Westminster Hall

Thursday 29th June 2023 Westminster Hall

Thursday 29 June 2023

[Mrs Pauline Latham in the Chair]

Backbench Business

Electronic Cigarettes

Thursday 29th June 2023 Westminster Hall

13:30

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

I beg to move,

That this House has considered electronic cigarette use.

E-cigarettes were introduced as a stop-smoking device, but in my opinion they have moved from being a stop- smoking device to an alternative addiction. Indeed, they are attracting many non-smokers. In 2007, there were around 10.6 million smokers, according to official figures. The number fell to 6.6 million in 2022, so 4 million smokers had stopped. Sadly, it is estimated that around 1 million of those people died, which means that around 3 million quit smoking. That is undoubtedly a huge success, although it cannot be attributed entirely to vapes.

In the Health and Social Care Committee yesterday, we heard from the industry that it estimates that around 5 million people currently vape in the UK, which means that, even by the most generous estimates, 2 million of them were not smokers beforehand—a significant proportion of the vaping market. With the market estimated to be worth £4 billion a year, these products clearly have huge profit margins. Vapes have been available for a long time, but if they are genuinely safe, healthy devices that save lives by stopping people smoking, why does the NHS not provide any on prescription? I wonder whether it is because they are not safe and the NHS has been unable to develop the safety profile as well as it might wish.

The idea that e-cigarettes are 95% safer than smoking was quantified by Public Health England. Members will no doubt have heard the figure before, because the vaping lobby never tires of repeating it, but if we look into its origins, its veracity seems to suddenly disappear. The figure originated in a 2014 paper in a journal called European Addiction Research, but it comes with some important caveats. The study was partly funded by the Italian Anti-Smoking League, and one of its authors was a member of that organisation and served as a consultant to an e-cigarette distributor at the time. That blatant potential conflict of interest did not escape the journal’s editors, who added a warning note at the end of the paper, but it certainly escaped subsequent reporting of the figure.

The scientific journal The Lancet was even more excoriating of the original article, accusing it of having

“an almost total absence of evidence”

and of being based on

“the opinions of a small groups of individuals with no prespecified expertise in tobacco control”.

Furthermore, it is worth noting that the paper is seriously outdated. Since 2014, a plethora of evidence has emerged about the negative effects of these novel and fast-evolving devices, in studies that were never considered when the figure of 95% was reached. I am concerned that the statistic will age about as well as the claims made to past generations about the health benefits of smoking.

As we delve deeper into the topic, it becomes evident that a growing body of evidence links vaping to severe complications. Chronic bronchitis, emphysema, increased blood pressure and significantly worse physical performance are just some of the adverse effects associated with vaping that scientists have found. Furthermore, the high nicotine content, which some say is roughly equivalent to between 40 and 50 cigarettes in a disposable vape, poses a grave risk to the health and wellbeing of young people. We heard yesterday in the Health and Social Care Committee from Dr Helen Stewart of the Royal College of Paediatrics and Child Health—I should declare my interest as a member of that college and a consultant paediatrician—who told us about the difficulties that children are facing. Some of them are not going to the toilet during school time because the clouds of vapour they experience there trigger their asthma and make them unwell. We heard about children collapsing, too.

The number of children vaping is increasing. The evidence submitted to the Health and Social Care Committee by the vaping industry suggests that over 83% of children have never vaped or are unaware of vaping, but that flies in the face of the experience of most of the children, teachers and doctors I have spoken to. Indeed, a report on Blackpool published by Healthwatch in May found that a staggering 31% of children and young people claim to vape or sometimes vape. More disturbingly still, when I asked Healthwatch if it could break down its figures by age, it said that one in ten 10 and 11-year-olds vapes. These are children in year 6. That rises to nearly one in five 12 to 13-year-olds, while for 16 to 17-year-olds the figure was almost one in two. We have also noticed that the number of children vaping is rising extremely quickly.

I would like share a distressing incident from my constituency. In just one school, St George’s Academy in Sleaford, there have been eight reported cases of children collapsing after vaping. Those incidents occurred at different times with different children. I was deeply troubled to hear about this, so I went to visit them and met with one of the intelligence officers from Lincolnshire police, who had collected five vapes from another school.

In just those five vapes they found Velvana Fridex Eko, a modern non-toxic coolant intended for cooling cast iron and aluminium engines, as well as Avanti coolant antifreeze, Steol-M, which is designed for filling hydraulic devices, and Rauvolfia serpentina, or Indian snakeroot. Also found was Agip antifreeze, trichloro- ethylene, and poster and watercolour varnish—1-methoxy-2-propanol—along with diethylene glycol diacetate and 2-methoxyethyl acetate, a substance that may damage fertility and unborn children and is harmful to the skin if inhaled or swallowed. They also found aviptadil, a synthetic vasoactive intestinal peptide that is used to treat certain medical conditions.

These vapes do not contain what the children think they do, and they can be very dangerous. The police found that some children had significant health issues. The eight children who collapsed in Sleaford were taken to hospital. Thankfully, they have all recovered, but in one description given to me, a child taken to hospital in the back of a car had one side of his face drooped down as if he had had a stroke. His mother was clearly terrified by this. Another young boy said that he thought he was walking along through the marketplace in Sleaford when he realised that people were gathered around someone who had collapsed. Then he realised, as if looking from above, that that person was him. We have heard some really scary stories about what has been going on.

We hear that vaping is a good route to quitting, but we should balance the fact that it may help adults to quit with the need to keep these devices away from children. One of the things that makes vapes attractive to children is how inexpensive they are. We have seen them at £4 each, three for a tenner and those sorts of prices, which is clearly within pocket money range. When children can get disposables so cheaply, they are easy to discard. If a child finds that mum or dad is coming down the corridor or up to the bedroom, they can dispose of them quite quickly. When teachers come into the toilet, they can be disposed of, including in sanitary waste bins, which poses other hazards, too.

How much nicotine is in vapes? The average disposable contains 2 ml of e-liquid at 20 mg/ml nicotine strength, which I am told is the equivalent of 40 to 50 cigarettes. The reason for that is that people only take about 10% of the nicotine from cigarettes into their lungs—the rest of the time it just goes into the air—so vapes are stronger in many cases than cigarettes.

The other issue I want to raise with the Minister today is marketing tactics. We heard yesterday from the chief executive of Totally Wicked, who I challenged on his marketing techniques. Totally Wicked sponsors Blackburn Rovers and a rugby team as well, so the stadium is called Totally Wicked. The young men on the pitch—the heroes, as he called them, who those young men and women admire so much—are running around with T-shirts emblazoned with “Totally Wicked”. He said that the young people’s ones do not have that logo on. I checked this morning and found no evidence of them selling any junior shirts, which begs the question of what happened to them all. The suspicion might be that they have disappeared off sale—we do not know.

The Online Safety Bill offers an opportunity to ensure that vapes are not advertised on platforms such as TikTok. Vapes have bright, attractive packaging, with colours and flavours such as bubble gum. Why does an adult smoker need a unicorn milkshake-flavoured vape to quit? My 12-year-old daughter is too old for unicorns, she would tell me now, so why an adult would need a unicorn, I do not know. These vapes have become fashion accessories, and are being matched to outfits. Walk into any corner shop and we can see a whole rainbow from which to choose. There are understandable concerns that some manufacturers are deliberately doing that. They would all deny it, of course, and I hope that it is not the case, but with flavours such as unicorn milkshake, bubble gum, candy floss and green Gummy Bear, it is clear that these things are far too attractive to children. I ask the Minister to consider whether, if these are truly stop-smoking devices and not lifestyle products that are attractive to children, they really need to be coloured and flavoured. I do not think they do.

The environmental impact of disposable vapes has been highlighted by a number of my colleagues in the House on a number of occasions. Some 1.3 million disposable vapes are discarded in the UK every week. The vast majority are not recycled. Their complex construction and high nicotine concentration make proper disposal challenging. They also contain lithium batteries, a precious and vital resource in our transition away from fossil fuels that is being discarded willy-nilly, sometimes into rivers and water courses. That further exacerbates the environmental consequences.

Vapes have also been known to cause fires in bins, bin lorries and recycling centres. They pose a danger. I am also advised that the plastic, because the nicotine salts leak into it, becomes hazardous waste and is non-recyclable in any case. I urge the Government to back my ten-minute rule Bill and to ban these devices. A ban has been backed by the Royal College of Paediatrics and Child Health, and by the Royal Society for the Prevention of Cruelty to Animals. It is a widely supported measure.

As well as the issue with colours and flavours, we need tougher regulations on the advertising and marketing of vaping products. Health warnings should cover 65% of the front and back of the pack, in the same way as for tobacco. Sports club sponsorships should be banned. I cannot see why these products need to be advertised on sporting shirts; there is also the worry that that will make them more attractive to children.

When the former Government brought in bans on where people could smoke and where cigarettes could be displayed, the number of smokers dropped dramatically. I appreciate that that is a nanny state measure and, as Conservatives, we are reluctant to bring in nanny state measures. Nevertheless, it did work. If we were to ask people now whether we should reverse that measure, I do not think that many, if any, would agree. I suggest that as a sensible step forward.

At the moment, we are banning sweeties at the till because we think that will help to stop people becoming obese, but I have been into shops where those sweeties have been replaced with vapes. I am sure most people would much prefer that their child had a packet of Rolos than a vape.

My third point is about regulation. The industry is actually quite positive on this issue, and is keen for regulation—at least, that is what they say. At the moment, anyone can sell a vape. When I take my son for a haircut, we could get three lemon-flavoured vapes for £1 while we are there. He is only eight, so he will not be getting any, but we could. If we go to the sweetie shops on Oxford Street, we can buy them along with the candy.

Having the same sort of regulations as for tobacco or alcohol would mean that people would have to be licensed and would be challenged to make sure that vapes did not get into the hands of children, and there would be bigger fines. I saw an example of someone being fined £200 for selling these things to children. That is clearly no disincentive. A proper regulatory framework, where people lose their ability to sell these fairly lucrative products in the event that they break the regulations, will reduce the supply to children.

I also wanted to raise taxation. I appreciate that it is not the Minister’s responsibility, but he can raise it with the Chancellor and other colleagues. This measure was supported by Action on Smoking and Health in the Health Committee yesterday. If vapes are around £4 and a packet of cigarettes is £12, we could add considerable amounts—ASH is asking for a £5 tax on every disposable vape—as a way of taking them out of the range of children’s pocket money, while making sure that they are still cheaper than a packet of cigarettes for those adults who genuinely are smokers who wish to quit. Children are very price-sensitive and we need to deter them from this harmful habit.

My final point is about education. We heard from the headteacher of St George’s Academy yesterday in the Health Committee. Children need to know about vapes, and understand that they are not lifestyle products for them to use but aids for adults to stop smoking. The relationships, sex and health education curriculum review that is being done at the moment offers Ministers an opportunity to ensure that that happens. I am interested to hear what the Minister has to say.

13:45

[Craig Whittaker (Calder Valley) (Con)]

It is always a pleasure to speak in a debate that you chair, Mrs Latham, and today is no exception. While I do not disagree with the speech of my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), I do come at the issue from a very different angle.

Every smoker is different. The reason they smoke and the reason they struggle to quit is different, and their ultimate method of quitting is different too. In my case, after smoking for the vast majority of the last 40 years, I can honestly say that I totally enjoyed virtually every cigarette I had over those decades. Quitting was never on my agenda, despite persistent nudging from friends and family members. Imagine my horror, then, when I was presented with a device called an IQOS, just to try out. It was even presented as a bet that I would find the experience similar to smoking a cigarette, but it would be about 90% less harmful for me. Just for the record, I do not have any shares in the company, nor do I stand to make any financial gain from the device.

The IQOS uses heated tobacco. On 12 March, I smoked my last traditional cigarette, and now, after losing the bet, use heated tobacco on a daily basis. My long-standing smoker’s cough has completely disappeared, and my breathing is now far stronger—I am sure that with the loss of a few more pounds it will become even stronger still.

I support the Government in their embrace of tobacco harm reduction strategies. I urge the Minister to continue to ensure access to a full range of less harmful alternatives to smoking. As we have seen, people who want to stop smoking use a variety of methods and aids to do so, whether that is patches, pouches, hypnosis, tablets or even going cold turkey. While for me the IQOS and the heated tobacco system is perfect, many people also use vapes.

While anything is better than smoking for one’s health, there are approximately 3.3 million vapers—although I think my hon. Friend the Member for Sleaford and North Hykeham said the figure was about 5 million in the UK. The only problem with vaping—apart from all the things she brought up—is that, according to Action on Smoking and Health, 35% of vapers also smoke cigarettes. The vape is dual use: people use it in places where they cannot smoke, and they smoke in places where they can. I strongly believe from my own experience that this is because vapes do not mimic the feeling of a cigarette as heated tobacco does.

On electronic cigarettes especially, I share my hon. Friend’s concerns about youth accessing vaping products. I am pleased that there are studies that have shown that heated tobacco products are less attractive than vapes to younger people who have never smoked. Additionally, the same research into heated tobacco products shows that they pose significantly less risk to users than traditional cigarettes. By heating tobacco rather than burning it, those products produce substantially less harmful and potentially harmful chemicals than cigarettes. That makes them less harmful for users—and, of course, they have stopped my long-standing cough.

We see the impact of reduced-risk tobacco products evidenced in some of the most progressive countries in the world. For example, in Japan, the first country to launch heated tobacco products, the sale of cigarettes has fallen by an average of 9.5% annually, compared with 1.8% before the introduction of heated tobacco. As a result, the burden on its healthcare system has also eased considerably, with a statistically significant reduction in rates of chronic obstructive pulmonary disease and ischemic heart disease.

Another reduced-risk tobacco product is Snus, which is not available in the UK, but is largely responsible for Sweden’s national smoking rate of 6%. That figure puts Sweden in place to be the first country in the world to reach smoke-free status. That is a target that the UK is due to miss by 2030—although I hope the Minster will tell me different. As we work to reduce the NHS backlog, it is essential that we take a pragmatic and evidence-led approach, and note research in countries such as Japan and Sweden where harm reduction policies are having a significant impact on reducing smoking rates and, as such, there is reduced demand on their health services.

While there are further lessons we can learn from other nations, we in the UK should be proud of our role as a world leader in harm reduction. For example, the Government’s “swap to stop” scheme is the first of its kind in the world. It is essential that the UK stands up for its positive harm reduction polices at international forums, such as at the upcoming COP10 to the World Health Organisation framework convention on tobacco control in Panama in November. Now the UK has left the EU, we have the freedom to speak up and ensure that our sovereignty and our health and taxation policy formation are protected. If we do not use that opportunity in November, the WHO may seek to impede our taxation sovereignty in this area. Indeed, more widely, it threatens to stop access to heated tobacco products—that is where the self-interest comes in, of course—as it looks to get signatories to apply the same rules to heated tobacco products and other nicotine products, such as vapes, as we currently do to cigarettes, despite their less harmful nature. As such, I would be grateful if the Minister outlined what plans he has to stand up for vaping and heated tobacco at COP10 in November, and committed to opposing any recommendations that are counter to our own sovereign-established position here in the UK.

As I have said, I am grateful for the opportunity to raise my personal experience of quitting smoking through the use of reduced-risk products, and we have a positive story to tell here in the UK about our approach to harm reduction. I look forward to hearing from the Minister about his plans to protect health in the UK. It has made a huge impact on my life, even after just four short months.

13:52

[Gavin Newlands (Paisley and Renfrewshire North) (SNP)]

It is a pleasure to see the MP for the second-best Rolls-Royce site in the UK in the Chair, Mrs Latham. I congratulate the hon. Member for Sleaford and North Hykeham (Dr Johnson)—if I can read my own writing, which is a first—on securing the debate. She set out the issues rather well and debunked many of the various questions—sorry, various assertions; I said I could not read my own writing—that the vaping industry likes to promulgate in the media.

The hon. Member spoke about the incidents at St George’s Academy, with eight reported cases of children collapsing after vaping. I will not try to repeat the rather horrific menu of ingredients that our children are being exposed to, but that was clearly deeply concerning. The hon. Member cited, among other things, marketing techniques. I could not agree with her more, and I will elaborate on that later. She said her 12-year-old would probably say she is too old for unicorns, but I would say you are never too old for Scotland’s national animal.

The right hon. Member for Calder Valley (Craig Whittaker) took a different tack, and I am genuinely pleased for him about his tobacco harm reduction journey. As somebody who grew up with a parent who smoked—I will not say, “in a smoke-filled house”; that would be doing my mother a disservice—I have always hated tobacco, to be perfectly honest, and the thought of heated tobacco is not something that sounds particularly nice. While largely based on the right hon. Member’s experience, his speech was a bit of an advert for heated tobacco. It may well have a place in reducing tobacco harm, but I am not sure whether it reduces the harm enough. I also disagree with his final point about the World Health Organisation recommendations to make vapes and other tobacco products as difficult to acquire as cigarettes, but I am more than happy to learn more about that.

As the hon. Member for Sleaford and North Hykeham said, the number of people using e-cigarettes in the UK has risen astronomically. It has now reached around 5 million people, which is over 8% of the population. That unprecedented increase in such a short time raises serious questions about the safety of e-cigarettes from both a public health and environmental point of view. Current evidence shows that the use of e-cigarettes is less harmful and risky than smoking tobacco, but that does not mean that e-cigarettes are not harmful; they are only the lesser of two evils.

According to a 2022 YouGov survey, the occasional and regular use of e-cigarettes among 11 to 17-year-olds has doubled since the previous year. As a father of a 13-year-old and a 16-year-old, I find that deeply concerning. The adolescent brain is particularly vulnerable to the effects of nicotine. Vaping can impact young people’s brain development, impacting their cognitive functions such as attention, memory and learning.

The same study found that 40% of those using e-cigarettes have never smoked tobacco. The WHO has also stated there is evidence to suggest that “never-smoker”—a new phrase to me—minors who use e-cigarettes are twice as likely to take up smoking later in life. That raises serious concerns, as the consumption of nicotine in children and adolescents can lead to long-term developmental consequences and potential learning and anxiety disorders.

We have said many times in this place that the scale of mental health problems, particularly among young people, was increasing significantly before the pandemic, but that increase became exponential during it. Frontline staff working with children and young people at Catch22 are concerned that vaping is a habit used to cope with those negative feelings. Running away from negative feelings and problems by using substances is a dangerous path which has led many adults to addiction and mental issues later in life. In short, vaping is a gateway to risker behaviour, problematic or dependent substance use, and mental health issues.

As we have touched on already, serious concerns have rightly been raised about the marketing of e-cigarettes. Specifically, the colourful branding and variety of flavours has been likened to that of sweets and other confectionary. Combined with content that glamorises e-cigarettes on popular social media platforms such as TikTok, those tactics can lead to misinformation about the dangers of vaping among the younger generations.

In July, an investigation by The Observer found that ElfBar, a company with no moral or social compass, was flouting rules to promote its products to young people in Britain. Items were advertised in TikTok videos by influencers, who in some cases claimed to be paid for the promotions and to benefit from free products. The videos, many of which showed influencers vaping on camera, were not age-restricted and were not always clearly marked as ads. Some attracted hundreds of thousands of views on TikTok, which is used by half of eight to 11-year-olds and three quarters of 16 to 17-year-olds. ElfBar is no longer able to sell its products domestically, with China having banned them, but it is free to export them to our young people.

E-cigarette emissions contain nicotine and other toxic substances that are harmful to users and to non-users, who are exposed to aerosols at second hand. Some products claiming to be nicotine-free have been found to contain nicotine. In addition, while cigarette smokers tend to be more discreet about blowing their smoke away from other people, in my experience many vapers have no qualms about blowing large plumes of emissions, which at times resemble small clouds, anywhere and everywhere. The result is that many of us cannot avoid walking through or breathing in their vapours.

Cheap and easy-to-use disposable vapes are booming in popularity, creating a mass waste issue. Shockingly, an estimated 13.5 million disposable vapes are bought in Scotland annually—two and a half disposable vapes per man, woman and child. Discarded vapes result in 10 tonnes of lithium being sent to landfill each year, which is equivalent to the lithium content of 1,200 electric vehicle batteries. The Scottish Environment Protection Agency has stated that when single-use batteries are disposed of incorrectly, which in most cases they are, heavy metals may leak into the ground when the battery casing corrodes. That can cause soil and water pollution, and endanger wildlife and human health. Scotland is trying to move towards a circular economy and a waste-free society, and working to support the recycling of electronic cigarettes, but any regulation to ban them must come from Westminster.

Of course the waste is a huge factor, but it pales into insignificance compared with the risk to our children and young adults that vaping poses. Despite what anyone from the industry says, the flavours, styling and advertising are quite clearly aimed at the young. My view is not only that advertising should be banned, but that disposable vapes should be banned as soon as possible. What are the Government doing to address the wide availability of disposable vapes to young people—vapes that, as we have heard, are often illegal and substantially more dangerous? More widely, what are the Government doing to tackle vaping among young people and children?

Although e-cigarettes are intended to be a healthier alternative to tobacco, recent research shows a completely different and, to be frank, fairly frightening picture. Too little is known about the long-term impact of e-cigs, and the demographic using vapes is far from what I am sure many envisaged. With statistics showing the escalation in younger generations using e-cigarettes, it is crystal clear that, beyond the point I just made about banning disposables, stricter regulations on marketing and sales are essential if we are to protect future generations. A study by Action on Smoking and Health found that corner shops were the “main source of purchase” for children and young people, so we must do more to crack down on shopkeepers who sell disposable vapes to those who are under-age.

Finally, it is critical that more research is carried out to ensure that we understand the long-term impact that vaping and exposure to high levels of nicotine has on health. We must never forget that nicotine is a highly addictive drug and can have a catastrophic impact on people’s health.

14:02

[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Latham, and to respond to the points made in the course of this afternoon’s debate on behalf of the official Opposition. I thank the hon. Member for Sleaford and North Hykeham (Dr Johnson) not just for securing the debate, but for the enormous amount of campaigning work that she is doing on this issue and for the wide-ranging and detailed scene-setting speech she gave at the beginning, which highlighted the extent of the challenge and the severity of the risk to children’s health.

Sadly, I think the hon. Lady has more work to do on her colleagues in the Government when it comes to her proposal to ban disposable vapes. The Secretary of State for Health and Social Care gave a speech this week on

“recasting prevention from a Conservative perspective”—

whatever that means—in which he argued that bans are left wing and an affront to personal freedom. I look forward to finding out what that means for the Government’s drugs policy, but let me be the first to welcome the hon. Lady—our new comrade—to the left. The lyrics to “The Red Flag” are in the post.

I will address the point raised by the right hon. Member for Calder Valley (Craig Whittaker). The central argument put forward by the vaping industry is that, at their most effective, e-cigarettes are a useful tool for driving down smoking rates. As Dr Javed Khan highlighted in his 2030 smokefree review, if we want to create a smokefree Britain, using vapes and other smoking cessation aids will be essential in reaching that ambition, but we should be under no illusion: although vapes are unquestionably less harmful than cigarettes, they are none the less harmful products.

I share the deep concerns that Members have expressed about the impact that the vaping industry is having on children, because it is not targeting children to get them off cigarettes, but to get them on nicotine. I do not care what the industry leaders told the Health and Social Care Committee yesterday; frankly, they are insulting the public’s intelligence. If someone walks down pretty much any high street in our country today, they will be able to buy brightly coloured vapes and e-liquids with names such as Vimto Breeze, Mango Ice, or indeed Unicorns. There is no doubt that these products are being designed, packaged, marketed and sold deliberately to children.

It is no wonder that there has been an explosion of under-age vaping in recent years. Action on Smoking and Health estimates that in just the last three years, under-age vaping has increased by 50%, which shows that the vast majority of kids are being exposed to e-cigarette promotions. In this debate today, we have heard about the impact of illicit goods and the harmful substances that many of these products, which are often sold to children, contain. I personally have heard horrifying stories about the extent of their promotion on popular social media platforms, where children are able to buy them with ease, although, frankly, they can also chance their arm quite successfully on our high streets.

The effects of these products should seriously trouble us all. Teachers have to monitor toilets in schools where children congregate to vape; children make up excuses to leave their classroom in order to satisfy their nicotine cravings; and children in primary school, aged nine or younger, end up in hospital because of the impact of vaping. Paediatric chest physicians report that children are being put in intensive care units for conditions such as lung bleeding, lung collapse and lungs filling up with fat. One girl who started vaping while she was at school told the BBC last week that she has:

“no control over it. I start to get shaky and it’s almost all I can think of.”

I have seen some people warning of a “moral panic” about under-age vaping, but children who are addicted to a drug are unable to focus in the classroom, and it affects their behaviour in other ways, too. We cannot sit back and allow a new generation of kids to get hooked on nicotine.

I recognise that this concern is shared by Members across the House, but I have to say that it is hard to swallow the comments of Ministers, including the Prime Minister, who try to grab headlines today by promising a crackdown on under-age vaping at some time in the future, because they had a chance to vote for such a crackdown two years ago. Labour tabled an amendment to the Health and Care Act 2022 to ban the marketing of vapes to under-18s, and it was Conservative Members who voted it down. I hope that Ministers have had a genuine change of heart, but either way there will be action on this issue after the general election. The next Labour Government will come down like a ton of bricks on companies pushing nicotine to children and we will ban the branding and advertising of vapes to children.

I want to press the Minister on the Government’s progress towards their Smokefree 2030 target, which Cancer Research UK estimates they are set to miss by nine years. That will result in thousands of additional deaths due to the health impacts of tobacco and pile more and more pressure on an already overburdened national health service. Cancer Research UK also estimates that, on current trends, smoking will cause one million cancer cases by 2040. What are the Government planning to do to get us back on track?

What has happened to the Government’s tobacco control plan, which was promised in December 2021? Prevention is better than cure, so the next Labour Government will shift the NHS from being a service focused only on treating sickness to one that prevents ill health in the first place, because that approach is better for patients and less expensive for the taxpayer. We would make all hospital trusts integrate smoking cessation interventions into routine care and we would expect every trust to have a named lead on smoking cessation. This would come alongside work with councils to improve access to e-cigarettes as a stop-smoking aid, and a clamp- down on the pervasive myths peddled by the tobacco industry that smoking reduces stress and anxiety.

That is Labour’s plan to build a healthier society; that is Labour putting the vaping industry on notice that we will not sit idly by and allow a generation of young people to become addicted to nicotine. Where is the Government’s plan?

14:08

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

It is a pleasure to serve under your chairmanship, Mrs Latham.

I start by thanking my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who is a former colleague in the Department for Health and Social Care. I thank her not only for this debate and her brilliant speech, which was full of interesting observations and ideas, striking and concerning anecdotes, and great wit, but for her work in really driving the debate on vaping in recent months and years. She has been a leading voice in this area. Likewise, I thank my right hon. Friend the Member for Calder Valley (Craig Whittaker) for his interesting insights.

Before I get into the main body of my speech, I will address some of the specific issues raised. My hon. Friend the Member for Sleaford and North Hykeham asked about the availability of prescription products. The reason they are not available is that the producers have not come forward with them at this stage. We remain hopeful that that will happen, but we are reliant on commercial companies wanting to do it. That is not about concerns that it is less safe than smoking; it is just about commercial partners bringing that forward for approval.

The SNP spokesperson, the hon. Member for Paisley and Renfrewshire North (Gavin Newlands), pointed out that, interestingly, vaping products are not available in China, even though it exports them to the rest of the world. I do not think that that has as much to do with the Chinese Communist party’s position on public health as it does with the fact that it gets huge revenues from its ownership of the tobacco industry, which is still extremely big in China. I think it has more to do with that than with an enlightened view on the relative safety of vaping and smoking.

The Opposition spokesman, the hon. Member for Ilford North (Wes Streeting), asked specifically what we are doing on smoking. Smoking rates came down from some 40% in the 1970s to 21% in 2010, and they are now at a record low of 13%. That is partly because we have doubled excise duties and brought in a minimum excise tax on the cheapest cigarettes, but it is also because we continue to take further measures, including the measures I announced recently, such as the help for a million smokers to “swap to stop”, which is an innovative, world-first policy, and our provision of health incentives to help those smoking during pregnancy to stop. We know from partners in local areas that evidence-based policy works. Much has been done and there is yet more to do in the future.

I absolutely understand the concerns, and I am just as motivated as my hon. Friend the Member for Sleaford and North Hykeham by the challenge of youth vaping. Until recently, our regulations, such as the minimum age of sale, advertising restrictions and the cap on nicotine levels, had been holding down vaping rates. However, over the last two years we have started to see a surge in the use and promotion of cheap, colourful products that do not always comply with our regulations. As hon. Members have mentioned, there has been a sharp increase in children vaping and the awareness of vaping. That is of great concern to me, for exactly the same reason that it concerns my hon. Friend.

Despite its high effectiveness as a tool to help adults quit smoking, we are absolutely aware of the risks that vapes pose to children. Vapes are not risk-free. Nicotine is highly addictive, it can be harmful and there are unanswered questions on long-term use, as raised by my hon. Friend. As Professor Chris Whitty, the chief medical officer, said:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape”.

Last month, the Prime Minister announced several new measures to tackle youth vaping, including taking steps to close the loophole in our laws that allows the vaping industry to give out free samples of vapes to under-18s. Recent data suggests that 2% of 11 to 15-year-old ever vapers—approximately 20,000 of them—said that they were given it by a vape company, so we will stop that.

Secondly, the Prime Minister announced that we will update the health education curriculum to teach kids about the risks of vaping, as called for by my hon. Friend, just as schools do for the risks of smoking and excessive drinking. To support that, the Office for Health Improvement and Disparities is producing a new resource pack for schools on vaping for the start of the new academic year. The resources have been informed by research with teachers and young people. The activities will feature films made with young people in which they will talk in their own words about the issues around vaping, as well as a clear presentation of the latest evidence. Those resources build on other content we have already produced for young people, including on the Frank and Better Health websites, and input into educational resources produced by partners including the Personal, Social, Health and Economic Education Association.

The Prime Minister also announced that we will review the rules on selling nicotine-free vapes to under-18s, to ensure that our rules keep pace with what is happening in the industry, and review the rules on issuing fines to shops selling vapes to under-18s, to allow local trading standards to issue on-the-spot fines and fixed penalty notices more easily. That will complement existing fine and penalty procedures and cover both illegal and underage sales for vapes and tobacco. Those steps build on measures we are already undertaking.

Earlier this year, in April, I announced new measures to step up our efforts to stop kids getting hooked on vaping. First, we launched a call for evidence on youth vaping to identify opportunities to reduce the number of children accessing and using vape products, and to explore where Government can go further. That explored a range of issues, several of which were touched on by my hon. Friend, including the appearance and characteristics of vapes, the marketing and promotion of vapes, and the role of social media, as touched on by the hon. Member for Paisley and Renfrewshire North. It sought to better understand the vape market, looking at issues such as the price of low-cost products, mentioned by my hon. Friend, and the environmental impact of vapes. The call for evidence closed on 6 June, and Department of Health and Social Care officials have begun to carefully examine the responses. We will be publishing our response in early autumn, identifying and outlining areas where we can go further.

I also announced in April that we are going further to enforce the existing rules on vaping. I announced a specialised illicit vaping enforcement squad, which is a dedicated team to tackle underage vape sales and the illicit products that young people have access to. That will hold companies to account and enforce our current rules. We are providing an extra £3 million to trading standards, which will help share knowledge and intelligence across the country. It will undertake test purchasing, disrupt illicit supply, including from organised crime gangs, and remove illegal products from shelves at our borders, which will tackle the horrifying issue raised by my hon. Friend about the content of some illicit vapes. There will be more testing to ensure compliance with our rules, and we will be bolstering the training capacity of trading standards too.

Companies failing to comply with the law will absolutely be held to account. In some cases, we have already got companies to withdraw products from their shelves if they have not met our rules. I am pleased to announce that National Trading Standards has begun setting up the operation, gathering intelligence, training staff and bolstering capacity to begin field work later this summer.

I absolutely appreciate the calls for single-use vapes to be banned due to their environmental impact, and also because of their appeal to young people. In 2022, about 52% of young people who vaped used disposable products, compared with just 8% in 2021. We are concerned by the increasing use of these products and their improper disposal, for the reasons my hon. Friend mentioned. We are exploring a whole range of options to address this through the youth vaping call for evidence.

This is absolutely not a reason for not doing anything, but one of the issues we will have to deal with is the nature of the industry, which is based in Shenzhen, is highly nimble and manufactures lots of different things. It will be a challenge to address issues specific to disposable vapes, because the industry will try to get around them by saying, “This is potentially refillable.” In theory, my biro is refillable, but in practice, and if it was cheap, it can simply be thrown away. Careful consideration needs to be given to the question of what is and is not disposable, if we are going to put some weight on it. I am not in any way arguing that nothing can be done, but extremely careful thought is required to ensure that the actions we take are highly effective.

All vapes, including single-use vapes, fall within the scope of the UK’s Waste Electrical and Electronic Equipment Regulations 2013, which require importers and manufacturers of vapes to finance the cost of collection and proper treatment of all equipment that is disposed of via local authority household waste sites and returned to retailers and internet sellers. From an environmental perspective, the starting point must be to assist businesses to understand their obligations and bring them into compliance. If we can achieve that, the environmental impacts can be reduced. The Department for Environment, Food and Rural Affairs will shortly be consulting on reforming the WEEE Regulations to ensure that more of this material is properly recycled.

We are committed to doing all we can to prevent children from starting vaping, and we are already taking robust action in a range of areas. We are also looking closely at how we can go further. As I mentioned, early this autumn we will publish the response to the youth vaping call for evidence and outline our next steps, and we want to move fast.

[Craig Whittaker]

Before the Minister concludes, does he have any thoughts on the World Health Organisation forum in Panama this November and whether the UK will be subscribing to the WHO requests or pursuing our own policies as a sovereign nation?

[Neil O’Brien]

My right hon. Friend asks an important question. We will set out our position for that conference of the parties in due course. On the question of heat-not-vape products, they are, as far as one can see from the evidence, more dangerous and contain more toxic chemicals than vapes, so there is a concern about the use of those products. When I was on the Science and Technology Committee, I remember looking at all these different products and the new things on the market. There is a substantial gap in terms of safety. It may be that they are safer than smoking, but there are serious concerns about the health effects of heat-not-burn products—even more significant than those about vapes, which have been raised in this debate.

I end as I began by paying tribute to my hon. Friend the Member for Sleaford and North Hykeham for all the work she has done to drive this important debate. As constituency MPs, we all see this important and growing issue in our schools and through talking to young people. We are moving at pace and will continue to do so to address these challenges. It is important that we calibrate our approach correctly so that it is effective. We have already done a number of things, and we stand ready to do more to tackle this extremely important issue.

13:46

[Dr Caroline Johnson]

I thank everyone who has contributed to this debate. It was interesting to hear that my right hon. Friend the Member for Calder Valley (Craig Whittaker) has given up smoking, on which I congratulate him. I hope he will soon be able to give up heated tobacco as well; I am sure his health will benefit.

I also thank the SNP spokesperson, the hon. Member for Paisley and Renfrewshire North (Gavin Newlands), and the Opposition spokesperson, the hon. Member for Ilford North (Wes Streeting), for their support. I think I am correct in saying that there was support from all corners of the House for doing everything possible to ensure that children cannot get their hands on vapes.

I welcome the measures in the Minister’s speech, particularly those on education, preventing the distribution of free vapes, the introduction of the enforcement team and nicotine-free vapes. I also welcome the consultation, but we need to be quick about this because more children are vaping every day. That means that every day more children are becoming addicted and developing a nicotine habit that they will find difficult to break.

One of the challenges of quitting smoking is giving up nicotine, and giving up the nicotine in vapes is no different; in fact, it may be more difficult. I urge the Minister to look very closely at banning disposables and at marketing. He did not mention this in his speech, but I do not think that vapes should be advertised on the kits of any sports team. In shops, vapes are often positioned in the front of display cabinets where children can see them. I have seen advertisements for vapes on taxis and things like that—they should not be there.

The Minister’s review should look closely at flavours and colours, because I do not think they are necessary for stop-smoking devices. He should regulate where they can be sold and increase the penalties for those that break the rules. The Minister did not mention tax. I appreciate that that is a matter for the Treasury, but vaping companies should be taxed heavily to lift their pocket money. That is the right way to go.

As well as education, children need support. A huge number of children are already addicted to vaping products, and they need support. When they realise and are educated about the harms and wish to quit, they will need support and help to do so.

Perhaps my most important ask of the Minister is for him to look at the latest evidence. The 95% safer approach was predicated on evidence that is not terribly robust and on a study that is nearly 10 years old. It was based on an apparent absence of evidence of harm, but we are now seeing evidence of harm. I urge him to review the evidence. We are in a situation in which our headteachers are telling us that children must be able to vape so that they can discuss the flavours to fit in with their peer group, and we must get away from that. This issue is urgent and I urge the Minister to act quickly.

Question put and agreed to.

Resolved,

That this House has considered electronic cigarette use.

14:23

Sitting suspended.

Bladder and Bowel Continence Care

Thursday 29th June 2023 Westminster Hall

[Sir Graham Brady in the Chair]

15:00

[Andrew Selous (South West Bedfordshire) (Con)]

I beg to move,

That this House has considered bladder and bowel continence care.

It is a pleasure to serve under your chairmanship, Sir Graham. This week is World Continence Week, so I am grateful to the Backbench Business Committee for allocating this debate on what is often a taboo subject, and therefore something of a neglected area of healthcare. Continence issues affect millions of people in England and across our whole country.

In 2018, the NHS England “Excellence in Continence Care” guidance was published. It estimated that there are 14 million people of all ages in England with bladder problems, and a further 6.5 million—again, of all ages—with bowel problems. Those are huge numbers, which is why this debate matters. Continence problems can take away people’s freedom and mobility, in some cases leading to people becoming housebound. Those problems can also lead to depression and wellbeing issues.

The Paediatric Continence Forum has informed me that continence difficulties, including bedwetting, daytime wetting, constipation, soiling and difficulties with toilet training are predicted to affect approximately one in 10 children. Unless treated, those problems can perpetuate into adolescence and adulthood. They have significant cost implications for the NHS in unplanned admissions, A&E attendance, costly consultant appointments and so on. Children need a community-based and nurse-led service.

I was honoured to take over as the chair of the all-party parliamentary group for bladder and bowel continence care, following the excellent work of my predecessors, the late Baroness Greengross and Rosie Cooper. It was the APPG that lobbied NHS England to produce the guidance that I have spoken about. I am also grateful for the many clinicians, royal colleges, charities, patient advocates and patients themselves who have given freely of their time and expertise to assist the APPG in bringing forward the debate today.

I am concerned that there has been little monitoring or review of the implementation of the “Excellence in Continence Care” guidance produced by NHS England. I hope the Minister will tell us what he is doing to address that. The last full published audit of continence care was carried out by the Royal College of Physicians in 2010. Dr Adrian Wagg, then the clinical director of the national audit of continence care, painted a stark picture when he said:

“Bladder and bowel incontinence affects 1 in 5 people causing ill health, depression, social isolation, and costing the NHS millions of pounds. Although these are treatable conditions, people of all ages, and vulnerable groups in particular (frail older people and younger people with learning disability) continue to suffer unnecessarily and often in silence, with a ‘life sentence’ of bladder and/or bowel incontinence”.

An up-to-date audit would provide a complete list of services and show regional gaps in provision. It could benchmark improvements. We could look at the number of services and specialists, identify areas for training programmes, recruitment and commissioning, as well as identifying the causes of incontinence and looking at the impact on the quality of life and comorbidities. Such an audit would also need to look at the costs involved and where savings might be made. I hope the Minister will commit to an updated audit.

Many people are too embarrassed even to talk to their GP about these issues. People suffer in silence and can become depressed and isolated, before eventually seeking help. That can affect employment, education and socialising. There is some evidence that half of people with those conditions will wait five years or more before seeking medical advice. The lack of awareness and promotion of pelvic floor health leads to acceptance of bladder weakness, particularly as part of ageing or as a result of childbirth; by the way, pelvic health is every bit as important for men as for women.

I note that NHS England’s maternity and women’s health team has an excellent initiative on perinatal pelvic health, which is very encouraging to see. I also commend NHS England for launching a programme in 2021 for pregnant women and new mothers to prevent and treat incontinence and other pelvic floor issues. It has 14 pilot sites around the country, and I would like to know what learning has come from these and what the next steps for the NHS are.

One of the most important things I can do in this debate is to promote the bladder and bowel CONfidence app, which is packed with helpful pelvic floor health advice. It was commissioned by the Florence Nightingale Foundation to celebrate the year of the nurse and midwife in 2020. The project was led by Dr Nikki Cotterill, professor in continence care at the University of the West of England. The app aims to provide quality-assured health and wellbeing information, promote safe self-care and aims to reduce avoidable demand on services. It signposts services and other sources of support and makes it easier for people to get help. I would like to know from the Minister what the NHS can do to promote the app and ensure that the information on it is widely known.

I understand that the NHS workforce plan is imminent. I very much hope that there is a plan to increase the number of specialist continence nurses, as many of them are retiring. I ask the Minister if NHS England is working with the General Medical Council to mandate that the medical, nursing and physiotherapy curriculums include bladder and bowel continence training more extensively in their syllabuses in all these areas. I would also like to know if Health Education England will be providing more specialist education courses for both stoma and urology continence nurses to enter the profession.

The APPG has worked with the Nursing and Midwifery Council to get basic training for bladder and bowel continence in their standards for nurses and midwives. We would like to see this mandated in their curriculum and be applied to general practitioner education standards as well. I would also like to know if the Minister has had any conversations with the Royal College of General Practitioners and the Royal College of Nursing about continuing professional development, including one-day training courses on continence care. This has huge potential to upskill the existing workforce to deal with this problem.

For many people, incontinence should not be accepted as a normal part of life. A high proportion of cases are curable, particularly bladder weakness. Consulting a medical professional may flag indications of underlying causes such as bladder, bowel or prostate cancer, which is why the five-year waits for a first consultation are so concerning. There is variability of access to specialist support across the country.

One of the clinicians who advises the APPG, Professor Charles Knowles, wrote the excellent report on pelvic floor services in 2021. I hope the Government took careful note of it, because it was a combination of work by 30 experts and made recommendations in six areas: awareness and education, technology-enabled care, integration of expertise, surgery procedures and premises, utilising human resources and novel approaches to freeing up resources.

As parliamentary co-conspirator with my friend and constituent Tim Briggs CBE, the originator of the Getting It Right First Time programme, I would like to know whether there is a GIRFT programme for continence care. If there is not, there certainly should be, because it has had amazing results in all the other specialisms. Are the royal colleges and the Department of Health and Social Care able to give greater direction on the need for so-called benign surgery for bladder and bowel conditions, which people are currently waiting longer for and can badly affect quality of life and wellbeing? I understand that clinicians who work with the APPG have highlighted that they believe there is racial inequality in the provision of continence care. Can we start investigating this by publishing ethnicity data on NHS treatment rates in continence care?

The APPG has led the Boys Need Bins campaign, given that men’s toilets very rarely have sanitary disposal provision. Around 11% of men in the 60-to-64 age group have urinary incontinence—that would include quite a few Members of the House—and the percentage rises with age. That figure does not include other continence issues, such as the need to use stoma bags. Men who need to use pads, catheters, stoma bags and other related items need to be able to dispose of their used products hygienically, discreetly and correctly.

One in eight men diagnosed with prostate cancer is likely to experience some degree of incontinence as a side effect, and men often say that this poses a greater problem to them than the cancer diagnosis itself. Prostate Cancer UK alerted me to the following comment in its survey regarding men having to use disabled toilets:

“Consequently, men are often forced to use disabled toilets in order to dispose of their pad or associated stoma bag products in the provided sanitary bin. It is important to note that nearly 1 in 4 men stated that they are not disabled so find it ‘embarrassing’ to use this toilet to access a sanitary bin whilst 42% stated feeling embarrassed, stressed, and anxious about using a disabled toilet, as they had experienced or felt that people will judge them. Indeed, one man told us that: ‘Whilst at a football ground, I had to ask a (male) steward if I could have access to an accessible toilet…(and) he commented, “You don’t look very disabled”’. This experience…felt inappropriate, degrading, humiliating and embarrassing.”

What do the Government expect these men to do when there is no disposal provision where they work or are being educated?

In June 2022, the BBC Radio 4 “PM” programme had a discussion about this issue that led Prostate Cancer UK and a number of other organisations to support the Boys Need Bins campaign. The campaign targets employers, hospitality venues, sports venues, retail outlets and local authorities—Winchester Council, for example, has successfully implemented such as scheme.

We have had reports of a postcode lottery in the supply of products needed. Getting the right products could lead to a reduction in urinary tract infection and skin problems such as dermatitis and pressure ulcers, and reduce costly hospital admissions. I would like reassurance that the NHS will look at the total costs in the patient pathway and not just at the unit cost per product, which could be a false economy, leading to higher costs for the taxpayer and less good outcomes for patients.

One of the most upsetting facts I discovered while preparing for the debate is that of hospital-acquired incontinence. A National Institute for Health and Care Research-funded study was published in June 2022 by the Geller Institute of Ageing and Memory, which is based at the University of West London. The research revealed that among patients with dementia admitted to hospital, over a third developed hospital-acquired incontinence, having previously been continent. There were some very upsetting accounts of patients who were not allowed to leave their bedside to reach the toilet, and even patients who were able to get to the toilet unaided were required to ask permission. Should there not be a right to self-toilet if someone can get to the loo on their own? The Spinal Injuries Association has contacted me to say that some of its members’ carers were not allowed to accompany them to hospital, leading to deep distress when people were not able to get to a toilet.

This is a very sensitive and delicate issue that does not get enough attention, and let me say straight away that I have all the sympathy in the world for nurses and healthcare assistants, who are rushed off their feet. We will not find the right way forward in this debate, but I implore the Minister to take this issue back to the Department so that we can preserve the continence, and therefore the dignity, of as many hospital patients as possible. If we get these issues right, we can save the NHS money that is currently spent on pads and appliances, reduce comorbidities and hospital admissions, and improve the lives and wellbeing of so many people.

A large number of people are admitted to hospital with urinary tract infections caused by catheter-associated urinary tract infection, and that greatly increases A&E attendance and unplanned admissions. Clinicians who advise the all-party group say that improving catheter care in the community would significantly reduce A&E attendance and hospital admissions.

I draw Members’ attention to a new service in Cornwall that has been piloting a continence car service run by NHS Cornwall 111. The cars are staffed by specialist paramedics who have additional skills, including catheter/continence management. The service reports that this has meant fewer patients being transferred to hospital and has taken the pressure off the local ambulance service. That seems to be yet another shining example of best practice in the NHS, so my question to the Minister is: what is NHS England doing to urgently evaluate it? If it is as good as it appears to be, we should mainstream it across all integrated care boards.

I want to give the last word to a young person in their 20s who has lived with chronic issues of bowel and bladder continence all through their life. This person wrote to me this week after seeing the debate advertised to say that they had never been referred to a specialist unit outside of paediatrics. It was only through a friend that they found out about the world-leading continence facilities at Northwick Park Hospital.

The pads that this person used suddenly stopped at one point because they had not been graduated from the paediatric to the adult system. They were discharged from the paediatric system and were no longer on anyone else’s system even though they have a lifelong condition. Despite the issues, this young adult works in an office and shares a flat with friends, ostensibly having a normal life even though since infancy they have needed to change pads three times a day to maintain cleanliness.

This person has three requests: first, they want the whole issue to be destigmatised in the public’s mind. Secondly, they want schools, colleges and universities and employers to care for students and workers experiencing these conditions sensitively and in an informed way. Lastly, they want proactive support for people living with bladder and bowel incontinence to explain the range of possible treatments available and the offer of mental health support for patients living with these conditions.

I salute the courage of this outstanding young adult for not being defeated by these issues and for working and leading a normal life. I want the Minister to take their comments to heart and back to the Department for action.

15:18

[Jim Shannon (Strangford) (DUP)]

Thank you for allowing me to speak, Sir Graham, on the subject of bladder and bowel continence care. I thank the hon. Member for South West Bedfordshire (Andrew Selous) for securing and leading the debate. It is not an easy subject to talk about—it is quite difficult—and for us men it is even more difficult because we usually try to avoid these issues or put them off, so it is good to air the subject for those who have these problems, and to ensure that they know that these things are better understood by the Department of Health and Social Care, by the Minister and by the shadow Minister.

I recently met those behind the Dispose with Dignity campaign. They work closely with Boys Need Bins to raise awareness of male incontinence—bowel or bladder—and to help to break the taboo and the silence around this experience for men. I believe that this debate will be the springboard for that aim. That is why I am here. I am happy to add my support to the hon. Member for South West Bedfordshire. This is the platform and place to ensure that this debate is heard.

In the UK, somewhere between 3 million and 6 million people experience urinary incontinence. Although leaks have traditionally been seen by society as a women’s issue, as the advertisements on TV would indicate, one in three men aged over 65 are estimated to have urinary incontinence. One in eight men will be diagnosed with prostate cancer and some will experience incontinence as a side effect of their treatment. As many as 60% of men who have a radical prostatectomy may experience urinary incontinence.

That brings me to my first questions to the Minister, who always grasps the issues that we bring to him and responds in a positive fashion. What are the numbers for those with prostate cancer? Are those numbers increasing? Are more men having prostate problems than in the past? What is being done by the Department of Health and Social Care to raise awareness of the symptoms of prostate cancer?

As I said earlier, many men do not go to see the doctor when there is something wrong. They should. It could be to do with pride, or embarrassment or shame, or just because they do not want to bother anybody. Whatever it may be, it needs to be addressed. I hope the Minister can tell us what is being done. The hon. Member for South West Bedfordshire said that sometimes men do not go to see their doctor even when they have had symptoms for five years; that is just too long to wait.

A poll of 500 men, half of whom have been diagnosed with prostate cancer—which shows that they are more likely to have these difficulties—shows that some men are resorting to desperate strategies to overcome the near certainty that they will be unable to find somewhere appropriate to dispose of used products outside the home. The survey found that their strategies include taking a bag out with them that they empty when back at home, and asking their partner to keep used products in their handbag, which creates a public health concern by its very nature, is unnecessary in the times we live in, and adds further pressure to partners who may also be in a caregiving role. They love their partner—that is never in doubt—but it can be quite challenging.

Approximately one in three men surveyed—32%—said that they were wearing pads longer than advised, which can cause further health risks. A quarter, or 25%, acknowledged that they have resorted to flushing them down the toilet, even though the water companies and the health service say that should not be done. Their initial response is to get rid of it, which is perhaps why that is happening.

Of the 504 men surveyed with experience of urinary incontinence, two in five, or some 44%, experience anxiety about using public toilets; more than a third leave the house less often—in other words, they just do not bother going out, because they feel that is the best way to deal with it; and almost eight in 10 stated that they feel anxious about a lack of suitable facilities when leaving the home, which is another indication of their concerns.

More than one in four men feel depressed about the impact that experiencing urinary incontinence has on their life, with that figure soaring to 100% of those aged 16-25—the hon. Member for South West Bedfordshire gave an example of a young fella at work. Everyone will agree that this situation is unacceptable. Mental health support should be made readily available.

There is currently no obligation on businesses, local councils or organisations with bathroom facilities to provide male sanitary bins in male toilets. It is time for that to be considered. The Government must change the situation so that men who experience incontinence can dispose of products easily, hygienically and with dignity, offering them the opportunity to live a better quality of life, free from embarrassment, stress or shame.

The Dispose with Dignity campaign is calling for the Health and Safety Executive-approved code of practice and guidance to be updated—the Minister’s thoughts on this would be helpful—to ensure that men have adequate access to male incontinence bins, thereby enabling them to have a better quality of life, free from shame and embarrassment. If that guidance is not updated, men will be forced to resort to unsanitary or environmentally damaging means of disposing of incontinence pads. Providing bins in disabled toilets is not an acceptable solution on its own; distinct and separate provision must be made for men in male toilets.

Urinary infection is not experienced exclusively by older men, so support, guidance and provision for all men is crucial. We have to look at the bigger picture— the spectrum of men from 16 to 66. I had a very positive meeting with the Dispose with Dignity campaign. Is the Minister prepared to meet that group? I think the hon. Member for South West Bedfordshire seeks the same thing. Even going through the civil service would be a positive step forward. It would enable other interested MPs to understand the physical and mental health implications of not having access to adequate sanitary provision, and to discuss potential regulatory solutions.

I believe that we can and must do better to ensure that men and women have dignity in their bladder and bowel continence care. I know that the Minister will take all that on board and will consider how we can do this better. This debate is the first step in achieving just that.

15:26

[Nick Fletcher (Don Valley) (Con)]

It is a pleasure to serve under your chairmanship, Sir Graham. I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on his moving opening speech. I also thank Prostate Cancer UK, PRS, the Men’s Health Forum and the Absorbent Hygiene Product Manufacturers Association for their campaigning work on this issue.

Since becoming a Member of this House in 2019, a key policy area that I have campaigned on is improving men’s health. The Boys Need Bins and Dispose with Dignity campaigns fall within that remit. They seek to break the taboo around this type of experience, which many men face but is never discussed.

There is no need for me to repeat the statistics that my hon. Friend set out, although they are important. However, the fact that we are having this debate at all shows that there is a need to discuss not only this issue but men’s health more broadly. In many ways, it shows that we are not taking men’s health seriously enough. It seems obvious to me that amending the Health and Safety Executive’s code of practice and guidance is necessary to ensure that men have access to the support they clearly want and need. It would be interesting to hear whether the Government support that in the name of equality, inclusion and dignity.

As I have stated many times in the House, and directly to Ministers, we need a men’s health strategy and a Minister directly accountable and responsible for delivery. Piecemeal initiatives and campaigns are welcome, but we would not have to do that work if we had an overarching strategy to look at all the health issues facing men and all the causes, and deliver all the solutions, just as the women’s health strategy does.

In addition to the statistics that underpin this debate, it is vital never to forget that one in five men do not live to 65, 33 men die every day of prostate cancer, and 13 men die every day by suicide. The psychological harm caused by this issue has a negative mental health impact on men. An overarching strategy would pull all that together. If we can have a women’s health strategy—which we need—why can we not have a men’s health strategy too? We could then deal with this issue under that umbrella. It could be the first win for the Government under a men’s health strategy.

It is important to deal with the common myth that men do not seek support for their health, and that they want to tough it out because they are men. Recent research from the Movember Foundation shows that men are more likely than women to make an appointment to see a health practitioner as soon as they think they have a physical health problem. Research from the Men and Boys Coalition shows that three in five men say they face barriers to seeing GPs.

The increasing problem with men’s health, which is in crisis, shows that the health sector is not male-friendly enough. Whether through the NHS, public health provision via councils or support through mental health services, supporting a men’s health strategy would start to change that, as would the initiative we are discussing today. People wrongly say, “Men do not speak up about their health,” when on issues like this they do and have. We must listen and act or men will think, “What’s the point?”

The Prostate Cancer UK campaign led by the actor Colin McFarlane shows that men are speaking up. There is even the annual March for Men happening next month—I encourage Members to sign up. We can no longer ignore these men, so we need the Government to change the code of practice and we need councils and health bodies to take a lead. I see that Winchester City Council is already doing so. We need to make it normal for bins to be provided—a new normal so that it is not seen as an issue or a pain, but just as the normal way of doing things. We need this normal and a new way of supporting men’s health.

I urge the Government to change the code of practice and—importantly—create a men’s health strategy and a Minister with accountability for this issue. We owe it to the men in our society and the women they share their lives with to deliver all this and more.

15:31

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Graham. I commend the hon. Member for South West Bedfordshire (Andrew Selous) on this comprehensive and moving debate. He gave voice not just to a particular individual but to many people, and that is one of the highlights of being in this place. I also commend the hon. Members for Don Valley (Nick Fletcher) and for Strangford (Jim Shannon) for being here and for their work on Boys Need Bins and men’s health. It is unusual that I am the only woman in this debate. I am happy to be in this company because the hon. Member for South West Bedfordshire is right that there is a taboo and we all need to work together to reduce the stigma.

It is estimated that 14 million people in the UK have some degree of urinary incontinence, while at least 6.5 million people experience bowel control difficulties. Those numbers are staggering. Although it affects twice as many women as men, one in 25 men over the age of 40 also experience urinary incontinence. Gynaecology waiting lists have faced the biggest increase of all medical specialities, with more than half a million women in the UK on gynaecology waiting lists last year. That is something I recently discussed with Dr Ranee Thakar and Kate Lancaster at the Royal College of Obstetricians and Gynaecologists.

We have known about the need for education and prevention for many years. It is something I worked on in the health service in the late 1980s, but we still have not seen the results, and people are living with poor continence all the time. It is different for everyone, but we have heard about some of the significant impacts that incontinence can have on quality of life and mental health, as well as through a reduction in physical and social activity. We should remember that in most cases the problem can be either prevented, cured or managed so that it does not interfere with daily life, but to do that the right support must be available so that we can all live our lives with dignity.

There are excellent innovations and surgical products for stoma wearers, and I pay tribute to the health staff, from specialist nurses to pelvic floor physios, who go over and above to support those with continence issues and to help people to adjust to life-changing surgery. Too often people with continence issues face unnecessary hurdles, and we have heard some today—whether that is a lack of public toilets, lack of awareness or, indeed, the normalisation of continued incontinence following childbirth. Those impacts cannot be underestimated, and I know from my constituents how a lack of amenities can cause isolation, while a lack of awareness around care can lead to people living with these problems for far longer than they should have to. There are also financial pressures on the NHS as a result of poor continence care, from costs associated with hospitalisation or catheterisation to high workload pressures and increased laundry costs. That means the cost to the NHS of incontinence-related care is more than £5 billion every year.

Many people are admitted to hospital with urinary tract infections, often caused by catheter-associated urinary tract infections. That increases A&E attendance and costly unplanned admissions. Improving catheter care in the community would significantly ease the burden and reduce A&E attendance and hospital admissions. That is one reason why the Labour party will shift more care out of hospitals into the community, so that the NHS becomes more of a neighbourhood service.

In Bristol, we are fortunate to have highly recognised work in this area. The CONfidence app, which has already been mentioned, is led by Dr Nikki Cotterill in association with the University of the West of England and Bristol Health Partners. I commend that work to the Minister. It aims to address inequalities for patients with pelvic floor disorders and improve services for the future, as well to provide vital care and support to people who are suffering in silence.

Another project conducted by Bristol Health Partners and the West of England Academic Health Science Network highlighted six opportunities, which I think are worth listing. We need to help people by improving perception; communication; the environment; health services; recognition and support, particularly for mental health issues and anxiety; and participation in society.

The hon. Member for South West Bedfordshire addressed the issue of race inequalities, which we are looking at in Bristol. We have a project to explore the barriers faced by women with incontinence in the Somali community, which I hope all of us across the country can learn from. Not everyone everywhere has the same experience, so it is important that we share. However, everyone facing these problems deserves access to high-quality information and suitable treatment in an NHS that is supported and fit for the future. You would expect me to say this, Sir Graham, but 13 years of Conservative Government have not helped the health service. Waiting lists and preventive care in the community are at breaking point.

People who support those living with incontinence need quality training to ensure the right bowel and bladder care regime for each patient. That is particularly important for those with mobility issues who rely on carers either at home or in a community setting. Nurses are currently required to learn specialist continence care on the job, because of the removal of NHS training courses over the last few years. That adds additional pressure to already overworked nursing and caring staff, putting patients’ quality of life and their health at risk. We are still waiting for the workforce plan, although we hear that it is imminent. I agree with the hon. Member for South West Bedfordshire that those living with incontinence would welcome an update from the Minister on whether the Government will introduce NHS training courses on stoma and continence care for nursing and care professionals.

This is not just an individual health matter, but a public health matter. It would be helpful if the Minister could explain what discussions he is having with integrated care boards throughout the country about tackling incontinence as a prevention issue, knowing, as we have heard, that it affects one in five people across the country. From the examples we have heard, it is clear that specialist treatment and support, including mental health support, is vital. How are the Government ensuring that those who need that support receive it, and particularly those in harder-to-reach communities?

Much has been promised in the women’s health strategy, but we are still awaiting action on things from tackling gynaecology waiting lists to appointing a deputy women’s health ambassador. We have heard good promises but we need to see the findings. Also, any disruption to the flow of medical devices into the UK would have a devastating impact on those who rely on them, and urology projects are no exception. Can the Minister give any assurances to the industry in respect of the sustainability of production and regulatory alignment post Brexit?

Finally, can the Minister provide any information on updating the guidance regarding the disposal of sanitary dressings in the building regulations and in approved document M? I understand that that work has been ongoing since 2020, but it would address many of the issues that have been raised today. If he cannot provide an update now, will he do so in writing? I think the hon. Member for South West Bedfordshire would appreciate that too.

15:38

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Sir Graham. It is unusual to have almost an hour to respond to a Westminster Hall debate. I assure you that I do not intend to use all that time, but I will endeavour to answer as many questions as possible.

I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing this important debate, and on his appointment as chair of the all-party parliamentary group for bladder and bowl continence care. I join him in paying tribute to campaigners such as the Urology Foundation for their incredible work during Continence Week and throughout the year.

I thank my hon. Friend for sharing the experience of the young adult who contacted him. That is what this debate, and this place, is all about. It is about destigmatising the issue, which was the No. 1 ask of that young adult. It is also about trying to bring about positive change not just for him but for patients up and down the country, especially given how many people we know are affected by continence issues.

We know—my hon. Friend set this out very articulately and eloquently—that incontinence is an issue with which too many suffer in silence. We must all learn to speak more openly about it. As the hon. Member for Bristol South (Karin Smyth) rightly set out, it is estimated that around 14 million men, women, young people and children, of all ages, are living with bladder problems. As has also been pointed out, all continence problems can be debilitating and life-changing. As we have heard, they can affect a wide range of care groups and can be of particular concern to the ageing population.

As my hon. Friend the Member for South West Bedfordshire rightly set out, this also creates pressures for our healthcare system. Complications and treatments for continence problems—for example, pressure ulcers, urinary tract infections, catheterisation, which my he pointed to, or faecal impaction—can all lead to admission and extended stays in hospital, which we should try to avoid wherever possible. The need to do what is right for patients and healthcare professionals alike means that care pathways should be commissioned to ensure the early assessment and effective management of incontinence.

To improve continence care across the whole public health and care system, NHS England has established the national bladder and bowel health project to improve continence care. As my hon. Friend rightly pointed out, it has also published “Excellence in Continence Care”, which is a practical guide for leaders and commissioners. That includes guidance for commissioners—so ICBs—and leaders in healthcare systems to ensure that people who are diagnosed with UTIs receive high-quality treatment.

I have heard my hon. Friend’s concerns about the implementation of the continence care guidelines. I will, as he asked, take this back to the Department and raise it with the Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), to discuss what more we can do alongside NHS England.

On 9 May, NHS England published its delivery plan for recovering access to primary care. It is an ambitious plan that includes proposals to improve options for community-based services to treat urinary tract infections. As part of that, appropriately trained community pharmacists will be commissioned to provide a clinical service to care for patients with urinary symptoms, providing timely access to assessment, information and advice.

In addition—this does fall within my direct remit in the Department—the National Institute for Health and Care Excellence has produced guidance on the management of faecal incontinence in adults, which healthcare professionals and commissioners are expected to take fully into account as part of the delivery of services. That guidance outlines that management strategies should consider diet, bowel habit, toilet access, medication and, importantly, coping strategies. Those management strategies will be required to account for the sensitive and socially stigmatising nature of incontinence, as my hon. Friend the Member for South West Bedfordshire set out. We know how important that is to patients, their families and—as the hon. Member for Strangford (Jim Shannon) pointed out—their carers.

I want to touch on another area, which my hon. Friend the Member for South West Bedfordshire touched on also, which is antimicrobial resistance, because we have updated the 2019 to 2024 national action plan on tackling antimicrobial resistance. The plan is core to this debate because it outlines that the UK will enhance the prevention of UTIs by providing early, accurate diagnosis and treatment of suspected and confirmed UTIs. That includes the prescription and use of antibiotics and therapeutics for older people, both in their own homes, which is critical, and in care homes, so that patients get the care they need, when and where they need it, and are less likely to suffer from the discomfort of urinary tract infections, or indeed secondary infections, which we know can follow.

To improve bowel care for people with spinal cord injury, NHS England has also published a service specification, with specialist multidisciplinary teams that provide advice and care in bowel management, including promoting and managing continence. My hon. Friend also referred to medtech, and I am really passionate—

[Andrew Selous]

The Minister might not be able to respond to this now, but before he moves on to the tech, the Spinal Injuries Association made the very good point that a lot of people with spinal injuries have carers—trained people—who are willing to come in and assist the very hard-pressed hospital staff, but are unable to. Can that be looked at? I get the complications, and I am not asking the Minister for an answer now, but one of my children spent some time in healthcare in hospitals in Africa, and in many parts of the world, if a patient’s family and friends do not go into the hospital, they will not survive. If we completely keep carers out and bar the door, have we not gone a little too far? There have to be standards, of course—it would have to be done in agreement with the staff and there would have to a be risk assessment. I absolutely get all that, but the current position seems bizarre, when there are hard-pressed staff and carers who are willing to come into hospital with their patients, so I wonder whether that could be looked at.

[Will Quince]

My hon. Friend makes a very good point. Instinctively, I totally agree with him, and I would be very happy to meet him to discuss, alongside NHS England, what more we would need to do to enable that to happen. I suspect that, in this kind of area, an individual with incontinence would often much rather have a family member, a carer or another trusted loved one support them through that process, alongside trained medical professions than anything else. So it is a good point, a fair challenge and one I will take away and consider in more detail.

Let me turn to medtech, which is a real passion of mine. We want to make sure that patients in our NHS get access to the most cutting-edge technological advances. We talk a lot about pharmaceuticals, but medtech is something that we should take very seriously, too. Earlier this year, we published our first ever medtech strategy, which says that the lowest price does not always translate to the best value. That is an important point, because the Government believe that the value of a product should be considered across the whole patient pathway, not in terms of the individual cost.

The application and adoption of value-based procurement in the NHS is a key priority in the medtech strategy, in order to realise, as I have set out, the potential of that technology to improve patient outcomes and, importantly and alongside that, to support the NHS workforce. Without getting too technical, the strategy includes a commitment to modernise part IX of the drug tariff, which lists devices that can be prescribed in the NHS.

The reason I am labouring this point is that the Government and I recognise how important patient choice is, and that a range of continence products is really important to living well with this condition. That is why there is a focus on making changes to part IX. By re-categorising part IX into groups of clinically comparable products that are interchangeable by their nature, cost-effectiveness can be compared fairly, and ICBs and clinicians will be more informed and more likely to use part IX. Doing so will also enable companies that are making innovative products to enter the market and encourage further innovation in this space, which will ultimately only benefit patients. We will continue to support the provision of a range of continence products in part IX of the drug tariff, to ensure equitable access for all patients.

The reason I labour the point about patient choice is that we must ensure that patients have a voice in the product range available in the drug tariff, so that patients’ interests are at the heart of how the tariff operates. We are currently engaging with patient groups, which is really important, and a targeted consultation will be launched later this summer to ensure that the tariff continues to be able to provide effective products to patients.

My hon. Friend and others also referred to the long-term workforce plan and the need for specialist continence nurses. I have spent the last few months saying that the plan will be published “soon”, then “very soon” and now “imminently”. I do not know if I can say “very imminently” —I am not sure there is such a thing—although I have spent most of today talking about the NHS long-term workforce plan. I anticipate spending most of tomorrow, and indeed Monday, talking about the NHS long-term plan. My hon. Friend and others will not have to wait very long before they will be able to read the plan in full. I am sure that he and others will understand why it would not be right for me to share details of it ahead of publication, but I mean it when I say that he will not have to wait very long at all.

On the points about public toilets and accessible toilets, I am conscious that I am straying into the territory of the Department for Levelling Up, Housing and Communities, which has responsibility for building regulations. It approves documents for the provision of toilets in publicly accessible buildings, which falls under the Building Act 1984 and the Building Regulations 2010. That legislation does not currently require sanitary bins in men’s toilets, but I understand the points made by my hon. Friends the Members for South West Bedfordshire and for Don Valley (Nick Fletcher), as well as the hon. Member for Strangford, about the anxiety that men feel. They make a compelling argument, and I would encourage them to raise it with the relevant Minister at DLUHC—I will do that too.

I understand that Colostomy UK has a stoma-friendly toilet campaign that is aimed at organisations, businesses and individuals. The campaign focuses specifically on accessible toilet facilities and the needs of people living with a stoma. The hon. Member for Strangford makes a fair challenge to the civil service and Government Departments to lead by example on that point. I will raise the issue with the Cabinet Office to see whether it is something we should explore further.

I thank my hon. Friend the Member for South West Bedfordshire for alerting me to the bladder and bowel CONfidence app, which was something that I was not aware of before my research ahead of the debate. I now know that a number of NHS trusts and medical centres are aware of the app and promote its use. Following this debate, I will look into whether NHS England could reference the app on its health webpages, which would be really helpful. I will also look into what more we can do to promote the app, as it sounds like a great tool.

My hon. Friend the Member for Don Valley raised the possibility of a men’s health strategy, and specifically a Minister with responsibility for men’s health. I know it is an issue that he is hugely passionate about and has campaigned long and hard on. I can give him the assurance that the major conditions strategy will take into account the needs of both men and women. Of course, we recognise that different approaches need to be taken for men and women in the provision of treatment of major conditions, especially over the whole course of life.

The Secretary of State for Health and Social Care, in Men’s Health—which is not a magazine I have read, but I have seen the cover—explicitly invited men to respond to the call for evidence to help us to ensure that the strategy takes into account the needs of men. I know that my hon. Friend the Member for Don Valley wants the Government to go further on this issue. He has already raised the issue with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), and I would also be happy to meet with him to discuss it.

[Andrew Selous]

I ask the Minister to forgive me if he was coming to this, but before he concludes, will he say a little bit about the third of dementia patients who go into hospital continent and come out incontinent? Many of them are actually trying to get to the toilet but have had difficulty. I find that very upsetting. As I said, it is not an easy issue, and I 100% get the pressures on the staff, but I think the issue is something that has not been spoken about. It has just happened under the radar. I am not expecting an answer today, but I would like a recognition that the Minister has clocked it, is concerned about it, and will take it back to the Department, because I was really upset when I learnt about that figure.

[Will Quince]

I entirely understand why my hon. Friend would be upset. In truth, I do not have an answer for him immediately. If he holds fire, however, I am going to make a broader offer to meet with him directly or alongside the APPG to discuss that and any other issues with NHS England and officials in the Department who are experts in the area. He raises a powerful point, and it is an issue that we need to explore further.

The hon. Member for Strangford raised prostate cancer statistics. I will write to him specifically, because I know he would like more detail on this issue. He is absolutely right that there has been a considerable increase in diagnoses of prostate cancer. I think the statistics are that in 2020 we diagnosed something in the region of 36,000 cases, whereas in 2000 it was 25,000, which is something like a 45% increase. Diagnosis is generally a good thing, especially early diagnosis, because it means that we are catching the disease early. However, I understand that about 51% of prostate cancers were diagnosed at an early stage in 2021, which demonstrates that we have a lot more to do in that space. I will write to the hon. Gentleman on that point, and will raise it with my hon. Friend the Member for Faversham and Mid Kent.

I have not answered all the questions that my hon. Friend the Member for South West Bedfordshire asked. As tempting as it is to take up the remaining 35 minutes of the debate, I will commit to meeting with him personally, or indeed with the all-party parliamentary group and campaigners, alongside NHS England and the Department, to talk about some of the other issues in detail. I think they certainly warrant that, so I would be delighted to do that.

In summary, NHS England has published its delivery plan, which sets out our proposals to improve options for community-based services to treat urinary tract infections. In addition, NICE has produced guidance on the management of faecal incontinence in adults. The annual spend on incontinence products from part IX items alone is approximately £255 million. As I said, we know how important patient choice is and understand that having a range of continence products is important to living well with this condition. That is why I can promise that there will be a focus on making changes to part IX of the drug tariff.

To conclude, I know that many people who experience bladder and/or bowel problems experience stigma, a point made eloquently by my hon. Friend the Member for South West Bedfordshire. They can be embarrassed to talk about the symptoms with friends, family and even, to some extent, healthcare professionals. That is why I am particularly pleased that my hon. Friend secured today’s debate, which has provided me the opportunity to play a small part in tackling the stigma that surrounds this issue. I think all hon. Members that have taken part in this debate have helped to defeat the stigma that surrounds the issue. I am not so naive as to think that there will be thousands watching this debate at home, but the debates are kept online and I hope people will watch. They will realise that it is vital to talk to medical professionals about their health issues and problems in this space and, wherever they feel it is necessary, to seek out professional care.

15:58

[Andrew Selous]

Thank you, Sir Graham, for looking after us this afternoon; I thank all my colleagues who came along. The hon. Member for Strangford (Jim Shannon), who is such a stalwart of these debates, was so right to say that this has traditionally been seen as a women’s issue. He pointed out that it is not and talked about the impact on intimate relationships, which is vital to highlight as well. He talked about the importance of the Dispose with Dignity campaign and the needs around it, which we have heard good commitments on from the Minister on today.

My hon. Friend the Member for Don Valley (Nick Fletcher) also supported the Boys Need Bins campaign and talked about the negative impact on men’s mental health. He called on us to listen and act, and asked how this issue could fit within the men’s health strategy. I am extremely grateful to him for coming along. I completely agree with the shadow Minister, the hon. Member for Bristol South (Karin Smyth), that this is an issue we need to prevent, cure and manage. She is 100% right about that. I am grateful for her support for the app, which comes from her part of the world.

I am hugely grateful to the Minister for his commitments. I will take him up on that meeting. I will also put him down as a Boys Need Bins champion in Government. I know it is not his departmental responsibility, but if he can be there with us to try to make progress, I will take that as a win this afternoon. I look forward to the meeting.

Question put and agreed to.

Resolved,

That this House has considered bladder and bowel continence care.

16:00

Sitting adjourned.