettes should be made available in mental health facilities unless there are clear evidence-based reasons for not doing so.
The Government response said:
“NHS England will provide guidance to mental health trusts that sets out that existing vapers should be permitted to use e-cigarettes as part of smoking cessation programmes, and…tobacco smokers should be supported to stop smoking through smoking cessation programmes”.
Can the Minister tell us whether that guidance has been issued? I very much hope that it has. If not, when will it be issued and what is the reason for the delay in issuing such important guidance? If it has been issued, what assessment has been made of how it is working?
The UK is making good progress in getting people to stop smoking and use e-cigarettes to achieve that, but that is at risk from recent concerns about e-cigarette use. Those concerns have been expressed particularly in other countries. We have put the concerns to Public Health England. The first is the claim that deaths in the US have been linked to the use of e-cigarettes and vaping products. The reality is that the US operates in a totally different regulatory context and “illicit products” were
“implicated in this outbreak…including vaping cannabis derivatives.”
That is from Public Health England. It has also explained that
“the suddenness of the outbreak across many USA states in just a few months, suggests that this is not a gradual effect of long-term use, but because of a specific agent coming into use in the affected population.”
Next are the concerns that flavoured e-cigarettes are “luring” children into vaping. Public Health England’s response explained that the data it had seen so far was reassuring that e-cigarettes were not re-normalising smoking. Furthermore, the UK and the US have different rules on advertising, nicotine concentration and education on vaping, which explains why flavours of e-cigarettes are less impactful in the UK compared with the United States.
The next issue is the introduction of a ban in India on the production, import and sale of e-cigarettes because of concerns about the risks that they pose to health and to the young. Again, an assertion has been made that is at risk of infecting the debate that we have in this country. However, Public Health England has explained:
“India is one of several countries that appears to be responding to the outbreak of lung disease among cannabis” vapers
“by proposing a ban on nicotine inhalers.”
It has also explained that smoking is far more prevalent in India and causes 7 million deaths a year there.
I suspect that the right hon. Gentleman knows better than I do, but I note the point that he makes. My view, based on the evidence that the Committee heard, is that the action taken by India is not based on evidence and is likely to result in more people dying of lung cancer. I think that is shameful.
I encourage all right hon. and hon. Members to read the helpful and comprehensive reply that we received from Public Health England on these issues and others, and which we have published so that anyone can delve into the detail. I am reassured that Public Health England is in “close dialogue” with a range of international partners, and I agree with Public Health England when it says:
“It is no exaggeration to say that inflating fears about e-cigarettes could cost lives.”
Incidentally, I have concerns about the attitude at the World Health Organisation, which does not take the same evidence-based approach, as far as I can see, as this country has done. Again, that has implications through the potential loss of life for millions of people across the globe.
It seems to me that people often conflate the fact that we do not have all the long-term evidence on vaping impact with an assertion that that should lead us to conclude that we should not be recommending vaping as an alternative to smoking. Frankly, that is stupid as a public policy approach, because we know that smoking is killing—I think—more than 70,000 people in England every year, and all the evidence so far shows that nothing like that is happening from vaping. According to Public Health England, it is 95% less dangerous than smoking. Therefore, the clear public health advice has to be that vaping is an appropriate way to help people give up smoking. Of course, the best thing of all is not to vape and not to smoke, but if that is not possible for someone, the clear public health advice needs to be that vaping is better than smoking.
Will the Minister set out what contact the Government —she or other Ministers—have had with other countries on international approaches to e-cigarettes? In particular, what are they doing at the World Health Organisation to encourage a more enlightened approach? What assessment have the Government made of the effects of those international approaches on public perception of e-cigarettes in the UK? What steps will the Minister take to ensure that this misinformation on e-cigarettes is challenged?
It is not only the World Health Organisation that is not using evidence for its advice, but the EU. The EU’s directive on the size of the bowls used and the amount of substance put in is not based on evidence. It is likely to mean that those people getting a nicotine kick—much less dangerous than cigarettes—will not find the products satisfactory and will go back to smoking.
I share the hon. Gentleman’s concern about the directive and the proscriptive rules relating to vaping, which do not appear to be sufficiently evidence-based.
E-cigarettes are positive in helping current smokers to stop smoking, and they are significantly less harmful than smoking conventional cigarettes. Yes, there are unknowns about long-term risks, and we need to maintain research on e-cigarettes, but doing nothing is not an option when people’s wellbeing and lives are at risk. I look forward to the contributions of other right hon. and hon. Members, and to the Minister’s reply.
It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate my friend, Norman Lamb, on securing this important debate.
E-cigarette use in the UK has followed a gently rising trend over the past few years, and last year, statistics from the Office for National Statistics showed that 6.3% of those over 16 were regular users—a rise of less than 1% over five years. In our August 2018 report, the Science and Technology Committee concluded that e-cigarettes should not be viewed in the same way as conventional cigarettes. They are an effective stop-smoking aid and should be formally considered as such.
In its response to the letter sent on behalf of the Committee by the Chair, Public Health England confirmed that it believed, as the Committee did, that e-cigarettes are around 95% less harmful than conventional smoking. As our Committee found:
“A medically licensed e-cigarette could assist smoking cessation efforts by making it easier for medical professionals to discuss and recommend them as a stop smoking treatment with patients.”
Existing smokers should be encouraged to give up, but if that is not possible, they should switch to e-cigarettes as a considerably less harmful alternative.
We must acknowledge that there are uncertainties about the longer-term health effects of e-cigarettes. They have not been in circulation long enough for any scientific research to be certain. Concerns have been raised in the United States, as was mentioned, about an isolated outbreak of serious lung injury linked to illicit vaping products, but I suspect, as the right hon. Gentleman said, that there may have been other factors at play in that instance. In any event, we have not seen that replicated in the UK, largely because, as ASH confirms, we have a strong regulatory system in place, which is not yet the case in the US.
The Government mandate strict conditions, namely a minimum age of sale, a ban on advertising in broadcast media, print or the internet, and a stipulation that products containing over 20 milligrams per millilitre of nicotine need a medicinal licence. Products must also be child-resistant and tamper-evident, and packs must carry a health warning covering over 30% of the surface area.
Moreover, to be balanced, any judgement on the future of e-cigarettes must take account of human nature and the most likely alternative to vaping, namely returning to harmful conventional cigarettes, which have proven to be a serious health risk over time. While some groups would prefer the firmest possible line—Cancer Research UK, for instance, is pressing for a tobacco-free UK within the decade—most groups agree that e-cigarettes can provide a useful route towards quitting harmful conventional cigarettes.
We have seen clear evidence that e-cigarettes are an effective quitting aid for adult smokers and, crucially, the percentage of young smokers trying e-cigarettes in Britain is small, with continued use smaller still. They flirt with the e-cigarette, but do not continue with it. There is little evidence to suggest that such products act as a gateway to conventional smoking—they are not, as some would suggest, a stepping-stone to conventional smoking—and figures show that almost 3 million people in the UK today are using e-cigarettes as an aid to quitting harmful conventional cigarettes.
Unfortunately, the Committee found that some aspects of the regulatory system for e-cigarettes are holding back their use as a stop-smoking measure. Restrictions on the strength of refills and maximum tank size have led some users to move away from e-cigarettes and return, sadly and regrettably, to conventional smoking. There seems to be little scientific basis for these limits, and I am pleased that the Government, in response to our report, intend to consider these anomalies and how to address them. It is good to see that the Government also agree with our conclusion:
“There should be a shift to a more risk-proportionate regulatory environment;
where regulations, advertising rules and tax duties reflect the evidence of the relative harms of the various e-cigarette and tobacco products available.”
Such a move might well bring about the welcome improvements in health that we, as a society, desperately seek, particularly from lung cancers and other by-products and unintended consequences of smoking. It is proven beyond doubt that conventional smoking is harmful. I look forward to seeing those changes implemented.
I take this opportunity to speak directly to conventional smokers. Despite being a fire officer for 31 years, sadly I was a 50-a-day smoker for many years, although I have long since stopped. Believe me: being a smoker was a costly, smelly and unhealthy mistake in my life. I only realised that afterwards. Yes, I enjoyed my cigarettes then, as the smoker today does. Even in my time in the fire service, when I left a fire with my breathing apparatus on and pulled the face mask off, some kindly colleague would have a pre-lit cigarette for me. It was certainly madness at the time, and I indulged in it. It is not easy to stop, but anything that is good is not always easy. Believe me, it can be done. My plea to those who do smoke is: you can stop if you put your mind to it, and it is absolutely worthwhile.
It is something to be neither proud nor ashamed of. It was part of the culture of the time. I was part of that culture. There are two things in life that I have never regretted: marrying my wife, Agnes, and giving up smoking. They are equally wonderful.
I have had the pleasure to serve on the Science and Technology Committee since shortly after I was elected to this House, and it has been a fascinating and often inspiring journey. I am incredibly proud of the work we have undertaken as a Committee, ably assisted by a very fine secretariat, and I wish to put on record my thanks to them for their support. Indeed, as my friend the right hon. Member for North Norfolk and I both intend to retire at the forthcoming election, this will be our last debate together, and I wish to thank him for his fine stewardship over the two years.
I am really happy to be here this afternoon, also giving my last speech in Westminster Hall, which is something that I have been looking forward to for a considerable time—since 2016, when something that I do not want to mention happened.
I have been active in smoking cessation over many years in Parliament. This is a good, well sourced and evidenced report about where we should move in the future to protect our fellow citizens. Let me admit two things—this is a bit of a confession. First, it has been more than 40 years since I stopped, but I, too, used to smoke cigarettes; I was quite addicted. Secondly, I ought to mention that although there is no money in it, I am an honorary fellow of the Royal College of Physicians.
The report makes it clear that e-cigarettes have proven to be a unique opportunity to steepen the decline of smoking rates in this country. They lack the dangerous tar and carbon monoxide components of conventional tobacco cigarettes and are consequently 95% safer, as Public Health England says. It should also be noted that second-hand vapour from e-cigarettes is substantially less dangerous than from tobacco cigarettes. As we all know, e-cigarettes can and do operate as a pathway from conventional smoking to quitting altogether. At present, something like 2.9 million Britons use them as a pathway towards quitting, with tens of thousands successfully stopping each year.
We were all surprised that under the previous tobacco control plan we got well below the target adult smoking rate: it is below 16% now, which is extraordinary. Sadly, that was not because e-cigarettes were used in smoking cessation programmes, although in my view that should be the future; it was because millions of our fellow citizens were buying those products themselves. Getting adult smoking below 16% is no mean feat, but more than 80,000 of our fellow citizens are still dying prematurely from tobacco use each year. We should never forget those statistics. If anything else were taking lives in this country every year at that level, we would be up in arms and this House would have done more to stop it.
Cancer Research UK’s briefing recommends that e-cigarettes be used as a tool to aid smokers who wish to quit in achieving their goal. However, it rightly points out —as the Chair of the Science and Technology Committee, Norman Lamb did—that unfortunately surveys have shown that 40% of clinicians are uncomfortable recommending e-cigarettes to their patients, and a further third are unsure whether they are safe to recommend, notwithstanding what Public Health England says about them. Moreover, just 30% feel that their knowledge is sufficient to advise patients on vaping.
Healthcare professionals must be made aware of the benefits of e-cigarettes in aiding people to quit. Although vaping is not completely risk-free, the reality is that it is significantly safer than smoking conventional cigarettes. Healthcare professionals must be made fully aware of that, so that they can ensure that their patients have the strongest chance of quitting smoking. It is difficult, and it may not necessarily be something that new doctors or doctors in training will be looking at. However, any health professionals attending or reading this debate, especially general practitioners, could do worse than go round to the vaping shop on their local high street to talk to the people who sell the products, because those are the people who trace their patients. They will know people who have gone from 50 cigarettes a day to none, or who used to need higher hits of nicotine but are now on lower and lower doses. I know people who still vape but use no nicotine at all; they are satisfying not an addiction, but a habit of using their hands. That is what ought to happen. It is quite true that there is no long-term evidence, just as there was not when the first heart transplant happened in South Africa, but it is pretty clear that there is evidence out there in our communities. We need our health professionals to go and talk to the people who have probably been dealing with their patients for some time.
Naturally, many people have raised deep concerns about whether vaping can operate as a gateway to smoking conventional tobacco cigarettes, but there is no evidence to suggest that such a phenomenon has materialised in any meaningful or demonstrated way. ASH, which I have been active with in this country for decades, has been monitoring what is happening annually, particularly around young children, and there is no evidence that it is causing nicotine addiction and leading people on to cigarettes.
I have to say that some of the evidence that we have seen about vaping in America is shocking. Some of the stuff that they put in is class A drugs—that is why we are having deaths. I know from going to America from time to time, where I have two step-grandchildren, that one company, which shall remain nameless in this debate, has been promoting vaping to young children with different flavours, although not necessarily with nicotine. When we talk to schools about it, they are up in arms about the nuisance and the litter. There is something to think about there, but we should not be too scared of it.
Although there are advertising restrictions and regulations on vaping, they are less stringent than those that apply to tobacco products. In June, the Library published a briefing paper that is well worth reading, “Advertising: vaping and e-cigarettes”. I first campaigned against tobacco in the 1993-94 Session when I introduced the Tobacco Advertising Bill, a private Member’s Bill to ban tobacco advertising and promotion. We are a long way down the road now, but there are still lessons to be learned from the Library’s paper about how these products are advertised.
The Science and Technology Committee has recommended that cigarette pack inserts could be used to refer smokers to e-cigarettes as a healthier alternative, but unfortunately that is currently banned under the Standardised Packaging of Tobacco Products Regulations 2015. We need to think quickly, because the people addicted to cigarettes are the ones who are going into shops and buying e-cigarettes. They are the people we should be targeting; I do not think that we can do it with things like websites. We could change those regulations in super-quick time—I can’t, because I’m off, but Parliament could, which would put us in a position to get to the people who are still addicted.
E-cigarettes need to be endorsed as mainstream in cessation programmes. About three years ago I visited the Leicester smoking cessation programme, which has been at the forefront of using such products. It has a wonderful scheme—led by a nurse at the time—in which pregnant women vaped at least throughout their pregnancy, which greatly enhanced the health and the life chances of their child. There is no reason why we should not make that mainstream. I know that people who smoke will now be referred to community pharmacies; that is good, but we should be looking at specific interventions with these products for people who are vulnerable, including unborn children.
Smoking cessations ought to be funded directly by the tobacco industry. I know that that would be an issue for the Treasury, but the Minister will need to talk to it. We often talk about making the polluter pay; tobacco companies should be paying for our smoking cessation programmes. Sadly, as we have said in previous debates, some of those programmes are now fading away. There are parts of this country that still have heavy and intense levels of adult smoking but have no smoking cessation programmes at all. That is wrong and, with more than 80,000 deaths a year, it should be stopped.
Unlike the three previous speakers, I rather hope that this will not be my last speech in Westminster Hall—but that is up to the people of Dartford, not me.
I am pleased to contribute to the debate, because I feel strongly that vaping is something that we should embrace as a country. It has been mentioned that Public Health England says that vaping is 95% risk-free; that is really significant, and it is not just Public Health England making such statements. Cancer Research UK says that there are significant benefits from vaping in comparison with tobacco consumption. ASH, the British Heart Foundation and the British Lung Foundation—organisations that understandably have traditionally frowned on anything associated with smoking—recognise that vaping saves lives. That is what we are talking about, and the sooner the country recognises that we have an invention that could save thousands of lives in the UK, let alone the rest of the world, the sooner we can start saving the maximum possible number of lives.
It was with great regret that we heard the stories coming out of the United States. It was only when we starting drilling down and saw that the deaths were potentially linked to acetates, cannabis oil and so on—those are the irritants actually causing the deaths—that we recognised that we should not allow those tragic circumstances to cloud people’s image of vaping. It is not only clinicians who are unsure about vaping, and whether they can recommend it to patients; the general public are also unsure whether vaping is as safe as some experts have said. We need to educate people, and say that it is a well-known fact that tobacco seriously damages health and therefore is highly risky, but that with vaping the risks are substantially smaller.
Nobody in this debate, or anywhere in the House of Commons that I am aware of, is suggesting that people who do not smoke should take up vaping. The suggestion is that it is people who smoke, and who are addicted to tobacco and nicotine, who will benefit from vaping. There are risks associated with pretty much anything, and vaping is no exception. The message should go out loud and clear that people who do not smoke should not start vaping, but people who smoke may wish to try that alternative as an effective way of reducing their tobacco consumption, or helping them to come off tobacco completely.
I welcome the fact that some tobacco companies have embraced vaping; they realise its potential. Japanese Tobacco International has highlighted to me some of the dangers associated with products that do not contain nicotine, and so do not come under the Tobacco and Related Products Regulations 2016 and can be targeted at children. They can be marketed to look like food, or something trendy that people will want to get involved with, and as they do not have to comply with the tobacco regulations, their ingredients are not known. We need to look at that.
The Science and Technology Committee, chaired by Norman Lamb, has looked at the 2016 regulations, which have serious flaws. For a start, they should not lump together tobacco and vaping products; they should be covered by separate regulations. That would bring an end to the ridiculous situation whereby a vaping product that has no nicotine in it must have a warning on its front saying, “This product contains nicotine”. If the vaping company does not put that warning on its product, it will fall foul of the regulations, but if it does, it might fall foul of other regulations; it is a crazy situation that has developed.
We need to consider whether it is right to allow more advertising of vaping products. I believe that it is, but regulations seem to prevent that. I think it is right that we should enable people to be educated, and aware of the products available and their potential benefits.
I do not want to turn this into a debate on Brexit, but there is no getting away from the fact that once we leave the European Union, we as a country can look at the regulations ourselves, and see what best suits our needs and what would be a sensible approach to vaping. We can ensure that people are aware of vaping and can benefit from it, so we should do so.
I have met a number of organisations that are trying to push forward a change in vaping regulations. Imperial Brands—formerly Imperial Tobacco—is doing a lot, and there is also a company called Blu, whose products are pioneering. That is a key part of the process. Companies are investing a lot in developing products that will be attractive to smokers, in that they will satisfy their cravings, so that they feel less necessity to smoke cigarettes.
I do not want to demonise smokers. If an adult chooses to smoke, knowing the risks, that is their decision. However, it is incumbent on the Government to ensure that people are aware of the alternatives to smoking, of the risks, and that there is comparatively less risk associated with vaping.
The Government are rightly pursuing a target of reducing the number of people who smoke and eventually eliminating smoking in this country. That is very ambitious, and if we are to achieve that, it will be necessary to introduce people to vaping through their GP.
On this idea that smoking is an adult thing, very few people start smoking after the age of 21. The hard reality is that for most people, the starting point comes when they are quite young. I think I was about 11 or 12 when I started getting addicted to nicotine. I think we have to be very careful about this. It is not really an adult choice; it is just something that adults have done from a very early age.
I totally agree. I take the view that if adults want to smoke, knowing the risks, that is up to them. However, there is a duty of care on the Government to ensure that tobacco products are not consumed by children. That is absolutely clear, and it is right that we keep the age at which people can start vaping at 18; we do not want vaping products targeted at children. In my experience, no responsible vaping company would do that or has done that.
The Government approach is sensible. I believe that they can embrace the potential of vaping to save lives. There are so many measures that could be taken—through the taxation system, through advertising, through education, and by making people aware of these products and making them more accessible to smokers.
We must recognise that for the first time in my life, there is something that genuinely can help people to get off tobacco—something effective that works. If we look at a graph of the number of people smoking and a graph of the number of vapers in this country, we can see a direct correlation: the more people vape, the fewer people smoke. We need to highlight that and celebrate it, and the Government should take that forward.
I have not put my name forward to speak, but I would like to say a few words.
Thank you, Sir Henry. I wanted to draw attention to the correlation between people who have mental health difficulties and the propensity to smoke. I pay tribute to my right hon. Friend Norman Lamb, who has championed the cause of mental health throughout his time in Parliament. I hope that Committee members will not mind my thanking him for everything he has done.
This debate relates specifically to England, and I am a Welsh MP, but I draw attention to the issue of cross-border healthcare. Many people in Wales who need to attend a residential mental health unit have to travel to England, and of course there is complete disparity between the practice in Wales and that in residential units in England. I realise that this is not totally within the Committee’s brief, but I would like it to consider how the policy for mental health units in England, which have particular rules and regulations around access to e-cigarettes, could be married up with the policy in Wales. There are significant differences between them. We talked earlier about learning from international bodies and countries around the world, but there is also a need to look at the whole UK, and consider how we can get parity between the nations. Thank you, Sir Henry, for allowing me to speak. Diolch.
It is a pleasure to serve under your chairmanship, Sir Henry. I apologise if I sound a bit croaky; I have a cold that is going round. Hopefully I will get rid of it soon, given what is to come over the next few weeks.
I thank Norman Lamb for introducing this debate, and for his characteristically well-informed speech. It is sad to think that it could very well be his last speech in what has been an illustrious career as an MP. I am sure that it will not be his last speech as a campaigner or activist. I also congratulate him on his work chairing the Science and Technology Committee, and on the excellent report that we are considering.
I thank all the other right hon. and hon. Members who have spoken, including Bill Grant, and my right hon. Friend Sir Kevin Barron, who I have enjoyed working with for many years. He has also had an illustrious career, and was an excellent Chair of the Health Committee for a number of years; he will be sorely missed in this place. There were also speeches by Gareth Johnson and by the hon. Lady who has just spoken; I did not catch the name of her constituency.
Excellent. Thank you.
As we have heard, there is still some uncertainty about the use of e-cigarettes. They entered the UK market only 12 years ago, and because this technology is still so young, we do not know for certain what its long-term impacts on health will be. What we do know is that e-cigarettes are around 95% less harmful than conventional cigarettes, and because of that, an estimated 2.9 million people in the UK are using them to stop smoking. Each year, tens of thousands of people successfully use e-cigarettes to quit. A randomised controlled trial, published in the New England Journal of Medicine earlier this year, found e-cigarettes used in a stop smoking service to be nearly twice as effective as licensed nicotine replacement therapies, such as patches and gum.
The importance of e-cigarettes as a smoking cessation tool should therefore not be dismissed. However, that must come with the caveat—I think everyone has made this point—that using an e-cigarette is not completely risk-free. There has been a recent outbreak of serious lung injury in the US linked to vaping, although that has not been replicated in the UK. Currently, 3.6 million people vape in the UK, yet the number of cases of severe respiratory pathology associated with vaping is low and diverse, with reports over a long period.
I agree with ASH’s recommendation that e-cigarette users should buy vaping products, including e-liquid, only from mainstream suppliers that sell regulated products, because using black market products may carry lethal risks. They should report any adverse effects from e-cigarettes to the Medicines and Healthcare Products Regulatory Agency using the yellow card scheme. If they experience serious adverse effects that they think are due to vaping, they should immediately stop vaping and get advice from their doctor.
Has the Minister considered launching an e-cigarette safety education programme that will ensure that e-cigarette users know the risks, and what to do if anything goes wrong and they manifest any such symptoms? That may lessen the possibility of manifesting the same patterns that we have seen in the US of lung injuries linked to e-cigarettes.
The Committee’s recommendation 4 says that NHS England should issue e-cigarette guidance to all NHS mental health trusts, and the default should be to allow e-cigarette use by patients. As we have heard, people with mental health issues smoke significantly more than the rest of the population, and could therefore benefit significantly from using e-cigarettes to stop smoking. Encouraging and allowing patients in mental health units who are smokers to switch to e-cigarettes as a means of smoking cessation would allow them to engage with their treatment sessions in the facilities without the interruption of smoking breaks.
A third of the 50 NHS trusts that responded to the Committee’s survey ban the use of e-cigarettes. The Government have agreed to issue guidance to NHS trusts about e-cigarettes. Will the Minister please tell us when she anticipates that it will be published? I know that she might have to rush it out in the next couple of days, but she might have a magic wand and be able to do that. Doing so could allow patients in mental health units to engage more fully with their treatment, which could improve outcomes.
As the Committee has found, e-cigarettes have a role to play in our society and in the Government’s commitment to achieving a smoke-free generation. However, we must ensure that advice on the safety of e-cigarettes, both short and long term, is updated regularly and publicly, so that users have the most relevant and up-to-date information available to them. The Government must also consider the role that e-cigarettes play in mental health services and improving patient outcomes across the NHS.
Every contact counts, especially when it comes to smoking cessation, and none should be missed. However, due to the Government’s public health budget cuts since 2013, which I know the Minister is not personally responsible for, smoking cessation services have suffered, leaving the most vulnerable smokers behind, without any support to quit smoking. That must change. Again, I ask the Government to reverse those public health budget cuts, so that local authorities can provide the smoking cessation services that their local communities need and deserve. I look forward to the Minister’s response.
It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate Norman Lamb on securing the debate, and I thank the whole Committee for the report, for its tone, and for the intelligent way in which it has approached the difficult subject of trying to stop behaviour that is detrimental to individuals.
We want smoking to reduce to zero, and for us to be smoke-free by 2030. It is an ambitious programme, but it will benefit many more people than just the individuals who smoke themselves, as it affects those around them. I thank the right hon. Gentleman, whom I have always highly respected, for his important work leading the Science and Technology Committee, and for his broader work on the health agenda. Although today’s debate might be his last in this place, I hope that it will not be the last time I hear him waxing lyrical on the airwaves about this subject. I say the same for Sir Kevin Barron, who has really been quite formative in this area, both on the Health Committee and in his work with the all-party parliamentary group on smoking and health.
It is timely that we are having this discussion at the very end of this year’s Stoptober campaign; I pay tribute again to the right hon. Member for North Norfolk for his work in starting it. There is never a better time to stop smoking, and I encourage everybody who is thinking about doing so to visit their local stop smoking service, or to go online, and consider all the options available to help them to quit.
I am really proud of the tobacco control work over the past two decades and the progress that has been made, for which we have been recognised internationally. According to the Association of European Cancer Leagues’ tobacco control scale, the UK has been rated consistently as having the most comprehensive tobacco control programme in Europe. As we have heard from the numbers discussed, it is working—but we are not there yet.
Smoking remains one of the leading causes of preventable illness and premature death, with more than 78,000 deaths a year. That is not only a waste but a personal tragedy for all families affected. We are determined to do more, as set out in our tobacco control plan, the NHS long-term plan and the prevention Green Paper, which only concluded on
Our ambition is to be smoke-free by 2030. We know that we need to work harder in certain groups, including pregnant women and those with mental health issues. Like the right hon. Gentleman, I was struck by the extremely high prevalence of smoking in some areas. He mentioned Blackpool but, as he knows from representing a coastal region, in many coastal areas there is a very high prevalence of pregnant women who smoke. They interact with many healthcare professionals during what should be the enjoyable, exciting time when they are expecting a baby. We should use every single one of those interactions to help them to quit.
I have already asked officials whether there are other forms in which we can message that particular group in a way that helps them to understand the risk, as well as the things that are available to help them. I listened to the right hon. Gentleman’s point about people with enduring mental health issues. Facilities should allow e-cigarettes and provide more support. That is an ongoing part of the agenda. I will write to Simon Stevens to see where we are, and I will let the Committee know.
I thank the Minister for her very kind comments. I am pleased that she will write to Simon Stevens, because pressure from Government Ministers on NHS England to recognise the significance of the subject is really important. I am conscious that I asked a lot of questions in my contribution, and she may well be unable to answer them all, but will she write to me before Parliament rises next week, if possible, to answer those questions that she is able to, so that we get that on the record?
I will do my very best. If there is anything I have not covered, I hope that the answer will be winging its way to the right hon. Gentleman on Monday.
The Government are absolutely clear that quitting smoking and nicotine use entirely is the best way for people to improve their health. We recognise that e-cigarettes are not risk-free, as has been stated by all Members who have contributed; however, they can play an exceedingly important role in helping smokers to quit for good, particularly when combined with “stop smoking” services. It is an addiction, and we are trying to achieve a step change in people’s practices and behaviours that enables them to quit entirely. We do not know the long-term harms of e-cigarette use, and no authorities in the UK assert that they are harmless. Based on current evidence, Public Health England and the Royal College of Physicians estimate that e-cigarettes are considerably less harmful than smoking because of the reduction in levels of exposure to toxicants in e-cigarette aerosols compared with tobacco smoke. However, I reiterate that quitting smoking is the best option.
It is fair to say that opinions on e-cigarettes are divided, both in the UK and globally. It is important that we listen to concerns, while looking objectively at the evidence base and seeking to build it further, which I think is the point that the right hon. Member for North Norfolk was making. On the question of research, I assure him that there is an NHS England dedicated lead—a director for prevention—in place, overseeing the NHS long-term plan commitments. I note the right hon. Gentleman’s comments about India and the fact that making decisions too quickly, not based on the research that is available, has unintended consequences.
As the House is aware, we have introduced measures in the UK to regulate e-cigarettes: to reduce the risk of harm to children; to protect against e-cigarettes acting as a gateway to starting smoking—another important point that has been made today—to provide assurance on relative safety, and to give businesses legal certainty. Regarding what has happened in the United States of America, we take those concerns seriously—we are aware of the tragic deaths associated with vaping in the United States and are monitoring the situation carefully. Public Health England and the Medicines and Healthcare Products Regulatory Agency are in close contact with the US agencies. Investigations are ongoing; they have not yet been able to confirm the definite cause of the deaths, although it appears that the majority of those who died had used illicit cannabidiol with THC products, which led to those unfortunate deaths.
To date, there have been no known deaths from e-cigarette use in the UK. The MHRA yellow card reporting system is in place to report any adverse effects. It has been running for three years and, to date, has been notified of about 85 individual cases; all have been minor, and none has been considered life-threatening. However, I assure the right hon. Member for North Norfolk and all other Members who have contributed to this debate that we remain vigilant on the issue and are grateful for all research done in this area, including—my hon. Friend Gareth Johnson alluded to this—by those within the charity sector who do a great deal of work in looking at the harms caused.
In our tobacco control plan, we made strong commitments to monitor the impact of regulation and policy on e-cigarettes and novel tobacco products. To inform future policy, we are looking closely at the evidence on safety, uptake, health impact and the effectiveness of these products as smoking cessation aids. Public Health England will continue to update its evidence base on e-cigarettes and other novel nicotine delivery systems.
The use of e-cigarettes by young people was mentioned by the right hon. Member for Rother Valley and by my hon. Friend the Member for Dartford. Such use currently remains low, at 2%, and we have not seen the rise that has occurred in the United States. However, we will monitor the data closely to ensure that regular use does not increase and it is not seen as a gateway to tobacco use, and will also keep a close eye on any new evidence about long-term harms caused by flavourings. If the evidence shows that we need to address either or both of these issues, we will consider taking action, including further regulatory action where necessary. I would like the industry to show stronger leadership in the areas of e-cigarette product labelling and, in particular, design to ensure that its products do not appeal to young people. Some of the current naming appears to lean in that direction.
In future, we will have the opportunity to reappraise current tobacco and e-cigarette regulation to ensure that it continues to protect the nation’s health. I thank all Members who have spoken today, particularly the right hon. Member for North Norfolk, who will be leaving this House. Today has been a bit of a goodbye party for him, for my hon. Friend Bill Grant—I am staggered by the revelation that he smoked 50 a day; I wonder that he had time to do much else, let alone run around being a fireman—and for the right hon. Member for Rother Valley. I am sure that all of them will continue to work in this area.
I reiterate the Government’s commitment to help people quit smoking, which is ultimately the best course of action, and to seek evidence on reduced-risk products. We will continue to be driven by that evidence. Although we can celebrate the fact that adult smoking in England has fallen by a quarter and regular smoking among children has fallen by a half, I will truly be able to celebrate—like all right hon. and hon. Members present, I am sure—if we reach the goal, which both the report and the Government are aiming for, of being smoke-free by 2030.
I thank the Minister for her response to the debate and for her kind comments. There has been a remarkable consensus about the action we are taking in this country, and the need for it to be evidence-based. It is clear that the United Kingdom is ahead of the game internationally on smoking cessation work, and that is something we should celebrate. However, we should never allow ourselves to feel that we have done the job. We have so much still to do, particularly given the number of people who die every year from smoking, as Sir Kevin Barron made clear. The carnage—the death toll—is enormous, so the work needs to continue.
We have heard some wonderful admissions. The right hon. Member for Rother Valley and Bill Grant have admitted to smoking heavily in the past; they are both wonderful living examples of life after smoking. [Interruption.] Less coughing, please. They are wonderful examples to others of the potential value of giving up smoking, and I wish both of them a very happy retirement from this place.
I will quickly pick up on one or two points. I agree with the right hon. Member for Rother Valley that inserts in packs are a very good way of targeting an important public health message directly at people who need to hear it, and who need to be reassured that giving up smoking and vaping instead is going to help their health—a point we made in the report. I also agree with him about the case for the tobacco industry making a contribution to the cost of smoking cessation services, on the basic principle that the polluter pays.
My hon. Friend Jane Dodds, who has had to leave, made some important points about cross-border health issues. I applaud her for championing access to mental health support in Wales, which is incredibly important. The point in this debate is that every mental health facility and, in particular, every in-patient mental health facility, whether in England, Wales or Scotland, should offer the same access and support to enable people to give up smoking, using vaping as the mechanism to do so. Giving up smoking will lead to significant gains in not only people’s life expectancy, but their mental health; smoking harms their mental health as well as killing them earlier.
Gareth Johnson and my hon. Friend Graham Stringer both made the point that regulation must always be evidence-based. That has not been the case with the European Union directive or internationally, given the debate we have had about the World Health Organisation and the approach that is taken in America. In this country we want our regulations to be evidence-based, to give people the best chance of giving up smoking and having a healthier life.
On a personal basis, not in my role as Chair of the Select Committee, I agree with Mrs Hodgson that investment in public health is important. There is much evidence that investment in early prevention work of all sorts, and in public mental health, provides—in brutal economic terms—a return on investment. It also changes lives. The plea to whomever becomes the Government after
I thank you, Sir Henry, for your stewardship of the debate, and I wish all hon. Members well for the next few weeks. I am very relieved that I am not fighting to retain my seat in the middle of winter.
Question put and agreed to.
That this House
has considered the Seventh Report of the Science and Technology Committee, Session 2017-19, E-cigarettes, HC 505, and the Government Response, Cm 9738.