E-cigarettes — [Sir Henry Bellingham in the Chair]

Part of the debate – in Westminster Hall at 1:30 pm on 31st October 2019.

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Photo of Norman Lamb Norman Lamb Chair, Science and Technology Committee (Commons) 1:30 pm, 31st October 2019

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.