Westminster Hall

Thursday 11th January 2024 Westminster Hall

Thursday 11 January 2024

[Mr Virendra Sharma in the Chair]

Backbench Business

Smokefree Future

Thursday 11th January 2024 Westminster Hall

13:30

[Bob Blackman (Harrow East) (Con)]

I beg to move,

That this House has considered the matter of a smokefree future.

It is a pleasure to serve under your chairmanship, Mr Sharma, for at least the second time. No doubt you would prefer to be participating in rather than chairing this debate on the evidence and recommendations submitted to the all-party parliamentary group on smoking and health’s manifesto for a smoke-free future.

It is a pleasure to see the new Minister in her place; I thank her for attending a function that we held soon after she was appointed. I welcome the new shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), and look forward to what she has to say. I declare an interest as chair of the APPG, which wants to ensure that Parliament has the chance to debate our recommendations, along with the smoke-free generation proposals set out in the King’s Speech, and consider what more needs to be done to achieve the Government’s Smokefree 2030 target.

I welcome the Government’s historic commitment to create a smoke-free generation by raising the age of sale for tobacco by one year every year from 2027. This measure, along with other commitments set out by the Government, will help to close the door on the tobacco epidemic once and for all. With their Command Paper, the Government have demonstrated their commitment to achieving the smoke-free ambition and to ending the harms caused by tobacco. It was a great pleasure to hear my words in this place echoed almost word for word by the Prime Minister at the Conservative party conference. I congratulate his speechwriter on having observed what we had to say in last year’s debate.

The smoke-free generation policy was due to be implemented first by New Zealand, but it was abandoned by the incoming Government in November under pressure from their coalition partners. That presents us with the opportunity to be the first to implement the policy, thereby cementing the UK’s position as a global leader in tobacco control. In response to New Zealand’s decision, we have seen the tobacco industry going into overdrive on its lobbying machine, arguing that the UK should follow New Zealand in rowing back on our commitments and even promising that it would not vociferously oppose the smoking age rising from 18 to 21. That demonstrates how big a threat it is to have the smoke-free generation policy.

Quite rightly, the Prime Minister has rejected the industry’s arguments and reiterated the importance of creating a smoke-free generation. I commend the Minister for her robust response to the industry when she called out its attempts to undermine and block this measure. As she wrote in the i newspaper:

“The tobacco industry will talk about free adult choice, but we all know there is no freedom of choice once deadly addiction sets in. The industry has a long history of trying to obstruct and delay tobacco reforms. But we have absolutely no intention of going back on our word.”

I welcome those words, and I trust that the Minister will echo them when she responds to the debate.

Government action to end smoking is what the public want. Polling carried out by YouGov for Action on Smoking and Health shows that three quarters of the public, including the majority of smokers, support the Government’s Smokefree 2030 ambition and that two thirds of people in England back the Prime Minister’s age-of-sale proposal, with equivalent levels of political support among voters for all the main political parties at the last general election. This should not be a surprise, because no one wants to see their children smoking.

Just like the public, the majority of independent retailers selling tobacco support the key measures needed to tackle smoking, including raising the age of sale for tobacco to 21, with just over half of retailers in favour and a quarter opposed. Although that happened before the Government announced the smoke-free generation policy, it shows that retailers support the principle of raising the age of sale. That should not be a surprise, either. Tobacco sales now account for a very small fraction of the profits from those shops—less than 10% in 2016—and are dwindling year on year. Most small retailer transactions do not involve the purchase of tobacco at all.

From the 2007 ban on smoking in public places to standardised packaging in 2015, progress on tobacco control has consistently been driven from the Back Benches. Indeed, I am delighted that most of the 2021 recommendations from by the APPG on smoking and health were included in the recent Khan review and are now in the process of being implemented by the Government and the Department of Health and Social Care. They include progress towards much tougher regulation of vaping to protect children, additional funding for stop smoking services and anti-smoking campaigns, the swap to stop campaign, and financial incentives for pregnant women to stop smoking. In particular, I welcome the Minister’s decision to expand the offer of financial incentives so that it includes not only pregnant women but, critically, their partners. Dads and partners have a key role to play in determining whether women smoke or are exposed to second-hand smoke during pregnancy. That announcement is to be commended.

However, the Government need to go further. The Government’s proposals to create a smoke-free generation and curb youth vaping are welcome, but they will not be enough to achieve the Smokefree 2030 ambition. It is imperative that that ambition is realised for everyone, not just for the next generation. According to Cancer Research UK, the Government are nearly a decade behind achieving their target for England to be smoke free by 2030. The most deprived areas are not on track to hit the smoke-free target of 5% smoking prevalence until after 2050. That would leave the most vulnerable people in our society bearing the brunt of the harms from smoking for decades to come.

In our recently published tobacco manifesto, the APPG set out the action needed to accelerate the decline in smoking rates, in order to get us within spitting distance of a smoke-free 2030. The long wait for Government action on smoking means that achieving 5% smoking prevalence by 2030 will be even more challenging than when the ambition was first announced in 2019. However, that target is still within reach. The closer we get, the more lives we can save.

Modelling carried out for the APPG by academics at University College London shows that if our recommendations are implemented in full throughout the next Parliament, smoking prevalence in England, which is currently at 12.7%, will be reduced to 7.3% by 2029. That would deliver immediate benefits to health and wellbeing, as well as saving countless lives in the longer term, and would lead to a 5% rate by 2030.

Smoking remains the largest cause of preventable death, ill health and inequalities in the UK. Some 6.4 million adults in the UK currently smoke, approximately an eighth of the population. Most adult smokers want to stop smoking, but on average it takes 30 attempts to succeed; many never do so. It is one of the resolutions that smokers make, and it is sad when they break them very quickly in the new year.

Two out of three long-term smokers die prematurely, often after years of disability from the cancers and the respiratory and cardiovascular diseases caused directly by smoking. NHS data shows that in 2022-23 there were more than 400,000 smoking-related hospital admissions in England alone, an increase of 5% on the previous year.

Despite Harrow having a below-average smoking rate, tobacco still takes a heavy toll, causing over 1,300 hospital admissions in 2019-20 alone. People in Harrow suffer many of the same health inequalities as the rest of the country, with those from the poorest backgrounds and those with mental health conditions much more likely to smoke than the general population.

Smoking places a major financial burden on individuals, families and the taxpayer. The average smoker spends just over £3,000 a year on cigarettes, which is significantly more than the annual energy cost for a typical household. That is money that could be better spent on products and services to improve people’s quality of life, but instead it literally goes up in smoke to maintain their deadly addiction. In the APPG’s latest report we estimate that the cost of smoking to public services and the wider UK economy is £89.3 billion a year, the equivalent of 3.9% of GDP.

What about the direct costs of smoking to the public finances? One of the arguments made by the tobacco industry and its allies is that higher smoking rates benefit public finances because smokers pay extra tax in the form of tobacco duties and then die younger, meaning they use less of their pensions. Those arguments are callous, cold-blooded and not even true. Detailed analysis of the evidence carried out for the APPG shows that, rather than saving the Government money, smoking had a direct cost to the public finances of £21 billion last year: more than double the excise tax revenues. That cost is made up of extra social security payments, lost taxation from smokers who are too sick to work and, of course, significant costs to the NHS and social care services. Implementing the recommendations in our manifesto would reduce the public finance costs of smoking by an average of £628 million a year, which would total £3.1 billion by 2029. The case is clear: ending smoking once and for all will transform the nation’s health and wealth. The only losers would be the tobacco industry.

Local stop smoking services have a key role to play in delivering a smoke-free future, so I am pleased that the Government have committed to a five-year funding plan for smoking cessation services. That new funding will definitely help to drive down smoking rates, generating a return on investment literally from year one. However, we are significantly behind where we hoped to be when the smoke-free ambition was announced in 2019.

As we all know, the public finances are under significant strain, so why should taxpayers foot the bill for measures to end smoking when the tobacco industry could be made to do so? Tobacco manufacturers make an estimated £900 million profit a year in the UK alone, with an average net operating profit margin of about 50%. That far exceeds the average for UK manufacturing, which stands at less than 10%. In the UK, four companies are responsible for 95% of tobacco sales and are therefore responsible for an overwhelming majority of the tens of thousands of deaths a year caused by smoking. Despite their staggering profitability, the companies pay very little corporation tax in the UK. Through the exploitation of their global footprints and tax loopholes, they have been able to successfully avoid a fair tax bill overall. Imperial Brands, the largest tobacco manufacturer by market share in the UK, lowered its tax bill by an estimated £1.8 billion over the last 10 years.

The “polluter pays” principle has been accepted and successfully implemented in other industries, such as environmental health, the soft drinks industry and, most recently, the gambling industry. It could easily be extended to the tobacco industry. It could be implemented by capping tobacco wholesale prices, and hence profits, to bring the profit margins in line with the 10% average for other manufacturers. A “polluter pays” health promotion levy could ensure that the excess profits were turned into Government revenues, raising an estimated £700 million a year. That could fund the Government’s smoke-free generation commitments several times over, with money left over for other public health measures.

It is hard to think of a policy that has broader public support. The 2023 smoke-free Great Britain survey conducted by YouGov for Action on Smoking and Health revealed that 76% of adults in Great Britain would support a levy on the tobacco industry, while only 6% were opposed. That includes majority support from voters for all the main political parties. I stress that a levy would not mean an increase in the cost price of tobacco bought over the counter. The Department of Health and Social Care already has the expertise and resource needed to administer a levy in the team that oversees the pharmaceutical pricing scheme.

The primary legislation needed for a consultation on our proposals was part of the Health and Care Bill and was passed by the House of Lords. Unfortunately, due to Treasury opposition, it was voted down by the Government in the Commons. Will the Minister commit to discussing the APPG’s proposal of a “polluter pays” levy on tobacco manufacturers with Ministers in the Treasury and with us?

In the short time that I have left, I want to discuss how we can combat youth vaping. For years, we in the APPG have been calling for the Government to toughen legislation on vaping, so I am delighted that the Government have finally committed to taking action. My views on youth vaping are summed up by the chief medical officer:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape; marketing vapes to children is utterly unacceptable.”

In our manifesto, the APPG urges the Government to prevent e-cigarettes from being sold at pocket-money prices and to curtail advertising and promotion of vaping, particularly in shops, where most under-age vapers access e-cigarettes. We know that the rise in youth vaping since 2021 has been driven largely by the availability and marketing of cheap single-use vapes, and anecdotal evidence points to the fact that many young people believe that vaping is perfectly safe because the Government are encouraging people to give up smoking and take up vaping. Of course, that is a false conclusion, because it gets people addicted to nicotine and possibly leads on to cigarette use later in life.

There is clearly a need to address the affordability of vapes for young people while ensuring that they continue to be a cheaper option than smoking for adults who want to quit. Given the effectiveness of vapes as a smoking cessation aid, it is essential that any regulation takes a measured approach and ensures that vapes are still accessible to adult smokers. Can the Minister confirm when the consultation response will be published and when we will see the legislation laid before Parliament?

The case is very strong for a “polluter pays” levy and for all the recommendations that the APPG has put forward. I look forward to the contributions from colleagues around the Chamber, to the response from the Opposition and from our excellent Minister, and to achieving what we all want: a smoke-free England by 2030.

13:47

[Mary Kelly Foy (City of Durham) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank the hon. Member for Harrow East (Bob Blackman) for securing the debate, and I declare my interest as a vice-chair of the APPG on smoking and health.

The Government’s announcement of their smoke-free generation policy was welcome after several years of inaction on tobacco from successive Conservative Governments, which have left us playing catch-up to achieve the Smokefree 2030 ambition. Indeed, regulations to protect children from taking up vaping and smoking in the first place would already be in the law today if the Government had accepted my amendments to the Health and Care Bill three years ago. Nevertheless, I welcome the commitment to curb youth vaping with tighter rules around packaging and promotion. The right balance needs to be struck to ensure that vapes are used only by adults who want to quit smoking.

In the north-east, the most disadvantaged place in England, we know better than most that smoking is not only the greatest cause of preventable deaths, but responsible for half the difference in life expectancy between the most and least advantaged in society. Smoking rates are a clear expression of the health inequalities that divide our country. That is why my colleagues and I show up time and again to demand that real and bold action be taken to make smoking history. Children of parents who smoke are three times more likely to take up smoking themselves, more likely to suffer significant income loss and more likely to live a shorter life.

It is high time to break the mould. The Government now need to make the best use of the additional funding that they have attached to the smoke-free generation policy. The Fresh tobacco control programme in my own region is a long-standing example of how budgets can be pooled and partners can work together to bring about positive results. I would be delighted to welcome the Minister to Durham and the north-east to learn more about the work of Fresh, which has been so crucial in reducing smoking rates far more rapidly than the national average.

Preventing the next generation from starting to smoke is not enough. There are 6.4 million adult smokers who need support to quit. The additional funding being provided to stop smoking services is vital, but we cannot ignore the threat to NHS provision of tobacco dependence treatments for in-patients, mental health patients and pregnant smokers. In November, the Health Service Journal revealed that NHS trusts were being told that they could raid these budgets to fund urgent and emergency care. At a time when the roll-out of those programmes has already been cut and is well behind schedule in many areas, the Government pay lip service to the need for prevention if we are to reduce pressure on our NHS. It is yet again a Cinderella service, trumped by the need to do more to treat those who are already sick.

What is more, funding for financial incentives to support pregnant smokers to quit and for the Swap to Stop vape campaign is only guaranteed for two years. We need a long-term and sustained commitment to protect our most vulnerable from the harms of tobacco smoke, including unborn babies. I hope the Minister can ensure that those schemes will be funded for at least the full five years needed.

While the measures announced by the Government, which the APPG and Action on Smoking and Health have long called for, will have an important impact, they are not enough to achieve the Smokefree 2030 target of a maximum 5% smoking rate. We need further action. Of course, more action means more funding, which is where the APPG’s recommendation of a “polluter pays” levy on tobacco manufacturers comes in.

As always, more money is needed if we are serious about a smoke-free future. Why, then, are we not seriously considering making the polluter, the tobacco industry, pay to address the damage that its products are inflicting on our communities? The industry makes vast profits in Britain every year. Why is it not being made to pay, instead of the taxpayer? As the APPG report makes clear, a levy on the industry would raise the funding necessary to achieve a smoke-free future for all, not just the most advantaged.

Ahead of the spring Budget, will the Minister commit to discussing the APPG’s proposal of a “polluter pays” levy on tobacco manufacturers? Would she discuss this with Ministers responsible for tobacco policy in His Majesty’s Treasury? As health inequalities worsen and lives remain at risk, the Government must make up for their lost time with bolder action. They must make the polluter pay.

13:53

[Ian Paisley (North Antrim) (DUP)]

Thank you very much, Mr Sharma, for chairing this debate and for calling me to speak. I congratulate the hon. Member for Harrow East (Bob Blackman) on moving the debate. He regularly secures debates on this subject, and has done so very well again today. I intended to speak on the issue of vaping, which he mentioned at the end of his comments. I agree with his point about children seeing vaping as a gateway into something, and that is very serious and needs to be addressed. It will probably be the real battleground for this issue in the future.

However, I want to turn to something else. With all policies, there are unintended consequences. I have no doubt that the Government’s intention is correct, but there are undoubtedly areas that raise unintended consequences.

I first want to turn the Minister’s attention to Northern Ireland. The impact on Northern Ireland will be significant, because under the Brexit arrangements—the protocol and the Windsor framework—the sale of tobacco products in Northern Ireland is regulated not by the UK Government but by EU law. It is therefore unclear how the Government would implement a generational ban in Northern Ireland under the current regulations and laws.

As recently as April 2022, the Danish Government tried to implement a generational ban, and the European authorities blocked them on the basis that it would impact Denmark’s European neighbours. Given the situation that Northern Ireland has unfortunately been placed in by the Government under the Windsor framework, this generational ban would not be implementable in a part of the United Kingdom, so 3% of the population of the UK do not matter when it comes to this policy. That is the impact that people will see. It one of the Prime Minister’s flagship policies, but its application would be prohibited in one part of the United Kingdom. The Government need to look at that issue if they are serious about this policy, and they must comment on how they intend to fix it.

If the UK Government were to find a means of introducing a generational ban in Northern Ireland while still adhering to the Windsor framework, they would therefore show that they are able to breach the final concluded Windsor framework agreement. If they are able to breach it on this issue, all the comments we have heard in this House over the past year—“It is finished,” “It is done,” “It cannot be changed”—are therefore set aside, as that would show that it can be done.

A generational ban in Northern Ireland would create an absurd situation whereby people living in County Armagh, County Fermanagh and County Londonderry could simply drive a few miles over the border to the local convenience shop or filling station in the Republic of Ireland and purchase cigarettes there, so I do not think the Government have thought through the implications for Northern Ireland. I would be very interested to hear how they intend to pursue these issues and address these matters.

I am an officer of the all-party parliamentary group for retail crime, safe and sustainable high streets, and I think the ban will have another unintended consequence on criminality in the whole United Kingdom, not exclusively in Northern Ireland. Every single day, there are 867 violent or abusive incidents affecting retailers across the United Kingdom. Most people working in retail shops—average corner shops—get abused at some point. I got that statistic from the British Retail Consortium, so it is an accurate figure. Asian Trader carried out a survey on the generational tobacco ban in November 2023, and it found that 86% of retailers believe that a generational prohibition on the sale of tobacco will have a negative effect on their business, and 55% say that it will complicate age checks in store and will lead to violent attacks on their staff. The majority of retailers say that the only way they can enforce a generational prohibition in the long term is through mandatory ID checks. Those are not my views; they are the views of retailers.

Of course, ID checks are an enforcement nightmare. Andrew Chevis, the founder of CitizenCard, the UK’s largest provider of proof-of-age cards, said in The House magazine in November 2023,

“I have deep concerns from both a retail and enforcement perspective”

about a generation ban. His concern is, of course, for the safety of retailers. I get that. Any of us who have retail or convenience stores in our constituencies—as we all do—will be concerned about these matters.

UK retailers already suffer sky-high levels of violence and abuse, and a generational prohibition could make that worse, as retailers will have to identify young-looking customers before they are able to sell them tobacco, and they will have to be convinced. I will be very interested to see the legislation when it is printed, and I would like the Minister to confirm whether, if a retailer decides, “Oh, that person is over the age, and I can legally sell it to them,” but it turns out that that person is not over the age—they were within a generational ban threshold—it is the retailer that has committed the criminal offence and not the purchaser. That goes right the way through.

In a few years, under this generational retail ban, a person who is in their 30s and should not be buying cigarettes in the first place—but they are in their 30s and are buying them—would not actually be committing a criminal offence as an adult, but the retailer would be committing an offence for selling them. That needs to be clear: who is ultimately responsible here when adults are making adult choices? I think that that needs to be cleared up.

As I said, a survey conducted by the British Retail Consortium identified that checking for proof of age is one of the biggest triggers for violence and abuse against UK retailers. I already quoted the figure of there being 867 violent or abusive incidents occurring every day.

The Prime Minister very kindly acknowledged some of these issues, just before the recess, when I had an event in Dining Room B with the retail crime, safe and sustainable high streets APPG. He kindly indicated, from his experience of when he was a kid working in a retail shop, how these things impact detrimentally on members of staff. If the Prime Minister can see that, then I think this issue needs to be properly looked at.

The Association of Convenience Store’s crime report is published every year. Its 2023 report says that there were 759,000 incidents of verbal abuse and that 34% of verbal abuse incidents are hate-motivated. It also says that, according to retailers, 87% of convenience store colleagues reported that they had faced verbal abuse in the past year. Therefore, although I think it is an unintended consequence, creating or increasing the opportunity for that sort of abuse to take place is a consequence that the Government have to deal with. Is there a better way of doing this? Is it better, for example, for the Government to say, “You are 21 or 22. You can only buy after you become an adult, at that higher age threshold”?

[Bob Blackman]

The hon. Member is giving a very thoughtful speech about some of the consequences. Does he accept the fact that, when individuals go into a public house, they will now routinely be challenged and asked for proof of identity if they look young? The challenge is often whether they are over 21, although they could, of course, legally buy alcohol at the age of 18. Many public houses will not serve anyone under the age of 21. Does the hon. Member accept the fact that, because this is already in operation, the retailer should have the right to challenge people who look young so that they can make sure that they are only selling to people who are over the legal age to buy?

[Ian Paisley]

That is a very good point when it comes to that threshold between 17 and 21 or 22. The problem is that this generational legislation creates a conveyor belt—from 18 to 19 to 20. Eventually you will be 37 and not be allowed to buy a cigarette under the law. But, if the retailer sells it to you, whether you are a young-looking, handsome 37-year-old or an old-looking boy, you will still end up not having committed a criminal offence, even though you have, but the retailer has committed an offence for selling it to you. At that point, where do the ID checks come in?

Perhaps the intention is that there will be a time in the next five, six, seven or eight years when no one will smoke. I want to turn to that. The one issue that I have pushed hard and heavy on since becoming a Member of Parliament is the criminalisation of illicit sales of tobacco that furnish criminals’ pockets. It is that illegal crime that really worries me.

The hon. Member for Harrow East, who moved the motion today, quite rightly commented on where he thinks the level of public consumption of cigarettes is. I think that the real figure is startlingly higher, because His Majesty’s Revenue and Customs estimates that 11% of cigarette consumption and 35% of hand-rolling tobacco consumption in the UK comes from the illegal trade. People are buying it illicitly, either as stolen products or black market products that have been brought into the United Kingdom. This is happening in a huge number of areas, and it is fuelling criminal gangs.

That is the higher level. There are more people consuming tobacco than some people want to admit but, unfortunately, they are buying it illegally. The Government are not benefiting in terms of tax and legitimate manufacturers are not benefiting. In fact, the companies are disadvantaged because the product is sometimes stolen from their companies, or is a copy—a counterfeit—of their products.

The Government must decide whether they want tobacco to be supplied to UK consumers by a taxed and regulated private sector, as it currently is, or by the public sector as a medicine, which may be one way of doing it, or by the criminal sector, in the same way that cannabis is sold. Those are the choices that the Government ultimately face.

In my view, a generational prohibition will gradually hand even more of the UK tobacco market to organised criminal gangs, who use the money from tobacco smuggling to fund activities including terrorism, people smuggling, prostitution and all sorts of other things. That view is lifted from the US State Department’s 2015 report, “The Global Illicit Trade in Tobacco: A Threat to National Security”. That is why the gangs deploy such resources. When the South African Government banned the sale of tobacco during covid, illegal traders quickly stepped in. Today, 93% of tobacco sold in South Africa is illicit trade and counterfeit trade. We need to get this absolutely right or else we create a bonanza for the criminal. The sooner we do that, the better, and I am sure the Minister will consider those issues.

I do not want to criminalise shopkeepers, and I know the hon. Member for Harrow East does not want that, but that will be an unintended consequence. As people get older, it will be very difficult to judge whether they can be sold a cigarette. Shopkeepers will have to ask for ID, and we do not have ID in Great Britain. In Northern Ireland, we have a form of ID in our electoral cards, but they do not carry a date of birth, although they do show that a person is over the age of 18. That would have to be changed if they were to be used in Northern Ireland.

What are the alternatives? Many retailers and others have suggested that raising the age of sale for tobacco products to 21 would be much simpler to implement and would avoid this potential negative consequence, and the nightmare of regulation. It would be far easier to implement and enforce, and would avoid the complete takeover of the UK tobacco market by criminals. I urge the Government to consider those alternatives in pursuing this incredibly important flagship policy. For the record, I do not promote smoking, but I believe in adults making choices. We have to try to solve the real problem, not create another one.

14:08

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate. I thank the hon. Member for Harrow East (Bob Blackman) for securing it. As with most subjects he chooses to discuss in Westminster Hall, I can echo most of what he says—not on all occasions, but on most. I am very pleased to be here to support him.

I am also pleased to see the shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) in her place and I look forward to her contribution —we have been friends for a long time. I am especially pleased to see the Minister—the Under-Secretary of State for Health and Social Care, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom)—in her place. She came to speak at an association dinner in my constituency, and she was greatly and well received. In fact, not only was she well received, she left a lasting impression on my constituents. I would fear it if the right hon. Lady came to Strangford to run as a candidate—I say that in jest; I very much appreciate the right hon. Lady.

As chair of the all-party parliamentary group on respiratory health, I have spoken many times about my strong support for the UK Government’s Smokefree 2030 ambition and my desire for Northern Ireland to follow the other UK nations in setting our own smoke-free target. Smoking is a terrible addiction that devastates communities across the United Kingdom and will continue to do so unless we take action. I welcome the action that the Government have taken, and my hon. Friend the Member for North Antrim (Ian Paisley) eloquently and forcefully outlined the position for Northern Ireland and the issues that we need to address.

I welcome the Prime Minister’s world-leading commitment to create a smoke-free generation. I was also pleased to see that the Government’s recent consultation on creating a smoke-free generation and tackling youth vaping was held in conjunction with the devolved Administrations. The Government recognised that it was important to bring the four regions together. The Government understand the issues and I hope that the Minister will address some of the issues to which my hon. Friend the Member for North Antrim referred. Northern Ireland and the devolved nations have responsibility for their own public health policies, but we will be successful in achieving a smoke-free future across the UK only if we work together. It is no secret that I always refer to the United Kingdom of Great Britain and Northern Ireland as “better together”. None of my Scottish colleagues is here today, which is a pity; if they were, I would be saying the same thing to them.

I commend the Minister for her vocal support for tobacco controls since being appointed. She was very clear in calling out attempts by tobacco companies to undermine the smoke-free generation policy. That was a clear direction, straight from our Minister and our Government. As the Minister knows, healthcare services are under severe pressure across the United Kingdom. Smoking is the leading preventable cause of death and disease in Northern Ireland; it killed some 2,200 people and was responsible for 35,000 hospital admissions in 2022. Smoking is responsible for more than seven in 10 cases of lung cancer and a similar proportion of cases of chronic obstructive pulmonary disease. The estimated hospital costs for treating smoke-related diseases in Northern Ireland are £172 million. It has a big impact on the Northern Ireland health sector.

There remain significant inequalities in smoking prevalence: those living in the most deprived areas are two or three times more likely to smoke than those living in the least deprived areas. The hon. Member for Harrow East referred to that, and perhaps the Minister could give us her thoughts on it. Inequalities in smoking prevalence also persist among other groups, particularly those with mental ill health: probable clinical depression is four times more common among current smokers than among those who have never smoked. If we do not take urgent action to reduce smoking rates, our already overburdened health service will continue to be put under huge pressure from smoking-related diseases for years to come.

As the analysis for the APPG on smoking and health demonstrates, smoking not only impacts healthcare services but severely undermines economic productivity. The hon. Member for Blaydon (Liz Twist) and I have shared many platforms where I have made that point. The economic impact is clear: smoking places a burden on public finances that far outweighs the income from tobacco taxes, because it reduces direct tax income and increases social security costs.

I also commend “A Vision for a Smokefree Northern Ireland”, which was published by ASH NI and Cancer Focus NI. The vision calls for Northern Ireland to have a smoke-free target of 5% smoking prevalence by 2035. If only that was achievable. It is good to have a goal—we always need a target to aim for—and I hope that we can rectify that soon. Northern Ireland has the highest rates of smoking in the UK. We are nowhere near to being on track. Indeed, we are on track to achieving 5% smoking prevalence by 2042, so it is a brave while away. Therefore we must step up all our efforts, both at the devolved level and at the UK level, if we want to achieve a smoke-free future, which will mean redoubling our efforts to prevent children and young people from starting smoking and supporting existing smokers to quit and stay smoke free.

“A Vision for a Smokefree Northern Ireland” also highlights the importance of strong enforcement to tackle the scourge of illicit tobacco and vaping products, to which my hon. Friend the Member for North Antrim referred. It is one of the big issues for us in Northern Ireland. The sale of illicit tobacco undermines efforts to reduce smoking rates. It is concentrated among poorer smokers and disadvantaged communities, and contributes to higher rates of smoking. Retailers that sell illicit tobacco are much more likely to be happy to sell to children, so the illicit market also poses a particular risk to children’s health, which needs to be addressed. That requires us to tackle not just the supply but the demand for illicit tobacco in communities where smoking is endemic.

The UK has made massive strides in reducing the trade in illicit tobacco over the last few decades. It has reduced the market share of illicit cigarettes from 22% to 11% in some 21 years. However, there is still more to be done. HMRC and Border Force are due to publish an updated strategy to tackle illicit tobacco. Again, that is not the Minister’s responsibility directly, but I am really keen to get some ideas. Northern Ireland, with its land border with the EU, is particularly geographically vulnerable to illicit trade run by criminal gangs. Border Force and HMRC have a key role to play in tackling smuggled tobacco, especially in our most disadvantaged communities where smoking rates are highest. I look forward to seeing the new strategy published in the near future. Maybe the Minister will give us some thoughts on the timescale and when we can aim towards that.

I will ask three or four questions if I may, Mr Sharma. Can the Minister confirm that the new illicit trade strategy will cover illicit vapes, which have become a significant challenge over the last few years and have helped to drive increases in youth vaping across the UK? I look forward to seeing the Government’s response to last year’s consultation on mandating inserts with information on stopping smoking inside tobacco packs. I hope that the measure will be introduced on a UK footprint, benefiting my constituents in Strangford. It is another way of tackling the disease and the problem. It has been required in Canada since the year 2000, where there is substantial evidence showing that inserts are effective in encouraging smokers to quit. The evidential base in Canada shows that the measure has been effective. I think we should be taking every effort to ensure that it happens here.

The Government’s guidance states that responses should be published within 12 weeks or an explanation should be provided as to why it has not happened. Again, if the Minister does not mind, I will ask about that. The 12 weeks was up on Tuesday past. I do not know whether the Minister is able to deliver the news and information we are looking for in the debate today, but I would like to have some update if at all possible. When the consultation closed on 6 December, the Government said that the next steps would be published in the “coming weeks”. That is where we are; we are in the coming weeks, and it would make sense to publish both responses at the same time. To delay the speculation, I would appreciate some clarity.

My second question is: can the Minister confirm when the response to the consultation on pack inserts will take place, and whether legislation to take that important measure forward will be included in the forthcoming tobacco and vapes Bill? I hope that it will be, because deterring children and young people from taking up smoking is vital if we are to create a smoke-free generation. I endorse the Prime Minister’s request, as does the House; we see it as a positive way forward, and the introduction of the warnings would be very positive. The APPG on smoking and health recommended that in both its 2021 and 2023 reports. It seems that the inserts would require only small amendments to the existing regulations—I am not a legislative person, but I have been told that that is the case—not new primary legislation, so we could probably do it easily.

There is a growing body of international evidence supporting the effectiveness of what are known as “dissuasive cigarettes”, particularly in making cigarettes less attractive to younger adolescents and those who have never smoked. Again, the Canadian Government recently announced that Canada would be the first country to introduce dissuasive cigarettes. It is quite interesting. I gave the example of what Canada did in the year 2000, 23 years ago, which is what we are looking towards today. Canada is doing it now on dissuasive cigarettes. May I suggest, Minister, with respect, that it may be time for us to do the same thing now, rather than waiting 20 years to do it?

I recognise that the Government already have a substantial legislative programme to enact before the next election. I understand that they are pushed for time and it is difficult sometimes to get everything in on both smoking and vaping. However, I ask the Minister to at least commit to consulting on warnings on cigarettes, to start the clock ticking on that simple and sensible measure. The UK waited for over 20 years after implementation by Canada to consult on cigarette pack inserts. We should not wait another 20 years after Canada implements warnings on cigarettes before we consult on this important measure.

Thank you, Mr Sharma, for giving me the chance to speak, and so early as well. I look forward positively to the Minister clarifying the issues that I have raised as everyone seeks to work together to find a healthier, stronger and smoke-free United Kingdom of Great Britain and Northern Ireland.

14:19

[Liz Twist (Blaydon) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I congratulate the hon. Member for Harrow East (Bob Blackman) on securing this debate on the APPG on smoking and health’s tobacco control manifesto for a smoke-free future.

I welcome the Government’s bold smoke-free generation announcement, which has my full support and that of my party. The more we can do to prevent future generations from ever taking up this lethal and addictive product, the better. Parliament will stand firm with the Government against attempts to prevent crucial legislation from passing into law. On that note, I was pleased to see the guidance recently published by the Minister’s Department on how all parts of government should act to prevent the tobacco industry’s interference in public policy, in line with our international obligations.

My constituency of Blaydon is in the north-east, a region that has traditionally had a higher prevalence of smoking than the rest of the country, although we have made significant progress in narrowing the gap and lots of action is still being taken. That is thanks to the tireless efforts of local councils and NHS trusts in our region working together to continue the work on smoking cessation, and to the huge efforts of Fresh, our brilliant regional tobacco control programme. I thank Ailsa Rutter and her team for all the work they do locally.

Smoking costs my local authority, Gateshead Council, almost £170 million a year in lost economic productivity and NHS and social care costs. That does not include spending on tobacco, which costs the average smoker over £3,000 a year—a total of £54 million in Gateshead. That spending literally goes up in smoke, providing no tangible benefit to the local economy—not to mention the devastating impact it has on the health and wellbeing of my local community.

One of the groups hit hardest by the health consequences of smoking is people with mental health conditions. People with diagnosed and long-term mental health conditions are more than twice as likely to smoke than the general population. For those with serious mental illness, smoking rates are as high as 40%. That leads to people with mental health conditions dying up to 25 years earlier than the general population, depending on their condition, and smoking is a leading cause of this disparity. As we know, smoking can indirectly contribute to poor mental health through illness, unemployment, poverty and addiction. Helping people to break that vicious cycle is vital if we are to improve the physical and mental health of people with mental health conditions and the population more widely.

At the current rate of decline, people with mental health conditions will not achieve the smoke-free target until the mid-2050s, around 20 years later than the population at large. Although it is positive to see “stop smoking” support being rolled out in mental health in-patient settings, I understand that the roll-out of support in community mental health services has been paused. We need to think about how we support people with mental health conditions right across the board, regardless of whether that is in the community or in in-patient settings. That includes tackling the myth that smoking is an effective form of stress relief, which could not be further from the truth.

There is also far too little awareness about the mental health benefits of quitting. It is vital that we get the message out, but we are still awaiting the response to the Government’s consultation on pack inserts, which was due early this week, as the hon. Member for Strangford (Jim Shannon) has already mentioned. I, too, ask the Minister when the response to the consultation on pack inserts will be available. When will the statutory instrument to take that measure forward be laid before Parliament?

I will finish by sharing an anecdote. Other Members have talked about the impact of vaping on young people and the approach that we should be taking, and I had a salutary reminder about that when I attended a Christmas fair in my constituency last year. I was buying bits and pieces to support traders and to make up Christmas eve boxes for some of the children I know. I bought some very pretty knitted bags from a craft store and was absolutely shocked when I got home to find a packet of Barbie candy sticks inside each one. I thought we had gone well past that sort of thing. Needless to say, I did not use them and they were thrown away. It is important that we are not complacent about how far we have come and how far we have to go, so that really struck me.

It is good to see the bold action that has been set out to tackle such a deadly addiction, but the Government need to do more to ensure that smokers in the most deprived groups are not left behind as we move towards a smoke-free future.

14:25

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Sharma, and to speak in this important debate. It has been great to hear the large degree of consensus across the House on our ambition to secure a smoke-free future. I thank the hon. Member for Harrow East (Bob Blackman) for securing this debate and for his work with the all-party parliamentary group on smoking and health. I also welcome the new Minister to her place.

I thank my hon. Friends the Members for City of Durham (Mary Kelly Foy) and for Blaydon (Liz Twist) and the hon. Members for North Antrim (Ian Paisley) and for Strangford (Jim Shannon) for their powerful contributions on why we need a smoke-free future. They talked about the health impacts that we currently see, but also offered practical solutions.

As we have heard today, smoking is an absolute blight on the health of our society. The “Global Burden of Disease” study found that despite the fall in smoking rates in recent decades, it remains the No. 1 risk factor that causes premature deaths in England. In 2019, tobacco caused an estimated 125,000 deaths in the UK. That is one person every five minutes—a staggering statistic. On average, smokers lose 10 years of life. Not only is smoking an expensive habit, as we have heard, but it is three or four times more common in some of our most deprived communities.

If everyone quit tomorrow, it is estimated that that could lift 1 million children out of poverty. That is to say nothing of the impact on the economy. Not only is it another cost to our NHS, but Action on Smoking and Health has estimated that smoking costs the United Kingdom £32 billion in lost productivity through lost earnings, unemployment and early deaths, and another £15 billion in social care costs. The evidence is overwhelming that for the future of the NHS, the economy and the health and wellbeing of the country, smoking is bad for Britain.

As Primary Care and Public Health Minister, I will drive a prevention agenda forward. The agenda has received many warm words from Conservative MPs and Ministers in the abstract, but very little by way of action over the past 14 years. We in Labour have set ourselves a clear mission to reduce the number of lives lost to the biggest killers. Realising a smoke-free future will be integral to that.

Smoking, of course, is the leading cause of cancer in the United Kingdom. It is strongly linked to cardiovascular disease, which is highly preventable, yet causes one in four deaths in the United Kingdom. Some 15,000 deaths from heart and circulatory diseases can be attributed to smoking every single year, so Labour has set clear targets on both cancer and cardiovascular disease. We will improve cancer survival rates by hitting NHS cancer waiting time and early diagnosis targets within five years so that no patient waits longer than they should, and we will reduce deaths from heart disease and stroke by a quarter within 10 years. Building a smoke-free future will be key to that to help more people make that journey.

We welcomed the Khan review when it was published in 2022, and we were pleased to see some of the recommendations taken forward. I will not use this debate to discuss the Government’s smoke-free generation legislation. We shall await their response to the consultation when it is published—perhaps the Minister can today share the timeline for that. To be clear, the Opposition support phasing out smoking over time, and we encourage the Government to get on with it.

When we proposed phasing out smoking, some Conservatives attacked us. The hon. Member for Blackpool South (Scott Benton), who cannot take part in the debate today, called it “health fascism’’ and

“an attack on ordinary people and their culture”.

I ask those Members what freedom they think there is in addiction. Is it in the average 10 years of life lost by smokers compared with non-smokers? Or the millions of children growing up with parents who smoke? It is a shame that the Prime Minister has failed to convince his MPs of the argument for the reforms and is calling a free vote. But he can rest assured that Labour will vote to see this through.

As Members have highlighted today, the legislation cannot be a substitute for smoking cessation services and other public health measures. Two thirds of adult smokers started before the age of 18; the legislation will come too late for them. Adults who have smoked for years and have not managed to kick the habit need help, too. Does the Minister share my concern that local government funding for “stop smoking” services and tobacco control has fallen by 45% since 2015? Has she assessed the impact of that against the 2030 ambition? Can she provide an update on when the major conditions strategy will be published?

One of the clearest cases to do more on smoking is the impact on children. There has been good progress in recent decades to bring down maternal smoking, but there is more to do. Last year, 9% of mothers were smokers at the time of delivery—still some 50% above the Government’s 6% target. At the current rate of progress, we will not hit that goal until 2032. That is why, as part of Labour’s child health action plan, which was launched today, we would make sure that all hospital trusts integrated opt-out smoking cessation interventions into routine care, with a named lead on smoking cessation, meaning that parents would have all the support they needed to quit and every interaction with the NHS actually encouraged quitting.

Children born to households that smoke are more likely to be born with heart defects, born underweight, or grow up to be smokers themselves—if they grow up at all. Smoking in pregnancy doubles the likelihood of stillbirth. It increases the risk of pre-term birth and miscarriage, and trebles the risk of sudden infant death syndrome. The health of Britain’s children should be non-negotiable. For my part, I want to ensure that children born in Britain today are part of the healthiest generation to have ever lived. But to do that, children deserve a smoke-free start. Can the Minister tell us what she is doing to ensure that every expecting mother is offered the smoking cessation support they need, and that partners, as we heard from the hon. Member for Harrow East, are also encouraged to quit?

For far too long, public health has been either an afterthought or a battleground on which to have ideological arguments. Strategies have been announced and binned in short order, health inequalities have widened, and the long-term crisis in the NHS has deepened. But, just as the last Labour Government delivered one of the most significant public health interventions in history in the smoking ban, the next Labour Government will grasp the smoke-free challenge. We will get serious about prevention, deliver equitable access to smoking cessation services, and take on tobacco companies that profit at the expense of public health. As part of our child health action plan, Labour will make sure that Britain’s children get the happy and healthy start in life that they deserve.

Recently, a school in my constituency had to apologise after handing out a leaflet to a child suggesting smoking as a self-help measure—absolutely shocking and bizarre. That is why Labour has decided to legislate to make tobacco companies include information in tobacco products that dispels the myth that smoking reduces stress and anxiety, and to crack down on businesses marketing vapes to children. We will ensure that the incremental ban on smoking comes into force so that the next generation are not addicted to tobacco. The last Labour Government led the way in tackling smoking, and the next one will do so again.

14:32

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to speak under your chairmanship today, Mr Sharma. I congratulate my hon. Friend the Member for Harrow East (Bob Blackman) on securing a debate on such an important issue, and pay tribute to his work as chair of the all-party parliamentary group on smoking and health. He really has been tireless in holding not only Health Ministers’ feet, but the Prime Minister’s feet, to the fire and making sure that we keep tobacco control a top priority. I am also grateful to the hon. Members for City of Durham (Mary Kelly Foy), for North Antrim (Ian Paisley), for Strangford (Jim Shannon) and for Blaydon (Liz Twist) for their participation today. I welcome the chance to update the House on our progress towards a smoke-free future. I welcome the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) to her place, and look forward to working constructively with her on the tobacco and vapes Bill and other things. I hope there will be much that we can agree and collaborate on.

I want my legacy as Public Health Minister to be weighed and measured by everything we have done to protect the vulnerable in society. Critical to that, of course, is keeping our children safe. We already know that in the United Kingdom, smoking kills around 80,000 people every year, causing one in four cancer deaths; costing £17 billion a year in ill health, lost productivity and demands on the NHS and social care; and putting a huge burden on our health service. Like many others, I have been appalled in recent years to see the number of children vaping treble. It is estimated that no fewer than one in five children have now used a vape.

That is why, in October, the Prime Minister announced action across four areas: first, creating a smoke-free generation by ensuring that children turning 15 this year, or younger, will never legally be sold tobacco products; secondly, supporting existing smokers to quit through significant new funding and support; thirdly, protecting our children from vaping by reducing the appeal and availability of vapes; and fourthly, introducing new action to enforce these rules.

I will address each priority area in turn. First, let us be crystal clear: the tobacco and vapes Bill will save many lives. Unlike other consumer products, there is no safe level of nicotine consumption; it is a product that kills up to two thirds of its long-term users and causes 70% of lung cancer deaths. We are not doing this blind. We already know that action to increase the age of sale works. When the age of sale was raised from 16 to 18 years old, smoking rates for 16 and 17-year-olds in England fell by almost a third. This is a tried and tested policy, and while we have seen some progress, I know there is a lot more to be done—almost 13% in that age bracket are still smoking.

Our modelling suggests that this measure to increase the age of sale will reduce smoking rates in England among 14 to 30-year-olds to close to zero as early as 2040. I am sure that is not early enough for my hon. Friend the Member for Harrow East, and colleagues across this Chamber, who would like to see that happen sooner—as would I. Nevertheless, that is what the modelling suggests. It is progress in the right direction and will save many lives. I am committed to publishing an impact assessment very soon that will set out for colleagues a more complete picture of the costs and benefits of the Government’s smoke-free generation policy.

No one doubts that smoking massively increases the risk of stillbirth; a number of colleagues have raised that today. Smoking also causes asthma in children, and is strongly linked to dementia, stroke and heart failure in old age, as well as to disability and death throughout the life course. Non-smokers, including children, pregnant mums-to-be and their babies are exposed to second-hand smoke, putting them at serious risk through absolutely no choice of their own. This is not about freedom of choice; it is about protecting the vulnerable. Almost every minute of every day someone is admitted to hospital because of smoking, and up to 75,000 GP appointments can be attributed to smoking each month—that is over 100 GP appointments every hour. Reducing that burden will therefore save the NHS money that we can reinvest into research, frontline care and cutting waiting lists.

This measure is not just the right thing for our children’s health; there is a very strong economic case for it too. Analysis by Action on Smoking and Health has estimated the cost of tobacco to society to be £17 billion a year. That figure is out of date, and I think my hon. Friend the Member for Harrow East has just updated it—the Department is very swiftly trying to verify that—but the last published data showed that the directly attributable cost of smoking to society was around £17 billion a year. That dwarfs the £10 billion a year the Treasury receives from taxes on tobacco products.

That cost of £17 billion includes £14 billion lost to productivity through smoking-related lost earnings, unemployment and early death, as well a direct cost to the NHS and to social care of £1.9 billion and £1.1 billion a year, respectively. The cost of smoking to the economy and wider society is equivalent to the annual salaries of over half a million nurses, almost 400,000 GPs, 400,000 police officers, or 400 million GP appointments.

Reducing smoking rates will bring down those costs and help our economy to become more productive. The smoke-free generation policy could provide cumulative productivity benefits of a staggering £85 billion within the next 50 years. That is why the Government are taking such bold and historic action through the tobacco and vapes Bill.

As well as stopping children starting, our second aim is to do more to help current smokers to quit. Quitting smoking is the best thing a smoker can do for their health: someone who quits before turning 30 could add 10 years to their life. That is very reassuring to me; I started smoking at the age of 14 and gave up as my 21st birthday present to myself, by which time I was smoking 40 a day. I was a student—how did I afford it? I have no idea! I am so glad I stopped. For anyone who doubts how addictive it is, I turned 60 last year and still—

[Bob Blackman]

Surely not!

[Dame Andrea Leadsom]

Yes, I know. You can’t believe that, can you?

Even to this day, talking about smoking all the time, I sometimes think, “Ooh a cigarette.” That is how addictive it is—40 years on and I still think, “Ooh!” It is that addictive, and that is absolutely appalling.

We have announced that we will more than double the funding to local stop smoking services across England to a total of £138 million a year, which will help around 360,000 people to quit every year. We are backing these efforts with substantial new money to support marketing campaigns. These measures are easy, common-sense and cost-effective ways to help people to kick the habit.

As colleagues will know, I am passionate about helping new mums, mums-to-be, new parents, new families and their babies, which is why I have asked officials to redouble our efforts to tackle smoking in pregnancy. Women who smoke during pregnancy are two and a half times more likely to give birth prematurely, and smoking is a significant driver of stillbirth. I want to do everything I can to spare parents the awful and heartbreaking tragedy of losing a baby, which we have heard so much about in this place only recently.

On average, just over one in 10 mums smoke at the time of delivery, but that number is as high as one in five in certain parts of the country, as some colleagues have spoken about already. We know that pregnant women who receive financial incentives are twice as likely to successfully quit throughout pregnancy compared to those who do not, so we are working to roll out a national financial incentive scheme by the end of 2024 to help all pregnant smokers and their partners to quit. This will build on our work over recent years to develop high-quality stop smoking support for pregnant women and their partners, with programmes such as the NHS long-term plan commitments on maternal smoking and the saving babies’ lives care bundle.

Thirdly, as I said at the start of my remarks, youth vaping has tripled in recent years. One in five children have now used a vape. I am especially worried about the damage being done to children’s bodies by illegal vapes, which is a growing concern for mums and dads across the country. The health advice is clear: young people and those who have never smoked should not vape. We have a duty to protect our children from underage vaping while their lungs and brains are still developing. There is not yet enough evidence on the long-term impact of vaping on young brains and lungs. I will not stand by while businesses knowingly and deliberately encourage children to use a product that is designed to help adults quit smoking. Those business do so with full knowledge that our children will become addicted to nicotine—well, not on my watch.

We have announced that we will take tough new action to reduce the appeal and availability of vapes through the tobacco and vapes Bill. In our recent public consultation, we sought views on restricting flavours, point-of-sale displays and packaging. On a visit to retail outlets in Hackney, I saw sweet counters and vape counters side by side, with the vapes in pretty packaging with cartoon characters and in little things that look like Coke cans. These vapes are not designed for 60-year-old smokers; they are designed for children, to get them addicted to nicotine.

The consultation has revealed something we already know: there are serious and justifiable environmental concerns over disposable vapes. It is a simple truth that more than 5 million disposable vapes are either littered or thrown away in general waste every week. That number has quadrupled in just the last year. Being sold at pocket-money prices, easy to use and widely available, disposable vapes are, of course, the product of choice for children. More than two thirds of current youth vapers use disposable products. We must and will take action.

Fourthly, a strong approach to enforcement is vital to ensure that our policy actually takes effect. The underage and illicit sale of tobacco, and more recently vapes, is undermining the work the Government are doing to regulate the industry and protect public health. We are cracking down on this evil and illicit trade by backing enforcement agencies including Border Force, HMRC and trading standards with £30 million extra per year. We will introduce powers in the tobacco and vapes Bill to give on-the-spot fines to tackle underage sales. I am pleased we can count on the strong support of trading standards officers right across the country.

Our public consultation closed on 6 December and we received nearly 28,000 valid responses. I am happy to assure all colleagues that we will publish our response in the coming weeks, ahead of the introduction of the tobacco and vapes Bill. I believe that our actions in this space show that the Government are willing to take tough, long-term decisions to protect our children and safeguard the health of future generations.

I will now answer some of the questions raised by hon. Members today; I thank them again for their contributions. In response to my hon. Friend the Member for Harrow East, our public consultation closed on 6 December and within the next few weeks we will publish the consultation. Of course we will then bring forward the Bill, which is, as everybody knows, a top priority for the Prime Minister.

As for the point about a polluter pays levy, the Treasury has looked at that in detail, but so far it has decided against it. I absolutely assure colleagues that I will take that point away and consider it again.

I thank the hon. Member for City of Durham for her invitation to visit her constituency, which I would be delighted to accept. She highlighted the fact that the discrepancy in life expectancy between different parts of her constituency is 50% attributable to smoking, which is a shocking figure. That is not uncommon around the country, so we need to tackle that issue.

I say gently to the hon. Member for North Antrim that when the legal age for smoking was raised, it reduced illicit tobacco sales by 25%; the evidence suggests that far from increasing criminality, raising the legal age for smoking decreases it.

The hon. Gentleman also asked a question about Northern Ireland specifically. I am pleased to tell him that in the Bill we propose to give Northern Ireland the powers to regulate in the same way as the rest of the United Kingdom. There has been a lot of consultation with the devolved Administrations and once the Stormont Assembly—which I urge him to get back up and running —is back up and running, Northern Ireland will be able to legislate to have exactly the same regime as the rest of the United Kingdom.

[Ian Paisley]

I do not know whether it is relevant, Mr Sharma, but for the completeness of the record I ought to have referred to my registered interests. I chair a charitable trust on employment and skills development that is named after Tom Gallaher, a leading industrialist of his age who was a tobacconist. I should just declare that on the record.

On the point that the Minister has just raised, may I ask her to go back to the Department and get advice for us? If Northern Ireland is restricted from regulating on this issue, because of our EU connection through the Windsor framework, even the Assembly would not be able to legislate on it, in the same way that the Danes were unable to do it. I really seek advice on that from the Minister.

[Dame Andrea Leadsom]

I am very happy to write to the hon. Gentleman on that point to give him absolute clarity.

I thank the hon. Member for Strangford for his contribution today. I very much enjoyed the visit that I made to his constituency, which was a long time ago—indeed, many years ago. He spoke about the importance of the four nations working together. I completely agree with him; the UK is much stronger together. I hope that in my remarks I have answered his other questions.

I also thank the hon. Member for Blaydon for her support for the Bill and for pointing out that it is vital, particularly in the north-east where smoking prevalence is higher than average in many other parts, that we really take steps to tackle the issue. I echo her expression of gratitude to local councillors, the NHS and to Fresh, the charity in her constituency, for the work that they have done to try to tackle smoking.

As I have said to the hon. Member for Birmingham, Edgbaston, I hope we can work together constructively to ensure that we introduce these changes as soon as we can.

In closing, I will quickly address the New Zealand Government’s announcement that they will no longer introduce the smoking measures that had been planned there. There have been many calls, not least from the tobacco industry—I wonder why!—for us to row back on our plans following that decision. In response to those calls, I stress that the New Zealand plans included a licensing scheme to limit quite significantly the number of retailers able to sell tobacco and plans to limit the amount of nicotine in consumer products. Our Government are introducing a smoke-free generation, by protecting future generations from the harms of smoking while leaving current adult smokers the freedom to continue smoking if they choose to do so.

[Jim Shannon]

I thank the Minister for her response to the debate. In my contribution, I gave a couple of examples from Canada that we had followed here, and I urged the Government here to follow the new ideas in Canada to dissuade people from smoking. Has she had an opportunity to look at some of the Canadian legislation? I am very simple: if I see something good, I think, “Let’s do it”. If it works there, it should work here as well.

[Dame Andrea Leadsom]

I absolutely agree. We should always keep an eye on what other nations are doing.

I reiterate that our position remains unchanged. This will be world-leading, and we want to be a trailblazer in the absolutely crucial area of protecting future generations; protecting the health of our nation; protecting our future children and babies; and, at the same time, protecting our NHS. Let other nations follow our example. I look forward to working with colleagues right across the House as we bring that to fruition, and I thank them for their contributions.

14:50

[Bob Blackman]

I thank my right hon. Friend the Minister and the shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), for their responses. I will politely and gently point out that every single measure on smoking has always been led from the Back Benches. I well remember that some 11 years ago I was sitting where I am sitting today, leading a debate on the standardised packaging of tobacco products, and both the Opposition Front Bencher and the Government Front Bencher said, “We have no plans for and do not support standardised packaging of tobacco products.” Two years later, it was introduced. Indeed, the smoking ban, originally put forward under a Labour Government, came from Back-Bench pressure, and the Minister at the time was trying to prevent it. We must be clear that Back Benchers lead the way on tobacco legislation.

I thank all hon. Members for their contributions. It is important that we ramp up and keep the pressure on Government to take action. It is good that we have seen actions over the last few months on introducing the Khan review, but we must remember that the proposed legislation does not introduce every single measure recommended in it. I urge my right hon. Friend the Minister to have another look at the Khan review to see what else can be done, possibly without the need for legislation, and to have discussions again with the Treasury on the “polluter pays” levy. After all, we would all like to see more money invested in the health service: let us get it from the tobacco industry, rather than the hard-pressed taxpayer.

I urge the Government to ensure that we take action on vaping and on youth vaping in particular. I am really concerned, as the Minister quite rightly said in her speech, that there is not yet evidence on the damage done by vaping. It must be safer than smoking, so giving up is a good thing to do, but damage is being done and addiction is being heaped on people. In many ways, what we see in vaping is what used to happen with the packaging of tobacco products: they were made to look sexy and cool for young people. We barred that and, as a result, youth smoking dropped. That is vital.

I also welcome the fact that there is cross-party support for the legislation, so we can ensure that we get it through quickly and on to the statute book. However, let us be clear: we need to go further in order to achieve a smoke-free England. It is for not just the next generation, but every future generation to come. Our all-party parliamentary group’s manifesto sets out the measures that we need to take that will just about get us to a smoke-free England in 2030. However, we need action on those measures soon if we are to achieve that, so I commend the manifesto to the House and look forward to the full implementation.

Question put and agreed to.

Resolved,

That this House has considered the matter of a smokefree future.

14:54

Sitting suspended.

New Dementia Treatments

Thursday 11th January 2024 Westminster Hall

15:00

[Damian Green (Ashford) (Con)]

I beg to move,

That this House has considered the matter of new dementia treatments.

It is a great pleasure to serve under your chairmanship, Mr Sharma. I thank the Backbench Business Committee for giving me the chance to introduce this debate.

It is timely to be having this debate at the beginning of this year because in 2024, almost for the first time since dementia became an increasingly widespread condition as people live longer, there are the first glimmers of hope. Alzheimer’s Research UK, which is one of the leading dementia charities, alongside various others such as Dementia UK, is openly talking about a tipping point. We must hope it is right, because the cold statistics and the human cost of dementia show that we desperately need progress on diagnosis and treatment for the set of diseases that cause the condition.

The figures are stark: nearly 1 million people in the UK live with dementia, and on current trends that number will have increased to 1.6 million by 2050. As I speak, in the UK there are no treatments that can slow, stop or cure dementia, and we have been living with that situation for a long time.

We all have constituents who are affected—there are 1,600 people living with dementia in my constituency of Ashford—but I first took a special interest in this issue for the worst possible reason: my father suffered from dementia in his last few years, so I saw close up and over a long time how cruel and debilitating a disease it is, not just for the victim but for the families and those closest to them. I am conscious that others in the Chamber will have had similar experiences. One in two of us will be directly affected, either by developing the disease ourselves, caring for someone with the condition or, in some particularly tragic cases, both.

The history of this disease could hardly be bleaker. It is the dark side of the historically wonderful fact that life expectancy has been rising very fast in recent decades in not just this country but many other countries too. One of the problems we face is that our health system has not been devised to cope with this disease.

Despite that bleak background, there is now a glimmer of hope—indeed, several glimmers of hope. The first is that new ways of diagnosing the diseases that cause dementia, such as blood tests for Alzheimer’s, are showing promise. The second, and the main cause of optimism among those who are involved in dealing with dementia day to day, is the development of treatments that slow the course of the disease. Since the treatments are the new things on the horizon, I will return to that subject in a moment.

The third glimmer of hope is that we are developing new insights that show how we can reduce the prevalence of dementia in the first place by addressing the factors that affect our brain health over the entire course of our life. I was fascinated to read that some experts think 40% of dementia cases worldwide could be preventable. That is clearly a long-term figure that we should bear in mind.

Although all three of those changes are important, for the purpose of today’s debate I want to concentrate on the treatments.

[John Spellar (Warley) (Lab)]

I congratulate the right hon. Member on securing this important debate. Is there not an enormously important fourth strand of this: effective management of the condition and the various aids, adaptations and regimes that enable people to continue to function longer, for the benefit of themselves, their families and wider society?

[Damian Green]

The right hon. Gentleman is completely right. There are new management techniques. I did not want to extend the debate too widely, but I am struck by the way that technology—not cutting-edge technology but technology available to all of us, such as smart speakers—can remind people that they need to take a red pill at 11 o’clock or remind relatives that the fridge has not been opened for five hours, meaning that someone has forgotten to take out their lunch. It can help with all those kinds of day-to-day issues and, if used properly, enable people to live in their own homes for longer, even if they are suffering this disease. I agree that that is a very important potential set of breakthroughs.

[Matt Hancock (West Suffolk) (Ind)]

I am grateful to my right hon. Friend for giving me the opportunity to add my voice in support of more research in this area. Is it not the case that, despite improvements, the amount of money spent on research and the structuring of proper research trials—which, by their nature, have to go on for many years—is a drop in the ocean compared with the savings we can make in the health system, improvements to people’s lives, and in the social care system? Is that not yet another motivation that makes this topic incredibly important?

[Damian Green]

My right hon. Friend has huge expertise over the entire health field and therefore in this area as well. He is completely right, and I will come on to savings, particularly potential savings in the social care budget as well as the health budget, in a couple of minutes. It is one of the points I want to emphasise to the Minister.

To return to the treatments, the Medicines and Healthcare products Regulatory Agency has already started consideration of lecanemab and donanemab—I wish treatments had more pronounceable names—two very important breakthrough drugs, and I believe a final decision is expected by the middle of this year. Inevitably, at this early stage of the development of drugs in any particular field, there are many more out there. Another 140 drugs are undergoing clinical trials around the world at the moment. They will not all work, but some of them will, so in scientific and research terms, this is genuinely an exciting period in this field.

Perhaps the most significant point I want to make to the Minister is to express the hope that the way in which the system decides whether to approve a drug is fit for purpose for this type of drug. That is genuinely in question and gives rise to the point my right hon. Friend the Member for West Suffolk (Matt Hancock) made about costs. There are inevitable gaps in our knowledge about the efficacy of new treatments in an area where, up to now, there have been no treatments. Much of the usual comparative work one would expect to be done in clinical trials cannot be done in these circumstances, so there is a task for Ministers to make sure that NHS bodies and the industry develop a joint plan to allow these new treatments to be available to the NHS at a reasonable price.

There is also an important specific point that could affect whether the National Institute for Health and Care Excellence gives financial approval to these treatments in the first place. The bulk of the current costs of dementia falls on the social care system, particularly on unpaid carers. Estimates suggest that around £22 billion a year of costs fall on informal or formal social care. The direct costs to the NHS are only £1.7 billion a year—a small fraction of the cost to the social care system. The current NICE assessment process will take into account only the NHS costs, and clearly that could adversely affect a decision about whether drugs are affordable.

Whether the current NICE system provides the proper result for this type of drug and disease would be questionable at any time, but it is particularly questionable when other arms of government are concentrating on getting more working-age people back to work. More than 1 million people between the ages of 25 and 49 are out of work because of caring responsibilities, and some of those will be caring responsibilities for people suffering from dementia, perhaps in its early stages, when we are not using technology well enough to allow people to lead more or less normal lives.

[Mr Philip Hollobone (Kettering) (Con)]

My right hon. Friend is making an excellent speech and a particularly pertinent point about NICE considering only the cost to the NHS. Is that not even more surprising given that NICE stands for “National Institute for Health and Care Excellence”? Clearly, the guidelines need urgent revision.

[Damian Green]

I am delighted to have my hon. Friend’s support. Since the old Department of Health was renamed the Department of Health and Social Care, it has been particularly important that, in all its manifestations, and indeed in all the manifestations of the bodies that report to it, the Department should reflect the treatment of health and social care as equals. That is a wider point that my hon. Friend should not tempt me to; I can go on at great length about it, and do not wish to in this debate.

As I said, caring responsibilities are a significant reason why so many people of working age are not working. I cited the figure for those between 25 and 49, but if we extend the age range up and down, less than a fifth of people who care for someone with dementia are in paid work. If someone is caring for someone with dementia, it is very likely that they will not be in paid work. I am grateful that others support my point that NICE should be instructed to consider the full cost of dementia to social care, as well as the NHS, to arrive at a proper evaluation of the economic case for the new treatments.

The prospect of these drugs becoming available also throws a spotlight on the need for better and, in particular, earlier diagnosis. At the moment, the drugs are effective only in the early stages of Alzheimer’s, and there is nothing like enough capacity for timely diagnosis. The latest NHS figures suggest that more than a third of the over-65s estimated to have dementia do not have a recorded diagnosis at all. There are significant regional variations within that figure. Some areas of the country are much worse: for example, diagnosis rates in Herefordshire and Worcestershire are as low as 53%. There is also evidence that minority groups, including black people and those of south Asian heritage, have higher rates of under-diagnosis. Without an increase in the effectiveness and timeliness of diagnosis, the beneficial effects of the new treatments will therefore be massively reduced.

For the new hopes I am discussing to be realised, we therefore need a revolution in our diagnostic capacity. At the moment, the most effective ways of diagnosing dementia—namely, PET scans or lumbar punctures—are accessible only to 2% of those seeking a diagnosis. The best short-term solution is to increase access to lumbar puncture, which is much cheaper and more scalable than expanding the expensive scanning equipment. Alzheimer’s Research UK suggests that the annual capacity for lumbar punctures should be increased from 2,000 to 20,000 a year. I am conscious that the Government are analysing the responses to the consultation on the major conditions strategy and that dementia is one of the six conditions covered by the strategy. My appeal to the Minister on that front is that, as we do in many cases in health and social care, we think at least as much about prevention as we do about cure.

Given the demographic pressures, it seems unarguable that, if we carry on as we have done since the NHS was created, concentrating almost entirely on treatments while relatively neglecting public health and preventive measures, we are heading for even more difficulties in the long run. But that is a much wider debate. In the specific area of preventing dementia, a number of factors, including hearing loss and high blood pressure, can and should be part of a preventive approach, which would reduce demand for expensive treatments in the long run and, even more importantly, allow people to continue to lead more or less normal lives.

One other point about the new era that we are hopefully entering with these treatments is that, as a country, we are well placed to contribute to the vital research that is needed. We have the scientists and the companies, but too few people are currently aware of the possibilities. Only 2% of people with a dementia diagnosis are currently registered to hear about clinical trials. The total UK share of the current clinical trials for dementia around the world is 7%. I hope that the Government will look at that aspect as part of the overall plan for dealing with dementia, which we are looking forward to.

Before I sit down, I should emphasise that I do not want to be ungenerous or over-critical about the Government’s action in this area. I am conscious that the Government have committed to doubling the funding for dementia research to £160 million by the next financial year, and I also very much welcomed the launch, last summer, of the Dame Barbara Windsor dementia mission; I am glad that the Government have put £95 million behind that. I know, of course, that the Minister and the Government widely recognise the horror of this disease, the fact that it is becoming more widespread and affecting more and more families and the fact that not just more money, but more creative thinking, will be needed to turn the tide.

I want to end on a hopeful note. This generation has the chance to see the end of the terrible situation whereby a diagnosis of dementia is a life sentence of an inevitably long degeneration. This absolutely needs to be a turning point for the millions of people who are touched by this dreadful disease. I hope that the Government and the medical authorities recognise the scale of the opportunity that scientific advance has given to them and all of us. This year could be key to setting the UK on a path to a more hopeful future. I am very confident that the Minister will be determined to lead us on that journey.

15:18

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is a pleasure to serve under your chairship this afternoon, Mr Sharma. I congratulate the right hon. Member for Ashford (Damian Green) on securing this very important debate and on his excellent speech. I learned a few things from that speech, and I had thought I was quite well informed on the developments in dementia research.

As some people may know, my mum, Angela, was diagnosed with Alzheimer’s disease when she was 64. I, along with my stepfather and brother, cared for her until she died in 2012. It was that experience that drove me, first of all, to be the first MP to become a Dementia Friends champion. As the right hon. Member knows, I was subsequently elected as co-chair of the all-party parliamentary group on dementia.

When we talk about dementia, we are using a collective term that covers the common symptoms associated with a range of brain diseases. The most common of them is Alzheimer’s disease, but there are dozens of others. My mother-in-law was diagnosed with vascular dementia in her 80s, and there is also dementia with Lewy bodies, frontotemporal dementia and, as I say, dozens of other conditions. Each of those diseases has a different pathology and, as a consequence, the specific therapies that we are talking about today will not necessarily be appropriate for them; they will need to develop their own specific therapies.

I absolutely agree with the right hon. Member for Ashford that this is a time of hope, because we are making groundbreaking discoveries and there have been developments in the therapies. I also totally concur with him about the importance of prevention. We know that what is good for our heart is good for our head as well. The previous debate that you were chairing, Mr Sharma, was about smoking and tobacco use; we know that has a significant impact on dementia prevalence.

I will reiterate some of the points that the right hon. Gentleman made about dementia. First, on prevalence, there are 900,000 people living with dementia in the UK, and that is likely to increase. I will pick him up on his point that life expectancy is increasing. It is not increasing; it is flatlining and has been since 2017. In areas such as mine, it is actually going down. The prevalence of dementia is reflected in that trend. I point people to the excellent work of Professor Sir Michael Marmot, who this week published his update that the picture is not changing, unfortunately.

People with dementia account for more than 70% of those in residential care homes over the age of 65, and 60% of those receiving home care. As we will have seen from today’s NHS performance data, it is estimated that a quarter of NHS beds are occupied by people with dementia, who remain in hospital on average twice as long as people who do not live with the condition. Again, I agree with the right hon. Gentleman that, unfortunately, that reflects the crisis we have in social care. We just cannot discharge people from hospital knowing that they are not going to have the support that they need, whether that is in the community or in specialist residential care beds. In addition to his point about NICE, we also need to be serious about the future of social care reforms, particularly the reforms recommended back in 2015 by Andrew Dilnot.

Most importantly, we need to recognise that dementia is now the UK’s biggest killer. It has overtaken heart disease and cancer as the biggest killer in the country. We also need to understand that dementia is not a natural and automatic part of ageing. Although, yes, because we are an ageing society, there will be an increase in the prevalence of dementia, it does not mean that we automatically get it as we get older. It is clear that dementia is the most significant health and social care challenge of our time.

I was disappointed that dementia has not had the political priority that it deserves. I was disappointed that the Government decided to absorb dementia into the major conditions strategy, and not give it the focus and attention that it deserves for all the reasons that the right hon. Gentleman has given. Unfortunately, that reflects a number of things, not least what is wrong with our political system and the short termism driven by where we are in the political cycle.

Despite the serious challenges, this is an incredibly exciting time for dementia research. I advise people to look at the all-party parliamentary group’s report on dementia research, which we conducted a couple of years ago. It went right through all the developments, from prevention and looking at biomarkers all the way through to the quality of care and the evidence base around that. There is a lot to be excited about.

In the past 18 months, we have seen the announcement of two effective disease-modifying treatments for early-stage Alzheimer’s that have been proven to slow the progress of the disease by 20% to 40%. That is really significant, and I share everybody’s excitement about it. Lecanemab and donanemab target and remove a protein called amyloid, which is what builds up in our brain and is harmful to it. It basically stops neurones communicating —not just with each other in the brain, but with all different parts of the body as well. They are really important drugs that will reduce the build-up, or clogging-up, of the neurones. As an aside, when I was undertaking personal care for my mum as she got to the late stages of her life—lifting her, lifting her head, and so on—I could feel the change in the shape of her head, because her brain was shrinking; it was just imploding on itself. I hope that gives a sense of what is happening in somebody with Alzheimer’s and of the ravages of the disease.

To have two new disease-modifying drugs for Alzheimer’s disease in the space of a year is a turning point in the fight against the disease and could mean the beginning of the end of this devastating condition. Science is proving that it is possible to slow down the progression of the condition, and lecanemab and donanemab are the first of what we hope will be many more effective treatments. Hopefully, one day, Alzheimer’s disease could be considered a long-term but manageable condition alongside diabetes and asthma.

Lecanemab has already been approved as a safe drug by the Food and Drug Administration in the United States. As we have heard, we expect the Medicines and Healthcare products Regulatory Agency to make a decision very soon. Then, of course, there is the clinical guidance associated with the implementation and use of these drugs, which is undertaken by NICE. I have to say that I had not picked up that, as the right hon. Member for Ashford said, it would look only at the impact on social care. I hope the Minister will respond that she will be writing to NICE to say that is just not acceptable. As co-chair of the APPG on dementia, I am quite happy to write a letter along those lines as well, together with the chair of the APPG on adult social care, the right hon. Member for Ashford. It just cannot happen. I urge the MHRA and NICE not to procrastinate, and to try to get this sorted as soon as possible without compromising the validity of their assessments.

However, very worryingly, even if these drugs were given clinical approval tomorrow, we would unfortunately not be in a position to make use of them. That is the state of our health system at the moment. For lecanemab and donanemab to be effective, they require an early diagnosis of dementia and a specific sub-type diagnosis of Alzheimer’s disease. In England alone, a third of people with dementia do not have a diagnosis, and many only have a non-specific diagnosis of dementia. Currently, none of those individuals would be able to access these novel therapies.

A few months ago, the APPG on dementia produced a report on diagnosis rates and the inequalities in the diagnosis rates. I heard of a diagnosis rate lower than the rate of 50% in Hereford mentioned by the right hon. Member for Ashford: a rate of 40% in Devon. The top marks go to Stoke. For whatever reason, Stoke seems to be doing very well, with a diagnosis rate of over 80%. Oldham, at 78%, has got a little bit of catching up to do to Stoke, but we are quite pleased with the direction of travel. We have not recovered to the pre-pandemic diagnosis rates. We all need to recognise what we can do about that.

I urge the Government to look at the following three areas as a matter of urgency. First, not enough people are being diagnosed at an early stage of disease progression. Many memory services are struggling to meet current demand, let alone the expected increase if disease-modifying treatments do become available. Secondly, there is a lack of sub-type diagnosis. As I mentioned at the start, there are more than 100 different diseases that cause dementia. Too often people receive a general diagnosis of dementia without a sub-type. Without that, it is impossible to determine an individual’s suitability for the new drugs.

Thirdly, there is insufficient access to positron emission tomography scanners and cerebrospinal fluid testing—the lumbar puncture testing that the right hon. Member for Ashford mentioned. As I mentioned, a specific diagnosis is required and the PET scanner and CSF test are the only tests that can give evidence of the presence of amyloid in the brain, but access to those tests is woefully restricted due to lack of equipment. I had not picked up on the cost-effectiveness, so I thank the right hon. Member for raising that.

Workforce and diagnostic barriers can be overcome with clear and decisive action from Government. I want to see at pace an expansion of diagnostic capacity so that everyone with suspected Alzheimer’s disease can access a test to confirm eligibility for treatment at an early stage in their disease progression. We must address the current inequalities in diagnosis across the country.

We need a transformational change to the diagnostic workforce to ensure sufficient workforce capacity with the necessary skills and expertise to administer the required specialist tests and make diagnoses. Meaningful involvement of the people living with Alzheimer’s disease and their carers must be central to plans for system preparedness, with continuous consultation from the outset and ongoing oversight through an established group.

I am sure we would all agree that we are at a pivotal moment for dementia in this country. Lecanemab, donanemab and the treatments that might follow have the potential to improve the lives of hundreds of thousands of people, but we need to act now to ensure we are ready to deliver them as soon as they become available. We have come such a long way in the past 20 years, with incredible advances in scientific research that has culminated in the discovery of those novel drugs. Such effort cannot be wasted by Government inactivity and failure to respond.

Simply put, scientists are doing their job to give us new treatments, but now it is up to the Government to do theirs and ensure the system is ready to deliver therapies to the people who need them. It is time to make dementia a priority and we should make a start.

I thank the Alzheimer’s Society for its support with the APPG.

15:32

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairship this afternoon, Mr Sharma. I thank the Backbench Business Committee for granting this debate. I pay tribute to work of the right hon. Member for Ashford (Damian Green) and my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams). They are formidable chairs of their respective APPGs on adult social care and on dementia. I know that the Minister has great respect for them, as we all do; they do fantastic work. Sharing the experiences of supporting family members was very apparent in this debate, and my hon. Friend’s image of holding her mother and feeling the ravages of the disease was incredibly well put. We have heard very moving statements this afternoon.

We are holding this debate at a crucial time for our country. We are a world leader—sometimes we overuse that term—in life sciences research that offers people living with dementia the prospect of new treatments as a lifeline. Finding a cure is where we all want to get to. The new treatments provide real hope and opportunity, but how do we get there? We have touched on that. New treatments and research help, but the workforce is where we will make a big difference. That is why we have committed to recovering clinical trial activity in the UK and delivering on the NHS long-term workforce plan.

We want to make sure it is easier to conduct lifesaving research in the UK for conditions such as dementia by implementing a more efficient set-up process so that people can sign up to participate in trials more easily, but that has to be supported by ensuring our NHS has the staff it needs to enable more clinical trials. Without the workforce to deliver new treatments, those living with dementia and their families will continue to face delays and we will not be able to access the benefits of early diagnosis. That is why I am pleased that the Government have finally accepted the need for a long-term workforce plan in the NHS.

As my hon. Friend the Member for Oldham East and Saddleworth said, it is disappointing that the Government shelved the plans for a dedicated dementia strategy. England remains the only nation without a specific dementia plan. That is very short-term thinking, and it would be interesting to hear from the Minister about that. In 2022, I said:

“We cannot give confidence to people suffering with dementia and their carers without a much clearer plan that is in place very quickly.”—[Official Report, 14 June 2022; Vol. 716, c. 141.]

That remains the case today.

Although we currently have no treatments to slow or cure dementia, as we have heard, there is hope on the horizon after the recent breakthroughs with drugs that target the underlying causes of Alzheimer’s disease, which are a hugely welcome step towards combating it. We need to ensure that our health service is ready and able to deliver the new treatments and technologies when they become available. The treatments, if approved, will depend on early diagnosis, which can be determined only by a PET scan or a CSF test. As the right hon. Member for Ashford said, the health service was not set up in 1948 to cope with dementia and similar diseases, so we need a 21st century service that can. It would be helpful to hear what plans the Minister has to ensure that the NHS is ready to deliver the new treatments. Has she had any discussions with NHS England about delivery ahead of the potential MHRA decision this year on the drugs currently under consideration?

There are too many people living with undiagnosed dementia. Part of the problem is the lack of scanning capacity for accurate diagnosis of dementia sub-types. We have one of the lowest per capita ratios of diagnostic scanners in the OECD, behind Russia, Slovakia and Chile. What steps are the Government taking to increase that diagnostic infrastructure? We have put forward a clear and costed plan to double the number of scanners, and, as with many of our other policies, the Minister is welcome to borrow it.

In a response to a written question last month, the Minister restated the commitment to double funding for dementia research, but I would welcome an update on whether that is on track for delivery this year. Further research continues to be vital to ensure that people living with dementia receive an early and accurate diagnosis. We have heard today about emerging techniques and new technologies, but we have to be able to access them.

It is estimated that more than 1 million people aged 25 to 49 are out of work due to caring responsibilities, so we need to alleviate the challenges and economic strain as a result of those caring for people living with dementia. It is not good for them, their families or, indeed, our economy. New treatments bring hope, but to benefit from them, we need a Government with the competence and foresight to seize the opportunity. Transforming dementia diagnosis and care is vital to improve the lives of those living with dementia and those who care for them. The bulk of the cost of dementia falls not on the NHS, but on unpaid carers and the care system, as hon. Members have said so eloquently today.

After 14 years, Mr Sharma, you would expect me to say that the Conservative party is not capable of making the NHS fit for the 21st century, let alone making the most of the new opportunities that our life science sector present for people. We want to make the NHS fit for the future, so that we are able to benefit from the exciting new treatments being developed and that all those with dementia and their families can be confident that they will receive the support they deserve.

15:39

[The Minister for Social Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I congratulate my right hon. Friend the Member for Ashford (Damian Green) on securing this debate. I also commend the campaigning of several charities in this area, including Alzheimer’s Research UK, the Alzheimer’s Society, Dementia UK, Age UK and many others that do so much to raise awareness of dementia, fund research, and support people with dementia and their carers.

I commend my right hon. Friend on his speech. Like many, he has his own experience of dementia with his father, which has clearly informed the significant work that he has done in this area. He spoke about some of the statistics, which I will come on to, and about how a dementia diagnosis can be a bleak prospect. He also spoke about some glimmers of hope for people with dementia and for us as a society—for instance, the fact that dementia can be preventable for some people; our growing understanding of the importance of brain health and how we achieve it; and the progress being made towards treatments that can genuinely make a difference in the future for people with dementia. I heard his specific question about the evaluation by NICE of the treatments and whether the evaluation approach is fit for purpose; I will come on to that shortly.

My right hon. Friend also talked about the importance of better and earlier diagnosis. Indeed, he mentioned that, at the moment, more than a third of people who have dementia are estimated not to have a diagnosis, although, clearly, the other side of that is that about two thirds of people do have a diagnosis. Although we know that the pandemic hit our ability to diagnose people, we have seen some recovery in the diagnosis rate since the pandemic. It is now at the highest level for three years. He rightly said that, overall, for this area, as for many others, prevention is at least as important as a cure. He spoke about the opportunity, in that dementia diagnosis should no longer be a life sentence for this generation, which is an uplifting prospect for all of us involved.

We also heard from the hon. Member for Oldham East and Saddleworth (Debbie Abrahams), who spoke about her experience with dementia and how she cared for her mother Angela when she had Alzheimer’s, until she died. I have huge respect for her, knowing how difficult that must have been. She is also extremely knowledgeable about dementia and spoke about the many different sub-types of dementia, and I thank her for her work as the chair of the all-party group on dementia.

The hon. Lady spoke about hospital stays for people with dementia; a significant number of people are in hospital with dementia. As part of my brief, I have oversight of discharges from hospital and urgent emergency care, and I have spent a lot of time thinking about the flow through hospitals. I think a lot about people with dementia and how we can support them to be discharged to the best place for their care afterwards, or how we can avoid long stays in hospital for them. It can then be so difficult for them to be discharged, given the potential deconditioning that happens to people in hospital.

The hon. Lady rightly talked about how dementia is now the No. 1 cause of death in the UK, but it should not be seen as inevitable for us as we age, and in an ageing society. I heard her three asks, calling for dementia to be diagnosed more often at an early stage; for us to do better at diagnosing sub-types of dementia; and for us to improve access to PET scans and lumbar punctures for diagnosis. I will come to some of those points in a moment. I can definitely agree with the Opposition spokesperson, the hon. Member for Bristol South (Karin Smyth), that we have heard speeches from formidable colleagues in the debate, as well as from a number of others who joined us and contributed through interventions.

I will start with the impact of dementia. We know that close to 1 million people in the UK suffer from dementia. Around 900,000 people over the age of 65 and almost 50,000 people under the age of 65 are estimated to have dementia. We expect those numbers to increase to more than 1 million by next year and more than 1.5 million by 2050.

The stats are one thing, and they clearly point to the scale of dementia in our society, but they do not necessarily bring to life the human cost of dementia—what it means for people who have it, their families and friends, what it means practically for someone with dementia and those close to them, and what the challenges are of living with dementia or caring for somebody with it. There are significant financial burdens, both on people working who are then diagnosed and may be unable to work, so they have lost income, and on carers, who may have to cut back their work hours or leave work altogether. There are then the financial costs of professional care, whether that is state-funded social care for those who receive it, or self-funded care.

Most significantly, there is the emotional cost of dementia—what the diagnosis means for the individual who learns what is making life so difficult for them and knows the prospects ahead as the disease progresses, what it means for those they love, and what the experience is like for people who are close to them and care for them. It can be very difficult to care for somebody while at the same time feeling as if the person they know and love is being stolen from them. That emotional cost is unquantifiable, but we know that it hits very hard.

Like other hon. Members, I feel that I have painted a pretty bleak picture of what dementia means to our society, but I have no doubt that there are real reasons for optimism. First, we now understand that a significant proportion of dementia—it is estimated to be around 40%—is either preventable or at least delayable, and that we can actually make a difference. Secondly, real progress is now being made in the research into treatments, and there is the prospect of treatments becoming available that will genuinely make a difference to the progress of the disease. There are real reasons for optimism, although, as a Government Minister, I feel that optimism on its own is not enough.

The question that I am sure hon. Members would like me to answer is what we are actually doing to realise this potential and turn the optimism into improved outcomes. To prevent and delay the onset of dementia, we are and have already been acting and intervening to influence the risk factors. We know that we can influence them. For instance, the known risk factors for dementia, similar to other conditions such as cardiovascular disease, include high blood pressure, obesity, diabetes, smoking, poor diet and lack of physical activity. These are things that we can and are intervening in.

For instance, we offer a health check for all adults aged between 40 and 74 in England to identify the early signs of stroke, kidney disease, heart disease, type 2 diabetes and, indeed, dementia. Dementia was incorporated specifically into that health check, in part to raise awareness of the fact that people can make a difference and reduce their risk of dementia, and to motivate people to take steps to reduce that risk. There is a much greater awareness that people can make a difference and reduce their risk of suffering from heart disease or diabetes. Alzheimer’s Research UK has found that about 70% of people know that they can reduce those risks, but less than a third of people know that they can reduce their risk of and prevent themselves from getting dementia. We have offered that health check to over 9 million people, and about 3.7 million people have had it already. We will continue to encourage people to take that up.

Looking ahead, there is more that we can, should and, indeed, will do to prevent people from suffering ill health, prevent dementia and help people to maintain their health. That is at the core of our major conditions strategy, to which my right hon. Friend the Member for Ashford referred. Crucially, that includes dementia, alongside the five other major conditions that represent the major burden of ill health in the country, including cancer and cardiovascular disease.

The hon. Member for Bristol South questioned the point of having a standalone dementia strategy. Actually, it is very important to include dementia with other major conditions and major causes of ill health, partly because we are moving towards having a society in which many people suffer from multiple health conditions. In fact, many older people will have dementia alongside other health conditions, so it makes sense to look at people’s health in the round, not just pick one condition.

As I mentioned a moment ago, dementia is a common risk factor for many major conditions, so it makes sense for our health system not to look at any condition in isolation, but to look at how we can improve people’s health in the round and reduce their risks. The major conditions strategy is absolutely the place where I point right hon. and hon. Members to look at our evolving Government strategy to address some of the health and lifestyle factors, to move into prevention and to support people in the event that they receive a dementia diagnosis.

The other area where there is cause for optimism is the progress that is being made in the research and development of new treatments. Finding a treatment to slow or, indeed, cure dementia, rather than just manage it, would change the implications of receiving a diagnosis and make such a difference to thousands or even millions of people in the UK and globally. This is a challenge that we share with many other countries, particularly those in the developed world, and we are rightly collaborating internationally on research.

Since 2018, the Government have spent over £454 million on supporting dementia research. In 2019, we made a manifesto commitment to double our funding for dementia research to at least £160 million a year. We have since launched the Dame Barbara Windsor dementia mission, backed by £95 million of Government funding. The UK Dementia Research Institute, of which the Government are a founding member, recently announced a new partnership with the British Heart Foundation to establish a centre for vascular dementia, backed by £9 million-worth of funding. Vascular dementia is the second most common form of dementia, affecting around 150,000 people in the UK. We are determined to be a world leader in dementia research and to be recognised as such.

I turn to some of the new treatments. My right hon. Friend the Member for Ashford referred to lecanemab and donanemab as two of the treatments about which there is great excitement. Crucially, the Government want to make sure that treatments are made available to people as soon as possible through the national health service. It is important to sound a note of caution, because we know that such treatments do not come without side effects; in fact, the trials saw some significant side effects, such as the risk of brain bleeds. As ever, it is very important that we follow the proper processes that we have in place to assess the use of treatments by the national health service. That includes both licensing through the MHRA and evaluation by NICE. For the two drugs I mentioned, those processes will happen during the course of this year.

My right hon. Friend asked what NICE takes into consideration in its evaluation. I can assure him and other Members that NICE takes into account all health-related costs and benefits, including the health benefits to carers of a treatment. It also considers the publicly funded cost of social care, so there is a social care element taken into consideration by NICE. I say that very specifically: I wanted to make sure, so I have double-checked in order to be accurate in saying it in this Chamber this afternoon.

I acknowledge and recognise the points that my right hon. Friend and others have made about the impact on unpaid carers and the economic cost. It is true that there is a limit to the costs that NICE considers. Clearly, looking at all the possible broader economic costs involved would have implications not only for dementia treatments but for the many other treatments that NICE considers. As that is a very big question, not just one that is pertinent to dementia, it is probably worthy of a separate conversation in its own right. Nevertheless, I assure him and other hon. Members here today that the publicly funded cost of social care is taken into account by NICE in its evaluation process.

There is also the question of the readiness of the national health service to make drugs available if they are successful through both the licensing process and the NICE evaluation. I assure hon. Members that NHS England is indeed working to ensure that the NHS is ready to support the adoption of new treatments, including the diagnosis processes that will be needed, while recognising—I believe the hon. Member for Oldham East and Saddleworth referred to this—that new treatments are likely to require greater access to forms of diagnosis such as PET scans and lumbar punctures, and also recognising that such treatments are likely to require earlier diagnosis in order to be effective.

One thing that I look forward to is that, particularly as treatments that require an earlier diagnosis become available, more people will come forward to seek a diagnosis, as they recognise that getting an earlier diagnosis will really make a difference, and then there will then be access to treatment. I feel optimistic that we will see a virtuous cycle where people learn that getting an early diagnosis can really make a difference in getting access to treatment.

[Debbie Abrahams]

I am reassured to some extent by what the Minister says, and I am grateful for her tone and her positive approach. Given the inequality—let us call it what it is—in current diagnosis, and these are non-specific dementia diagnosis rates, have she and her Department conducted any analysis of the gaps in more specific PET and CSF testing? Can she publish that data or write to us with it? That would reassure us, because rather than just hoping something will happen, we could identify it: “Yes, in Greater Manchester we are at 90% of the level we need for all these tests,” and similarly in Kent and so on. If she could do that, it would be very helpful.

[Helen Whately]

I fully appreciate the hon. Member’s question, and I can assure her that I do look at the variation in diagnosis rates between different areas, as she rightly pointed out in her speech. I would be happy to write to her with further detail on the specific question of more sophisticated diagnosis techniques and our readiness for new treatments and for carrying out earlier and more sophisticated diagnoses.

I assure hon. Members of the Government’s ambition for the UK to be a world leader in dementia research, diagnosis and treatment; I would also like us to lead the world in the prevention of dementia. That is why the Government are investing in research. We are getting ready to make new treatments available and building on what we are already doing in prevention with our major conditions strategy. Given the scale and impact of dementia on our society, successful prevention and treatment are not just a nice-to-have, but an imperative for individuals, for their families, friends and loved ones, and for our society.

15:59

[Damian Green]

I will spare hon. Members the thought that I could go on for another half an hour, I think, under the rules—[Interruption.] I can hear shouts of “More!” from the Minister. I thank all those who have taken part, particularly my fellow APPG chair, the hon. Member for Oldham East and Saddleworth (Debbie Abrahams). There is clearly a Venn diagram with an overlap between the APPGs on adult social care and on dementia; we share an interest in this as chairs, as well as an interest driven by personal history.

I hear what the Minister says about the NICE funding decision-making algorithm. Through her, I urge NICE to be as open-minded as possible as to what costs it takes into account. I do take the Minister’s point that one can perhaps extend the boundary of what costs are caused by any particular medical condition beyond what is reasonable. However, I think the costs to the economy of those who are not working only because they are caring for someone with dementia are a genuinely legitimate cost that could be taken into account when assessing the economic viability or effect of introducing a particular treatment. I hope that the NICE guidelines can reflect that. Otherwise, I am very grateful to have had the chance to raise these subjects in this debate.

Question put and agreed to.

Resolved,

That this House has considered the matter of new dementia treatments.

16:01

Sitting adjourned.