Tuesday 7th January 2025
(2 days, 20 hours ago)
Public Bill CommitteesTobacco and Vapes Bill 2024-26 View all Tobacco and Vapes Bill 2024-26 Debates Read Hansard Text Amendment Paper: Public Bill Committee Amendments as at 7 January 2025 - (7 Jan 2025)
The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
Q
Professor Sir Chris Whitty: May I take one impact that extends my previous points about outdoor smoking, and then maybe pass on to Sir Gregor and Sir Frank? For outdoor smoking, the previous Bill—the very good Bill put forward by the previous Government—did not have anything that addressed the needs of current smokers. It also did not address the needs of people exposed to smoke, despite the fact that, like over 88% of the population, they are not smokers and many of them are medically vulnerable.
The Bill allows the Government to take powers to prevent outdoor smoking, first with additional public consultation and then additional measures in Parliament. Ministers—you, Minister, have demonstrated this in the House of Commons—have indicated the areas where they intend to use these powers to reduce the risks of passive smoking. These are the areas of the greatest vulnerability: around hospitals, where some of the most medically vulnerable are highly concentrated; and around children’s playgrounds, where children are—I think everybody who does not have shares in cigarette companies would agree that exposing children to second-hand smoke is an unacceptable thing to do. That is one area where the Bill has gone further than the previous one. Maybe Sir Frank might want to add to that.
Sir Francis Atherton: In Wales, we have had smoke-free hospitals, schools and play areas since 2021, under our earlier public health legislation, and it is completely non-controversial. There are clearly issues around implementation and enforcement, particularly around hospitals, but if you go now to schools and hospitals there is no controversy whatever. So that will not make a huge amount of difference in Wales.
The one thing that will make a difference, I think, is aligning the vaping legislation with the smoking legislation. I say that because, going back to the earliest question, vape use among young people in Wales has shot up over recent years—8% of 11 to 16-year-olds regularly vape, up from 5% and a bit in 2021. It has absolutely shot up. Bringing together vaping and tobacco legislation in terms of vape-free and smoke-free places is a really important thing and one for which I have been arguing for quite some time.
Andrew Gwynne
Q
Professor Sir Gregor Ian Smith: Perhaps I can begin this answer; my colleagues may then want to come in. Alignment in this respect is really important, partly because of the clarity of message that exists to the public around about what is legally acceptable in relation to smoking and to vaping. Alignment across tobacco smoking and vape use is similarly important across the four nations.
Public health messaging is incredibly important. Having a consistent message across our four nations helps to ensure that the message is much more clearly understood and adhered to by the public. I welcome the attempts by Ministers to ensure that alignment exists within the Bill, so that as we go forward we give protection to those who do not smoke in the way that we are planning on doing with the Bill as it proceeds.
One of the most important aspects is to make sure that, although in Scotland, for instance, legislation prevents smoking within 15 metres of the likes of public places such as outside a hospital, we bring that much more closely in line with where the Welsh position is—so to the whole of the hospital grounds. Extending it to protect, as Sir Chris has said, more vulnerable places such as play parks is something I would certainly welcome in Scotland. We should do that in step across the four nations. I again emphasise that public messaging is incredibly important in making sure that we get the adherence we seek.
Andrew Gwynne
Q
Professor Sir Chris Whitty: I have already given my view that, although I have a lot of sympathy for choice and freedom arguments in many situations, tobacco addiction and second-hand smoking are not among those.
Sir Francis Atherton: If anything, choice is undermined by the addictive nature of nicotine. It is incredibly addictive. We know that now; we have known it for many years, actually. The tobacco industry has known it for many years, which is why the industry, through vaping and other means, is quite keen to have the next generation of people in our countries addicted to nicotine. Choice is completely undermined and taken away by the addictive nature of the product being marketed.
Professor Sir Gregor Ian Smith: Nicotine addiction is horrific. Nearly 9,000 people a year still die in Scotland as a result of tobacco-related health issues. Two thirds of people who begin smoking are potentially at risk of dying as a consequence of their addiction. We know that the industry targets both the younger age spectrum and vulnerable groups to sustain their industry.
If you have ever spoken to a patient with a serious tobacco-related illness such as chronic obstructive pulmonary disease, who is now suffering from the consequences of that—the limited ability to live their life—and the addictive nature of the disease, you soon begin to learn that they are filled with nothing but regret and guilt for the part that their addiction has played in the development of the disease. The stigma associated with tobacco-related disease is quite terrible for those who experience it. The basis of that is this lack of choice that they have developed as a consequence of the addictive nature of the nicotine products.
Professor Sir Chris Whitty: If I could just add a specific example from—
The Chair
Sorry, Sir Chris, but before we go further, I am trying to establish whether Sir Michael McBride has contact with us yet. If you can speak, Sir Michael, then we will know whether we have connection. It is as simple as that, really.
Professor Sir Michael McBride: Yes. The problem is not on my side, so I asked that you unlock me. I think I have now been unlocked, so perhaps I can speak.
The Chair
We will now hear evidence from Hazel Cheeseman, chief executive of Action on Smoking and Health; Sheila Duffy, chief executive of ASH Scotland; Suzanne Cass, chief executive of ASH Wales; and Naomi Thompson, health improvement manager at Cancer Focus Northern Ireland. We have until 10.55 am for this panel. I call the first Member to ask a question—the Minister.
Andrew Gwynne
Q
Hazel Cheeseman: We are all delighted to see this Bill return, and in such a strong form. There is complete consensus across the ASHs of the four nations that this is a Bill that is needed, wanted and workable.
As the chief medical officer said in the previous session, the improvements in this Bill are that there are more provisions that will assist in reducing smoking among people who are already smoking and in protecting those exposed to second-hand smoke. It also creates a comprehensive set of regulations around all tobacco and nicotine products and provides us with that future-proof—the flexibility to respond to evidence as it emerges and changes and to the market as it emerges and changes over time.
The Bill is enormously welcome for its comprehensiveness and robustness, and therefore for the opportunity to significantly reduce the uptake of smoking among the next generation and to aid people in quitting. The Minister will not mind me saying that I think there is more that the Government will need to do to accelerate that progress, in terms of investing in support for those who are already smoking and ensuring that we have the right strategy in place for that, but the Bill is a really good step in the right direction.
Andrew Gwynne
Q
Sheila Duffy: We have seen that tobacco control measures work. We have seen that they have reduced adult smoking rates over time. The points made by the chief medical officers were well made: we are looking to the generation growing up now in the UK; we are looking to protect them from addictions that so many now regret and that are claiming lives unnecessarily.
Suzanne Cass: I would add that tobacco control policies that are put in place are popular, and are really welcomed among members of the public; they are also welcomed among people who smoke. There is a huge surge of public support for tobacco control policies, and that grows—it does not diminish—as we introduce new policies; it grows, and that public support increases.
Naomi Thompson: In Northern Ireland, we are working towards a smoke-free Northern Ireland by 2035, and the reality is that tobacco control over the past 10 years has managed to bring things down to a stage where 2035 has potential. That is why tobacco control needs to continue. A Bill like this is just brilliant to keep that focus. If we can prevent people from starting, that will be absolutely key to making Northern Ireland, certainly, smoke-free by then.
Andrew Gwynne
Q
Suzanne Cass: As you know, ASH Wales and the Welsh Government have been at the forefront of implementing smoke-free spaces. We campaigned for smoke-free playgrounds and smoke-free school gates, both on a voluntary basis. Luckily, the foresight of the Welsh Government has made that provision legislation when it comes to hospital grounds, playgrounds, sports grounds, mental health units and a raft of other smoke- free spaces. We are obviously delighted that the Welsh Government has implemented that legislation.
The legislation has made a huge difference, in that it has allowed a platform for communication—communicating the message that it is not okay to smoke around children. There is a massive amount of public support for that messaging, and we have had the opportunity to communicate it. When it comes to smoke-free hospital grounds, a lot of us are looking at that legislation and the possibility of implementing it.
We have obviously had the legislation in place in Wales since 2021, and what we would say on the lessons learned is that there has to be a package when it comes to implementation. We cannot just legislate; we need to be looking at the support that is in hospitals for smokers to quit, we need to have trained staff and we need to have enforcement on the ground. There needs to be a whole package that comes with that legislation. That is the enormous lesson that we learned.
We implemented that legislation in 2021—in the midst of covid, which was tricky—but we have had problems around enforcement and problems around compliance. It is a very different kind of tobacco policy from that in the other smoke-free spaces. When it comes to the other smoke-free places—playgrounds, sports grounds and other areas like that—there is a lot of compliance, but when it comes to hospital grounds, you have to do a bit more of the legwork. But it is well worth it, because what comes with that is on-site hospital support for stopping smoking, and the message to everybody coming on to that site that smoking is not okay and that there is support available if you want to quit. So it comes with a whole raft of measures that support that smoke-free message.
The Chair
I call Caroline Johnson—apologies; I should have called you before the Minister.
Dr Johnson
Q
Dr Ian Walker: First, thank you very much for the opportunity to be here. I start by thanking Parliament for boldly introducing this Bill; it is genuinely world leading. I have spoken to organisations across the world that are envious of the position we find ourselves in. That is a very important question, and the answer is absolutely yes—I think this Bill will be very important in reducing the number of cancers caused by smoking tobacco. We know that there is no bigger thing we could do to actually influence that going forward for the next generation and generations thereafter.
As you have heard this morning, we know that we still have 6 million people smoking across the UK, and we know that we can expect hundreds of thousands of cases of cancer caused by smoking over the term of the next Parliament. As we move towards a truly smoke-free generation over the next 20, 30 or 40 years, we will absolutely expect to see the number of cancers caused by smoking—and, alongside that, the number of other illnesses associated with smoking—reduce.
Andrew Gwynne
Q
Dr Ian Walker: To start with smoking and cancer, the links between passive smoking and cancer, particularly lung cancer, are very clear. It is fair to say that there is less evidence around different scenarios that you might predict through this Bill, such as different outdoor environments and so on, but that is more because those studies have not necessarily been done. It is an important point to make that there is an absence of evidence, rather than evidence of absence.
You heard from the CMO of England this morning that if you can smell cigarette smoke, you are exposed to it. The direct risk, then, is linked to how long you are exposed to it, how concentrated the environment is, how close you are to it and so on. Nevertheless, passive smoking is harmful—not just for cancer, but for vulnerable people with many other conditions as well—so we are very much supportive of the introduction of smoke-free places and the ability to restrict people smoking in particular outdoor spaces.
Sarah Sleet: When it comes to people with lung conditions, second-hand smoke is incredibly important; it is a well-known, severe risk factor for people with lung conditions. About one in five of us in the UK will experience a lung condition—there are around 7 million people with asthma and about 1.6 million people living with chronic obstructive pulmonary disease. Those are two major conditions that are profoundly affected by second-hand smoking, and are clear risk factors in terms of deaths from asthma and people being hospitalised with exacerbations, so it is incredibly important that we deal with the issue of second-hand smoking. People said earlier that there is no choice about second-hand smoking, and yet it profoundly affects those with lung conditions. It is incredibly important that we ensure that we protect those vulnerable people as far as possible.
When it comes to the discussion about how far we should go in terms of smoke-free and vape-free places, we would consider going further than what has been suggested already and looking at other areas to make smoke-free. I know there has been discussion about hospitality and trying to balance the potential economic impact that has been talked about if we make the outside of hospitality places smoke-free. However, we think, given the balance between the public health impact and what we have seen with smoke-free indoor spaces and its impact on business, we could go further and should go further, there.
Andrew Gwynne
Q
Sarah Sleet: People with asthma and lung conditions are in the middle, where they are affected by both smoking and vaping. It is really important to get the balance right. Smoking is terrible—it is terrible for people with lung conditions—and we need to make sure we can drive down smoking rates as much as possible.
Vaping can play a part in helping with smoking cessation, but it should only be used for smoking cessation. People who have never smoked, and definitely children, should not be taking up vaping. We see vaping as a staging post to being completely nicotine-free. It is important to get the balance right between making vaping available for those who need smoking cessation and not encouraging people to try vaping or to keep vaping longer than they need to.
The legislation is good in allowing that flexibility for adjusting over time, as we get more evidence in. It is really important to put evaluation in place and make sure that robust evaluation does flow through over time, so we can adjust and respond to it. Traditionally—certainly in respiratory diseases—there has generally not been enough research and evaluation, so we need to correct that now.
Dr Ian Walker: First, I want to confirm that we are very much supportive of taking those powers. I think one of the real strengths of the Bill is the ability to adjust, moderate and titrate those powers and the actions that we take over time, not just as new evidence emerges, but as the tobacco industry and new products may emerge to try to circumvent the regulation that is in place. That is a really important part of the Bill.
I think the crux of the question was about what is important to consider through the consultation. From our perspective, it is important to get a balanced view on what the right actions are in this area. Of course we all agree that we want to limit, reduce and stop access for children and young people and to limit the appeal to never-smokers, while balancing that carefully against making cessation tools available to people who are trying to quit. It is important not to forget the 6 million people who are currently smokers and the long-term health implications ahead of them. We need a balance so that it is as easy as possible for those people to quit when they have chosen to do so. There will be many balancing features and balancing points of evidence that will be really important through the consultation in coming to the right outcome.
Andrew Gwynne
Q
Dr Ian Walker: Critical. Without a doubt, there is no single bigger action that you could take to reduce the cancer burden on the country. The cancer burden sits at a very personal, individual level for people getting their own diagnosis; it sits at a family level and at a friend level. It also sits at an economic level for the country and at an NHS level, in terms of the burden that smoking-related illnesses cause for the NHS.
From my perspective, this is a world-leading piece of legislation. It is absolutely an opportunity for generational change and a long-term legacy that will see our children and grandchildren never able to legally buy tobacco in the UK and never exposed to the harms that that would cause them.
Sadik Al-Hassan
Q
Sarah Sleet: As I said earlier, the research evidence around vaping harms is currently very poor. There has not been enough. It takes a long time to build up evidence of things that are generally very progressive rather than having an immediate impact, so we will have to wait. We need to put that in place, and we are going to have to wait to get that evidence back.
We have had anecdotal reports from our beneficiaries and those who contact the organisation about places—particularly in closed spaces, but sometimes outside—where there is a concentration of vaping. It is that classic thing where you go through a door and suddenly everybody around you is vaping immediately outside it. We get reports that that exacerbates people’s asthma and sometimes their COPD, but they are anecdotal. We really need the evidence base to support what is happening.
Dr Ian Walker: The only thing that I would add specifically from a cancer perspective is that although there is very little long-term evidence, because the products have not been around long enough and the cumulative effects have not been seen yet, what we do know, based on the current evidence, is that vapes are far less harmful than cigarettes. You heard the advice earlier that if you smoke it is better to vape or take other nicotine products, but if you do not smoke you should not vape, because we do not know yet what the long-term effects will be. In particular, we are very light on evidence on what the impact of vaping will be on bystanders.