Cigarette Stick Health Warnings Bill [HL]
Monday 14th June 2021
(3 years, 5 months ago)
Lords ChamberRead Full debate Cigarette Stick Health Warnings Bill [HL] 2021-22 Read Hansard Text
Cigarette Stick Health Warnings Bill [HL]
Friday 3rd December 2021
(2 years, 11 months ago)
Lords ChamberRead Full debate Cigarette Stick Health Warnings Bill [HL] 2021-22 Read Hansard Text Read Debate Ministerial Extracts
Lord Young of Cookham (Con)
My Lords, I hope that we will now move to calmer waters.
I am sanguine about the prospects for this Bill reaching the statute book at this late stage of the Session. However, that is not fatal as its provisions could be implemented by a simple amendment to the Tobacco and Related Products Regulations 2016—easily done now that we have left the European Union. I have chosen this subject to keep up the pressure on the Government on public health and to help shape the agenda for the forthcoming tobacco plan; perhaps my noble friend the Minister can say when we might expect it. I do so also because the campaign against the harm done by tobacco has been one of my preoccupations since entering Parliament in 1974.
This Bill extends the logic of health warnings on cigarette packs to the cigarettes themselves. If implemented, it would require both cigarettes and cigarette papers to display health warnings such as “Smoking Kills” or “Smoking Causes Cancer”. I first proposed this measure as a Health Minister in 1979 in Margaret Thatcher’s Government. I was told by representatives from the tobacco industry that we could not add health warnings to cigarettes because the ink used to print the warnings could be hazardous to health. Thankfully, the debate around tobacco control has progressed significantly since then, and I am confident that noble Lords will see the compelling case for dissuasive cigarettes. From being an initiative that, I believe, I was one of the first to suggest, it now commands broad support from the Royal College of Physicians, Cancer Research UK, the Health Foundation and the Association of Directors of Public Health—in all, some 71 organisations concerned with reducing the harm done by tobacco.
Smoking remains a leading cause of premature death. The Chief Medical Officer, Chris Whitty, has said that it is likely to have killed more people last year than Covid-19. However, smoking kills on the same scale every year and will go on doing so for years without robust action. In 2019, one in seven of the UK population were smokers. In England alone, around 280 children under 16 start smoking for the first time every day. Smoking is highly addictive: only one in three smokers will be able to quit before they die.
There is evidence that, over time, the responsiveness of smokers to existing warnings declines. New techniques are therefore needed to refresh their interest. Cigarettes are cancer sticks and consumers should be warned on the product, not just on its packaging. There is a growing body of research evidence from around the world supporting the effectiveness of what are known as “dissuasive cigarettes”, particularly in making cigarettes less attractive to younger adolescents and those who have never smoked.
This measure is popular. In a poll conducted by YouGov for Action on Smoking and Health, 70% of those surveyed supported health warnings on cigarettes, two-thirds of them strongly. Only 8% opposed the proposal. This includes majority support from voters from every main political party, including 70% of those who voted for my party in 2019. Adding health warnings to cigarettes and cigarette papers is a simple measure with minimal cost that would help deliver the Government’s Smokefree 2030 ambition. Tobacco manufacturers already print on cigarette papers, so this would be cheap and easy to implement.
This measure was one of several tobacco amendments to the Health and Care Bill tabled in the other place by officers of the APPG on Smoking and Health, of which I am a vice-chairman. As it stands, the Bill fails to include a single mention of smoking or tobacco and represents a significant missed opportunity to introduce key policies for achieving Smokefree 2030. Disappointingly, the Government refused to adopt the recommendations in the Commons, saying that they needed to
“conduct some further research and build a more robust evidence base in support of such additional measures before introducing them.”—[Official Report, Commons, 28/10/21; col. 812.]
However, these warnings are already under consideration in Canada, Australia and Scotland. Here is an opportunity for the UK to be ahead of the curve instead of waiting for others to lead. The robust evidence will be available only if someone does it.
Health warnings such as “Smoking kills” have been shown to be effective on billboards and tobacco packs, so why would they not also be effective on cigarettes? Adding warnings to cigarettes is important, because young people in particular are likely to start with individual cigarettes rather than packs. In addition to all the existing research on the effectiveness of health warnings, there have been at least eight peer-reviewed academic studies published since 2015 which specifically looked at warnings on cigarettes and found them to be effective, particularly in making cigarettes less attractive to younger adolescents and never-smokers.
This is a simple measure with minimal cost that would help deliver the Government’s ambition to make England smoke-free by 2030. This worthy ambition was announced in 2019, yet we are still waiting to hear what steps the Government will take to make it a reality. At the current rate of decline in smoking prevalence, Cancer Research UK has estimated we will miss that ambition by seven years, and double that for the poorest in society.
We will achieve a smoke-free 2030 only by motivating more smokers to make a quit attempt, using the most effective quitting aids, while reducing the number of children and young adults who start smoking each year. Dissuasive cigarettes will contribute to both objectives and reinforce the impact of other measures which require significant investment, such as behaviour change campaigns and stop smoking services.
This measure, along with the other tobacco amendments proposed in the Commons, will be retabled in the Lords after Second Reading next week by myself and colleagues from the All-Party Group on Smoking and Health, some of whom I welcome in today’s debate. I am confident these amendments will have strong cross-party support.
I end by quoting my honourable friend Bob Blackman MP, chairman of the all-party group, speaking during a recent debate on the Health and Care Bill in the other place:
“if we look back over the years, the measures on smoking in public places, on smoking in vehicles, on smoking when children are present and on standardised packaging of tobacco products were all led from the Back Benches. Governments of all persuasions resisted them, for various reasons … but we on the Back Benches who are determined to improve the health of this country will continue to press on with them, and we will win eventually. It may not be tonight, but those measures will come soon.”—[Official Report, Commons, 22/11/21; col. 74.]
I can assure the Government that, when the Bill comes to the Lords, we in this Chamber will take up the challenge. I beg to move.
Lord Rennard (LD)
My Lords, almost exactly 20 years ago, I described in this place how 300 lives were being lost each day in this country because of smoking tobacco. I asked then what the scale of public outcry demanding action would be if a similar number of lives were lost as, say, the result of a plane crash occurring every single day. My speech was in support of my noble friend Lord Clement-Jones’s Tobacco Advertising and Promotion Bill, a Private Member’s Bill which he successfully steered through all its stages and which, when it became law, largely banned tobacco advertising.
Measures of tobacco control such as that have been shown to be effective and significantly reduced rates of smoking in this country. The facts have refuted the many self-interested and bogus claims made over many years by the proponents of the tobacco industry. However, further action is needed because smoking remains a leading cause of premature death, now killing around 250 people every day in the UK. To put that in perspective, 151 people died yesterday as a result of the Covid pandemic. People should be horrified to hear that smoking is likely to have killed more people last year than Covid-19.
We need this Bill to help reduce the appeal of cigarettes to children and young people and to encourage existing smokers to quit. Who could seriously disagree with those aims, given that half of all people who smoke will die because of the habit and most people who take up smoking do so when they are young?
The warnings on cigarette packs have helped to inform smokers of the serious dangers associated with the habit and helped some of them to quit, but evidence shows that the effectiveness of pack warnings wanes over time, and new measures are needed to grab the attention of those who continue to smoke.
It is a terrible thing, as the noble Lord, Lord Young of Cookham, referred to, that many children have access to individual cigarettes. This means that a health warning on individual cigarettes is necessary to help prevent young people taking up the habit. Warnings on cigarette sticks are a logical next step, following the successful introduction of warnings on cigarette packs.
Reducing the number of children and young people who take up smoking is vital if we are to reduce health inequalities. Half of the difference in life expectancy between those in the poorest communities and those in the most affluent in this country is accounted for by smoking tobacco. Tackling this issue is a must if levelling up is ever to be a meaningful and not meaningless slogan. Around two-thirds of adult smokers take up smoking as children. Currently, 280 children take up smoking every day in England. Only a third of these children will presently succeed in quitting during their lifetime, and another third will die of a smoking-related disease.
The Bill’s proposal should not be seen in isolation, but as part of a comprehensive strategy for delivering the smoke-free by 2030 ambition, which is government policy and to which we all subscribe. The detail of all that is required was set out in the latest report from the All-Party Group on Smoking and Health, of which I am proud to be a member. I am pleased that the Government have committed to considering its recommendations for the forthcoming tobacco control plan, but we are still waiting to hear when we will see the details of that plan, publication of which is not yet in sight.
We cannot afford to wait before acting. The Health and Care Bill presents a perfect opportunity to enact measures to reduce the prevalence of tobacco smoking and, in particular, to reduce the number of children and young people who become addicted to it. The Government’s Bill could provide for the introduction of dissuasive cigarettes, as suggested in this Bill. Further amendments could provide for a complementary package of proposals to address the loopholes in existing legislation, strengthen tobacco regulation still further and provide the funding for tobacco control measures, which are desperately needed if the Government’s stated ambition of being smoke-free by 2030 is to be achieved.
In the meantime, we should signal strong support for this Bill, as we did 20 years ago for my noble friend Lord Clement-Jones’s Tobacco Advertising and Promotion Bill. As I said then:
“There are many terrible things in this world: natural disasters and those made by man. Sadly, there is nothing we can do about many of them. But smoking-related deaths and illnesses are terrible things about which we can do something, by supporting the Bill.”—[Official Report, 2/11/01; col. 1685.]
Lord Naseby (Con)
My Lords, I declare an interest; I have never smoked in my life, but I hold a modest amount of stock in British American Tobacco. More importantly, in the late 1960s, I was a director of a substantial advertising agency handling the Gallaher brand’s advertising, and I have therefore taken a particular interest in this market ever since.
I remind the House that we are talking about a legally marketed product, not one that is illegal on the market. There are, as noble Lords will know, significant health warnings on the packaging. That was introduced not so very long ago. I was in the communications industry; there is no evidence that those warnings are now useless or diminishing in effect. If you go into any CTN or tobacconist’s today, the cigarettes are not on display; they are behind the shutters, and that is all well controlled.
In my judgment, the Government should focus on investing in public information campaigns, which they have been doing. That is a much more effective way to raise awareness of the impact of smoking and highlight the widespread availability of alternative smoke-free nicotine products such as e-cigarettes, nicotine patches and heated tobacco products.
In addition, the regulations are already clear that tobacco products with a clearly noticeable taste or smell other than that of tobacco are prohibited. We do not need any new regulation. When one looks also at the purported health benefits of implementing a ban on using flavours as ingredients, it is entirely speculative. The ingredients do not encourage smoking or prevent smokers quitting.
On the question of age, I remember that when I was flying for national service in Canada at the age of 18, there was a ban on young men going into pubs if they were under the age of 21. All we did was make sure we found someone who was 21 and he bought the alcohol. Exactly the same would happen here. At the age of 18, adults are well aware of the risks associated with smoking and should be free to access a legal product if they so wish, as they do with alcohol. Raising the age to 21 will not change the demand for the product. Instead, it will result in 18 to 21 year-olds shifting from legal, tax-paid products to unregulated and untaxed products from illegal channels.
On a practical level, the age at which people can access restricted projects such as alcohol, tobacco, vaping, betting and the National Lottery has thankfully been standardised by Her Majesty’s Government, and it would be an absolute waste of time and confusing to the consumer if this bit of another market was done at different age.
Then there is a call for stricter control of retail licensing of selling tobacco products. But the tobacco traceability and security features system, known as the track and trace system, already provides a de facto retail registration scheme. An important point is that retailers cannot legally sell tobacco products unless they are registered through this system. Alongside that are regular, unnoticed, unnotifiable checks on all retailers. That is the most effective way to ensure that they comply with that. The most effective way to protect legitimate businesses and government revenues, as I point out to my noble friend on the Front Bench, is through the tobacco traceability and security features system registration and the enforcement measures associated with it. That is key to the whole thing, really.
The tobacco industry itself supports a significant increase in penalty thresholds, reflecting the quantity of illicit tobacco that has been seized, and whether it is a first or second offence that has been committed. As I understand it, the tobacco industry currently adopts and advocates a wide range of measures to prevent young people taking up smoking. For instance, as we all know, there is the CitizenCard—although perhaps we do not all know, judging by one or two of the comments made this afternoon. That card is recognised by the PASS proof of age scheme and supported by the Home Office, the Chartered Trading Standards Institute, the Security Industry Authority and the National Police Chiefs’ Council. In conjunction with the proof of age card, the CitizenCard runs a wide UK campaign, and that creates a good barrier to prevent underage people buying tobacco products. If any retailers do not do it properly, they are reported to trading standards for follow-up and possible enforcement.
Finally, looking at the industry levy itself, following a public consultation by Her Majesty’s Treasury in 2015 into the design of a levy on tobacco manufacturers’ profits, the Government concluded that it would be unworkable and so decided not to introduce it. Nothing has changed since then, and the reasons for rejecting this approach remain valid. On 16 June Her Majesty’s Government restated their position on the tobacco levy:
“We do not believe a levy is an effective way to raise revenue or protect public health.”—[Official Report, 16/6/20; col. 189.]
I will finish on the question of whether there should be a profit cap on individual manufacturers and importers. At this time and in this country, we do not want to put a message out to the world that we, as a Government, are interfering in a legitimate business, and wish to ensure that it is difficult for that to go forward. This Bill is totally misguided. Its promoters are ignoring the extensive controls that there are already. It interferes with individual liberty to choose, and above all it sends out a message that the UK is hostile to business, which is not a message that I wish to see.
Baroness Uddin (Non-Afl)
My Lords, I thank the distinguished noble Lord, Lord Young of Cookham, for bringing this Bill to the House. It is a privilege to stand in support of it.
I am a lifelong one-woman evangelical missionary in my family for the anti-smoking movement—not at all successfully in the end. I confess that at 11 years of age, alongside my cousin and brother’s band of brothers, a cricket team, I participated in the initiation of smoking the dried stick of a flower plant. I put on record that I cannot recall what it was, only that it smelled good.
I am happy to say that almost all of us did not become lifelong smokers. I put away these encounters until my marriage to a devotee of nicotine who has completely ignored me, and all government campaigns and advice. Sadly, four of our children have subsequently smoked, although happily they do not smoke now—and there is no smoking allowed inside my house. As if this was not enough, as a professional, I proceeded to work with smokers who progressed to being addicted to cannabis and other weed products. Therefore, I have witnessed some of the evident damage that smoking causes to health and well-being, as well to as the NHS and the health of our nation, with the associated dimension of increasing allergies and asthma among children. I fundamentally disagree with the noble Lord, Lord Naseby.
We must acknowledge and welcome the progress of government action on reducing smoking among the general population. We have come a long way and now have a greater level of knowledge and understanding of the devastating health impact and addictions that result from smoking. I assume that there is sufficient research and evidence on the serious injury and impact of smoking on young brains, as well as on the immense long-term destruction caused by smoking addiction. Smoking continues to cause premature and painful deaths, as has already been said by noble Lords. It is harrowing to learn that each day nearly 300 children under 16 smoke for the first time.
As a professional working in the field of drug addiction, I know all too well the implications for these adults who begin by trying smoking and then smoke into later life, experimenting with many other forms of addiction. I was speaking a few days ago to one of a group of young people in their 20s. A former smoker, he had proceeded to try cannabis and unsafe weed. I asked whether the warnings that have been suggested on cigarette papers would be a strong enough deterrent. The response was simply that, once they are hooked on the products, the warnings to quit smoking imminently have difficultly impacting their and their peer group’s decisions. However, he made the point that access to cigarettes was the main factor and that, although it is illegal, they can be bought from some shops quite easily by children as young as 12 or 13.
This one opinion is reinforced by ASH’s point that smokers are becoming too familiar with, perhaps complacent about, existing warnings and that we may need to explore alternative techniques to break what often becomes a lifelong, habitual practice, which is difficult to break away from and an embedded part of social interaction with peers, among younger groups. While there is clear evidence that the anti-smoking campaigns and education programmes have been impactful, resulting in dropping numbers of smokers among certain groups of the population, including pregnant women—on which I have done a lot of work in the community—this is not evident among larger numbers of children in some parts of inner cities. Where I live, the numbers gathering outside school gates speak volumes about the societal failure of public education on the danger of beginning smoking when young.
The message that smoking kills or causes cancer on every cigarette stick may not prevent the first test of peer pressure or experimental trial, but it would certainly reinforce the warning to children about the danger of smoking in the long term. That is very important. Therefore, I am in favour of making all the necessary efforts to warn against the danger of smoking and this should extend to writing warnings on all cigarette papers, including the filters used with hand-rolled tobacco. The latest fad of vaping also requires our attention, as it will be an imminent problem, because it still contains significant amounts of nicotine.
I would like to see more specific public education targeting children and families on the danger of addiction to smoking. The promise to create a smoke-free England by 2030 is a huge challenge, knowing that even then millions will have perished in its wake. Nevertheless, we should remain committed to these ambitions, and I thank the noble Lord, Lord Young of Cookham, and other noble Lords for their sterling efforts.
Lord Moylan (Con)
My Lords, it is painful for me to find myself in disagreement with my noble friend Lord Young of Cookham. It is astonishing that he has brought this Bill forward in the middle of the Covid pandemic, because there are three well-established principal risk factors in relation to the harm you suffer if you contract Covid and fall ill with it. They are age, sex and smoking. To avoid the harmful effects of Covid infection, you overwhelmingly want to be young, moderately want to be female and mildly want to be a smoker—but he does not want to put that fact on cigarettes. I looked in vain in the schedule for a piece of scientific evidence or statement that would derive from that scientific proposition. What he actually wants to put on the cigarettes, as shown by the words in the schedule, is lurid propaganda, not facts or evidence.
We turn first to the evidence. I was confused—and I will give way if my noble friend wants to explain—by what he said about the evidence for the effectiveness of this measure. He said, first, that it had never been tried and that there was therefore no evidence. He went on to say that, since 2015, there had been a number of peer-reviewed studies on the effectiveness of health warnings on cigarettes. Perhaps he meant cigarette packs, but he actually said “on cigarettes”. What is it? Is there evidence that the measure he is proposing is going to work or, since it has never been tried, is there not? My view is that it is likely he is saying that there is no evidence at all. We now have a Bill promoting propaganda with selective statements based on no evidence at all. Why would we want this?
The second reason is that the Bill—and this is a really awful pun—is a smokescreen. It is intended as a provocation on the way to achieving the stated objective of Action on Smoking and Health, which is a smoke-free Britain or UK by 2030. I think that is the target date, but I am happy to be corrected. There is no electoral mandate or evidence of electoral support for this policy. It would be better if those promoting these provocative and regressive measures were more honest and came forward with a Bill that actually criminalises smoking cigarettes, so that we can have that debate.
Finally, it is a patronising Bill because it is based on the assumption that adults are incapable of making an appropriate trade-off between the pleasures of cigarette smoking and the undoubted risks that it brings for the smoker. That is another reason why I think this House should have nothing to do with it. In my limited experience here, some Bills are bad Bills, but this is the first Bill I have come across that I suspect is just designed to provoke. I hope that the Government will not give it their support and that it will not pass.
Baroness Merron (Lab)
My Lords, it is a pleasure to speak in this Second Reading debate on a Bill on which varying views have been expressed. I fear that the noble Lords, Lord Moylan and Lord Naseby, will be somewhat disappointed in me, but it is a risk I am prepared to take because I congratulate the noble Lord, Lord Young, on bringing the Bill forward today. He rightly commands much respect across the House and is a doughty and informed campaigner on this issue.
I am pleased to say that this measure, which was proposed in the other place as an amendment to the Health and Care Bill, has the support of these Benches. It is important to remember why we are talking about it today. We are not talking about it as a measure for a measure’s sake, but as a major contribution to the improvement of people’s health, the reduction of inequalities and people living longer and healthier lives. That is the reason we are discussing it today.
We welcome the Government’s ambition to be smoke-free by 2030, and I hope the Minister will be able to welcome the measures outlined in the Bill. If we look at the 2019 prevention Green Paper, the Government committed to making smoking obsolete, but regrettably there is still no sign of the proposed and promised bold action that they agreed was essential to achieve that extremely challenging shift. There have been great strides in reducing smoking rates and improving people’s health and life expectancy over the past 20 years, but we must acknowledge that a continuing decline in smoking rates is not guaranteed and needs further work. As we have heard, evidence shows that we must constantly renew and refresh our tobacco control strategy to avoid stagnation in smoking rates and a widening of the already significant inequalities in rates between those who are richer and those who are poorer. With only nine years left to end smoking, Cancer Research UK analysis shows that the 2030 target will be missed by seven years and that it will be doubled for the most disadvantaged. I hope that is of concern to this House.
I am pleased to observe that tackling smoking is not a party-political issue. Governments of all stripes have implemented a comprehensive approach to tobacco control, starting at the beginning of this century with banning smoking in public places and in cars carrying children, then the point-of-sale display ban, which I saw through as Minister of Public Health at the time, through to standardised tobacco packaging. They have all helped to drive down smoking rates and have discouraged people, particularly the young, from starting smoking in the first place.
Nowhere is this consensus more evident than in the cross-party support for the Government’s smoke-free 2030 ambition, which if delivered would represent one of the most transformative public health statements and achievements in modern history. It is supported by more than three-quarters of the public, with majority support from voters of all political parties. This suggests a mandate to demand bolder action from the Government to end smoking by 2030.
Ending smoking will improve the quality of people’s health and save millions of lives in decades to come. It will also help to dramatically reduce health inequalities and lift thousands of households out of poverty, making it absolutely central to the levelling-up agenda. Tobacco is the leading cause of health inequalities in our society and is responsible for half the 10-year difference in life expectancy between the richest and the poorest. For every smoker who dies, another 30 are suffering from serious smoking-related diseases that affect not just the smoker but all those around them. This burden is dis- proportionately concentrated in our poorest communities; the Covid pandemic has really laid this bare for all to see. Consequently, people in these communities would accrue the greatest benefit from policies to deter people from smoking and make it easier to quit. Ending smoking for all would lift 500,000 households out of poverty. That includes 740,000 working-age adults, 180,000 pensioners and 330,000 children concentrated in the north and Midlands.
Ending smoking in these communities would not just benefit the health and well-being of individuals but inject into local economies money previously and literally going up in smoke. This would show just how serious the Government are when they talk about levelling up, but disappointingly they have thus far opted not to support the amendments proposed to the Health and Care Bill to get us on track to meet the smoke-free 2030 ambition. This includes the measure we are discussing today. These amendments form a key part of the comprehensive package of messages and measures needed to drive down overall smoking rates while also tackling the disproportionately high rates of smoking among poorer and more vulnerable groups.
To their credit, Ministers in the other place expressed support for the principle behind the amendments, but said they needed more time to consider the proposals. My point to the Minister today is that it has been more than two years since the Government announced the 2030 ambition. With that in mind, when will action be under way to deliver this important commitment?
Ministers have also stated that the Health and Care Bill is not the right place for measures to tackle smoking, which will instead be announced and introduced in the forthcoming tobacco control plan. However, this plan has already been delayed twice and seems unlikely to be published this year as proposed, meaning that we might not see concrete action to deliver the smoke-free 2030 ambition until 2023. When can we expect to see the plan?
We cannot afford to wait this long. The Government have the opportunity to adopt this Bill or accept the tobacco amendments to the Health and Care Bill. We have an opportunity now to move this agenda forward and start building back the nation’s health as we emerge from the worst of the pandemic. I urge the Government not to waste this chance. The Bill would play a contributory and important role in helping us reach the smoke-free 2030 ambition. I hope the Government feel able to support it.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, I add my congratulations to my noble friend on progressing his Private Member’s Bill to this stage and on securing this important debate.
Over the past two decades the UK has introduced a range of public health interventions and a strong regulatory framework to help smokers quit, and to protect future generations from using tobacco. Thanks to these, smoking rates in England are down to a record low of 13.9%, from 19.8% in 2011. If we go back even further, we see that the smoking rate was at 45% in the 1970s. As the noble Baroness, Lady Merron, has said, these reductions have been cross-party; Governments of all colours have tried to tackle this issue.
Those reductions are something we should be very proud of but not complacent about. While we celebrate this success, we recognise that there are still 6 million smokers in England, with smoking remaining one of the biggest causes of preventable mortality and, as a number of noble Lords have acknowledged, one of the largest drivers of health disparities. One of the reasons why I am very pleased that we now have the Office for Health Improvement and Disparities is that there will be a laser-like approach in the attempt to tackle these disparities.
Smoking rates still range from 23.4% in Blackpool to 8% in Richmond upon Thames. In addition, smoking rates vary significantly among certain groups. Nearly one in 10 pregnant women still smoke, increasing the risk of health problems for their babies. The Government are determined to reduce smoking rates in groups that smoke disproportionately, as well as across the board—so, work is going on not just in respect of pregnant women but elsewhere. For example, we know that 23% of routine and manual workers smoke, while the rate among people with long-term mental health conditions is nearly 26%. That is why there is so much to do. We have to make sure that we understand those parts of communities where we can, laser-like, focus our action. That is why the Government have set the bold ambition for England to be smoke free by 2030.
The Government recognise the good intentions behind the Bill. I pay tribute to my noble friend Lord Young of Cookham not only for the Bill but for his long-standing commitment to encouraging smokers to quit. My noble friend himself has told me about his work in the 1970s but also as a Health Minister in the 1980s. Let no one be in any doubt that the Government are clear that we strongly support measures to stop people smoking but also to educate current smokers of its dangers. We have already introduced a number of measures, such as graphic health warnings on tobacco packaging and information on packs giving further advice on how to quit.
While we sympathise with the aims of the Bill, we believe that policy should be evidence-led. It is therefore vital that we conduct further research to build up a strong evidence base to support measures before bringing them forward. To date, sadly, no country has introduced such a measure so there is very little evidence so far on its impact in supporting smokers to quit, compared with other measures we are looking at. Several other measures have been tried in other countries—for example, warnings inside the pack as well as outside—and there are a number of other issues we are examining.
The Government are in the process of developing a new tobacco control plan that will include an even sharper focus on tackling health disparities and will support the Government’s levelling-up agenda. We want to explore a broad range of new regulatory measures to support our ambition to be smoke free by 2030. So, I reassure noble Lords that we will be reviewing this proposal as part of that work.
I turn to some of the specific questions that were asked. A number of noble Lords asked about the tobacco control plan. Rather than implementing blanket measures that may not always reach some of the communities that need to be reached, we want to ensure that the plan has an even sharper focus on disparities and that it supports the Government’s levelling-up agenda. We need bold but impactful proposals. With the establishment of the Office for Health Improvement and Disparities, we are going to draw on its advice on how to address the high levels of smoking among some of these groups, and harness that advice to develop robust and effective proposals that will ensure that our plan delivers the smoke-free 2030 that this country deserves.
We are developing policy for the tobacco control plan and intend to publish it next year. There is a current tobacco control plan, which runs until 2022. We hope to include a number of measures that focus on health disparities and groups where smoking rates are not falling fast enough. I have already mentioned pregnant smokers and smokers with mental health conditions, but that also includes smokers in many deprived parts of the country.
We were asked about the amendments to the Health and Care Bill. We were grateful for the suggested amendments, which show support for strong tobacco control, but once again we need to see the evidence and make sure that such measures are targeted at groups we want to encourage, as well as more generally. At this stage we do not believe we should accept the amendments but, as I have said, next year we will be publishing our new tobacco control plan, since the current one runs until 2022.
Some of these examples include stop smoking services, which we have found produce high quit rates of 59% after four weeks. Since 2000, they have helped nearly 5 million people to quit. We have also protected a public health grant over the course of the spending review to ensure that local authorities can continue to invest in stop smoking services, because they have been seen to be successful. As long as they are successful, they will continue to be part of our armoury.
The noble Lord, Lord Moylan, asked about evidence. The Office for Health Improvement and Disparities continues to monitor developments in tobacco control across the world. We share our knowledge with international partners and draw on their evidence-led experiences to make sure that we are introducing effective measures, rather than just introducing measures we feel might work without evidence.
The noble Lord, Lord Rennard, talked about youth smoking. He is absolutely right, but youth smoking rates continue to decline, and they are currently at their lowest rate on record. In 2018, 5% of 15-year olds were regular smokers, 2% of 11 to 15 year-olds were regular smokers, and 16% had never smoked. While the youth rates are declining, we should not be complacent. We know that smoking remains an addiction largely taken up in childhood, with the majority of smokers starting as teenagers and then becoming addicted. We want to build on that recent success and protect young people from harmful tobacco, and we have an area of focus targeted at that.
My noble friend Lord Naseby talked about the tobacco levy. We recognise that the tobacco industry is already required to make a contribution to the public finances through tobacco duty, VAT and corporation tax—in many ways, it pays our wages. The department will continue to work with HMT regarding tobacco taxation and revenue funding. This includes reviewing options such as the future levy, but we want to make sure that it is an effective way to raise additional funds to support stop smoking services.
The noble Baroness, Lady Uddin, was very honest in her appraisal of her ability to stop smoking in her family. But she made some interesting points, not only about having failed to prevent her family smoking but about whether young people will read the warnings on the cigarettes. I think that is a point we have to look at. Will they be dismissed, just as the effectiveness of the warnings on the outside has waned over time? Will the same thing happen here?
Lord Naseby (Con)
As I mentioned, I spent 20-odd years in advertising. The Bill says that the warning has to be in red on blank white paper—quite frankly, that will be very difficult to read. If my noble friend is serious about this, I suggest he takes advice from those who know a little more about printing.
Lord Kamall (Con)
I thank my noble friend Lord Naseby for that intervention; I will take account of his advice. In fact, I want to thank him for his advice, given the number of years he spent in the advertising industry. Something we are looking at generally in the public health approach in this country are those experts from the advertising industry who have looked at behavioural studies and behavioural economics to encourage people to buy their products or to smoke, and to attract a number of them—as poachers turned gamekeepers—to help us understand the skills they use to attract smokers and people eating high-fat food, and to turn that around to discourage people from taking up smoking and eating food that might cause obesity.
The noble Baroness, Lady Uddin, also talked about smoking in pregnancy, and we recognise this problem. It is sad that 10% of pregnant women still smoke, and they are not falling in line with other groups. Therefore, we are looking at how we address that at prenatal and neonatal clinics, but also during that whole experience. How do we reach those mothers, and would that really be effective?
One of the questions asked was about a number of different ideas that came up. Basically, we want to follow the evidence. That is really important. There is a tobacco plan already in progress, which will end in 2022. Next year, in 2022, we will publish the new tobacco plan, and we are looking at evidence from around the world and at what works. But we also want to see how we can work across government. For example, we are working closely with the Department for Education to ensure that the harms of smoking are in the curriculum, but many of us will remember being at school and receiving education on a number of different issues related to lifestyle. A number of my friends would say, “I’m never going to smoke or drink”, and two years later, I would see them at parties, smoking and drinking.
Therefore, we have to understand how effective these messages are, how long they work for, and how we can make sure that they continue to work. We understand and accept that we need to continue to take action; we must not be complacent. We want to look at the evidence: some 64,000 people still die each year from smoking; two-thirds of long-term smokers will die from it; it is one of the greatest drivers of health disparities and, as many noble Lords have said, it causes a great, heavy financial burden. In fact, each year smoking costs society £12.5 billion, with a cost to the NHS of around £2.5 billion. We believe that making smoking obsolete would free up £15 billion per year, benefiting especially the most disadvantaged families and the most deprived communities.
Given the lack of evidence and the other measures being considered, the Government do not feel that the Bill is appropriate at this point in time. However, the Bill’s requirements will be considered as part of the wider range of regulatory proposals to support our smoke-free 2030 ambition. We want to see evidence-based, targeted proposals and to make sure that they are effective.
I once again thank my noble friend Lord Young of Cookham for this important debate and encourage him to continue pressing the Government. I also thank noble Lords for their insightful contributions.
Lord Young of Cookham (Con)
My Lords, I thank everyone who has taken part in this debate, starting with the noble Lord, Lord Rennard, whose long-standing commitment to the campaign to reduce the harm done by smoking is well known; he also underlined the all-party commitment. He trailed the broader package of a suite of measures as part of the APPG manifesto published earlier this year, of which this is one component. We look forward to taking that agenda forward on the forthcoming Bill.
My noble friend Lord Naseby and I have been on opposite sides of this debate ever since we both joined the House of Commons on the same day in 1974. I was reading last night a contribution that he made in May 1980, much of which he repeated today, showing consistency. I say to my noble friend that much of his speech was not about the Bill but about raising the age limit, the licensing regime, a potential levy and a tax on profits. I understand that. He described the promoters of the Bill as misguided. I wonder whether he would like to reflect on that, given the wide range of health organisations that I mentioned—for example, the Royal College of Physicians and Cancer Research UK—and whether he also believes that they are misguided in supporting the Bill.
Lord Naseby (Con)
The misguided bit is that the promoters of the Bill have not taken any advice on communication. It is quite clear to me, as one who has been a professional in that world, that to place a communication, as my noble friend suggested, on a narrow cigarette that is burning away, in red on a white background, is not good communication.
Lord Young of Cookham (Con)
I will come to that specific point, but he described the promoters of the Bill as misguided and I was making the point that he includes among those misguided people a very wide range of serious health opinion. As I said, I will come to his point.
The noble Baroness, Lady Uddin, put the Bill in personal terms. I am grateful for her contribution. She made the point that we need to move on from the health information on packs, which is now taken for granted, to a new means. On my noble friend’s point, he raised the question of whether it would be easy to read. A cigarette is right under your nose so it is probably easier to read what is on the cigarette than what is on the pack. Also, the pack is not seen by other people, whereas, if you put a message on the cigarette, those in the company of the smokers will also see it. I see that as an added advantage of this move.
I listened with some disbelief to my noble friend Lord Moylan. He started off by saying that he was surprised that I had introduced this Bill in the middle of a pandemic, implying that I should wait until the pandemic is over before introducing what I think would be a very useful health measure. Astonishingly, he described the message that I want to put on the cigarettes—“Smoking kills”—as propaganda. Even the tobacco manufacturers now admit that smoking is bad for your health. I just wonder whether my noble friend has ever read the 1962 report of the Royal College of Physicians—the whole weight of evidence. The health warning that smoking kills, and damages your health, is not propaganda but accepted health fact. He should move on.
My noble friend then described the 2030 target for a smoke-free England as ASH’s target, but it is not; it is a government target to which the Government have committed—I look to my noble friend on the Front Bench. Finally, my noble friend Lord Moylan described what I am doing as patronising. There is the libertarian wing within my party, of which he is clearly a member. I have listened to these arguments about things being patronising for the last 30 or 40 years. When there was a proposal to introduce compulsory crash helmets for motorcyclists, that was described as patronising. Parliament legislated and I do not think there is any question of repealing that. I heard exactly the same argument about seatbelts for drivers and then passengers; people said that was patronising legislation. I heard it about banning sponsorship for sporting events and banning smoking on public transport and then in public places. I am sure I will hear it again during the passage of the Health and Care Bill, which has a provision for adding fluoride to water.
Every single one of those measures has been adopted by Parliament, and I do not think anybody would seriously suggest that any of them should be repealed. In due course, measures such as the one I am promoting today will be accepted as conventional wisdom. I hope that, in a few years’ time, my noble friend will accept that this is the direction in which public opinion is moving. As I pointed out, this is a popular measure; it is popular within my party. I am glad I have got that off my chest.
I am very grateful to the noble Baroness, Lady Merron, for her support and her predicted support for the other measures that I and other noble Lords will introduce as amendments to the Health and Care Bill, which gets its Second Reading on Tuesday. That is much appreciated, as is her own record as a Minister in the Labour Government.
Finally, I am grateful to my noble friend the Minister, whose personal commitment to reducing the damage done by smoking shone through his speech. He put the Bill in the slightly broader context of government policy and recognised the imperative to drive down smoking. He said he had strong support for measures to stop people smoking. I will pick up one or two points from his speech for which I am very grateful. He said that the tobacco control plan would be published next year. “Next year” spans several months, so I wonder whether he could at some point be a little more specific about the timing of this plan, for which we have been waiting for some time, rather than referring just to 2022. He made the point that everyone is waiting for robust evidence. If everybody waits for robust evidence, no one will provide it, so at some point a country has to go first. I was grateful that he said that while he was unable to support this measure at the moment, he would consider it as part of the suite of measures to be looked at as part of the tobacco control plan. I accept what he says. That about sums up everything.
Cigarette Stick Health Warnings Bill [HL]
Friday 18th March 2022
(2 years, 8 months ago)
Lords ChamberRead Full debate Cigarette Stick Health Warnings Bill [HL] 2021-22 Read Hansard Text Read Debate Ministerial Extracts
Lord Young of Cookham (Con)
My Lords, this Bill extends the logic of health warnings on cigarette packs to the cigarettes themselves. If implemented, it would require both cigarettes and cigarette papers to display health warnings such as “Smoking kills”. This is likely to be particularly effective for dissuading children, who tend to start smoking with individual cigarettes rather than packs.
While England is undoubtedly among the most successful nations in the world at tackling the tobacco epidemic, we have tended to follow rather than lead when it comes to the implementation of bold policies to address this deadly addiction. The Bill gives us the opportunity to be the first, helping to cement our place as a world leader in tobacco control.
We know that only one-third of the 280 children who take up smoking every day in England will successfully quit, and another third will go on to die from smoking-related diseases. These cigarette warnings were one of the recommendations by the APPG on Smoking and Health for the forthcoming tobacco plan, which we discussed at a recent meeting with Javed Khan, the chair of the Government’s independent review into smoking. We were encouraged by his interest in all our recommendations, including this one, and we look forward to seeing his report, which is due to be published on 22 April.
While we could be the first to implement cigarette warnings, this is not a novel policy. I first proposed cigarette warnings as a Health Minister in Margaret Thatcher’s Government in the late 1970s. By 2024, I will have been in Parliament for 50 years. I hope I will not have to wait that long before this policy is introduced. I beg to move.
Baroness Merron (Lab)
My Lords, I pay tribute to the noble Lord, Lord Young of Cookham, for his tireless efforts and creativity—over many decades, as we have heard—in tackling the negative effects of smoking on the health of individuals and communities. This is a considered and sensible Bill, and we are happy to support it today.
Additional health warnings at the point where people are about to smoke, on cigarettes and cigarette papers, is not a measure for its own sake; it is a further step towards helping to drive down smoking rates and indeed discourage people—especially the young, as the noble Lord referred to—from starting to smoke in the first place. By our doing this, people will have the chance to live longer and have healthier lives, and health inequalities between the richest and the poorest stand a chance of being reduced. For every smoker who dies, there are another 30 who are suffering from serious smoking-related diseases.
Just this week, on Report on the Health and Care Bill, your Lordships’ House voted in favour of a consultation to explore whether the “polluter pays” principle might be effective in the case of tobacco. This Bill seems to chime well with the mood about the direction that smoking legislation in the UK needs to go in. I wish the Bill every success and once again congratulate the noble Lord, Lord Young of Cookham.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, I congratulate my noble friend Lord Young of Cookham on progressing his Private Member’s Bill to this stage and securing this important debate. I am sure the many numbers of people who wish to quit smoking will also be grateful to my noble friend for his long-standing commitment to this cause, as my noble friend himself said, since his time as a Health Minister in the 1980s.
I thank noble Lords for their contributions today and at Second Reading, as well as during the debate on the Health and Care Bill when tobacco controls came up. Your Lordships’ continued engagement highlights how important this issue is and how it will continue to be an important issue for this House.
As I have stated before to this House, the Government are committed to reducing the harms caused by tobacco and are proud of the long-term progress that successive Governments of different parties have made in reducing smoking rates, which are currently, at 13.5%, the lowest on record. However, we cannot be complacent. With nearly 6 million smokers in England, smoking is still one of the largest drivers of health disparities and causes a disproportionate burden on our most disadvantaged families and communities.
I am grateful to noble Lords who have acknowledged that, as part of our plans to make England smoke free by 2030, we have commissioned the independent review into tobacco control, led by Javed Khan OBE. The Khan review has been asked to set up focused policy and regulatory recommendations for the Government on an evidence-led basis, including on what the most impactful interventions could be to reduce the uptake of smoking, particularly among young people, but also about how we support smokers in quitting for good. As my noble friend rightly said, we are hoping that this will be ready by the end of spring this year.
I am grateful to all noble Lords who have met Mr Khan directly, sharing their ideas and allowing him to consider them and the proposal in the Bill among other reforms to encourage smokers to quit. The independent review will both inform the health disparities White Paper and support the development of a robust tobacco control plan. I have been assured—because I know noble Lords are not always keen on the phrase “in due course”—that the White Paper and the tobacco control plan will be published later this year.
Our plans will have a sharp focus on helping to level up society and support disadvantaged groups. As I hope many noble Lords will acknowledge, this Government are committed to tackling disparities. I am sure that noble Lords will probably get tired of the number of times that I have spoken about the Office for Health Improvement and Disparities. We have to tackle those disparities. Where we know that the rates of smoking are highest, we truly want to make smoking a thing of the past. We want to have a healthier population as we build back better from the pandemic.
Once again, I thank my noble friend for this important debate. I thank all noble Lords, and I hope we can all work together to help to make England smoke free by 2030.