Tuesday 30th April 2024
(7 months, 3 weeks ago)
Public Bill CommitteesTobacco and Vapes Bill 2023-24 View all Tobacco and Vapes Bill 2023-24 Debates Read Hansard Text Amendment Paper: Public Bill Committee Amendments as at 30 April 2024 - (30 Apr 2024)
The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)
Do you want me to ask both questions now?
Dame Andrea Leadsom
Could you talk us through ASH’s assessment of the economic cost to the UK economy of smoking? Secondly, what is your view on the importance of restricting vaping for children?
The Chair
Can we start with Sheila Duffy, please?
Sheila Duffy: In terms of a complete ban, you are talking about a ban on retail distribution of tobacco. The hope is that we will put it out of sight and out of fashion for the generation growing up. My preference is always to look at the product and the industry, rather than the consumer, so we need to maintain other issues like good fiscal policy, high price and tax.
On packaging and flavours, we know that the tobacco industry sold the sizzle on tobacco—it sold the image, it sold how it made people feel and it sold the very short-term-felt attractions and benefits. In the 1950s, people were recommended smoking to appear glamorous, to appear rugged and confident and to clear their chests in tuberculosis hospitals, and we did not know at that time how devastatingly harmful it was to health and how many years of life it would rob people of.
We must learn the lessons. It is the sizzle. It is the packaging, the marketing, the promotions that we must get on top of with vaping products, because that has driven the interest among young people, and the exponential —the doubling, tripling of regular use among children that were not smoking. There is a link between regular vaping and moving on to smoking, which I can send you the evidence for.
In terms of the economic cost, the World Bank looked at this years ago. Tobacco is not good value for any economy because the long-term costs are huge. What you are talking about is privatising the profit but socialising the costs, and that is a huge burden on the NHS and a huge burden on people’s lives. It undermines their health and the health of their families.
The final question was on the importance of restricting e-cigarettes for children. Well, let us learn the lessons from tobacco and let us take some strong steps to stop the next generation becoming addicted. I note that the devices mainly being used under-age and by children are of the highest permitted nicotine level. They are advertised with bright colours—cartoon characters in some places. They are absolutely all over social media and there is money going into influencing. These are being targeted. We are not talking about medicinal use. We are talking about recreational products, which are addictive and health-harming. We have to get on top of this.
The Chair
In view of the pressure on time, I ask the two other witnesses, if they agree with what has already been said, to say so and then make any additional points that need to be made. Obviously, if you do not agree, that changes the nature of it.
Deborah Arnott: I agree with the points being made. On the costs of smoking, the Minister has cited our figures to date—thank you for that. We have done a lot of work on this. New figures will be published next week, so we will give an update on those and on what additional costs we think there are, other than the ones that have been taken into account by the Government so far. That will be available for the Committee, too.
Dame Andrea Leadsom
Q
Deborah Arnott: I would rather not summarise it now, but it will come very quickly and we can provide it to the Committee in advance of publication, so the Committee will get the full details.
The Chair
Thank you.
Deborah Arnott: I would like to go on to talk about Preet’s question about clauses 61 and 62, and I would also like to talk about clause 63, because they are the ones that are absolutely crucial to prevent vapes from appealing to children.
I do not know whether I am allowed to do this, but I will show the Committee these things. This is a completely reusable vape and this is a completely disposable vape. They look almost identical and they are the same price. The disposable vapes ban being implemented by DEFRA will get rid of disposable vapes—
The Chair
We will also take the Minister, and then we can answer both sets of questions together.
Dame Andrea Leadsom
I am also interested in the impact of smoking and vaping on children’s hearts and lungs in particular. I would very much appreciate hearing the professional assessment of you both of the particular vulnerability of children’s lungs and hearts, as compared with adults. I know that the Opposition spokesman and I share that grave concern, as do a number of colleagues. My second question is: do you expect the smoke-free generation policy to stop young people starting smoking?
The Chair
I do not know which order you want to take the questions in.
Dr Griffiths: I am happy for us to do a double act between us.
Thank you for such clear questions. In terms of inequality, we know that the burden of smoking falls unevenly. We have a third more smokers in the third most deprived areas, so it affects people’s health unequally. Heart disease is the world’s biggest killer, and there is absolutely no doubt that smoking is one of the major drivers of cardiovascular disease, so the picture is clear and very well established from an inequalities point of view.
In terms of young people, we share your concern at the British Heart Foundation. It scares me to think that, today, 350 young people will start smoking for the first time—and the same tomorrow and the day after, and the day after that. We know that a huge proportion of them go on to become long-term smokers. Tragically, we see the burden and the cost to life and quality of life that that causes, with about 15,000 deaths every year across the UK from heart and circulatory disease associated with tobacco. So, we are deeply worried about people starting, and it is not just us at the British Heart Foundation who are worried. We know that the majority of smokers wish they had never started, but nicotine is an incredibly addictive substance. Once people have started, it is incredibly difficult to stop, so we share your concern.
Just to cover two things on the biology, the way that smoking is so damaging to our hearts and circulatory system is manifold. It damages the lining of our circulatory system, causing our arteries to clog up with fatty deposits, which puts us at an incredibly high risk of heart attacks and strokes. We know that a smoker’s risk of having a heart attack is double that of someone who does not smoke. For stroke, the risk is three times greater, but if someone smokes 20 cigarettes a day, they are six times more likely to have a stroke. So, there is really clear evidence on the biology that smoking is damaging.
We are deeply worried about young people starting, which is where the power of this Bill comes in. What an opportunity to create, for the first time, a smoke-free generation, relieving tens or hundreds of thousands of people from the risk of death and disability from smoking. We, as the BHF, would urge for the Bill to be pushed through in full.
Dame Andrea Leadsom
Q
Dr Griffiths: Thank you, and apologies if we did not cover that as clearly as we could have. Obviously, there is no such thing as a safe cigarette, there is no safe number of cigarettes to smoke, and there is no safe age to start smoking at all. We would emphasise our concern for children starting to smoke, because the damage starts as soon as you start smoking. There is no safe number of cigarettes to smoke. Combined with that, the fact that nicotine is so addictive that it leads to most people—over two thirds of those who start—becoming long-term smokers, worries us enormously. In terms of both the risk and the damage of starting smoking, the number of people who start and the fact that they go on to adopt a lifelong smoking habit caused by nicotine is of deep concern to us.
Sarah Sleet: It is worth thinking about children’s wider environment. Children who live in households where the adults smoke are four times more likely to smoke themselves, and find it much harder to give up. Children are getting into a cycle of deprivation and damage to their long-term health right from the very beginning. For children, stopping smoking availability is going to be profoundly helpful for their future lives, their ability to contribute to the economy and their overall prospects. This Bill, which tackles the issue from childhood up, will be one of the most profoundly important health interventions that you can make.
Preet Kaur Gill
Q
Dr Griffiths: As Deborah from ASH said, vapes are a fairly new product, so the research and evidence base, which we have in abundance for tobacco and smoking, is still forming for vaping. However, there are indications that it is not great for health. We are cautious and worried about the long-term implications. What we do know is that vaping can be an important cessation tool for those trying to quit smoking, and that many do want to quit, so we strongly encourage anything that stops smoking, but the people who are turning to vaping as an alternative to smoking for the first time is of deep concern to us. We do not understand the long-term health implications, but the addiction to nicotine deeply concerns us.
Sarah Sleet: We strongly agree. It is a very delicate balancing act between stopping the harm caused by smoking and looking to the long-term with regard to vaping. Quite clearly, smoking is far more damaging for adults and children. Anything that can steer people away from smoking will be healthier than continuing to smoke in the long run, but we do recognise that more attention and more research need to be put into vaping.
Dame Andrea Leadsom
Q
Dr Griffiths: We support the Bill exactly as it is written at the moment. It is really important to recognise that, as proposed, it does not inhibit anybody who is currently a smoker from purchasing tobacco, but it does take us on a really clear and, I believe, a transformative path to a smoke-free generation.
Dame Andrea Leadsom
I understand that, but why?
Dr Griffiths: Because it is a really clear path to make sure that we move to a situation where we have a generation that is prohibited from buying cigarettes, and who are disincentivised from doing so.
Sarah Sleet: We have heard today the evidence about just how harmful and destructive smoking is, particularly for people in more deprived areas. If we really want to tackle that, we need to remove smoking as a normalised, available, legal option going forward. This seems to me a very measured and thoughtful way of introducing a smoking ban that will take hold. It is very important for our children going forward.
Preet Kaur Gill
Q
Dr Griffiths: I would observe that there is so much variation between products and how people are consuming them. I think it is quite difficult to give advice in a standard way, and that it is part of it being an emergent product and market. As we have discussed, there is no doubt that, with nicotine being so deeply addictive, it is an incredible worry that a child has a single puff on a vape, given the potency of nicotine and where we know it leads people, having seen that over generations with smoking.
I should perhaps take a moment to emphasise that we also really support the £70 million investment being allocated to public health campaigning and cessation services, as well as enforcement. You are right that we need to be really clear with the messaging of the Bill to encourage support from parents and others around children in particular. We really applaud the decision to put resourcing behind this as well. We know that effective public campaigning can be an incredibly powerful tool. We were really proud to run the “Give Up Before You Clog Up” fatty cigarette campaign way back 20 years ago, and we know even that campaign led to 14,000 smokers seeking to quit. We know public campaigning works, and it was a great thought to allocate that resource as part of this work—it will be needed.
Sarah Sleet: The variation in nicotine levels and the method of delivery, which affects the uptake of the nicotine, is undoubtedly very concerning in vapes. I am a mother of three adult children who all vape, and I am very concerned about how often they are doing that and what impact that is having. We must also remember that, from what we know at the moment, it would appear that smoking is far and away the most damaging activity, compared with vaping. There is a little bit of concern that we overemphasise the harms of vaping to the extent that people say, “Well, I might as well smoke then. I’ll do that instead.” We need to be very careful about how we have this conversation.
Preet Kaur Gill
Q
Matthew Shanks: It is an interesting question, whether vaping or smoking is more popular among children in schools. All I can say is that it has increased in the past three or four years. We see evidence of vaping; it is more difficult to catch children vaping, because of the size of the vapes, the fact that the smell is slightly different and does not set off smoke alarms in the same way, and so on. I think it is fair to say that smoking and vaping are still as popular as they were among younger children in certain areas, and vaping is being seen to be a safe alternative.
The marketing of vapes in different flavours and colours makes them akin to a progression from chewing gum for some families—with bubble gum flavours and so on. There is also anecdotal evidence of parents talking about, “If it’s grapefruit, it must be safe.” There is that evidence around it as well out there—because of the way in which vapes are marketed, and if you see them in shops, they seem safe and okay.
With behaviour, the size of vapes makes it very difficult to admonish children, because they can hide them very easily. They can look like mini hard drive sticks—I think that is deliberate targeting in how they are marketed, with the cleverness of it. Certainly in terms of behaviour, it is something else that we are dealing with, when we say to a child, a teenager, “You’ve been vaping”, but they say, “No, I haven’t”—there is nowhere for us then to go, which immediately sets up an issue.
The earlier question about toilets was interesting, because children tend to vape in toilets. It is easier for them to vape in toilets than it was for them to smoke in toilets. You just need to see people on public transport vaping—it is easy for it to dissipate and disappear quickly. So, yes, I would say that vaping is a real issue in schools for children.
Patrick Roach: I support fully what Matthew has just said. I do not think that it is an either/or; the reality is that smoking is a threat to children and young people, in terms of their health and wellbeing and their ability to participate and progress educationally, but so too is vaping.
The NASUWT, at the start of this academic year, published our own research into vaping in schools from the perspective of teachers and school leaders, and it very much reinforces what Matthew has just said, in that vaping is pretty much predominant as an activity taking place among secondary-aged pupils. But we are also seeing teachers reporting pupils vaping from as early as 10 years of age, so the primary phase is also impacted. Three quarters of teachers report a significant increase in the participation in vaping by pupils in their schools, so we are seeing an upward curve in respect of vaping activity within schools.
On the issues that have just been mentioned about the difficulty that schools have in detecting and controlling this kind of behaviour, the way in which vape products are available to pupils is that they are masquerading as hard drives, as highlighter sticks or as other things that it would be legitimate for a pupil to bring into school. This is not like a situation in which you catch a pupil with a packet of cigarettes and you confiscate it; first, you have to identify what on earth it is that that pupil has. At the end of the day, good order in schools is dependent upon there being trust and respectful relationships between teachers and students. You cannot go around every moment of every day asking pupils to turn out their pockets and then inspecting what is in them.
The reality is that we are seeing the impact of vaping not just on pupils’ health, because we are seeing pupils who are presenting as ill as a result of the overuse of vaping products—although, in fact, all of it is overuse—and therefore becoming ill in schools, but on educational participation, progression and achievement. When pupils are diving off into the toilets to vape, that interrupts teaching and learning. When pupils are late arriving at school, perhaps because they have been vaping en route, that impacts on pupils’ learning. We are also seeing bullying behaviours within schools because, quite often, vaping products are being informally circulated, exchanged or acquired. Therefore, it becomes another source of behavioural challenges for teachers and head teachers. So, from a teacher’s perspective, vaping is a serious issue within schools, and one that we are pleased that this Bill is seeking to address.
Dame Andrea Leadsom
Q
Could you therefore expand on that, in terms of the specific health impacts and, at the one end, the ability of children to concentrate on the class when they are spaced out on vapes, and, at the other end, the very real risk to children from doing something stupid with a vape that was entirely unintended, with disastrous consequences?
Patrick Roach: I very much appreciate your remarks about the research that the NASUWT has undertaken. We come at the problem of vaping from the point of view of our members in classrooms, in schools the length and breadth of the country. What do teachers need in order to be able to teach effectively and what do they believe that pupils need in order to learn effectively? They need good order in the classroom.
My perspective is not that of a medical practitioner or of someone wanting to assume that I have the knowledge about the impact of vaping on a child’s physical development. Our concern is the impact on a child’s educational development, participation and achievement. The reality is that everything you have mentioned there is absolutely right, whether it is about the way in which vaping products might be unintentionally used by pupils; or about how they seek to conceal them about their person; or, indeed, the drinking of vaping fluids, as if somehow that will get the high without necessarily being detected; or about the use of vaping products as a stimulant, which impacts not only on concentration but on behaviour and, indeed, on a child’s wellbeing in the classroom.
Matthew has already referenced the difficulty of detecting vapes sometimes, because they can dissipate very quickly; and they can also trigger fire alarms in schools. We have had plenty of examples of teachers and headteachers reporting that their school has had to evacuate the building not just on one or two occasions in a day but multiple times—five or six occasions. That is a loss of learning not just for one pupil or class of pupils but the entire school. We are really concerned about the impact of all that.
Teachers are not just concerned about a child’s educational development, though; they are also concerned about a child’s wellbeing in the round. Teachers are reporting the very damaging impact that vaping can have on a child’s mental and physical development, just as smoking can. That is one of the reasons we have spoken out—and we are pleased that the Government have responded—to say that we need to be doing more to strengthen the enforcement of rules around vaping, access to it and the availability for school-age pupils. We need to do as much as we possibly can to prevent any school-age pupil from getting access to vaping products, whether in or outside school. We are pleased that the Bill seeks to do just that.
Matthew Shanks: I absolutely echo and reinforce what Patrick has said. Also, as school leaders we are looking after teachers, but we are caring for families as well. The Bill will help families to understand that it is not okay for their children to vape. Anecdotally we have parents saying to us that they let children vape at home, because it is better than them smoking or being out on the streets; parents do not see the harm in it. It is really important that that is recognised. The banning of tobacco sale was interesting in terms of the prescription of it; I would posit that at the moment vaping is seen as safe by the general public.
Kirsten Oswald
Q
Matthew Shanks: I completely agree. The way in which vapes are marketed—the colours, flavours and so on—and the places where they are marketed suggest to people that they are safe. The fact that they are put forward as a “safe” alternative to cigarettes, the fact that parents use them and the fact that there are lots of colourful vape shops open in high streets: all those aspects promote the idea that vaping is okay.
At the same time, getting into a child’s mindset—we have all been there, as children—we like to break the rules and feel like we are pushing at boundaries. We know that it is not okay, but it is made okay. I would suggest that more children engage in vaping than in cigarette smoking, because they are not sure what the harmful effects are. That is the danger in it. I do think it leads on, because the younger children vape, but by the time they are 16 or 17, vaping might not be cool any more, so they go on to cigarettes or other things.
Anecdotally, we have heard of schools down in the south-west where people are putting cannabis into the vapes, so the addiction grows from that point of view as well. It leads to children coming out of lessons agitated. If I did not have three coffees in the morning, my agitation would be quite high. If children are not getting nicotine, as well as going through all the other things they are going through, they really do present as confrontational to staff, which makes it difficult to deal with them in classrooms and engage them in their learning. At the same time, to repeat a point I made earlier, you have parents at home who are saying, “Well, it’s okay to do.” I absolutely concur about the way it is marketed and so on.
Patrick Roach: To add to that, because those are important points: vape producers and manufacturers, and indeed those supplying vapes, are advertising freely in ways that make their products increasingly attractive to children and young people, with the way vapes are advertised and the marketing descriptors used for them. All the evidence we have, and certainly what our members tell us—our survey was of 4,000 teachers, so this is not anecdotal; it has an impact right across the system— suggests that the way those products are marketed and described deliberately seeks to entice young people to make use of them.
We believe that this is a strong Bill that very clearly sets out the societal expectations in this space, but as with any legislation, there is always scope for loopholes. If there are areas in the Bill where there is potential to further strengthen the legislation, I think the enticing way products are described, before an individual understands what they are getting themselves into, is something that needs to be considered and addressed.
From our point of view, it is about advertising, but it is also about access to these products. With the best will in the world, and no matter how they are advertised, if the products are easily available at the point of sale it makes things incredibly difficult. I remember that when I was bringing up my own children I worried about going to the supermarket with them, because they would be surrounded by candy and sweet products at the checkouts. You could not navigate your way through the checkouts. Thankfully, things have moved on: that has changed, and many parents are benefiting from those changes.
Young people are very much interacting with many of these products at the point of sale. They are in the shops that are in the vicinity of or on the route to and from school. They are being marketed in places that young people will frequent, whether that be a local café, the hairdressers or the barbers. They are in places where young people will be. They are also immediately available. The more we can do to stop the immediacy of marketing of these products and that easy availability, no matter how they are described, the better.
Preet Kaur Gill
Q
My second question is this. I know that over-65s are much less likely to smoke. I have a constituent, Eric, who has suffered from a stroke and has suffered with chronic obstructive pulmonary disease and is now a tobacco campaigner in his 80s. Why is this Bill important to the people Age UK works with?
Paul Farmer: Age UK fully supports the proposed legislation, and we have been working alongside the Richmond Group of Charities to highlight the significant health benefits of phasing out smoking, which will help individuals and have a wider impact on society. It will have particular benefits for the NHS, which as we know faces significant challenges at the moment.
Our job at Age UK is to think about not just the health and wellbeing of older people as they are now—I will come to your second question in a moment—but issues affecting future generations of older people. This is quite a rare opportunity for us to have a significant impact on those future generations for reasons we will look at later.
It is worth noting, however, that this Bill is heavily supported by older people. Polling shows that 69% of over-65s support it. Why is that? That goes to your second question. We know from older people and the work we are currently doing that health and wellbeing in later life is pretty much the top priority for older people. Age UK has recently published our blueprint for older people for the next few years, as we enter an election year. It is very clear from the work we have done with older people that health and wellbeing is right at the heart of what is most important for people.
Of course, that is logical: the ability to feel well, remain active and maintain our independence is a major determinant of the quality of life that we aspire to in later life. We also know that there is a huge gulf in life expectancy and life experiences between those who have the opportunity to age well and those who do not. I will not go into the points your earlier witnesses made about the importance of healthy life expectancy in detail, but that is right at the heart of older people’s considerations. It is important that we do something about the fact that healthy life expectancy for those who are most disadvantaged is quite so stark.
How does that affect smoking? As you know, smoking is a leading cause of death and disability. It is responsible for half the difference in healthy life expectancy between the most and the least affluent communities. People living in the areas with the lowest healthy life expectancy are 1.7 times more likely to smoke than those living in the highest healthy life expectancy areas. These are fundamental reasons why the intervention of this legislation will make a difference.
Dame Andrea Leadsom
Q
Could you give us a view, as an Age UK representative, of the sort of advice that older people who have smoked all their lives and are now bearing the brunt of the decisions they took would give to those who argue, “It’s a matter of personal choice. Everyone should be free to smoke if they want”? What would an older person say to that young person?
Paul Farmer: I think a lot of people would say that they wish they had never started. Those are certainly the conversations we have been having with older people in preparation for this session. The reason for that is that, as you enter into your later life, you start to understand the consequences of smoking through your personal experience. The list is frightening.
Dame Andrea Leadsom
Q
Paul Farmer: Very clearly, there is the relationship between smoking and multiple forms of cancer, COPD, pneumonia, heart disease, aortic aneurysm and stroke, vascular diseases, diabetes, rheumatoid arthritis, hip fracture, cataract and macular degeneration—and dementia. In a society where we are increasingly debating dementia’s impact, I think the relationship between smoking and dementia is a really important context.
These are in and of themselves very challenging physical health conditions, but we can also see the correlation with people who experience multiple long-term conditions. I think many older people who experience those multiple long-term conditions—who have to live with the impact of them often because they smoked in their early life—would say this impacts on the individual being able to do the things they want to do in their later life. There is a severe detriment on pursuing their ambitions of later life as a result of having smoked in earlier years.
Dame Andrea Leadsom
Q
Paul Farmer: I think different people will have different opinions about choice, and whether it was as a result of choice. I think what many older people have been telling us is that if they had known about the damaging consequences of smoking, they would not have started in the first place and would certainly have considered it in a greater way.
I want to pay huge tribute to colleagues at British Heart Foundation, who I know you have just heard from, who I think have taken the best way of trying to campaign over a long term on this issue. This is a long-term issue. Sadly today’s generation of older people is seeing the consequences of what has not happened.
Kirsten Oswald
Q
Paul Farmer: We work with people over the age of 50, which may be news to some of you here. One of the reasons why we have recently chosen to drop the age group that we increasingly work with is precisely for prevention and early intervention.
This is not the earliest intervention; you can, of course, argue that many health interventions need to take place among children and younger people. However, from an Age UK point of view, we know that there is potential to intervene in people’s lives and support them to live healthier lives—it is not just about health, but in this context it is mainly about health—which means that your healthy life expectancy can improve and, as I mentioned earlier, you can fulfil some of the ambitions of your later life. The burden on the NHS of unhealthy life expectancy is a big issue.
The bulk of our direct work is with people over pensionable age, if you like. In each of those generations, you see the differences in experiences of smoking. Somebody now in their 80s or 90s almost certainly will not be alive if they are a heavier smoker, because they probably will not have benefited from any of the public health information that has taken place under previous Governments, so that is obviously the major difference.
In terms of the different health conditions, we know that certain health conditions will increase with age. Dementia is the greatest example of that, where we know that the older you are, the more likely you are to develop dementia. In a sense, as our population as a whole has gotten healthier and lived longer, it has become increasingly apparent where those health inequalities are at their most acute.