Smokefree 2030 — [Caroline Nokes in the Chair]

– in Westminster Hall at 9:30 am on 26th April 2022.

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Photo of Bob Blackman Bob Blackman Conservative, Harrow East 9:30 am, 26th April 2022

I beg to move,

That this House
has considered progress towards the Government’s smokefree 2030 ambition.

It is a pleasure to serve under your chairmanship, Ms Nokes. For those who do not know, today is my birthday. What better way to celebrate my birthday than to speak in Westminster Hall? On a personal level, it is tinged with sadness, because tomorrow is the anniversary of my mother’s death. She died from smoking—officially, it was lung and throat cancer, but I am clear that smoking killed my mother. That is one of the reasons I am so passionate about ensuring that young people do not start smoking and that those who smoke give up as quickly as they can, because the medical reality is that the lungs can recover. In fact, if smokers quit at an early enough stage, even seasoned smokers who have smoked for many years will see their lungs recover.

I thank the Chairman of Ways and Means and the Backbench Business Committee, on which I sit, for granting this debate. Originally, our intention was to focus on Javed Khan’s long-awaited review. The officers of the all-party parliamentary group on smoking and health and I believed that the review’s recommendation would be published last Friday. Javed has had to delay his publication, but I hope that when we see it, it will be as radical as we believe it to be. Given the delay in publication—until the middle of May, I believe—we were left having to decide whether to proceed with this debate or wait. My view is that, given that we have the opportunity to debate this issue, and possibly even shape Javed Khan’s views and recommendations, it is better to proceed and get the answers from the Minister about where we stand on the review. I hope the Government will commit to introduce all the recommendations of Javed Khan’s review, whatever they may be, to achieve what I am sure we all in this room wish to achieve: a smokefree 2030.

Mary Kelly Foy—I will call her my hon. Friend—and I have co-sponsored this debate, and I am sure she will speak on many of aspects, particularly levelling up. The Government have a bold ambition, which I strongly support—I am sure we all do—to bring the end of smoking within touching distance. But it is deeply disappointing that, three years on from that being announced in the Green Paper, we do not seem to have made much progress. There is no road map to put us on the route to success. The purpose of this debate is to remind the Minister of the urgent need to deliver the bold action that was promised in the 2019 Green Paper.

The 2030 ambition was acknowledged by everyone to be extremely challenging only three years ago. We have lost three years, so it is even more challenging now. We should be clear that if we do nothing, we will not achieve that target, so there is no time to be lost. When the ambition was announced, we had 11 years; now, there is only eight. We are nowhere near achieving our ambition, particularly for our more disadvantaged communities in society, which have the highest rates of smoking.

Photo of Gregory Campbell Gregory Campbell Shadow DUP Spokesperson (International Development), Shadow DUP Spokesperson (Cabinet Office)

I congratulate the hon. Member not just on jointly securing the debate but on his birthday. He talks about the harder-to-reach, socially disadvantaged communities. Does he agree that if we do not get the younger elements in particular to a smoke-free society, we will not get future generations, and the 2030 target will not be met?

Photo of Bob Blackman Bob Blackman Conservative, Harrow East

I thank the hon. Member for that intervention. Clearly, people start smoking when they are young. They continue to smoke well into their later life, and it is very hard for people to give up if they have already committed to smoking cigarettes, because nicotine is the most addictive drug that we know of. Therefore, it is very hard for people to get off it once they have started, so it is far better that we prevent people from starting to smoke in the first place. At the moment, I believe that around 200 to 300 young people start smoking every day, which is why it is imperative to stop them doing so right now. Indeed, Cancer Research UK has estimated that we will have to wait until 2047 for the smoking rate in disadvantaged communities to reach 5% or less, which is the smokefree ambition.

Photo of Alex Cunningham Alex Cunningham Shadow Minister (Justice)

I wish the hon. Member a happy birthday and congratulate him on securing the debate. One of the problems that we have is that some deprived communities are in larger areas where the smoking rate has actually come down, but it has remained high within those communities. We also have a high incidence of smoking in pregnancy, which causes other tremendous problems. Does the hon. Member agree that we need specific action to help people who are pregnant to quit smoking, and that we also need to tackle the whole community at the same time?

Photo of Bob Blackman Bob Blackman Conservative, Harrow East

I thank the hon. Member for his intervention and for the work that he has done on combatting smoking over many years. He raises the issue of smoking in pregnancy, which is the one target that the Government came closest to missing at the time of the last review. The target was 11%, and the Government just about achieved it. I am very clear that, for young women who are pregnant, we need to ensure that, if they smoke, they should be referred immediately to quitting services at the first meeting to discuss their pregnancy through the health service, and not just them but their partner as well. If both give up smoking, there is a strong chance that they will continue to not smoke. They need to understand the damage that they will do to their unborn child and the damage that they are doing to themselves. If we get to that point, it will improve the position no end. That is in the NHS plan, but for future years. I see no reason at all why that could not be introduced now. That is a management decision by the NHS, and I would ask my hon. Friend the Minister to encourage the NHS to do precisely that.

The all-party parliamentary group had an excellent meeting with the chairman of the independent review, Javed Khan. It was a very encouraging meeting, and we expect his recommendations to match the scale of the challenge, but unless his review is turned into a meaningful plan of action that is backed up by funding, it will not be worth the paper it is written on. We need new sources of funding, and the 2019 Green Paper recognised that we would need funding to end smoking, that there was pressure on budgets and that existing sources of funding were not sufficient. Three years and one pandemic later, the pressure on budgets in even greater. In its submission to me, the Local Government Association said that local authorities are paying some £75 million for quitting services overall. Clearly, they need additional funding to achieve what is required.

We are talking about disadvantaged communities, and levelling up is quite rightly a flagship policy for the Government, but there is no new funding to deliver on the bold ambitions set out in the levelling-up White Paper. The Institute of Fiscal Studies says that

“instead, departments will be expected to deliver on these missions from within the cash budgets set out in last autumn’s Spending Review. Departments and public service leaders might reasonably ask whether those plans match up to the scale of the government’s newfound ambition—particularly in the face of higher inflation.”

The levelling-up White Paper missions include narrowing the gap in healthy life expectancy between the local areas where it is highest and lowest by 2030, and increasing healthy life expectancy by five years by 2035. Smoking is responsible for half of the 10-year difference in life expectancy between the most and least disadvantaged in our society, so achieving the Government’s levelling-up mission on life expectancy will depend on delivering the smokefree 2030 ambition.

The Under-Secretary of State for Levelling Up, Housing and Communities, my hon. Friend Neil O'Brien, has said that the Government must “floor it” when it comes to prevention and public health, but we cannot floor it unless there is gas in the tank. Gas in the tank is what we are lacking right now. Funding for public health is in a parlous state. We must face up to the fact that funding for smoking prevention has been particularly hard hit.

After the spending review was published, the Health Foundation estimated that funding for smoking cessation and tobacco control had been cut by one third since 2015. The cuts in budgets for tobacco control are the falsest of false economies. Unlike most pharmaceutical drugs, smoking cessation saves money, and with no negative side effects. The National Institute for Health and Care Excellence has estimated that, for every pound invested in smoking cessation services, £2.37 will be saved on treating smoking and smoking-related diseases, as well as increasing productivity.

Photo of Mary Glindon Mary Glindon Opposition Whip (Commons)

I am so pleased that the hon. Gentleman’s birthday is in this month of VApril, and I congratulate him on this debate. Does he agree that the vaping industry, which is supporting harm reduction by encouraging people to turn to vaping, should get more support, and that vaping should be part of the Government’s harm-reduction strategy? Vaping is also more economical. Encouraging people away from cigarettes to vaping would be a good step in the direction of better health.

Photo of Bob Blackman Bob Blackman Conservative, Harrow East

I thank the hon. Lady for that intervention. Vaping has its purpose, which is to encourage people to quit smoking and take up vaping. I am concerned that people may take up vaping and then escalate to smoking. We do not yet have medical evidence on the long-term effects of vaping on health, so I am cautious. Clearly, it is better to vape than smoke, but let us not encourage people to take up vaping as an alternative to stopping smoking completely.

The all-party group has encouraged the “polluter pays” approach. The situation is very frustrating. The Government recognised in the Green Paper three years ago that budgets are tight and new sources of funding are needed. As recommended by the all-party parliamentary group, which I chair, the Government agreed to consider the “polluter pays” approach to funding. They also acknowledged that there were precedents, and that the approach had been taken by other countries, such as France and the USA.

Only months after the consultation closed in October 2019, the pandemic struck and put the prevention strategy on the back burner. It soon became clear that an effective prevention strategy was essential to build back better from the pandemic. It is also essential to deliver on the Conservative manifesto commitments to level up, reduce inequality and increase healthy life expectancy by five years. Those commitments are baked into the levelling-up White Paper and, the Government have said, will be enshrined in statute.

On the anniversary of the Green Paper’s publication, on 22 July 2020, the all-party group held a roundtable to examine the actions needed to deliver the smokefree ambition. The then Public Health Minister, my hon. Friend Jo Churchill, and her opposite number, Alex Norris, were the keynote speakers. The Minister gave her commitment that the Department would continue to explore further funding mechanisms with the Treasury, as had been promised in the Green Paper.

On 30 March, the former Public Health Minister, my hon. Friend Steve Brine, challenged why the commitment to consider a “polluter pays” approach had not been fulfilled. The response at the Dispatch Box from the Health Minister, my hon. Friend Edward Argar, was:

“My understanding—although my recollection may fail me, so I caveat my comment with that—is that this was initially looked at that stage, but was not proceeded with.”—[Official Report, 30 March 2022; Vol. 711, c. 867.]

My hon. Friend the Member for Charnwood might like to check his recollection. The all-party group on smoking and health, following its initial recommendations, put forward detailed proposals to Government in its June 2021 report about how a “polluter pays” levy could operate. I shared a copy of the report with Health Ministers at that time and wrote to the Secretary of State in July 2021, and again in December, asking for a meeting to discuss the levy. In September, I wrote to the Chancellor about the proposals. However, to date I have not had the courtesy of a reply to any of those letters.

If the “polluter pays” levy has been seriously looked at and a decision has been taken not to proceed, that was certainly not communicated to MPs or the all-party parliamentary group. That is precisely why officers of the APPG tabled amendments to the Health and Care Bill calling for a consultation on the levy. The amendments would not have committed the Government to going ahead, but would have ensured that they fulfilled their commitment to consider a “polluter pays” approach and that our proposals get the consideration they deserve. Our amendments were carefully considered by the other place and passed by a majority of 59—the greatest defeat the Government suffered on the Health and Care Bill. However, to the great disappointment of the APPG, the Government opted to oppose our amendments when they returned to the Commons for consideration. That leaves us without a mechanism for funding the smokefree 2030 ambition, with only eight years to go.

It appears that when the noble Lords met Ministers and Treasury officials to discuss the amendments, it was the Treasury, not the Department of Health and Social Care, that objected to the proposal to consult on a levy—not to introduce one, but to consult on the principle. The Treasury has a philosophical aversion to anything that smacks of hypothecation—raising funds to be put to specific purposes. Its preference is for funds raised to go into one big pot—the Consolidated Fund, from which all Government spending flows—that it controls and allocates, thereby giving it ultimate control. However, there are already numerous exceptions where hypothecation has been justified. One is the health and social care levy, which has just come into force. Another is the pharmaceutical pricing scheme, which the Department of Health and Social Care uses to raise funds for the NHS and provides a model for how our proposals could be implemented.

The noble Lord Stevens, formerly chief executive of the NHS, pointed out that the pharmaceutical pricing scheme was put in place by a Conservative Government in 1957 and has been sustained ever since with the support of Conservative, Labour and coalition Governments. He also said—and who could disagree?—that if it is deemed appropriate to have a form of price and profit regulation for the medicines industry, which delivers products that are essential for life saving, it is not much of a stretch to think that an equivalent mechanism might be used for an industry whose products are discretionary and life-destroying. I completely agree with him on that approach.

The Government already accept the principle that the polluter should pay to fix the damage they do. The extended producer responsibility scheme, which comes into force in 2024, is another good example. It requires producers of packaging waste to pay for its collection and recycling. Lord Greenhalgh, the Housing Minister, said:

“The reality is that we cannot keep looking to the Treasury to keep bailing everybody out—we have to get the polluter to pay.”—[Official Report, House of Lords, 5 January 2022; Vol. 817, c. 566.]

I could not agree more, and that principle applies even more strongly to smoking, which, as the chief medical officer pointed out, is a deadly addiction created and marketed by companies for profit.

There were objections because we were part of the European Union, but when speaking for the Government on Report in the House of Lords, the noble Lord Howe stated:

“the tobacco industry is already required to make a significant contribution to public finances through tobacco duty, VAT and corporation tax.”—[Official Report, House of Lords, 16 March 2022; Vol. 820, c. 297.]

However—this is the key point—tobacco companies pass on the cost of tax increases to smokers, which means that it is not the tobacco industry that contributes to the public finances but ordinary smokers, who have little choice but to buy cigarettes to maintain their deadly addiction. Indeed, when HM Treasury consulted on and rejected a levy in 2015, it was on the grounds that it would add an extra tax burden to smokers. That may have been true in 2015, but it is not the case today.

In 2015, we could not prevent tobacco manufacturers from passing the costs on to consumers because we were in the European Union. We are no longer part of the European Union, and therefore by capping tobacco prices and controlling profits, the Government can ensure that tobacco manufacturers bear the full cost of the levy, helping incentivise the industry to move out of combustible products and make smoking obsolete by 2030. I can think of few better Brexit dividends than making tobacco companies pay for the damage they do.

To quote my noble Friend and fellow APPG officer Lord Young of Cookham, speaking in the other place, our proposed levy will allow the Government to

“put the financial burden firmly where it belongs, on the polluter—the tobacco manufacturer—and not the polluted—the smoker.”—[Official Report, House of Lords, 16 March 2022; Vol. 820, c. 290.]

The reality is that this levy could raise £700 million a year from the profits of the tobacco companies—money that could be applied to smoking cessation services.

There is public support for this measure. It has been endorsed by more than 70 health organisations, including Cancer Research UK, Asthma + Lung UK, the British Heart Foundation, the Royal College of Physicians and the Health Foundation. It is also supported by three quarters of the public, including those who voted Conservative in the 2019 election, with fewer than one in 10 being opposed to the levy. What could be better than introducing a tax that the public support?

If we want to achieve a smokefree 2030, it is vital that we tackle high rates of smoking among our most deprived communities, pregnant women and people with mental health conditions. As the Government have said, this will be “extremely challenging” and cannot be achieved on the cheap. Health Ministers in both Houses have said that they do not want to prejudge the review, and therefore could not accept amendments calling for a consultation on a levy. However, as I have said, that review will report very shortly—in the middle of next month—and the discussions I have had with the chairman of the review make it very clear that the measures he will be recommending will need investment, and will be radical.

Once Javed Khan has reported back to the Government, there will need to be serious consideration of how the funding to deliver the smokefree 2030 ambition can be found. That will need to be done in parallel with decisions about what interventions are needed, as interventions cost money and can be delivered only if the funding is found. Pressure on budgets has only worsened since 2019, with the covid-19 pandemic wreaking havoc on our nation’s health and on Government finances. The Government made it very clear in the spending review that there is no new money for public health, so an alternative source of funding is urgently needed. With only eight years to go before we reach 2030, the Government need to decide where that money is coming from.

The existing funds are not sufficient, and our proposals provide a new source of funding in addition to tobacco taxes. If the Government are unwilling to accept our proposals, they must come up with an alternative solution that will match the scale of their ambition. As such, my question to my hon. Friend the Minister is this: if the Javed Khan review recommends a levy, will she commit to meet with us as APPG officers and with independent experts to discuss our proposals for a “polluter pays” levy to provide the investment that is needed to deliver the Government’s smokefree ambition?

My final point is that this review also needs to look at shisha tobacco, chewing tobacco and snus. Unfortunately, those areas are completely unregulated at the moment, but are extremely damaging to people’s health. I look forward to hearing the contributions of other Members and of the Front Benchers.

Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee

I will call the Front Benchers at 10.40, so perhaps Back Benchers could try to limit their contributions to about six minutes.

Photo of Mary Foy Mary Foy Labour, City of Durham 9:54 am, 26th April 2022

It is a pleasure to serve under your chairmanship, Ms Nokes, and I wish my hon. Friend Bob Blackman many happy returns. I declare an interest as a vice-chair of the APPG on smoking and health; I hope, therefore, that I can speak for a little more than six minutes, if that is okay.

The north-east is the most disadvantaged region in England, with high rates of smoking and all the harms that it brings. However, I am proud to say that in the last five years, the fastest declines in smoking rates have been in the north-east. Credit goes to our local authorities, which prioritised tackling smoking and banded together to fund Fresh—the longest-running and most effective regional tobacco control programme in the country. However, the north-east started with much higher smoking rates than the rest of England, so we have further to go to achieve a smokefree 2030.

More than 4,000 people died prematurely from smoking in our region last year, with 20 times as many suffering disease and disability caused by smoking, yet there is also an economic cost to our already disadvantaged communities. Smoking costs the north-east £685 million in lost productivity, £125 million to the NHS and £67 million in social care costs to local authorities. We simply cannot afford this strain on our economy.

When the smokefree 2030 goal was launched nearly three years ago, the Government acknowledged the scale of the challenge, admitting that it would be extremely challenging and promised bold action to finish the job. Since then, however, the Government have sat on their hands. Rather than stepping up their efforts to achieve the smokefree 2030 ambition, the Government have failed to announce a single new policy to that effect, while the £1 billion cut to public health funding since 2015 appears to be baked in.

The Minister knows that half the difference in life expectancy between the rich and the poor is due to differences in smoking rates. The Government’s lack of action threatens our ability to achieve not just the 2030 smokefree goal, but their levelling-up mission to narrow the gap in life expectancy between areas where it is highest and lowest by 2030 and to increase healthy life expectancy by five years by 2035.

Today’s debate was originally secured to discuss the recommendations of the independent review. The fact that the review was delayed made the debate even more necessary. The Secretary of State committed, when he announced the review in February, that it would report back in April. Javed Khan said he would report back on 22 April, so we were very disappointed that the Secretary of State told Parliament last week that he hoped it would be published in May, with no commitment that that would be the case. That is just the latest of many delays and missed opportunities, which we want to put on the record.

We want a commitment from the Government that they will accept no further delays in bringing forward a plan to achieve a smokefree 2030. Let us start with the Green Paper that announced the Government’s goal of a smokefree 2030, which was launched with much fanfare in July 2019. Further proposals included considering the “polluter pays” levy, which my hon. Friend the Member for Harrow East mentioned, and giving the ultimatum of making smoked tobacco obsolete by 2030. Cabinet Office guidelines say that Departments should:

“Publish responses within 12 weeks of the consultation or provide an explanation why this is not possible.”

The Green Paper consultation ended in 2019. In July 2020, on the anniversary of the Green Paper, the then public health Minister, Jo Churchill, told the APPG that work was under way to publish the further proposals envisaged in the Green Paper, and that she was keen to work with us to explore whether the current regulatory framework was sufficient. Since then, we have heard nothing.

The lack of an outcome on the Green Paper was disappointing, so in November 2020, we held a debate urging the Government to commit to publishing a new and ambitious tobacco control plan. We were therefore delighted when the then Minister committed in December to publishing a new tobacco control plan in 2021. The APPG commissioned Action on Smoking and Health, working in collaboration with SPECTRUM, the academic public health research consortium, to provide us with a report setting out our recommendations and the measures that the Government needed to take to achieve their 2030 ambition. The then Minister attended the launch of our report, welcomed our recommendations and committed to publishing the plan by the end of 2021. We are understandably disappointed by the delay in its publication.

There were other opportunities that could have been seized but were not. The Government were legally required to review the impact of existing tobacco product regulations, including those on standardised packaging, health warnings, product standards and e-cigarette regulations. The regulations set out in law a deadline for the review to report by May 2021. To that end, the Government launched a consultation last January to assess whether the objectives were still appropriate and whether the regulations were fit for purpose. Those regulations predated the Government’s commitment to a smokefree 2030, and it was blindingly obvious that they needed to be strengthened to match the scale of the Government’s new goal.

Since the regulations came into force, it has been clear that there are serious loopholes. The menthol ban relies on subjective rather than objective measurements to determine whether the regulations are being adhered to. An investigation by the Express newspaper revealed that the industry has exploited that loophole in the law and that Britain’s biggest tobacco giant sold £1 billion-worth of cigarettes flavoured with menthol in the year after the ban came into force.

That was not the only loophole; although e-cigarettes can be sold to those aged 18 and above, it is completely legal to hand them out free to children. While the advertising, promotion and sponsorship of e-cigarettes are heavily regulated, packaging and labelling are not. That has allowed the use of sweet names for vaping products, with cartoon characters and garish colouring, all of which appeal to children. Those are clear gaps in the law that need to be fixed without further delay.

The consultation was well timed to feed into the Health and Care Bill. ASH and SPECTRUM provided the Government with detailed and well-evidenced proposals for a number of improvements that would strengthen regulations and fix those loopholes. When the outcome of the review was not published in May 2021, as was required, we hoped that the Health and Care Bill would contain the further proposals the Government had promised to bring forward. Imagine our disappointment when the Bill was introduced to Parliament last July. Although it included measures on prevention and public health, there was nothing on tobacco or smoking, despite the Government’s much-trumpeted smokefree 2030 ambition.

That is why, in Committee, I tabled a set of amendments for increased regulation on tobacco, based on the APPG’s recommendations. The amendments included requirements to consult on a “polluter pays” levy; introduce pack inserts containing quit information; put warnings on cigarettes; close loopholes in the existing regulations on menthol and e-cigarettes; and consult on raising the age of sale to 21—a measure that has been proven to reduce smoking rates in the population at large by 30%. That measure has also been shown to reduce inequalities, because it has the greatest impact on the poorest and most disadvantaged communities. Throughout the passage of the Bill, Ministers in both Houses have repeatedly said that the Government were sympathetic to our aims and amendments, and that they would be considered for the next tobacco control plan. However, the tobacco control plan has already been delayed by a year and still does not have a publication date.

If the Government had supported those amendments, we would now have the foundation in place for a comprehensive strategy to end smoking by 2030. Instead, the Government have chosen to reject the amendments and, yet again, to kick tobacco control into the long grass. Now we are waiting for the tobacco control plan. Before the plan can be published, we have to wait for Javed Khan’s independent review, which will be followed by a public health disparities White Paper in the spring, which will in turn be followed by the tobacco control plan. That will leave only seven years to deliver the smokefree 2030 goal.

Since evidence first emerged of the harms caused by tobacco in the 1950s, smoking has killed more than 10 million people in the UK, and it continues to kill hundreds more every day. Up to two thirds of those smokers die prematurely from their addiction. There is a crucial message around children: every day, 280 children start smoking—that is more than 280,000 since the smokefree 2030 ambition was launched. Smoking is highly addictive; two thirds will go on to become daily smokers. With that in mind, can the Minister assure us that the tobacco control plan to deliver the smokefree 2030 ambition will be published no later than three months after the independent review? Will she also assure us that the Queen’s Speech will include a commitment to bring forward legislation in the next Session to deliver regulatory measures essential to delivering the Government’s ultimatum to the industry to make smoked tobacco obsolete by 2030?

I end with a comment from the chief medical officer. He pointed out that one in five people who die from cancer will die from lung cancer, and went on,

“the reason that people like me get very concerned and upset about it is that this cancer is almost entirely caused for profit…a small number of companies make profits from the people who they have addicted in young ages and then keep addicted to something which they know will kill them.”

Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee

I shall now put Members, starting with Hywel Williams, on a formal time limit of six minutes.

Photo of Hywel Williams Hywel Williams Shadow PC Spokesperson (International Development), Shadow PC Spokesperson (Work and Pensions), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Cabinet Office), Shadow PC Spokesperson (International Trade), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Chief Whip 10:06 am, 26th April 2022

I congratulate Bob Blackman on securing this important debate and on his very persuasive speech.

I will start with some context. Hon. Members might wonder why a Welsh MP, and a Plaid one at that, is speaking in a health-related debate when health is a devolved matter. I have a long-term interest in the negative effects of smoking. Many years ago, I supported Julie Morgan, then the MP for Cardiff North, when she tried to bring in a ban on smoking in public places in Wales. Unfortunately, we were unsuccessful. The Welsh Assembly was very anxious to bring in the ban at that time, which was some years before it was actually brought in in England and Wales. We had to wait.

I am no statistician, and certainly no epidemiologist—I cannot even say the word—but I did a back-of-the-envelope sum at the time and I reckoned that, because of the delay in bringing in the ban in Wales, between 15 and 20 people such as bar staff would have contracted smoking-related illnesses that would eventually killed them. That is the argument that we made at the time: the lack of devolution cost lives.

The second point to contextualise my interest in this matter is that, some years ago, I asked Alan Milburn, the then Secretary of State for Health, about nurses’ pay. His reply, which I remember distinctly, was that it was one of the abiding

“joys of my life that I am not responsible for all things Welsh”.—[Official Report, 22 January 2002; Vol. 378, c. 739.]

Actually, health was devolved, but nurses’ pay was not. The point I am making—apart from the fact that he was wrong—is that devolution is not always particularly clearcut. In the short-term, more devolution is not really the day-to-day issue; the issue is policy divergence, not devolution.

In Wales, we see that in our early adoption of the wellbeing approach to health, which is one of the landmark policies that the Welsh Labour Government have brought in, supported by my party. In some ways, this answers the point made by the hon. Member for Harrow East about there not being cash available; this is not a cash issue—it is a policy and attitudinal issue. In Wales, we have a health—not an illness—policy, but without control over illness-creating factors such as tobacco and alcohol.

Unsurprisingly, my answer is to have fuller devolution in the short term and full powers in the long term, but if I were to pursue that point now, I am sure Ms Nokes would pull me up. For now, I will just say that the Welsh Government have the goal of being smokefree by 2030, as is the case in England. The impact on public health in Wales is frightening, as it is elsewhere—smoking is the largest single cause of avoidable early death. In 2018, around 5,600 deaths in people aged 35 or over in Wales were attributable to smoking, 16.5% of all deaths in that age group. The cost to the Welsh NHS is around £300 million per year, which is, to my mind, of itself a completely persuasive point.

The aim for England to be smokefree by 2030 was announced two years before we got around to it in Wales. However, in the meantime, Wales has taken a lead on action, having published its draft strategy and delivery plan last November. Interested hon. Members from England are still waiting for England’s tobacco control plan, and I share their concern at this delay. I would also say that this is undermining the Welsh Government’s ability to achieve their own targets, because under the current devolution settlement there are many policies that Wales cannot implement. These policies include the trailed “polluter pays” levy on tobacco manufacturers to fund tobacco control. The key tobacco controls are not devolved; they are reserved. Everything from tobacco taxes to packaging, labelling, product regulation to raising the age of sale are policies that we cannot change in Wales.

During the passage of the Health and Care Bill, I added my name to the amendment tabled by Mary Kelly Foy that would have introduced tougher regulations on smoking and would certainly have benefited people in Wales. However, these measures cannot be brought in. I would formally like to state my support for raising the age of sale to 21 and putting warnings on cigarettes, advice to quit inside packs and the rest of it.

Those measures would reduce inequalities and smoking uptake. A sensible point—for me at least—is that this is not only a health issue. It is also a class issue. Clearly, it affects people on lower incomes. It is also an age issue. To conclude, I would like to ensure that the Minister is aware of all of these matters, and I ask her to commit to meeting her opposite number in Cardiff regularly to discuss how these measures can be implemented.

Photo of Alex Cunningham Alex Cunningham Shadow Minister (Justice) 10:12 am, 26th April 2022

It is a pleasure to serve under your chairmanship, Ms Nokes. For the record, I confirm that I am vice-chair of the APPG on smoking and health.

The Minister may know that in health debates and in correspondence I spend much of my time banging on about health inequalities and the need for a new hospital in Stockton. Although we still need one, this morning I want to address another major health inequality. According to the most recent data from the Office for National Statistics, the average gross disposable income in the north-east is the lowest in the United Kingdom, at £16,995 per household—a full 43% lower than in London, where it is the highest.

Analysis of national data published by ASH has shown that the proportion of smokers living in poverty is also highest in the north-east. In our region, 42% of households containing smokers live in poverty, compared with only 17% in London. That is 112,000 north-east households. The average annual spend on tobacco per smoker is £2,000, so helping my constituents quit smoking will not only improve their health and wellbeing, but put badly needed money into their pockets. Smoking is an addiction. It is not a lifestyle choice. Smokers living in poverty tend to be the most addicted and need the most help to quit.

The Government’s arguments against the “polluter pays” levy are unconvincing. When we considered the Lords amendments to the Health and care Bill on 30 March, the Minister for Health, Edward Argar, said that the Government

“cannot accept these Lords amendments, because the proposals would be very complex to implement, take several years to materialise and risk directing a lot of Government resource into something that we do not see as a sustainable or workable way to fund public health. This would also rightly be a matter for Her Majesty’s Treasury.”—[Official Report, 30 March 2022; Vol. 711, c. 866.]

I will address each of these arguments in turn.

First, on the Treasury, as my hon. Friend Bob Blackman said, the Department of Health and Social Care already oversees a similar scheme for pharmaceuticals, put in place by health legislation that is a model for our proposals, so there is already a precedent for the Department to take the lead. It is clear that the Treasury would need to be involved, but the scheme we propose is not an additional tax. Rather, it is a pricing and profit control scheme put in place by health legislation and overseen by health Ministers.

The Minister for Health provided no evidence to justify his statement that the proposals would be “very complex to implement”, would need

“a lot of Government resource”,

and would not be a

“sustainable or workable way to fund public health.”

Indeed, evidence provided to the APPG by independent export analysts and economists demonstrates the opposite. The Department of Health and Social Care has a track record of more than 50 years of overseeing the pharmaceutical scheme. The expert analytical, finance and economic skills needed to run the tobacco levy are no different and the Department already has a team in place.

Let us not forget that the pharmaceutical market is complex. It has an enormously varied range of products, is constantly evolving and has heavy research and development costs that have to be taken into account by the analysts. More than 60 pharmaceutical manufacturers operate in the UK. Indeed, some of them are in my Stockton North constituency. Tobacco manufacturing is far simpler. Cigarettes and rolling tobacco are commodity products, cheap as chips to make. Only four manufacturers account for more than 90% of the market. Selling cigarettes is highly profitable, far more than pharmaceuticals or consumable staples. Imperial Brands sells around four in 10 cigarettes smoked in the UK and made a 71% operating profit in 2019, which is £71 in pure profit for every £100 of sales. It is not alone. The average for the big four manufacturers was 50%. By way of comparison, a 10% operating profit margin is considered average and Associated British Foods, Britain’s largest food manufacturer, made only 6% in 2021.

Clearly, some Government resource and expertise would be needed to develop a tobacco-specific scheme, but the potential returns, which would vastly outweigh the running cost, make it a no-brainer. As we have heard, £700 million a year could be raised from the four major tobacco manufacturers on sales of £14 billion, provided we could cap their profits at no more than 10%. At last, we have a Brexit dividend for the NHS, though it falls well short of the £350 million a week promised on the side of a bus not so long ago.

Market failure justifies the scheme, for this is an industry dominated by four big companies making eye-wateringly high profits from selling lethal products that kill most of their consumers. The extremely high profitability of cigarettes makes them as addictive to the companies as to the smoker. Big tobacco says it wants to turn over a new leaf and move out of cigarettes but shows no signs of doing so. Why would it? Selling cigarettes is far more profitable than any of the alternatives. The levy would provide the incentive the industry needs to deliver the Government’s ultimatum. That is a crucial function of the levy—a point Ministers seem not to have taken on board.

Lastly, the Minister for Health said it would

“take several years to materialise”.

That is not the case. The Government have already wasted three years when they could have put the scheme in place. I join my colleagues in inviting the Minister to meet the APPG officers and our independent experts to discuss our proposals. However, let me say in closing that if the levy had been implemented three years ago, we could already have invested £2 billion in smoking cessation and be well on our way to being a much healthier nation.

Photo of Liz Twist Liz Twist Opposition Whip (Commons), Shadow Minister (Scotland) 10:18 am, 26th April 2022

It is a pleasure to serve under you as Chair, Ms Nokes. I commend Bob Blackman and my hon. Friend Mary Kelly Foy for securing today’s debate. I also wish the hon. Member for Harrow East a very happy birthday.

Smoking, as we have heard, is not a lifestyle choice. It is a lethal addiction entered into by the vast majority of smokers even before they reach adulthood. It is an addiction that is increasingly concentrated among the most disadvantaged in society, fuelled by an industry—the tobacco industry—whose behaviour must be stringently regulated if we are to achieve our smokefree 2030 ambition.

Like my hon. Friend the Member for City of Durham, my constituency of Blaydon falls under Gateshead Council in the north-east, which I regret to say is the most disadvantaged region in the country. Smoking rates in Gateshead are particularly high, bringing disease, death and disability disproportionately to my constituency. In 2019, more than 17% of adults in Gateshead smoked, compared with 15.3% for the north-east as a whole, and far higher than the average for England of 13.9%.

That higher rate of smoking translates to a lower average life expectancy. The average male life expectancy in Gateshead is eight years less than in Westminster, and five years less for women. Smoking costs the NHS in Gateshead £9.3 million, and £5.6 million to local authorities for social care costs that are entirely due to smoking and entirely preventable. Tobacco addiction has been levelling down communities across the country for decades, and will go on doing so until the Government decide to get serious about delivering the smokefree ambition—for all in society.

Smokers in Gateshead spend on average £2,000 a year on smoking. The total spend in Gateshead is £54 million, an eye-watering amount of money that goes up in smoke for no benefit to the local community. Ending smoking will significantly increase disposable income in poorer communities such as those across Gateshead, helping to grow the local economy and to improve health and wellbeing for tens of thousands of people.

In March, I was pleased to be able to attend the event in Parliament marking national No Smoking Day and to reflect on the progress that has been made in tackling smoking over the years. Also, however, the event looked at what more needs to be done. The Minister spoke passionately about the Government’s commitment to making England smokefree by 2030, and said that investment in stop smoking services would be at the heart of the forthcoming tobacco control plan.

I agree wholeheartedly. Smokers need to be motivated and supported to quit. However, the funding for stop smoking services has been cut by a third in real terms since 2015. That funding must be reinstated if the services are to play their vital role in delivering the smokefree 2030 ambition.

That is not the only area that needs extra funding to achieve a smokefree 2030. Smoking during pregnancy is the leading modifiable risk factor for poor birth outcomes, including stillbirth, miscarriage and pre-term birth. The Government’s ambition is to reduce smoking in pregnancy to 6% by 2022, but with rates at 9.6% in 2020-21, that is unlikely to be delivered.

The rate of decline in smoking during pregnancy has been higher in the north-east, and that is because we have invested in specialist interventions. We are delighted to see that initiative being rolled out across the country as part of the NHS long-term plan. Smoking during pregnancy rates remain too high, however, so the north-east has gone further by introducing voucher schemes to provide a financial incentive to pregnant smokers to quit. That is particularly powerful for women on low incomes. In South Tyneside, an area of high deprivation, the proportion of pregnant women who are recorded as being smokers at their time of delivery has dropped by a third in the three years since the scheme was put in place.

Maternal smoking cost the NHS £20 million in 2015-16, with more than 10,000 episodes of admitted patient care. Since smoking is so damaging, incentive schemes are cost-saving, with an estimated return on investment of £4 for every £1 invested. Implementing financial incentives at scale is a vital measure that needs to be part of the forthcoming tobacco control plan, which I hope to see included in the independent review—but it will need funding.

I will touch briefly on mental health. Much more investment is needed to tackle smoking among those with a mental health condition. As many as one in three smokers have a diagnosable mental health condition. The NHS long-term plan tobacco dependency treatment pathway presents a major opportunity to tackle smoking among those with serious mental illness, but many others are not in that category. We need to ensure that much more work is done on pilot projects for IAPT—improving access to psychological therapies—counselling. Counsellors are willing to deliver such support, and they should be given the opportunity to do so.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 10:24 am, 26th April 2022

It is a pleasure to serve under your chairmanship, Ms Nokes.

I thank the hon. Members for Harrow East (Bob Blackman) and for City of Durham (Mary Kelly Foy) for securing this important debate. I well remember, as the hon. Lady will remember, that she had this debate in the main Chamber under the covid regulations. I was happy to assist in supporting her at that time, and my support is the same now.

As we turn our attention to the rebuilding of public health following the covid-19 pandemic, tackling smoking must be among our top priorities. Smoking is the leading cause of premature death, killing some 2,300 people in Northern Ireland each year—it is a devolved matter, but I think these figures are quite shocking—with 30 times as many suffering serious diseases and disabilities caused by smoking.

Ms Nokes, I have never had a wish to smoke. I can well recall the first time that I did, with my grandfather, back in the ’60s. He smoked Gallahers; there were no filters on them. I always admired my grandfather, and I said to him one day, “Granda, can I have a smoke of that cigarette?” I pestered and pestered him, and then, one day, he says, “Now, take one, and take a deep breath,” and I did. As a wee six-year-old, I was violently sick. I was green at the gills. In those days, we had—if I can say it—a po under the bed. I was sick into that, and I never had any wish, ever, to pursue the smoking of a cigarette ever since. It left a lasting impression. Maybe that is what we need to do for the young people of today. It is a bit drastic, perhaps, but none the less, it had a very sobering effect on me.

Achieving a smokefree 2030 would reduce the pressure on NHS services at a time when they are under the most severe strain in living memory. However, analysis by Cancer Research UK shows that at current rates of decline, Northern Ireland will not achieve the smokefree ambition of smoking rates of 5% or less until a decade after England—not until the late 2040s—with our most deprived populations not being smokefree until after 2050. We have really big issues to sort out in Northern Ireland regarding that.

While Northern Ireland and the devolved nations hold responsibility for our own public policies, the Government in Westminster maintain responsibility for important UK-wide policies. I therefore ask the Minister—as others have in relation to Wales—what discussions have taken place with the Northern Ireland Assembly and the Minister, Robin Swann?

There is substantial research supporting the implementation of health warnings on cigarettes and cigarette papers, and that is clearly under consideration in Canada, Australia and Scotland. Such warnings could be implemented by a simple amendment to the Standardised Packaging of Tobacco Products Regulations 2015. Tobacco manufacturers already apply print to cigarette papers, so that would be cheap and easy to implement.

Health warnings, such as “Smoking kills”, have been shown to be effective on billboards and tobacco packs, so why would they not be as effective on cigarette sticks too? Adding warnings to cigarette sticks is important because young people in particular are likely to initiate smoking with individual cigarettes rather than packs. Is that something that the Minister and the Government would be prepared to look at?

Cigarette pack inserts providing health information are not a new idea; they have been required in Canada since 2000. The health messages are effective, and research has been carried out in the UK which supports their use here too. The Government have already acknowledged in the prevention Green Paper that,

“there could be a positive role for inserts in tobacco products giving quitting advice”,

so, again, I look to the Minister for her thoughts on that.

All those measures would be cheap and easy to implement and would benefit all the UK nations. They would also support and reinforce the impact of other measures that require significant investment, such as behaviour change campaigns and stop smoking services. Although the Government opposed the introduction of the measures as amendments to the Health and Care Bill, they did leave the door open—I believe—to considering them when developing the next tobacco control plan. Does the Minister—or the Government—intend to do just that?

I have spoken before in this House about the use of licensing for tobacco retailers. In Northern Ireland, since 6 April 2016, retailers have been obliged to register with the tobacco register of Northern Ireland, with a final deadline of 1 July 2016. That built on a similar scheme already in place in Scotland, and a scheme that was due for implementation in Wales.

Since 2018, we have seen the implementation of a tracking and tracing scheme, which requires every retailer to have an economic operator identifier code. Since leaving the EU—as the hon. Member for Harrow East mentioned—the UK has established and launched its own system, with Northern Ireland operating in the UK and EU systems. That makes it easy for all nations in the UK, including England, to not just implement a retail register scheme, but go further and implement a comprehensive retail licensing scheme. If the Minister can give us some thoughts on that, I would be very pleased.

Retail licensing is the obvious back-up to the tracking and tracing of cigarettes and would help tackle the illicit trade that gives smokers access to cheap tobacco. Those who sell illegal tobacco have no compunction about selling it to children too, so the illegal trade makes it not just less likely that smokers will quit, but more likely that children will start smoking. My hon. Friend Mr Campbell, who is no longer in his place, mentioned that in his intervention on the hon. Member for Harrow East.

I await with interest Javed Khan OBE’s independent review, which is due to be published shortly. I hope it will address this important issue. England remains an outlier on that important measure, which could help tackle illicit trade and protect children from tobacco. We can and must address these issues collectively, bringing knowledge from the nations we represent. I am happy to support the Minister here at Westminster in taking this matter forward and, from a Northern Ireland point of view, it is important that we address these issues together. If we do so, I am confident that we will then deliver a policy that helps not only us, but the constituents we serve.

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health and Social Care) 10:30 am, 26th April 2022

It is a pleasure to serve under your chairmanship, Ms Nokes. I begin by thanking Bob Blackman for his tireless work in this area, along with my hon. Friends, and for the way he opened the debate. I also wish him a happy birthday.

Over the past 50 years, positive steps have been taken towards ending smoking, on both sides of the House. I am pleased to be here today responding to the debate on behalf of the shadow health and social care team from Her Majesty’s Opposition, because, from my point of view, it is a matter of great pride that I was in Parliament when Labour’s smoking ban was passed into law in 2006. It has become one of the defining public health achievements of the last Labour Government. The positive impact that it has had on the health of the nation is plain to see.

However, there is still much more to do, as we have heard in various speeches this morning. Smoking continues to be the leading preventable cause of ill health and mortality in England. The NHS estimates that 78,000 people in the UK die from smoking each year, with many more living with debilitating smoking-related illnesses. Smoking causes 44,000 cancer diagnoses per year, with almost 70% of all cases of lung cancers caused by smoking.

Smoking blights communities right across the country and contributes to the yawning health inequalities that we currently witness. However, smoking affects not only those who choose to do it; it affects many people around them, too. For example, a child who is exposed to second-hand or passive smoke has an increased risk of cot death, and of developing chest infections, meningitis and many other serious conditions.

The consequences of smoking are stark and affect not only our health, but our economic prosperity. My constituency of Denton and Reddish in Greater Manchester sits across the boroughs of Tameside and Stockport. Each year, smoking costs Tameside over £95 million in lost productivity and health and social care costs, and in Stockport that figure is just above £77 million. In my constituency, 22% of adults smoke, which is well above the national average of 14.5%. We will never truly level up while smoking continues to hold communities and individuals in a vice grip. We need to take robust and radical steps if we are to have any hope of reaching smokefree 2030.

Unfortunately, as we have heard in various contributions, there has been characteristic dither and delay from this Government, I am afraid to say. We were promised an updated tobacco control plan last year, but so far it has failed to materialise. The Government like to talk the talk on smoking cessation services but, as we have heard from numerous contributions, they have brutally slashed the local authority funding that allows those very services to exist.

The public health grant has been cut by £1 billion in real terms since 2015-16, and stop smoking services have suffered a funding decline of around one third over the same period, as we heard from the hon. Member for Harrow East. The Government cannot have it both ways; either they are for a smokefree 2030, and therefore they should support smoking cessation services, or they are not, in which case they should ditch the warm words. I will take the Government at face value—they want a smokefree 2030—so let us get that investment reinvested in smoking cessation services and let us restore public health funding.

I would be grateful if the Minister set out in her response a timeline for publishing the next tobacco control plan, and I want her to commit to publishing Javed Khan’s independent review into smokefree 2030 policies by no later than the end of May. Furthermore, can she outline what plans her Department has to improve access to smoking cessation services, and will she admit that stinging cuts to the public health grant have left communities such as mine, and those of many other hon. Members here today, worse off?

Yesterday, Members voted on the Government’s Health and Care Bill. The all-party parliamentary group on smoking and health set out several recommendations, as we heard from my hon. Friend Alex Cunningham, on how to achieve a smokefree 2030. Several of those recommendations were tabled as amendments to the Bill. Labour Members were proud to support many of those amendments and proposals, yet the Government refused to back them, much to the disappointment of health leaders and politicians across the House.

The need for a smokefree 2030 has been reinforced during the course of the pandemic. We know that during the first year of the coronavirus crisis, the number of 18 to 34-year-olds who classed themselves as smokers increased by a quarter, from 21.5% to 26.8%. That is a huge increase and one that will have a lasting negative impact on the health of people across the country, unless they are given the tools to stop smoking for good.

In short, we are falling behind. We have a smokefree 2030 ambition, but very little in the way of funding and a seeming lack of urgency from the Government to publish the tobacco control plan.

Photo of Mary Glindon Mary Glindon Opposition Whip (Commons)

My hon. Friend is probably aware that I am an advocate for vaping. Major reports by the former Public Health England and the Royal College of Physicians have highlighted the reduced risk potential of vape products. Does he agree that the Government must address consumer misperceptions regarding the relative risk reduction of vaping compared with smoking combustible cigarettes?

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health and Social Care)

I thank my hon. Friend for that intervention, and I think my answer will be very similar to that given by the hon. Member for Harrow East earlier. Yes, vaping has a clear role to play in reducing people’s addiction to nicotine and tobacco products, and clearly it has health benefits over smoking. However, I am increasingly concerned, partly because I see it in my own constituency—I recognise that this is only anecdotal evidence, but I see kids vaping. There is no good reason for children in Tameside or Stockport, or anywhere else in the United Kingdom, to be vaping.

I think the Government have to look very clearly at what is happening here, because vaping has a real role to play in helping people to wean themselves off nicotine and tobacco products, which I support. However, if we are starting to see children vaping because it is seen as the cool thing to do, as a replacement for what smoking was back in the day, then I think that is a cause of real concern that needs to be looked at. Like the hon. Member for Harrow East, I really do see the benefits of vaping, but we have to tread with caution, because we are starting to see the next generation of vapers being created. I want all children to be not just smokefree but vape-free. As I said, children have no reason to vape.

In closing, can the Minister say whether she recognises our concern about the lack of a tobacco control plan; whether she recognises the need to do more in such a short period, because we are now only eight years away from 2030; and whether she will pledge to resume public awareness campaigns about smoking and start to get really serious, as I know she wants to be, about a smokefree 2030?

Javed Khan’s independent review is exceptionally welcome, but we need to know that his recommendations will not be brushed aside. The tobacco control plan, when it comes, must contain the bold measures needed to create a healthier and more resilient nation. I give the Minister my word that the Labour party is ready and waiting to support the Government on that. We will give her the backing she needs to drive through the necessary reforms in Parliament. We cannot afford to waste more time. The clock is ticking, and as each second passes a smokefree 2030 slips further from our grip. Let us take this opportunity to redouble our efforts, with support from across the House, to make a smokefree 2030 a reality.

Photo of Maggie Throup Maggie Throup The Parliamentary Under-Secretary for Health and Social Care 10:40 am, 26th April 2022

It is a pleasure to serve under your chairmanship, Ms Nokes. I thank my hon. Friend Bob Blackman and Mary Kelly Foy for securing this important debate. I wish my hon. Friend a very happy birthday—it is probably one of the best birthdays he has had, given that he has started his day this way.

I am grateful to all hon. Members for their participation. We debate smokefree 2030 regularly, which indicates how important it is. We are all passionate about making England smokefree by 2030, and the devolved authorities have the same passion. The personal circumstances expressed by my hon. Friend the Member for Harrow East no doubt drive his passion, and I am sure that the personal circumstances of other hon. Members drive their passion too. I appreciate the passion and dedication shown by Members from all parties, who work together to tackle the harms caused by smoking. I am pleased to update the House on our progress towards achieving the Government’s smokefree 2030 ambition.

Over the past 20 years, through successive and progressive policies, as Andrew Gwynne indicated, and regulatory measures, we have made progress in reducing smoking rates. Smoking prevalence in England is now 13.5%—the lowest on record. That is a fantastic public health story, but there are still nearly 6 million smokers in this country.

Photo of Alex Cunningham Alex Cunningham Shadow Minister (Justice)

Over the years, we have seen smoking in public places and all sorts of other things change under Labour and Conservative Governments. That reduction is a tremendous achievement, but in communities such as Stockton Town Centre ward in my constituency, smoking rates are still several times higher than that, and there are very high figures for smoking during pregnancy—way above the Government target. I hope the Minister recognises that, although we can cheer and say, “This is wonderful,” it is not wonderful in a lot of our communities.

Photo of Maggie Throup Maggie Throup The Parliamentary Under-Secretary for Health and Social Care

I think the hon. Gentleman must have read the next page of my speech, because I was about to come on to that. He makes a really important point. As has been mentioned by the hon. Gentleman, my hon. Friend the Member for Harrow East and the hon. Member for East Londonderry (Mr Campbell), who is no longer in his place, smoking rates are far higher in poorer areas of the country, among those socioeconomic groups. We see smoking rates of 20% in more deprived areas, compared with 5% in wealthier areas, and nearly one in 10 pregnant women still smokes, which increases the risk of health problems for their baby. Smoking prevalence for people with long-term mental health conditions is over 25%, so the burden of tobacco harm is not shared equally.

We cannot let that continue, so the Government are committed to doing more. Over the past decade we have made significant steps towards making England smokefree—a bold and ambitious target that we committed to in 2019. We continue to enforce high taxation to reduce the affordability of tobacco. As part of the annual Budget process, Her Majesty’s Treasury will continue the policy of using tax to raise revenues and will encourage cessation by continuing with duty increases on tobacco products above the retail prices index. We continue to invest in local stop smoking services and our high-impact marketing campaigns such as Stoptober—I hear it is VApril this month.

Between 2010 and 2021, almost 5 million people set a quit date with stop smoking services, and 2.5 million reported quitting after four weeks. We continue to enforce a strong regulatory framework, and we have introduced policies such as smokefree legislation and standardised packaging. All these measures, and many more, have been instrumental in helping smokers to quit and protecting future generations from starting this lethal habit.

Photo of Liz Twist Liz Twist Opposition Whip (Commons), Shadow Minister (Scotland)

The Minister has spoken about the great progress that has been made in 11 years, but is it not about time that we started expecting the people who caused this problem to pay for the cost of further tobacco control measures and getting people off smoking? Is it not about time that the “polluter pays” principle is adopted?

Photo of Maggie Throup Maggie Throup The Parliamentary Under-Secretary for Health and Social Care

If I may, I will come to that later in my speech, but the hon. Lady makes a very good point.

On top of the measures, the NHS has renewed its commitment to tobacco treatment through the NHS long-term plan, delivering NHS-funded tobacco treatment services to all in-patients, pregnant women and people accessing long-term mental health and learning disability services until 2024. The Government also continue to explore ways to move smokers away from smoking and towards alternative nicotine products such as vapes, as highlighted by Mary Glindon. We know that the best thing a smoker can do for their health is to quit smoking altogether, but we also know how hard that can be. It remains the Government’s goal to maximise the public health opportunities presented by vapes while ensuring that such products are not appealing to young people and non-smokers. The hon. Member for Denton and Reddish made a very good point on this issue in his speech, and it requires balanced and proportionate regulation.

Despite the progress made so far, the Government acknowledge that we need to go further to achieve our ambition to be smokefree by 2030, which is why the Secretary of State for Health and Social Care asked Javed Khan OBE to lead an independent review into tobacco control in January this year. The Khan review is expected to be published next month and will make a set of recommendations to the Government. The review has two objectives. The first is to identify the most impactful interventions to reduce the uptake of smoking, particularly among young people. The second is to identify how best to support smokers to quit, especially in deprived communities and among priority groups.

Mr Khan has met hon. Members from both the all-party parliamentary group on smoking and health and the all-party parliamentary group for vaping, and he has carefully considered their views and proposals. Quite a number of members of those APPGs have expressed their approval of that route and how Javed Khan is getting into the depth of everything. Once the review is published next month, the Government will consider its recommendations, which will help inform both the upcoming health disparities White Paper and the new tobacco control plan, to be published later this year.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the Minister for her response to this issue, and what she is saying is very positive. I am ever mindful that Northern Ireland has the highest rate of deaths due to smoking. Health is a devolved matter, and we are 10 years behind the rest of the UK on achieving our goals. What discussions could the Minister have with the Northern Ireland Assembly, and particularly with the Health Minister, Robin Swann, to enable us to catch up and achieve the goals and targets that the Minister has referred to?

Photo of Maggie Throup Maggie Throup The Parliamentary Under-Secretary for Health and Social Care

The hon. Gentleman makes a very good point. Hywel Williams also mentioned discussions with the devolved nations, and I am very happy to have discussions with my counterparts in the devolved health authorities.

As we have heard from my hon. Friend the Member for Harrow East and others, many in this room are supportive of a “polluter pays” levy. As they will be aware, tobacco taxation is a matter for Her Majesty’s Treasury, and the tobacco industry is already required to make a significant contribution to public finances through tobacco duty, VAT and corporation tax. As part of the development of the tobacco control plan, the Department will also continue to explore and review with the Treasury the evidence base on the best options to raise funding in support of the Government’s ambition to be smokefree by 2030. As a number of Members asked, I am happy to meet the APPG to discuss funding matters and the levy in detail, while the Khan report is being published. I have met the APPG before and am happy to continue having those meetings.

Photo of Alex Cunningham Alex Cunningham Shadow Minister (Justice)

Surely the Minister has not lost sight of the fact that the “polluter pays” levy is a levy and not a tax, and the Department of Health and Social Care can introduce it, as it has for the pharmaceutical industry. Will she give a further explanation of that, rather than just saying that it is a Treasury matter?

Photo of Maggie Throup Maggie Throup The Parliamentary Under-Secretary for Health and Social Care

I fully appreciate the hon. Gentleman’s point. I enjoyed listening to his dissection of the issue, and I look forward to continuing discussions with the APPG.

The UK will continue its role as a global leader in tobacco control and remains fully committed to the World Health Organisation’s framework convention on tobacco control. The Department has received global recognition for its support of the official development assistance FCTC 2030 project over the past six years. This project helps low and middle-income countries improve their tobacco control and, ultimately, their population’s health. We will continue to support the project for a further three years under the current spending review settlement.

I turn to the questions raised during the debate. My hon. Friend the Member for Harrow East raised the point that the independent review is late. The review is on track to be published in advance of the health disparities White Paper, which it was set up to help inform, this summer. The review was originally intended to be published this month, so it is just a short delay that will not compromise the review’s impact.

The hon. Members for Stockton North (Alex Cunningham) and for Blaydon (Liz Twist) talked about smoking in pregnancy. The Department continues to explore options to support smoking cessation among pregnant women, which will be set out in our new tobacco control plan. Already, as part of the NHS long-term plan, we have made commitments for a new smokefree pregnancy pathway providing focused sessions and treatment to support expectant mothers and their partners to be smokefree. It is important that partners are involved.

The hon. Member for City of Durham mentioned the breaches of menthol regulations. The Office for Health Improvement and Disparities is investigating a range of cigarettes to determine whether the flavour is noticeable. Once that is complete, we will explore whether further action needs to be taken against companies who are in breach of the regulations.

My hon. Friend the Member for Harrow East and the hon. Member for Denton and Reddish talked about stop smoking services, which provide support to help smokers quit and are highly cost-effective. Local stop smoking services continue to offer smokers the best chance of quitting. They produce high quit rates of 59% after four weeks, and they have helped nearly 5 million people to quit since 2000. The services are a key part of the Government’s tobacco control strategy, and will remain so in the new tobacco control plan.

On any regulatory reforms the Government wish to take forward, we will review what legislative powers we have available to us, either through secondary legislation or exploring whether a Bill is required. I was asked why we rejected the tobacco amendments to the Health and Care Bill. We were grateful to Members for suggesting the amendments, which showed their strong support for tobacco control, but it is only right for my Department to fully consider the issues they raised—I am sure those issues will also be raised in Javed Khan’s report—before publishing the new tobacco control plan. We felt that was the right place for the suggestions made in debates on the Health and Care Bill.

I would like to reassure the hon. Member for Denton and Reddish that I am serious about making England smokefree by 2030, as is the Secretary of State. I thank the hon. Member for the support he and the Labour party have offered in the mission to make England smokefree. It is definitely a cross-party issue, and it is really good that we will all be able to work together.

The point about how we are supporting people with mental health conditions to cease smoking has been made a couple of times. The new universal smoking cessation offer is available through the NHS long-term plan for long-term users of specialist mental health services and people with learning disabilities. It is important that we tackle health inequalities brought about through mental health issues, and help those people to quit smoking as well.

I again thank hon. Members for securing the debate and for all their contributions to it. We have made good progress in reducing smoking rates, but the Government acknowledge that we need to go further to level up society and achieve a smokefree country by 2030. Later this year, we will publish a new tobacco control plan setting out how we will achieve our bold ambition. Working together across all parties, our mission is to make smoking a thing of the past and save future generations from the death and misery we all know it causes.

Photo of Bob Blackman Bob Blackman Conservative, Harrow East 10:56 am, 26th April 2022

I thank everyone who has contributed to the debate, including the Front Benchers, and I thank my hon. Friend the Minister for her commitment, which we all share. We have to remember, however, that Professor Sir Richard Peto has pointed out that smoking has killed nearly 8 million people over the past 50 years in the UK alone. That is 400 a day, every day—far more than have died under covid. It is obviously something that can be prevented, but more importantly even than that, 2 million more people are expected to die over the next 20 years unless we get smoking rates down.

We all support the Javed Khan review, and we are looking forward to it. I understand that it is going to be published on 17 May. I can inform my hon. Friend the Minister that we will be calling for another debate on its recommendations and looking forward to a commitment from the Government that they will be implemented. However, the most important thing is that all those recommendations, whether they are on raising the age of sale, more tobacco control or licensing—we could go through all the options—will cost money to implement, which is why today we have concentrated on the levy.

I return to the central point that I made at the beginning of the debate: the difference between a levy and taxation that is imposed on the tobacco companies is that the companies just pass the costs of taxation on to the consumer, so they suffer no consequences whatsoever from it. Those companies would not be allowed to pass a levy on to the consumer; they would have to pay it out of their profits, making their product that kills people less profitable. Until we get to that stage, we are not going to have the money in the health service that is required to stop smoking—to encourage people to quit, and to encourage young people not to start. That is why we have concentrated on the levy today. I look forward to helping my hon. Friend the Minister in her arguments with the Treasury, if that is what we need to do to achieve that goal.

Question put and agreed to.

Resolved,

That this House
has considered progress towards the Government’s smokefree 2030 ambition.