Bob Blackman (Harrow East) (Con) I beg to move, That this House has
considered the recommendations of the Khan review: Making smoking
obsolete, the independent review into smokefree 2030 policies, by
Dr Javed Khan, published on 9 June 2022; and calls upon His
Majesty’s Government to publish a new Tobacco Control Plan by the
end of 2022, in order to deliver the smokefree 2030 ambition. I
thank the Backbench Business Committee, on which I have the honour
to serve,...Request free trial
(Harrow East) (Con)
I beg to move,
That this House has considered the recommendations of the Khan
review: Making smoking obsolete, the independent review into
smokefree 2030 policies, by Dr Javed Khan, published on 9 June
2022; and calls upon His Majesty’s Government to publish a new
Tobacco Control Plan by the end of 2022, in order to deliver the
smokefree 2030 ambition.
I thank the Backbench Business Committee, on which I have the
honour to serve, for enabling us to have the debate this
afternoon. On behalf of the all-party parliamentary group on
smoking and health, which I chair, I welcome the Under-Secretary
of State for Health and Social Care, my hon. Friend the Member
for Harborough (Neil O'Brien), to his new role as public health
and primary care Minister. The all-party group has a long track
record of acting as a critical friend to the Government on this
agenda and I am confident that that collaborative and
constructive approach will continue.
May I take the opportunity to commend the hon. Member for City of
Durham (), who co-sponsored the
debate application with me but is not able to be here today? She
is currently recuperating from a stay in hospital. I am sure that
the whole House wishes her a speedy recovery.
The all-party group originally proposed the debate before the
summer recess to ensure that Parliament had the opportunity to
scrutinise the independent review by Javed Khan OBE, “Making
smoking obsolete”. When the Secretary of State—well, the then
Secretary of State, my right hon. Friend the Member for
Bromsgrove ()—announced the Khan review in
February, he said that it would
“assess the options to be taken forward in the new Tobacco
Control Plan, which will be published later this year.”
We have since had several changes of Health Ministers and
Secretaries of State, but it should not be forgotten that a new
tobacco control plan was first promised in 2021.
Achieving the Government’s smokefree 2030 ambition and making
smoking obsolete is vital to the health and wellbeing of our
entire population. It will also help to deliver economic growth,
because smoking increases sickness, absenteeism and disability.
The total public finance cost of smoking is twice that of the
excise taxes that tobacco brings into the Exchequer. Each year,
many tens of thousands of people die prematurely from smoking,
and 30 times as many as those who die are suffering from serious
illnesses caused by smoking, which cost the NHS and our social
care system billions of pounds every single year.
Javed Khan’s review, which was published in June, concluded that,
to achieve the smokefree 2030 ambition, the Government would need
to go further and faster. He made four recommendations that he
said were critical must-dos for the Government, underpinned by a
number of more detailed interventions. I will concentrate on the
four main recommendations, given time.
The four must-dos were: increasing investment by £125 million a
year to fund the measures needed to deliver smokefree 2030;
raising the age of sale to stop young people from starting to
smoke; promoting vaping as an effective tool to help people to
quit smoking tobacco, while strengthening regulation to prevent
children and young people from taking up vaping; and prevention
to become part of the NHS’s DNA and the NHS committing to invest
to save. Since then, we have had conflicting reports about
whether the Government intend to publish a new plan at all. That
has been deeply concerning to me and others who support the
ambition and want to see it realised. To abandon, delay or water
down our tobacco strategy would be hugely counterproductive when
the Government are trying to reduce NHS waiting lists, grow the
economy and level up society.
As well as increasing funding, Khan recommended enhanced
regulation. Both of those are supported by the majority of voters
for all political parties, and the results of a survey published
just this week show that tobacco retailers share that view as
well. I therefore commend the “Regulation is not a dirty word”
report by ASH—Action on Smoking and Health—to the Minister. It
shows that most shopkeepers support existing tobacco laws and
want the Government to go further in protecting people’s health.
Retailers want tougher regulations—that is what they think will
be good for business—and not deregulation.
There is no time to be lost. When the ambition was announced, we
had 11 years to deliver it. Now, we have less than eight years,
and we are nowhere near achieving our ambition, particularly for
our more disadvantaged communities with the highest rates of
smoking. Research cited in the Khan review estimates that it will
take until 2047 for the smoking rates in disadvantaged
communities to reach the smokefree ambition of 5% or less. Will
the Minister put on record his commitment that the Government,
having considered the Khan review recommendations, will publish a
new tobacco control plan by the end of 2022 to deliver the
smokefree 2030 ambition?
As Javed Khan made clear with his leading recommendation,
smokefree 2030 cannot be delivered on the cheap. However, public
health interventions such as smoking cessation cost three to four
times less than NHS treatment for each additional year of good
health achieved in the population. Yet that is where the cuts
have fallen to date. The public health grant fell by a quarter in
real terms between 2015 and 2021, and funding for tobacco control
fell by a third, while NHS spending continues to grow in real
terms.
Last week, London launched its tobacco alliance with a vision to
deliver the smokefree 2030 ambition across London. Cabinet
members for health and wellbeing from across London are writing
to the new Secretary of State to make clear their commitment to
achieve the ambition and pleading for the funding they need to
deliver it. Before I became the MP for Harrow East, I was a
councillor in the London Borough of Brent for 24 years, so I am
well aware of what local authorities want to do on tobacco, but
they lack the resources they need so to do.
Javed Khan called on the Government to urgently invest an
additional £125 million a year in a comprehensive programme,
including funding for regional activity such as that proposed in
the capital. His recommendation was that, if the Government could
not find the funding from existing resources, they should look at
alternatives such as a corporation tax surcharge—a windfall
tax—and a “polluter pays” tax. Banks and energy companies have
been made subject to windfall taxes, so why not the tobacco
manufacturers, who make eye-wateringly high profits from products
that kill many tens of thousands of people every year? Four
manufacturers, who are collectively known as “big
tobacco”—British American Tobacco, Imperial Brands, Japan Tobacco
International and Philip Morris International—are responsible for
95% of UK tobacco sales and the same proportion of deaths. For
every person their products kill, it is estimated that 30 times
as many suffer from serious smoking-related diseases, cancers,
and cardiovascular and lung diseases caused directly by
smoking.
A windfall tax could be implemented immediately through the
Finance Bill. Experts on tobacco industry finances from the
University of Bath have estimated that that could raise about £74
million annually from big tobacco. However, that is much less
than the hundreds of millions in profits that big tobacco makes
annually, because it would be a surcharge on corporation tax paid
in the UK and tobacco manufacturers, just like the oil companies,
are very good at minimising corporation taxes paid in the UK. For
example, Imperial Tobacco, which is responsible for a third of
the UK tobacco market, received £35 million more in corporation
tax refunds than it actually paid in tax between 2009 and 2016.
In contrast, a polluter pays levy would take a bit longer to
implement, but it could be designed to prevent big tobacco from
gaming the system as it currently does with corporation tax.
The polluter pays model we propose enables the Government to
limit the ability of manufacturers to profit from smokers while
protecting Government excise tax revenues, so it is a win-win for
the Government and for smokers. Unlike corporation taxes, which
are based on reported profits and can be—and indeed are—evaded,
the levy would be based on sales volumes, as is the case in
America, where a similar scheme already operates. Sales volumes
are much easier for the Government to monitor and much harder for
companies to misrepresent.
The scheme is modelled on the pharmaceutical price regulation
scheme—the PPRS—which has been in operation for over 40 years and
is overseen by the Department of Health and Social Care. The
Department already has teams of analysts with the skills to
administer a scheme for cigarettes, which would be a much simpler
product to administer than pharmaceutical medicines. Implementing
a levy would not require a new quango to be set up, as the
Department has all the expertise needed to both supervise the
scheme and allocate the funds.
Despite paying little corporation tax, the big four tobacco
companies make around 50% operating profit margins in the UK, far
more than any other consumer industry. Imperial Tobacco is the
most profitable, with around a 40% market share in the UK. It
made an operating profit margin of over 70% in 2021. Why should
an industry, whose products kill when used as intended, be
allowed to make such excessive profits, when 10% is the average
return for business? The polluter pays model caps manufacturers’
profits on sales and could raise £700 million per year, which is
nearly 10 times as much as a windfall tax.
Amendments to the Health and Social Care Bill calling for a
consultation on such a levy were passed in the other place.
Health Ministers were sympathetic, but the Treasury was opposed
so they were reversed when the Bill came back to this place to be
considered. However, that was before the Government knew they had
a fiscal hole of around £40 billion that had to be filled. The
£700 million from tobacco manufacturers would more than provide
the £125 million additional funding that Khan estimated was
needed for tobacco control. That would leave £575 million a year
that could be used for other purposes, perhaps even for other
prevention and public health measures which otherwise in the
present economic climate are unlikely to secure funding.
The polluter pays principle has been accepted by Conservative
Governments in areas such as the landfill levy, the tax on sugar
in soft drinks and requiring developers to pay for the costs of
remediating building safety defects. The Government promised to
consider a polluter pays approach to funding tobacco control in
the prevention Green Paper in 2019. Surely, we can now put it
into practice.
(Blaydon) (Lab)
The hon. Gentleman will know that in the north-east smoking
remains the leading cause of death, as well as of inequalities in
healthy life expectancy. The all-party group has come forward
with the polluter pays model, which is really important, and I
ask the Government to consider it again as a means of funding the
essential work on stopping smoking.
I thank the hon. Lady for her intervention. Clearly, there is a
difference in smoking rates across the country, and we need to
ensure that that is addressed. I will come on to that in my
speech in a few moments.
We need the levy to be introduced, so will the Minister commit to
investigating the feasibility of a windfall tax, backed up by a
polluter pays levy, to provide the funding needed to deliver
smokefree 2030?
I want to talk about the need to protect generations to come. The
Government are set to miss the ambition, set in the 2017 tobacco
control plan, to reduce SATOD— smoking status at time of
delivery—rates to 6% by 2022. Currently, 9.1% of women, or about
50,000 women a year, smoke during pregnancy. Smoking during
pregnancy is the leading modifiable risk factor for poor birth
outcomes, including stillbirth, miscarriage and pre-term birth.
Children born to parents who smoke are more likely to develop
health problems, including respiratory conditions, learning
difficulties and diabetes, and they are more likely to grow up to
be smokers. Reducing rates of maternal smoking would contribute
directly to the national ambition to halve stillbirth and
neonatal mortality by 2025.
Younger women from the most deprived backgrounds are the most
likely to smoke and be exposed to second-hand smoke during
pregnancy. Rates of smoking in early pregnancy are five times
higher among the most deprived areas than the least deprived.
That contributes to this group having very significantly higher
rates of infant mortality than the general population. As such,
if we can drive down rates of smoking in younger, more deprived
groups we will then have a rapid impact on rates of smoking in
pregnancy. Two thirds of those who try smoking go on to become
regular smokers, only a third of whom succeed in quitting during
their lifetime. Experimentation is very rare after the age of 21,
so the more we can do to prevent exposure and access to tobacco
before this age, the more young people we can stop from being
locked into a deadly addiction.
If England is to be smoke free by 2030 we need to stop people
from starting smoking at the most susceptible ages, when they are
adolescents and young adults, and not just help them quit once
they are addicted. The all-party group, which I chair, has called
on the Government to consult on raising the age of sale for
tobacco to 21, which, when implemented in the US, reduced smoking
in young adults by 30%. This is a radical measure, but one that
is supported by the evidence and by the majority of voters for
all political parties, retailers and young people themselves. It
would have a huge impact on reducing smoking rates among young
mothers, who are more likely than older women to smoke. It would
also reduce rates among young men, so reducing the exposure of
young pregnant women to second-hand smoke throughout their
pregnancy. If men smoke it makes it harder for pregnant women and
new mums to quit smoking, and makes it more likely that mother
and baby will be exposed to harmful second-hand smoke. Will the
Minister consider committing to a consultation on raising the age
of sale for tobacco, as supported by both the public and tobacco
retailers?
Finally, I want to warn the Minister about the Institute of
Economic Affairs’ alternative smokefree 2030 plan, which popped
into my inbox yesterday. The IEA’s plan is an alternative that is
entirely in the interests of the industry, which is hardly
surprising given the funding the IEA has received from big
tobacco. The IEA itself refuses to be transparent about its
funding, but through leaked documents it has been exposed as
being funded by the tobacco industry for many years. I am sure
the Minister is aware that the UK Government are required, under
article 5.3 of the international tobacco treaty, the World Health
Organisation framework convention on tobacco control, to protect
public health from the
“commercial and other vested interests of the tobacco
industry”.
The guidelines to article 5.3, which the UK has adopted, spell
out that that includes organisations and individuals that work to
further the interests of the tobacco industry, which includes
industry funded organisations such as the IEA and the UK Vaping
Industry Association.
I look forward to hearing contributions from across the House. I
hope my hon. Friend the Minister will echo the words of his
predecessors in his new role and restate for the record on the
Floor of the House the Government’s commitment to complying with
article 5.3. I hope he will state that on his watch the
Government will continue to prevent the tobacco industry-funded
organisations from influencing tobacco control policy.
1.18pm
(Stockton North) (Lab)
I draw the attention of the House to my interests as a vice-chair
of the all-party parliamentary group on smoking and health. I,
too, welcome the Minister to his place and wish him well. I look
forward to working with him. I congratulate the hon. Member for
Harrow East () on an excellent and measured speech. I could make
my shortest speech ever by simply saying, “I agree with Bob.” I
won’t. [Laughter.] I will reiterate some of the points he
made.
When I wander through parts of my constituency, particularly the
areas of greater deprivation, I am struck by the number of people
who still smoke, including children on their way home from school
in school uniform. I know that in recent times rates of smoking
have come down across the borough of Stockton-on-Tees, thanks to
initiatives by the council, health staff and Fresh, the
north-east charity that helped drive a reduction. Although the
incidence of smoking has come down overall, it is still a major
issue in areas such as the town centre ward, where it remains
high, as does the number of young women smoking in pregnancy.
Sadly, public health is in a dire state after 12 years of
Conservative rule and, in recent times, the promise to act on
smoking does not align with what is being delivered. Time and
again, Members from across the House have asked for the
long-overdue tobacco control plan, but despite making commitments
to introduce the necessary measures to further reduce tobacco
harm in this country, the Government have not done so. We will
never meet the Government’s targets if we do not have a plan, so
I hope that the Minister will today give us a date for the plan
and promise to make available the resources to make it work.
I want to be a little parochial and make it clear again why I
have always focused on this health issue, in particular, during
my 12 years in Parliament. In my patch of Stockton, 13.2% of
adults smoked in 2019 compared with 13.9% in England. That rises
to 19.1% among those in routine and manual occupations. When we
look at the proportion of women who smoked during pregnancy in
2021, it is worrying that the figure for Stockton was 14.1%
compared with 9.6% nationally. The fact that one in 10 expectant
mothers smoke across the country is bad enough, but the
proportion is 50% higher in my patch and much higher, again, in
deprived communities. Smoking can be a family issue. Any
expectant mother committed to quitting will struggle if their
partner or others in their household smoke. We need a plan to
work with whole families to discourage smoking and end the
dangers to the unborn child.
There is, of course, an economic argument to invest in smoking
cessation. At the local level, smoking costs £62.3 million every
year. That includes £47.2 million in lost productivity and costs
of £9.2 million to the NHS and £5 million to social care. It is
particularly distressing that 7.4% of our Stockton North
population suffer from asthma—higher than the 6.5% across
England. Furthermore, the level of COPD—chronic obstructive
pulmonary disease—in my constituency is 3.1%, which again, is 50%
higher than the rate of 1.9% across England. In England, 14.1% of
people have high blood pressure, but the proportion is 16.2% in
my constituency. It is therefore no surprise that 75% of adults
in the north-east support the ambition to reduce smoking
prevalence to less than 5%—fewer than one in 20 people—by 2030,
with just 9% opposed. Along those lines, 76% of adults in the
north-east support activities to limit smoking or think that the
Government should do more.
We can all celebrate the fact that, in the past five years, the
fastest decline in smoking rates in England has been in the
north-east, although that was from a very high starting point.
That is due to highly effective regional collaboration between
local authorities and the NHS, supported by Fresh, to which I
referred earlier, but they cannot do that alone. Government
action could have a fast impact if they were to bring in
legislation introducing the further regulation of tobacco
products, as the hon. Member for Harrow East mentioned.
My hon. Friend is speaking powerfully about the experience in the
north-east and nationally. He will be aware that, between 2007
and 2019, when the Government led the way in introducing tough
new regulations, our smoking rates declined far faster than in
the rest of Europe and most of the world, but that has dropped
off, so we need to take further action. Is he aware of this
recent research into smoking habits? University College London’s
smoking toolkit study has surveyed smokers’ behaviour monthly
since 2006. After years of steady decline in adult smoking—the
proportion went from 24.1% in 2006, as he said, to 14.8% in
2020—smoking rates have stagnated, standing at 14.9% as we reach
the end of 2022. Worse still, although the uptake of smoking
among young adults declined year on year from 2007, that started
rising again after 2019.
I am grateful to my hon. Friend; I was not aware of some of the
research to which she referred. However, the reduction in smoking
has plateaued in recent times, and that is lamentable. I have a
big enough heart to say that the Conservative Government have
done much over the years to reduce smoking, building on much of
what the Labour Government did between 1997 and 2010, but we
cannot allow ourselves to stop there. We need to do so much
more.
There are often arguments—many of which are put forward by front
organisations funded by the tobacco industry—that further smoking
regulation would be the “nail in the coffin” for small
businesses, but that is not so. As the hon. Member for Harrow
East mentioned, a recent survey commissioned by Action on Smoking
and Health found that small tobacco retailers in the UK support
further measures to reduce the harm of tobacco, including
increasing the age of sale from 18 to 21, mandating a licence to
sell tobacco and requiring tobacco companies to pay for services
to help smokers to quit. John McClurey, a retired local retailer
from Newcastle said, “Tobacco is a burden” to small businesses.
The Government could help to lift that burden and charge the
tobacco companies to do so.
In my last speech on smoking in Westminster Hall, I again
stressed the need for a levy on the tobacco companies, but
Ministers were reluctant. The new Minister will want to take
action in this space. As we all know, cash will be tight and the
Budget in two weeks’ time will be difficult, so he can earn
himself brownie points by requiring the industry that makes
billions in profits while killing our people to pay up instead.
It needs to pay, because more than 4,000 people died prematurely
from smoking in the north-east alone last year, with 30 times as
many suffering disease and disability caused by smoking.
Going hand in hand with the personal suffering caused by smoking
is the economic cost to our already disadvantaged communities. In
their election manifesto, the Government claimed:
“We are committed to reducing health inequality.”
Why, then, are there such pronounced inequalities? In the
north-east, 42% of smoking households are in poverty and tobacco
spending accounts for a higher share of gross disposable
household income per head than in any other UK region or nation.
Please do not give me the argument that if people are poor, they
should give up their fags. Smoking is an addiction and they need
help to quit. Ending smoking in such communities would not just
benefit the health and wellbeing of individuals but inject money
into local economies that was previously going up in smoke.
The Minister will know that, at the current rate of decline,
poorer communities risk being left behind as we move towards the
hoped-for smokefree 2030. It will not happen in the communities
to which I have referred without robust action. Most of the
quitting has been done by people from better-off communities, and
the benefits have largely accrued to those communities. In 2019,
fewer than one in 10 professional and managerial workers
smoked—well on the way to the smoke-free target of less than
5%—compared with nearly one in four workers in routine and manual
occupations.
Half the difference in life expectancy between rich and poor is
due to smoking, which means that the scope for reducing health
inequalities related to social position is limited, unless the
many smokers in lower social positions can succeed in stopping
smoking. Smoking is linked to almost every indicator of
disadvantage. Those overlap different communities, so smokers in
routine and manual occupations, or who are unemployed, are also
more likely to be living in social housing and to be diagnosed
with mental health conditions.
There is a clear need for a new tobacco control plan that targets
investment and enhanced support at disadvantaged smokers,
wherever they are. As long as smoking remains the norm in some
communities, not only will it be harder for smokers to quit, but
smoking will continue to be transmitted from one generation to
the next. The evidence shows that most people who smoke started
as children. Prevention is key, so what will the Government do to
reduce the appeal of cigarettes?
Does my hon. Friend agree that raising the age of sale, as the
APPG proposes, would reduce youth uptake? According to the UCL
modelling that I spoke about, it would reduce smoking among 18 to
20-year-olds by a third. It would narrow the inequalities in
uptake: as my hon. Friend has powerfully explained, children from
more disadvantaged backgrounds are more likely to take up
smoking.
I have no doubt that everything my hon. Friend says is totally on
the money. We can take action, and it need not cost the
Government a fortune either. My hon. Friend raises the issue of
age. Some parts of the UK have a Check 25 policy—would it not be
wonderful if we could introduce such a check on the sales of
cigarettes? It might help to put an end to smoking among younger
people.
High smoking rates among people with mental health conditions are
a leading cause of premature death and disease. Smoking accounts
for two thirds of the reduction in life expectancy for people
with a serious mental illness. The smoking rate among people with
serious mental illnesses is more than three times that of the
general population. The rate among people with depression and
anxiety is just under twice that of the general population, but
they account for 1.6 million smokers. There is now good evidence
that smoking exacerbates levels of poor mental health, whereas
stopping smoking contributes to improvements in mental health.
Tobacco remains the biggest cause of cancer and death in the UK,
so Cancer Research would like to see the ambition to make England
smoke free by 2030 implemented. I ask the Minister whether we can
expect to see that ambition realised.
I would like to say a little about “The Alternative Smoke-Free
2030 Plan” published by the Institute of Economic Affairs, which
the hon. Member for Harrow East has also received. After the
disastrous free-market policies promoted by the IEA and adopted
by the last Prime Minister and Chancellor, I find it hard to
believe that any current Minister would give any credence to the
IEA’s recommendations on anything. However, the hon. Member makes
an important point: as a party to the World Health Organisation
framework convention on tobacco control, the Government and all
public authorities are required to protect
“their public health policies…from commercial and other vested
interests of the tobacco industry”.
If the Minister is in any doubt about the role played by the IEA,
he should take note of the leaked documents that show that during
the passage of the tobacco products directive, Philip Morris
International described the IEA as a “media messenger” on its
behalf, able to assist in “policy outreach” to “pro-actively
relay our positions”, while British American Tobacco described it
as a “vehicle for delivery” of its UK reputation initiatives. I
would like the Minister to restate for the record, on the Floor
of the House, the Government’s commitment to complying with
paragraph 3 of article 5 of the convention and to preventing
tobacco industry-funded organisations from influencing tobacco
control policy.
The arguments for bringing tobacco regulation forward are
multifaceted and can no longer be ignored. As a member of the
APPG, I look forward to working with a new Minister who can do
the maths to realise the cash value of a tobacco control plan,
especially if we make the polluters pay, and—better still—who can
help us to ensure that we have healthier people in all our
communities.
1.33pm
(Erewash) (Con)
It is a pleasure to follow the hon. Member for Stockton North
(). Like him, I could tear up
my speech after listening to that of my hon. Friend the Member
for Harrow East (). I congratulate my hon. Friend and the hon. Member
for City of Durham () on securing this important
debate, which I have been eagerly awaiting for some time. I wish
the hon. Member for City of Durham a speedy recovery.
I thank the all-party parliamentary group on smoking and health,
which is so excellently chaired by my hon. Friend the Member for
Harrow East, for all its work on this important area. It has
undoubtedly been instrumental in changing the Government’s policy
on smoking and their perception of the issue. I am sure that its
work has contributed to saving many lives. I thank my hon. Friend
for his invitation to become a member of the APPG; I am delighted
to accept.
The reasons why we need to tackle smoking and become smoke free
by 2030 have been well rehearsed in previous debates in
Westminster Hall and this Chamber and repeated today, but I make
no apology for highlighting the key reasons again. Smoking
remains the single biggest cause of preventable illness and
death. Surely we have a duty to do everything in our power to
prevent ill health and death. Shockingly, cigarettes are the only
legal consumer product that will kill most users: two out of
three smokers will die from smoking unless they quit. More than
60,000 people are killed by smoking each year, which is
approximately twice the number of people who died from covid-19
between March 2021 and March 2022, yet it does not make headline
news. In 2019, a quarter of deaths from all cancers were
connected to smoking.
The annual cost of smoking to society has been estimated at £17
billion, with a cost of approximately £2.4 billion to the NHS
alone and with more than £13 billion lost through the
productivity costs of tobacco-related lost earnings, unemployment
and premature death. That dwarfs the estimated £10 billion income
from taxes on tobacco products. People often tell me that we
cannot afford for people to stop smoking because of the revenue
generated by the sale of tobacco, but I argue that as a society,
and for the good of our nation’s health, we cannot afford for
people to smoke.
Achieving smoke-free status by 2030 will not only save the NHS
money but, more importantly, save lives. If we are determined to
bring down the NHS backlog, we need to prevent people from
getting ill in the first place. If we want to achieve our goal of
improving productivity, we need a healthy workforce. It takes a
brave and bold Government to implement policies whose rewards
will mainly be reaped by the next generation, but that is the
right thing to do.
I want to focus on just one of the well-researched and
well-received recommendations in the Khan review: the age of
sale. The fact that retailers use the Challenge 21 and Challenge
25 schemes indicates just how hard it is to determine a young
person’s age. Age of sale policies are partly about preventing
young people from gaining access to age-restricted products such
as cigarettes and alcohol. More importantly, as Dr Khan states,
they are about stopping the start. Dr Khan recommends
“increasing the age of sale from 18, by one year, every year
until no one can buy a tobacco product in this country… This will
create a smokefree generation.”
That may seem pretty drastic, but so are the consequences of
smoking. If we ask smokers when they started, the majority will
say that it was when they were in their teens. The longer we
delay the ability to legally take up smoking, the fewer people
will take it up, and the fewer will therefore become addicted.
Let’s face it: never starting to smoke is much easier than trying
to quit.
We have already proved in the UK that raising the age of sale
leads to a reduction in smoking prevalence. Increasing the age of
sale from 16 to 18 in 2007 led to a 30% reduction in smoking
prevalence for 16 and 17-year-olds in England. Other hon. Members
have mentioned the change in America. I would argue that
increasing the age of sale by one year every year is more
acceptable than raising it in one go from 18 to 21, for example,
or even to 25.
Dr Khan has also called for additional investment in the stop
smoking services currently provided by local authorities.
However, I am a great believer in making every contact
count—every contact that someone makes with a GP, as an
out-patient, as an in-patient or on a visit to a pharmacy. Every
time a smoker sees a healthcare professional, it should be seen
as part of the healthcare professional’s duty to better the
health of their patient.
I was honoured to share the stage with Dr Javed Khan at the
launch of his review in June, and I was pleasantly surprised by
the virtually universal welcome that his recommendations
received. Indeed, polling carried out by YouGov backs that up:
76% of respondents support Government activities to limit
smoking, or think that the Government should do even more; just
6% say that they were doing too much; 76% support a requirement
for tobacco manufacturers to pay a levy or fee, to finance
measures to help smokers quit and prevent young people from
smoking; 63% support an increase in the age of sale; and, for the
benefit of those on the Government side of the Chamber, 73% of
those who voted Conservative in 2019 support the Government’s
smoke free 2030 ambition.
In our 2019 manifesto we committed ourselves to levelling up, and
that commitment has been reiterated by our new Prime Minister.
Levelling up is not just about infrastructure; it is also about
levelling up our health and life chances. That is particularly
important for my constituents, because 16.6% of adults in Erewash
are currently smokers, which is above the national average. With
average annual spending on cigarettes estimated to be around
£2,000, it is not just the health of smokers that is being
affected, but their pockets as well. Becoming smoke free by 2030
would lift about 2.6 million adults and 1 million children out of
poverty, and so would aid our levelling-up agenda.
Before I end my speech, I want to raise the issue of
e-cigarettes, or vaping. The Khan review contains a specific
recommendation on this, and I want to explain why it is so
important. As with cigarettes, the age of sale is 18, but time
after time I see young people at the end of the school day using
vapes—and that is outside schools without sixth forms. It is
illegal for a retailer, whether online or on the high street, to
sell vaping products to anyone under the age of 18, so I am not
sure how under- age users are obtaining the devices. The
manufacturers are obviously aiming some of their marketing at
this age range through the use of cartoon characters, a rainbow
of colours, and flavours to match. The function of e-cigarettes
should be solely as an aid to quit smoking, and not, as I fear,
as a fashion accessory and, potentially, the first step towards
taking up smoking.
The proliferation of vape shops in our high streets and online
proves that vapes have become an industry in their own right, and
are now being used by tobacco companies to maintain their profits
as restrictions on tobacco increase. I therefore ask the Minister
to work with his colleagues in the Home Office, the Department
for Levelling Up, Housing and Communities and the Department for
Education to see what more can be done to clamp down on the
illegal supply of vapes to those under the age of 18. I also ask
him for an update on progress in getting a vaping device
authorised through the Medicines and Healthcare products
Regulatory Agency—a step that would send the strong message that
vapes are an aid to quitting smoking and not an alternative to
smoking.
Finally, let me ask a question that has already been asked by
other Members today: will the Minister provide a date on which we
can expect the tobacco control plan to be published?
Madam Deputy Speaker ( )
I call the shadow Minister, .
1.43pm
(Denton and Reddish)
(Lab)
It is a pleasure to speak in this important debate. It has been a
small but, I think, perfectly formed debate, in which there has
been a large degree of consensus throughout the House on our
ambition for England to be smokefree by 2030.
I commend the hon. Member for Harrow East () not just for the work he has done on this subject
over a long period, particularly in the all-party parliamentary
group, but for the way in which he introduced the motion, which,
as my hon. Friend the Member for Stockton North () observed, enabled us to
say, “We agree with Bob.” I congratulate my hon. Friend for his
own work on the subject. I thank the hon. Member for Erewash
() for her contribution, and
also thank her for her time as the public health Minister: I used
to enjoy our debates across the Dispatch Box, and I wish her well
in whatever comes next.
The Health and Social Care Front Bench is a bit like a whirling
dervish at the moment. We had the hon. Member for Erewash a few
months ago, then the hon. Member for Sleaford and North Hykeham
(Dr Johnson)—she was in post for just six weeks, and I want to
thank her as well for the work she did in that short time—and now
we have the new Under-Secretary of State for Health and Social
Care, the hon. Member for Harborough (Neil O’Brien), whom I
welcome. Let me also echo the words of the hon. Member for Harrow
East in wishing my hon. Friend—indeed, my friend—the Member for
City of Durham () a speedy recovery after
her hospital treatment.
It is now nearly five months since the release of the Khan
review. Both the hon. Member for Erewash and I spoke at the
launch, and I think the review was universally welcomed. It was
generally agreed that we must move apace in ensuring that we meet
the ambition of a smokefree 2030. In those five months we have
had three different Health Secretaries, and we are now on our
third Prime Minister. I do not blame the current Minister for all
this chopping and changing, but it is little wonder that the
Government have failed to find time to respond to the Khan review
amid the endless changes. I hope that when the Minister responds
to the debate, we will finally be given some clarity. I hope he
will set out a timetable for when the Government will respond to
the Khan review, and will outline which measures in the review
itself the Government are currently considering. I also hope he
will be able to reassure Members on both sides of the House that
the Government stand by their commitment to create a smokefree
England by 2030.
The importance of that smokefree 2030 cannot be overstated.
Tobacco is the primary driver of health inequalities throughout
the United Kingdom. In 2019-20, there were more than half a
million hospital admissions and more than 74,000 deaths
attributed to smoking. My constituency of Denton and Reddish
straddles two local authorities, Tameside and Stockport in
Greater Manchester. The public health charity Action on Smoking
and Health—ASH—estimates that smoking costs those two local
authorities about £172 million in lost productivity and health
and social care costs. That is unsustainable.
Behind those stark economic figures, however, are individual
lives that are being harmed or lost as a direct result of
smoking. We know that more than 50% of people over the age of 16
who smoke say they want to quit—in fact, many say that they wish
they had never started in the first place—and it is therefore
imperative that the Government support them in their efforts to
do so. Unfortunately, stop smoking services have suffered a 33%
real-terms cut in their budgets since 2015-16. There is a drastic
need for that to be reversed.
The Government have made a commitment to a smoke- free 2030,
which is commendable. We support them, and we want them to
succeed. However, a commitment alone is not enough: we want to
see action to get there, and we need to see that action fast. The
former Secretary of State had an interesting relationship with
the tobacco industry, to put it mildly. She had previously
accepted hospitality from the industry, and had voted against
several sensible public health tobacco measures. During her brief
but eventful tenure, it was reported that she had scrapped the
Government’s proposals to publish a tobacco control plan, as well
as the health disparities White Paper. I asked the Minister about
the White Paper earlier this week during Health questions, and
received something of a non-answer. I will therefore ask my
questions again today, in the hope of getting some clarity. Are
the Government planning to scrap the health disparities White
Paper—yes or no? Are they planning to scrap the tobacco control
plan—yes or no? We need transparency, as there seems to be an
information vacuum in the Department of Health and Social Care.
If the Government are indeed rowing back on their public health
responsibilities, they should have the guts to say so, and face
scrutiny for that decision.
By doing everything from inviting tobacco lobbyists into the
heart of No. 10 to accepting gifts from the big four tobacco
firms, the Government have shown themselves too willing to ally
themselves to an industry that is damaging the health of the
nation. However, the damage done by the tobacco industry is not
confined to public health. Recent analysis conducted by The Daily
Telegraph has revealed that the Russian Government have received
almost £7 billion from tobacco companies in taxes since Putin’s
invasion of Ukraine. That is despite several tobacco companies
pledging to cut ties with Russia. I would be interested to know
what the Minister makes of this revelation. Will the Government
make it crystal clear to tobacco companies that they are expected
to follow the lead of those companies that have ceased trading
with Putin’s tyrannical regime?
Labour Members believe that if we want to ease pressure on our
NHS and improve public health, we need to get serious about
prevention. That means ensuring equitable access to smoking
cessation services, and taking on tobacco companies that profit
at the expense of public health. Smoking prevalence is not a
problem that the Government can ignore and hope will magically go
away. As a Greater Manchester MP, I have been really encouraged
by Greater Manchester’s “Make Smoking History” strategy. If the
Minister has not looked at that, I encourage him to do so,
because it really is best practice. Indeed, it is cited as best
practice in a case study in the Khan review.
Greater Manchester’s comprehensive approach to tobacco control
means that smokers in Greater Manchester have more offers of
support in quitting than ever before. Thanks to the scheme,
smoking rates among people in routine and manual jobs have
reduced faster in Greater Manchester than in any other region of
England. If these strategies can work regionally, they can, with
the political willpower, be scaled up to national level.
I urge the Minister to take the brave decisions. They are
sometimes tough and often very unpopular with a significant vocal
minority of people, but taking those decisions is the right thing
to do, as history often shows. Smoking has gone up among young
adults aged 18 to 24 in the past three years. To put that in
context, in 2007, around 41% of young people said that they had
smoked. By 2019, that had fallen to just a quarter, but in the
short space from 2019 to 2022, that increased to a third. That is
going in the wrong direction. Between 2007 and 2020, smoking
fell, as successive Governments really ratcheted up the
regulation of smoking and introduced smoke-free laws. They
increased the age of sale from 16 to 18; banned the display of
tobacco products; introduced standardised packaging and large,
graphic health warnings; banned smoking in cars with children;
and, lastly, banned menthol in 2020. Those measures worked, but
they have to continue, as does the pace of change, if we are to
meet the goals of Smokefree 2030.
The last Labour Government implemented one of the biggest and
most significant public health interventions in modern political
history. I am most proud of it, but it was not popular in all
quarters; I was almost banned from holding surgeries at Denton
Labour club. It was the ban on indoor smoking. When we go abroad
to countries that still have smoking indoors in public places—in
bars, restaurants and cafes—we wonder how on earth we put up with
that in our country until fairly recently. Absolutely nobody with
a modicum of common sense would want to reverse that
legislation.
When we were in government, we supported taking the bold steps
necessary to protect public health, and many thousands of lives
were saved as a result. That is why we want the Government to
commit to Smokefree 2030. They will miss that target unless they
up the pace of change, accept the recommendations of the Khan
review, and legislate to put measures in place. For far too long,
public health has been an afterthought, or a battleground on
which to have ideological arguments. We have had obesity
strategies scrapped, tobacco strategies binned, and health
inequalities widened. This neglect cannot continue. We will
support the Government in being brave on public health. We will
give the Minister the majority he needs, if he does not have one,
to pass the right measures in this House. Labour Members will do
right by Britain, and encourage the Government to do the same. Be
brave, and build a healthier, happier and fairer Britain; we will
support you.
1.56pm
The Parliamentary Under-Secretary of State for Health and Social
Care (Neil O’Brien)
I thank my hon. Friend the Member for Harrow East () and the hon. Member for City of Durham () for securing this
important debate. I add my voice to the voices of those who have
wished the hon. Member for City of Durham a speedy recovery. A
lot of the people who contributed to this debate, including the
hon. Members for Stockton North (), and for Blaydon (), and my hon. Friend the Member
for Erewash (), who all spoke eloquently,
have personal experience on this subject, and a real passion for
and dedication to achieving a smoke-free England by 2030—a goal
to which the Government are completely committed.
I am pleased to update the House on the Government’s work on the
Khan review—the independent review of Smokefree 2030 published in
June. Tragically, smoking remains the single biggest cause of
preventable illness and death across the country. There are still
six million smokers in England, and up to two out of three of
them will die from smoking unless they quit. Smoking causes seven
out of 10 cases of lung cancer, and most people diagnosed with
lung cancer die within a year. One in five deaths from all
cancers in the UK was connected to smoking in 2019. Smoking
substantially increases the risk of heart disease, heart attack
and stroke. Smoking is responsible for around 3.7% of all
hospital admissions, and so costs the NHS a staggering £2.4
billion each year.
People who start smoking as a young adult lose an average of 10
years of life expectancy, or around one year for every four years
of smoking after the age of 30. As many hon. Members have said,
action is vital if we are to meet the Government’s manifesto
commitment of extending healthy life expectancy by five years by
2035. The Government are committed to levelling up society and
extending the same chances in life to all people across the
country. As various Members have said, smoking is one of the
largest drivers of health inequalities, and rates vary
substantially across the country; we heard about that from the
hon. Member for Stockton North. As Dr Khan stated in his
independent review, smoking prevalence is four and a half times
higher in Burnley than in Exeter, so there is huge variation
around the country.
Smoking is a huge drain on the household finances of the most
disadvantaged families. In Halton in Cheshire, smokers spend an
estimated £3,551 a year on tobacco—nearly 15% of their income.
That is a shocking statistic. Reducing smoking presents a huge
economic opportunity to increase productivity and people’s
incomes. Smoking is very high in certain populations, and as my
hon. Friend the Member for Erewash said, a third of all
cigarettes smoked in England are smoked by people with a mental
health condition—an incredible fact.
Behind all these statistics are individuals, families and
communities who are suffering from the harms of tobacco. That is
why we are so committed to our goal to be smoke free by 2030. We
have committed to doing more to help smokers quit and to stop
people taking up this deadly addiction in the first place,
because we know that most smokers want to quit and many wish they
had never started.
The UK is considered a global leader on tobacco control, and
investment in evidence-based stop smoking interventions, a strong
regulatory framework, local authority stop smoking services and
the NHS has ensured that we now have the lowest smoking rate on
record: 13.5% in England, down from 21% in 2010 and 45% in 1974.
That is a huge change in our society.
In the 2017 tobacco control plan, we set a bold ambition to
reduce smoking prevalence among 15-year-olds from 8% to 3% or
less by the end of 2022. I am pleased to say we are well on track
to meet that target. The Government have also committed to an
escalator that increases duties by more than two percentage
points above inflation until the end of the current Parliament.
In 2010, the average price of a packet of cigarettes was £5.70;
and in 2022 the average price is £12.72. Since 2010, duty on
cigarettes has more than doubled, and a minimum excise tax has
been introduced to increase the price of the very cheapest
cigarettes, because we know that one of the most effective ways
of stopping people smoking is making it more expensive.
On top of that, we continue to fund a range of comprehensive
tobacco control interventions. We have provided £72.7 million to
local authority stop smoking services through the public health
grant, and more than 100,000 people have quit with the support of
a stop smoking service in 2020-21. This year alone, we have
provided £35 million to the long-term NHS commitment on smoking,
which means that by the end of 2023-24 all smokers admitted to
hospital, whether an acute hospital or a mental health hospital,
will be offered NHS-funded tobacco treatment services. We will be
using those regular touch points, as my hon. Friend the Member
for Erewash suggested, to drive down smoking.
My hon. Friend the Member for Harrow East asked about maternal
smoking, and the same model is being provided for expectant
mothers through the new smokefree pregnancy pathway, including
focused sessions and treatments. A new universal tobacco
treatment offer is being piloted as part of specialist community
mental health services for long-term users of specialist mental
health and learning disability services, to help the most
vulnerable populations.
The change in treatment for women who smoke in pregnancy is
remarkable. Women now routinely get a carbon monoxide test.
People will be offered support. In some cases, there are exciting
experiments with vouchers and financial incentives that can help,
particularly in some poorer communities, people to stop smoking.
There is a lot of work on maternal smoking.
Since leaving the EU, we have implemented a new UK-wide system of
track and trace for cigarettes and hand-rolled tobacco to deter
illicit sales. I have talked about how we have increased duties
to drive up prices and to deter smoking, which would of course be
undermined if illicit products were circulating.
We have limited the number of cigarettes that people can bring
into the country via duty free to 200, making it much harder for
those who want to illegally evade excise duties on tobacco. That
will help to prevent the sale of cheap cigarettes, further
reducing the illicit market.
Although smoking rates have fallen, we recognise that they are
not falling fast enough. That is why we asked Dr Khan to
undertake the independent review to help the Government to reduce
the devastation that smoking causes. The review makes a number of
bold recommendations.
Stop smoking services run by local authorities and funded through
the public health grant continue to offer smokers the best chance
of quitting, and people who get help from local stop smoking
services are three times more likely to quit successfully than
those who try to quit unaided. I pay tribute to the work of those
services, and I assure them that they remain a key part of the
Government’s smokefree 2030 ambition.
The Minister knows as well as I do that local authorities have
been under tremendous financial constraints in recent times. How
can we ensure that local authority public health continues to be
funded so that these services can continue? At the moment the
services are quite inadequate.
Neil O’Brien
The hon. Gentleman is right that these services are hugely
important. All authorities saw an increase last year and there is
a 2.8% increase this year, with funding heavily weighted towards
more deprived areas, but there is much more we need to do, and we
keep it under active review.
We are also building investment in anti-smoking marketing
campaigns. It was heartening to see the number of people who
joined the annual Stoptober campaign last month. This well-known
initiative encourages smokers to abstain for 28 days each
October, as we know that smokers who manage to quit for 28 days
are five times more likely to quit permanently. In England, the
Stoptober campaign has now helped more than 2.1 million people
quit since its inception in 2012.
Dr Khan also called for the NHS to prioritise further action to
stop people smoking. The long-term NHS plan commitments are a
huge step towards preventing smoking-related illness, and they
are making significant progress towards reducing preventable ill
health and reducing the burden of smoking on the NHS. I have
talked about using touch points in hospitals to offer people help
to stop smoking.
We have discussed vaping as a substitute for smoking. We
recognise that vaping is far less harmful than smoking and can be
an effective quitting device. We also recognise that there is
more the Government can do to tackle the myths and misconceptions
that surround vaping. Our recently published “Nicotine vaping in
England” report set out the most up-to-date evidence on vaping,
providing an even more compelling case for supporting smokers to
switch. However, in recognition of the recent increase in vaping
rates among children, which my hon. Friend the Member for Erewash
mentioned, we are doing more to prevent children from vaping. We
have updated our online materials, and we are working closely
with the Department for Education to communicate with schools on
how best to set policies around vaping.
My hon. Friend asked a specific question about the MHRA and
medical licensing. We are working closely with the MHRA to
support a future medically licensed vaping product, which would
carry many benefits, including tackling scepticism of
e-cigarettes among healthcare professionals. We understand that
several products are applying for medical licences early next
year. I pay tribute to my hon. Friend for all the work she has
done on public health.
As a world leader in tobacco control, the Government continue to
support lower and middle-income countries to implement effective
tobacco control strategies, and through official development
assistance funding to the World Health Organisation-led framework
convention on tobacco control 2030, we are supporting a further
nine countries to protect their populations from the harms of
tobacco.
Both my hon. Friend the Member for Harrow East and the hon.
Member for Denton and Reddish () mentioned article 5.3 of the
tobacco control treaty, to which I can confirm the Government are
absolutely committed. I consider myself forewarned about the
report mentioned by my hon. Friend the Member for Harrow
East.
The Government are determined to address the challenges raised by
the independent review and to meet our bold smokefree 2030
target. I understand the compelling arguments made by the Khan
review and the very strong evidence in the recent “Nicotine
vaping in England” report. Over the coming weeks, we will be
quickly taking stock on whether a refreshed tobacco control plan
is the best way to respond, and on how and when to take forward
all the suggestions made by that review.
The Government recognise that more action needs to be taken to
protect our people from this dangerous addiction. We know that
the action we take must be comprehensive, bold and ambitious. The
prize of reaching a smokefree 2030 will be huge for this country,
particularly for our most disadvantaged citizens. I thank all
hon. Members who have taken part in this debate.
2.08pm
With the leave of the House, I thank my hon. Friend the Minister,
who is new in post, for answering this debate. I am grateful for
the extremely welcome support from the shadow Minister, which
demonstrates the will on both sides of the House to deliver a
smokefree 2030.
I thank all colleagues who have contributed, including the hon.
Members for Stockton North () and for Blaydon (), and my hon. Friend the Member
for Erewash ().
Achieving a smoke-free England is key, and it is a major part of
the levelling-up White Paper’s mission to increase life
expectancy by five years by 2035. I know this is close to the
Minister’s heart, because he was previously the Minister for
Levelling Up. I remind him that in that role he said:
“ultimately on public health and on prevention, we need to think
extremely radically and really floor it, because otherwise the
NHS will just be under humongous pressure for the rest of our
lifetimes because of an ageing population.”
I think we all agree with those statements. He needs to act
radically and immediately on the Khan review and bring forward
those proposals. I think he has the commitment of the whole House
to deliver them, if legislation is required, but he could do much
of what is in the Khan review just by regulation.
We need a tobacco control plan that will end smoking, increasing
healthy life expectancy and narrowing inequalities, but without
funding, a plan will not deliver. That is why we are proposing
the polluter pays levy, which is popular, feasible and supported
by voters of all political persuasions and by tobacco retailers.
The idea has come to pass and we must now implement it.
Question put and agreed to.
Resolved,
That this House has considered the recommendations of the Khan
review: Making smoking obsolete, the independent review into
smokefree 2030 policies, by Dr Javed Khan, published on 9 June
2022; and calls upon His Majesty’s Government to publish a new
Tobacco Control Plan by the end of 2022, in order to deliver the
smokefree 2030 ambition.
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