Smoking Cessation: Prescription of E-cigarettes

(Limited Text - Ministerial Extracts only)

Monday 1st November 2021 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement to the House on the Government’s announcement that e-cigarettes will be available on prescription.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

I am grateful to the right hon. Gentleman for his question. Covid has been a stark reminder that our underlying health and lifestyle determine how resilient we are to new risks and diseases. Covid did not strike evenly. People who smoked, were overweight, or struggled with chronic conditions fared worse. We are determined to level up health for a society that is not just healthier but fairer.

Smoking rates are down to 13.9%—the lowest on record—but tobacco continues to account for the biggest share of avoidable premature death in this country. It contributes half the difference in life expectancy between richest and poorest. Action against smoking is therefore at the heart of our mission to level up. Our goal is for England to be smoke free by 2030. To support this goal, we have an ambitious tobacco control plan, and will soon publish a new plan with an even sharper focus on tackling health disparities. Our new Office for Health Improvement and Disparities will support this vital mission nationally and locally.

Ministers from my Department have long been clear, including in this place, that we support e-cigarettes as part of a gateway process for stopping smoking. Last week, the Medicines and Healthcare Products Regulatory Agency updated its guidance on licensing as medicines e-cigarettes and other inhaled nicotine-containing products. The updated guidance sets out the steps needed to license an e-cigarette as a medicinal product, as well as quality, safety and efficacy standards.

Having e-cigarettes as a licensed product will enable them to be available on prescription, which I know will give health professionals greater confidence in their use. I am happy to update the House further when we are closer to having a licensed product. We will continue to consider e-cigarettes, and indeed any other innovative ways of improving the health of our nation, so that we can end disparities and level up to a healthier and fairer country.

[Jonathan Ashworth]

We welcome the announcement that e-cigarettes will be available on prescription. It should be a really significant step in helping 7 million smokers to quit. As the Minister says, smoking kills; it leads to 90,000 deaths and 500,000 hospital admissions every year across the UK. I think she will find broad support for what she has announced, but the House would have preferred to have heard this first, rather than via a press release issued by the Secretary of State on Thursday evening.

The Minister says that she will return to the House when she has more detail. What is the timeframe for that, and when does she expect the first prescriptions for e-cigarettes to be issued? She will know that to those who find it hardest to quit, the offer of e-cigarettes will be important, but it would be much better if it were backed up with access to specialist support services. However, smoking cessation services have been cut by over £22 million in the last five years. Indeed, areas with high levels of heart disease, cancer and stroke are among those hit hardest by the cuts. For example, Dudley has had a 17% cut. Derbyshire, which is where her constituency is, has had a 20% cut. Hartlepool and Wolverhampton have had cuts of 81% to their smoking cessation services.

To be frank, there will be no levelling up unless health inequalities are tackled, and unless we prevent cancer, heart disease, stroke, chronic obstructive pulmonary disease and diabetes where we can, but that demands fully funded local public health services, whereas in recent years, the public health grant has been cut by £1 billion in real terms, and in the Budget last week, it was just maintained at present levels. As the Association of Directors of Public Health has warned, this will mean further

“significant… reductions in public health services and capacity across the country.”

Will the Minister guarantee no further cuts to smoking cessation services? She mentioned the tobacco control plan, which is supposed to be published this year. Can she tell us at what point in the next two months that will happen?

[Maggie Throup]

I welcome the right hon. Gentleman’s support on the issue we are talking about and on our ambitions to make this country smoke free by 2030.

On the MHRA, the updated guidance provided further details on the steps required to license an e-cigarette as a medicinal product. To achieve a licence, a product would need to meet the standards of quality, safety and efficacy expected of a medicinal product. If successful, that would potentially allow safe and effective products to be made available for prescription for tobacco smokers who wish to quit. The update provides clarification and gives more guidance to potential providers on that issue.

The right hon. Gentleman asked about timescales. We anticipate that if a product was put to the MHRA today, for example, there could be an 18 to 24-month process for that product to be licensed. At this stage, we could not say anything further than that, so we are quite a long way from any e-cigarette being licensed and provided as a prescription medicine.

The public health grant increased by £135 million in 2020-21 and by £55 million in 2021-22. With regard specifically to the public health grant for smoking services, it is up to the local authority to decide how it spends its allocation of funding, but in addition, in our long-term plan, we have committed to helping to drive smoking cessation for a number of different groups. We want to provide help with cessation plans for in-patients and pregnant women, and to provide support for those with mental health and learning disabilities to tackle their smoking addictions. All in all, a lot of money is being spent both at the public health level and at the NHS level. We will continue to make sure that we do whatever we can in our power to make England smoke free by 2030.

[Mr Robert Goodwill (Scarborough and Whitby) (Con)]

Many people who wish to stop smoking are motivated by the wish to be healthier, but there is also a financial impact on the family from somebody smoking, not least because the Chancellor put 88p on the most expensive cigarettes and even the cheapest are almost a tenner now. However, many people buy cigarettes under the counter or from a mate down the pub. Will the Minister engage with her opposite number in the Home Office to ensure that combating tobacco smuggling remains a priority for Border Force?

[Maggie Throup]

My right hon. Friend makes a very good point. I promise I will engage with my opposite number in the Home Office to tackle the illicit import of cigarettes and other substances.

[Mr Toby Perkins (Chesterfield) (Lab)]

My mother smoked herself to death and died of lung cancer at the age of 62, so no one needs to tell me how important it is that we do all we can to support people to give up smoking. I also know people who have given up smoking through e-cigarettes but now find that they smoke quite a lot more than they did with traditional cigarettes. What analysis has been done of the impact on overall intake of switching from traditional tobacco cigarettes to e-cigarettes? Do the Government have longer-term concerns about moving people off e-cigarettes to not smoking altogether?

[Maggie Throup]

The hon. Gentleman is quite right that our goal is to help people to stop smoking completely. My heart goes out to him regarding the story about his mother. My father was a smoker and it damaged his health as well. We all have these personal stories. The evidence is clear that e-cigarettes are less harmful to health than smoking tobacco and are an effective way to help people to stop smoking, but, as the hon. Gentleman said, there is always more to be done.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

History has shown us that an absence of evidence of long-term harm is not the same as evidence of absence of long-term harm. Indeed, in the 1940s, conventional cigarettes were considered healthy. With that in mind, how will the Minister ensure that children are protected from breathing in the vapes of e-cigarettes, prescribed or otherwise, and that their prescription by a doctor is not seen as a green light that they are healthy, encouraging uptake among teenagers?

[Maggie Throup]

My hon. Friend is right that e-cigarettes are just a gateway to stopping smoking completely. That is the ultimate goal. We want to ensure that people go from smoking to e-cigarettes, and then to no smoking at all.

[Mary Glindon (North Tyneside) (Lab)]

COP9 is due to start next week and, as yet, the Government have not announced their delegation. Will the Minister therefore please tell us who the delegates might be and what their approach will be to COP9, given that the World Health Organisation is completely against vaping?

[Maggie Throup]

There will be officials at COP9. It is a very important meeting. The UK’s approach to e-cigarettes has been and always will be pragmatic and evidence-based. I am sure that will be the message they put forward at COP9.

[Bob Blackman (Harrow East) (Con)]

I declare an interest as chair of the all-party parliamentary group on smoking and health. Clearly the best way of ceasing smoking is to stop altogether. I welcome the fact that this proposal was originally contained in the last tobacco control plan in 2017, so I congratulate my hon. Friend on her prompt action on assuming the job. We will get an opportunity to debate the tobacco control plan on 16 November in Westminster Hall, and I trust she will reply to that debate. Will this particular proposal be targeted at the extreme smokers—the people who are hardened smokers and smoke a lot—and pregnant women to encourage them to give up?

[Maggie Throup]

I thank my hon. Friend for his question. I am looking forward to our debate in a couple of weeks’ time. As I mentioned earlier, the NHS already has measures in place through the long-term plan to help those who are pregnant to stop smoking. That is important. Should e-cigarettes be licensed as a medicinal product, it will be a gateway for those smokers to stop smoking through that method and hopefully stop smoking completely.

[Rachael Maskell (York Central) (Lab/Co-op)]

What investment will the Government put into research into the long-term use of e-cigarettes, so that we can understand the impact that will have? Will the Minister also commit to invest in health checks, so that we can screen people for public health issues, such as smoking and other forms of harm, and get the right interventions at the right time and address these issues?

[Maggie Throup]

This Government are determined to level up, and as part of that we are levelling up for health, as well as some of the issues that the hon. Lady mentioned. Our Office for Health Improvement and Disparities will play a big role in moving forward with this issue.

[Mr Richard Holden (North West Durham) (Con)]

We know that smoking is a key cause of major health inequalities across the country between different demographics and different areas. Does my hon. Friend agree that if we want to level up health outcomes in the country, we will need to target products to support people by providing effective alternatives to smoking? As a smoker who wants to quit, I have seen many of my friends using multiple different products recently, from snus to heat-not-burn. Will she consider other options, in addition to e-cigarettes, that can cause less harm and enable people like me to quit?

[Maggie Throup]

My hon. Friend tempts me to say that he is a great role model. Perhaps he should try e-cigarettes and then probably try stopping smoking completely. He can put that message out across the Chamber about why levelling up is so important.

[Matt Hancock (West Suffolk) (Con)]

I welcome not only the Minister’s emphatic support for the cessation of smoking by 2030 as a target, but the cross-party support. We have seen in this short discussion today unanimous support for the use of e-cigarettes as a route out of smoking. The UK is one of the most advanced countries in the world in the proper evidence-led approach to the use of e-cigarettes. The Medicines and Healthcare products Regulatory Agency is perfectly placed to herald that evidence and make sure the approach is evidence-based. Can she assure me that we will speed up the processes as much as possible? We must follow the evidence, but we must follow it rapidly.

[Maggie Throup]

I thank my right hon. Friend for the work he has done on this important issue. He is right that the MHRA’s expertise is recognised worldwide, so it is only right that it looks at it, and it provided clarification last week. As health disparities are so important, it is fantastic that we have cross-party support on the issue.

[Mr Speaker]

Before we come to Andrew Rosindell with the ten-minute rule Bill, may I say how wonderful it was that Vivienne, who belonged to Sir David Amess, has become Westminster dog of the year? It is a great tribute.