Bob Blackman (Harrow East) (Con) [R] 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...Request free trial
(Harrow East) (Con) [R]
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.
The hon. Member for City of Durham ()—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.
Mr (East Londonderry)
(DUP)
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?
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.
(Stockton North) (Lab)
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?
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 the Member for Harborough (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.
(North Tyneside) (Lab)
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.
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 the Member for Bury St Edmunds
(), and her opposite number, the hon. Member for
Nottingham North (), 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
the Member for Winchester (), 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 the Member for Charnwood (), 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. , 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 , 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.
(in the Chair)
I will call the Front Benchers at 10.40, so perhaps Back Benchers
could try to limit their contributions to about six minutes.
9.54am
(City of Durham) (Lab)
It is a pleasure to serve under your chairmanship, Ms Nokes, and
I wish my hon. Friend the Member for Harrow East () 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,
the hon. Member for Bury St Edmunds (), 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.”
(in the Chair)
I shall now put Members, starting with , on a formal time limit of
six minutes.
10.06am
(Arfon) (PC)
I congratulate the hon. Member for Harrow East () 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 , 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 , 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 the Member for City of Durham () 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.
10.12am
(Stockton North) (Lab)
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, the
hon. Member for Charnwood (), 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 the Member for Harrow
East () 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.
10.18am
(Blaydon) (Lab)
It is a pleasure to serve under you as Chair, Ms Nokes. I commend
the hon. Member for Harrow East () and my hon. Friend the Member for City of Durham
() 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.
10.24am
(Strangford) (DUP)
It is a pleasure to serve under your chairmanship, Ms Nokes.
I thank the hon. Members for Harrow East () and for City of Durham () 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, ?
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 the Member for East Londonderry (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.
10.30am
(Denton and Reddish)
(Lab)
It is a pleasure to serve under your chairmanship, Ms Nokes. I
begin by thanking the hon. Member for Harrow East () 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 the
Member for Stockton North (), 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.
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?
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.
10.40am
The Parliamentary Under-Secretary of State for Health and Social
Care ()
It is a pleasure to serve under your chairmanship, Ms Nokes. I
thank my hon. Friend the Member for Harrow East () and the hon. Member for City of Durham () 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 the hon. Member for Denton and Reddish () 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.
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.
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.
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?
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 the hon. Member for North Tyneside (). 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.
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, , to enable us to catch up and
achieve the goals and targets that the Minister has referred
to?
The hon. Gentleman makes a very good point. The hon. Member for
Arfon () 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.
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?
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 () and for Blaydon () 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.
10.56am
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.
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