Tobacco Control Plan
(2 years, 10 months ago)
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Mrs Maria Miller (in the Chair)
I remind Members that there have been some changes to normal practice in order to support the new hybrid arrangements, and timings of debates have been amended to allow technical arrangements to be made for the following debate. There will also be a suspension between each debate.
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Mary Kelly Foy (City of Durham) (Lab)
I beg to move,
That this House has considered recommendations for the forthcoming Tobacco Control Plan.
It is a pleasure to serve under your chairmanship, Mrs Miller. In December, the Minister confirmed to Parliament that the Government will publish a new tobacco control plan this year, setting out measures to deliver the smoke-free 2030 ambition in the 2019 prevention Green Paper. I welcome this announcement: as a former chair of the Gateshead tobacco control alliance, this issue is close to my heart. In my own area of County Durham, adult smoking prevalence is 17%, compared with 13.9% nationally, and rising to 27% among people in routine and manual occupations. Some 16.8% of mothers smoke during pregnancy, compared with 10.4% in England, and smoking in County Durham has an annual cost to society of approximately £122 million.
The Secretary of State himself stated that the “extremely challenging ambition” of a smoke-free 2030 will not be delivered by business as usual. The new report from the all-party parliamentary group on smoking and health sets out the evidence-based recommendations needed to achieve that ambition. Smoking is responsible for half the difference in life expectancy between rich and poor, and the impact is passed down through generations, with those who grow up in smoking households far more likely to become smokers. With 1,500 people dying from smoking-related diseases every week, and less than a decade to go to achieve a smoke-free 2030, there is no time to waste.
However, this will not happen without investment. That is why the key recommendation of the APPG’s report is for a smoke-free 2030 fund, requiring the tobacco industry to pay for tobacco control. This is the “polluters pay” approach that the Government committed to considering in the 2019 prevention Green Paper. As such, can the Minister assure me that the proposals put forward by the APPG on smoking and health will be considered as part of the forthcoming control plan? In particular, will the Government deliver on their commitment to consider a US-style “polluter pays” approach to fund the tobacco control measures needed to deliver a smoke-free 2030?
More investment is needed, because the huge gap in smoking prevalence between those in routine and manual occupations and those in other occupations is stubbornly persistent. Ending smoking would lift around 450,000 households out of poverty, including more than 250,000 million children and 140,000 pensioners, concentrated in the most disadvantaged parts of the country. That would not only benefit the health and wellbeing of individuals but inject money into local economies, which would show just how serious the Government are about the levelling-up agenda.
Smoking is linked to almost every indicator of disadvantage, and those indicators overlap different communities. Smokers in routine and manual occupations or who are unemployed are also more likely to live in social housing and to be diagnosed with mental health conditions. The Government have been unsuccessful so far in reducing the inequality gap in smoking and need to redouble their efforts to achieve a smoke-free 2030 for all. There is a clear need for a national strategy that targets investment and enhanced support at disadvantaged smokers.
Unfortunately, smokers from deprived communities with higher smoking rates tend to be more heavily addicted than those from more affluent areas. Analysis of Government data shows that in 2019 nearly half of England’s smokers were in routine and manual occupations or were long-term unemployed. They are just as motivated to quit as other smokers, but it is harder to succeed when smoking is more commonplace and cheap, illicit tobacco is widely available.
Regional tobacco control programmes have been effective in tackling these disparities, as shown by the example of Fresh in the north-east, which is the longest-running—indeed, the only surviving—regional office of tobacco control. When Fresh was founded in 2005, smoking prevalence in the north-east was over 20% higher than the national average for England, and the disparity was growing. Since then, the north-east has seen the greatest decline in smoking prevalence of any region: smoking prevalence in the north-east is now only 10% higher than the England average. However, the regional work done in the north-east and elsewhere has been limited by cuts to the public health grant for local authorities since 2015-16. This led to the closure of the regional offices in the north-west and the south-west, and funding in the north-east has been significantly reduced. New funding streams are needed.
Smokers can successfully quit only if they are motivated to make an attempt to quit. Sustained mass multimedia behaviour change campaigns are the most impactful and cost-effective way to provide that motivation. The US Government’s “Tips From Former Smokers” campaign was funded by tobacco manufacturers through the USA’s user-free scheme, which raises $711 million annually from the tobacco industry. The Food and Drug Administration campaign led to over half a million sustained quits in three years, and it was associated with healthcare cost savings of $11,400 per lifetime quit.
Such campaigns have an immediate impact and can be targeted with precision at disadvantaged smokers, yet investment in behaviour change campaigns has fallen year on year in England. This has coincided with a significant decline in the number of adult smokers who have tried to quit. In 2008, 40% of adult smokers in England had tried to quit within the previous year; by 2018, that had fallen to just 30%. Over the same period, funding for mass media campaigns fell by over £20 million.
Behaviour change campaigns need to be targeted at key groups and communities to reduce socioeconomic inequalities. The effectiveness of national campaigns can be significantly enhanced when they are supplemented by targeted regional campaigns. Regional funding for stop-smoking behaviour change campaigns in the north and midlands would support the levelling up of some of the more deprived regions of England. These are the regions with the highest rates of smoking, combined with the lowest gross disposable household income. Supporting smokers in these regions to quit will prevent people’s hard-earned incomes from going up in smoke, lifting thousands of households out of poverty and providing a boost to local economies.
Modelling by University College London for the all-party parliamentary group on smoking and health estimates that a sustained national behaviour change campaign aimed at deprived smokers, combined with regional campaigns in the north and midlands, would result in an additional 1 million quit attempts, 179,000 successful quit attempts and 45,000 more ex-smokers in C2/DE occupations in England by 2030. The investment required is estimated to be about £28 million a year, which the tobacco manufacturers could easily afford to pay from their £900 million profits in the UK—and more than three quarters of the public want the tobacco manufacturers to pay for those measures. Does the Minister agree that targeted investment to tackle high rates of smoking among our most deprived communities is vital to delivering the Government’s levelling-up agenda?
Sadly, illicit tobacco is more accessible to children, and as it is cheaper than legally sold tobacco it reduces the incentive for adult smokers to quit. In 2018-19, the total tax revenue lost because of illicit tobacco was estimated by Her Majesty’s Revenue and Customs to be £1.9 billion. The illicit trade is heavily concentrated in the more deprived communities, contributing to higher smoking rates. Addressing that disparity requires tackling both the supply and demand for illicit tobacco in communities where it is endemic.
In the north-east, there have been dedicated multi-stranded programmes of work in place since 2007 to reduce the supply and demand as part of a broader activity to reduce smoking prevalence and improve the population’s health. Such programmes drive a strategic approach to tackling illicit tobacco at local, regional and national level. One programme was described as follows:
“an exemplar of partnership working…and…deserves to be widely disseminated”—
a recommendation supported by the National Audit Office. Unfortunately, that has not yet been possible owing to lack of funding, and the funding in the regions where it does exist is under threat because of cuts to public health budgets. Fresh and the Greater Manchester health and social care partnership have estimated that it would cost approximately £5 million annually to roll it out across England.
As the Minister said at the launch of our report, we need to get HMRC to do more to tackle illicit tobacco. Just £5 million for a highly effective regional programme is peanuts and would return far more in lost revenue than it costs. Will the Minister commit to discussing with HMRC how funding can be found for the illicit tobacco partnership to extend cover to all the regions of England to reduce the use of illicit tobacco, which is endemic in poorer communities in every part of England?
We are delighted that the Minister was able to attend the launch of the report by the APPG. I know how passionate she is about the issue. I look forward to hearing her response to our report and recommendations. I am confident that if the Government can embrace our recommendations in the forthcoming tobacco control plan, we will be well on the way to a smoke-free England by 2030.
Mrs Maria Miller (in the Chair)
Before I call the next speaker, I should say that I shall be moving to Front-Bench contributions at 2.35 pm. I suggest an informal five-minute time limit to enable all colleagues to make their contributions. I call Bob Blackman.
Bob Blackman (Harrow East) (Con) [V]
It is a pleasure to serve under your chairmanship, Mrs Miller. I am the co-sponsor of the motion, so I crave your indulgence slightly because I have a rather longer speech than five minutes will allow. It is a pleasure to follow my co-sponsor, the hon. Member for City of Durham (Mary Kelly Foy). I chair the all-party parliamentary group on smoking and health, which published the report on the tobacco control plan yesterday.
We were delighted when my hon. Friend the Minister set out the need for a new control plan last December, and we commissioned Action on Smoking and Health and SPECTRUM, a widely acknowledged scientific research consortium, to put together a report for us on what needed to be done and why. The importance of the ambition is very clear: the chief medical officer, Professor Chris Whitty, recently said that smoking is likely to have killed more people in Britain than the covid-19 pandemic, with more than 70,000 people dying from smoking last year in England alone—and for every person killed by smoking, another 30 live with the serious consequences of smoking-related illnesses. Ending smoking is essential if we are to reduce health inequalities between rich and poor, level up the nation and increase healthy life expectancy by five years, in line with the Government’s manifesto commitments.
The smoking rate in my Harrow East constituency is lower than average for England, but there is no room for complacency. More than one in 10 of my constituents smoke, and smoking kills 250 of my constituents every year. In 2018, there were 1,566 smoking-attributable hospital admissions in Harrow alone. Research shows that smokers are likely to need social care a decade earlier than non-smokers because of the impact of smoking-related diseases and disability.
Inequalities in smoking have grown, not shrunk, in recent years. To be smoke free by 2030, we need to reduce smoking by two thirds in only a decade, and by three quarters for smokers in routine and manual occupations. Cancer Research UK has said that, at current rates of decline, we will miss the target by seven years, and by double that for the poorest in society, because there are still 6 million smokers in England. We will achieve a smoke-free 2030 only by motivating more smokers to attempt to quit using the most effective quitting aids, while reducing the number of children and young adults who start smoking.
It is right that the Government brought forward the ambition of the prevention Green Paper, and we need to ensure that bold action is implemented, with appropriate investment. The Health Foundation estimates that a minimum of £1.2 billion is needed to restore public health funding to 2015 levels, and that a further £2.6 billion is needed to level up public health across the country.
The APPG’s view is that when it comes to ending smoking, the industry that makes excess profits from the sale of tobacco should pay, as it does in the US. The US’s user fee legislation raises $711 million annually from the tobacco industry; a similar approach could be introduced in the UK, with a statutory smoke-free 2030 fund imposing a targeted tobacco manufacturer profit cap and utility-style price controls in order to raise funds from the industry through a charge-based mechanism on sales volumes. It would not apply just to tobacco, because obviously this is about incentivising the industry to deliver on making smoking obsolete by 2030. It is quite clear that this is more than demonstrated by the market failure that has happened, and we need to get on with it. Will the Minister commit that the APPG recommendations for a “polluter pays” approach will be considered as a funding mechanism for the forthcoming tobacco control plan?
We also need to look at raising the age at which young people can buy cigarettes. Clearly, young people who start smoking continue to smoke into adulthood, so one of the areas that we have explored is raising the age of sale. It was raised from 16 to 18, which produced a 30% reduction in smokers aged 16 to 17 years old. It would be helpful if we could get to a position whereby 18 to 20-year-olds were prevented from smoking, so will the Minister commit to conducting a consultation on raising the age of sale from 18 to 21 and to coming to a decision about whether to go ahead by the end of 2021?
We have been a leader in the tobacco control plan, but obviously the position is that we have set the record. Now that we are free from the European Union, we can make decisions on our own. Will the Minister investigate extending Official Development Assistance funding for the FCTC 2030 project for a further five years?
Finally, the Minister is the lead for the World Health Organisation’s FCTC in the Department of Health and Social Care, so will she commit to provide the leadership in other Government Departments and public authorities that we need to fulfil their legal obligations to prevent tobacco policy from being influenced by the tobacco industry?
I have been able to touch on only four of the recommendations that we have made, and there are 12 in the report. I urge all Members to read the full report and the recommendations. The recommendations are supported not just by the APPG, but by leading health organisations too numerous for me to mention. There is good evidence that the recommendations will work in synergy to drive down smoking rates, and the forthcoming tobacco control plan offers the perfect opportunity to put them in place. I commend our recommendations to the House, and look forward to the reply of my hon. Friend the Minister.
Mary Glindon (North Tyneside) (Lab)
It is an honour to serve under your chairmanship, Mrs Miller. I thank my hon. Friend the Member for City of Durham (Mary Kelly Foy) for having secured this important debate and speaking so eloquently, especially as the Department of Health and Social Care is looking to publish a new tobacco control plan later this year. The forthcoming plan is an enormous opportunity for the Government to cement the UK as a global leader in tobacco harm reduction. Having left the European Union, the Government must—alongside the post-implementation review of the tobacco and related products regulations—set a clear direction for reducing smoking prevalence and improving public health.
However, if the Government are to achieve their ambition for a smoke-free society by 2030, their forthcoming tobacco control plan must champion the less harmful alternatives to combustible tobacco. In particular, a significant and growing body of scientific evidence shows vaping to be the most effective alternative for adult smokers looking to quit smoking. In their blueprint for better regulation, the UK Vaping Industry Association made a series of recommendations to the Department of Health for consideration when reviewing the tobacco and related products regulations—a process that is already underway. These recommendations, many of which I support, can also be applied to the Government’s tobacco control plan.
The first recommendation involves effectively tackling the increasing levels of misinformation, as well as the increasing misperception of the relative harm of e-cigarettes versus combustible tobacco. Action on Smoking and Health data suggests that millions of smokers—more than half of the 6.9 million remaining in the UK—could now be dissuaded from exploring switching to e-cigarettes because of incorrect views or confusion about the harm of e-cigarettes. To combat increasing misinformation, the UKVIA recommends that the Department of Health launch an effective communication strategy. This should include the introduction of approved health claims and switching messages that can be displayed on vape device and e-liquid packaging alongside nicotine health warnings, a proposal similar to those explored by the Governments of Canada and New Zealand.
In addition, it is important that medical professionals at local stop smoking services are sufficiently supported, with clinicians signposted to the latest clinical guidance and evidence on e-cigarettes. An evidence-based approach to smoking cessation must be adopted consistently by local stop smoking services to support patients in their harm reduction journey. This is critical, considering the upcoming trials in NHS A&E departments. The forthcoming tobacco control plan should also make provisions for a review of the regulation of nicotine in e-cigarettes, to better understand the role nicotine plays in allowing e-cigarettes to be a satisfying alternative for adult smokers wishing to make the switch away from smoking. For them to compete with combustible cigarettes and provide a satisfactory alternative for those looking to switch, they must provide a comparably satisfying nicotine experience. It is the toxic by-products of combustion, not the nicotine, that are responsible for smoking-related death and disease.
Understanding the alternatives to combustible cigarettes and making a clear distinction between smoking and vaping is critical to our smoke-free ambitions and changing misconceptions. Our all-party parliamentary group for vaping made several recommendations in our report on vaping in workplaces and public places. These are endorsed by the UKVIA and, if implemented, would support adult smokers in their transition to less harmful alternatives and give those who have already made the switch the best chance of sticking at it. I can provide the Minister with a copy of that report, if she so wishes. My late husband Ray is an example of such a switcher: having smoked from the age of nine with a couple of interludes, he made the switch to vaping several years ago, and was never separated from what he called his “pipe”. I might add that he did not die of a smoking-related illness.
Finally, I turn to another opportunity to enact the meaningful regulatory change to support smoking cessation. The Government are currently considering the submissions made to the consultation on the review of the Tobacco and Related Products Regulations 2016. Like many others, I eagerly await the publication of the Department’s response, which has already been delayed from May 2021 until later this year. It is hoped that the Department of Health and Social Care will continue to take an evidence-based approach to the regulations and listen to the experts. The TRPR review can help shape the UK’s approach to tobacco harm reduction considerably and can significantly support the next tobacco control plan. I look forward to the Government’s response to the tobacco and related products regulations review and the publication of the tobacco control plan. I hope that they make the most of these unique opportunities to support adult smokers in their transition to a less harmful alternative.
Mr David Jones (Clwyd West) (Con)
It is good to serve under your chairmanship, Mrs Miller. I congratulate the hon. Member for City of Durham (Mary Kelly Foy) and the APPG on securing this debate. I declare an interest: I am an honorary life governor of Cancer Research UK.
Smoking is, of course, a significant cause of ill health and death in this country, and the Government should be congratulated on the progress they have made to reduce the incidence of smoking, but the rate of reduction is sadly still not enough. A recent Cancer Research UK report found that, at current quit rates, the UK will not reach its smoke-free target until 2037 at the earliest—seven years late. To meet the target, quit rates will need to increase by some 40% over the next 10 years. In other words, we are at risk of enduring several more years of heartbreak for families, strain on the NHS and avoidable deaths—a pattern that can, and of course should, be broken.
Three months ago, I was fortunate enough to be selected for a Westminster Hall debate on this issue. I made the point then that the tobacco control plan was our chance to break that pattern. Now is our opportunity, and if we are to seize it, the control plan must be ambitious. I would like briefly to propose three courses that I believe should form part of the plan’s recommendations.
First, the key issue with smoking is, of course, the smoke. An evidence-based policy that seeks to assist the 7 million cigarette smokers in the UK must put forward alternative products to combustible tobacco. Continuing to raise awareness of those products is key, so I suggest that the plan should facilitate the use of cigarette pack inserts and online communications as ways of reaching smokers directly. E-cigarettes and other alternatives to combustible tobacco save lives, and we should make sure that that message reaches every smoker in Britain.
My second point is about access to those alternative products. E-cigarettes have been hugely important in the fight against smoking, and I commend NHS England for promoting them to smokers. The strategy is based on evidence, and has a proven positive effect on the health of the nation. In 2017, more than 50,000 smokers who would otherwise have carried on smoking stopped with the aid of a vaping product.
The tobacco control plan should advise what else can and should be used to assist smokers to quit, in addition to e-cigarettes. That is crucial when we consider that, for all the impact vaping has had, 50% of people who have tried e-cigarettes go back to smoking. We should not limit our response to one weapon. Nicotine pouches, heated tobacco and other emerging products are there to be used, and their efficacy and utility should be the subject of urgent study. The tobacco control plan should embrace the new products and allow for more measures for companies to promote.
Thirdly—this relates to my previous point—the plan should contemplate legislation for a new robust regulatory framework that can cover all the products within the market. We should not allow our focus to be narrowed to e-cigarettes alone. New products are entering the market, and the UK must be open to the kinds of innovations that save lives.
I have two brief final points that I wish to make, to which I hope the Minister will respond. First, there is a slight lack of clarity about whether the new plan will take account of the conclusions of the post-implementation review of the Tobacco and Related Products Regulations 2016 and the Standardised Packaging of Tobacco Products Regulations 2015. On Monday, I received a written reply from the Minister, in answer to a written question, which said:
“Evidence gathered from this Review will be considered as part of the development of the new TCP.”
I hope the Minister will confirm that all the evidence from the review will be fully reflected in the plan.
Secondly, I return to a point I made in the previous Westminster Hall debate—that is, the opposition of the World Health Organisation, which has called for a ban on reduced risk alternatives to combustible tobacco. To listen to that call would run counter to the success in smoking reduction that has been achieved in the UK, and I strongly urged the Government to stand up to the WHO at COP9 and to advocate a change in policy from it.
Ian Paisley (North Antrim) (DUP) [V]
It is an honour to serve under your chairmanship, Mrs Miller, and lovely to see you in the Chair. I refer Members to my registered interests. I am the chairman of the Gallaher charitable trust, which was formed after the closure of a tobacco company in Northern Ireland.
Let me turn to the subject of the debate. Facts are stubborn things. We all appreciate that, and we must ensure that any actions we take to address facts are based on evidence. I am a non-smoker. I do not encourage people to smoke. I do not want people to smoke, and I recognise the impact that smoking has on people’s lives, but like many substances, tobacco is a lawful product, and I will not tell other adults what they should do or not do with lawful products.
Tobacco is one of the most highly regulated products and the most highly taxed product in the UK—about 90% of the cost of an average packet of cigarettes is taxation. That tax disadvantages poorer households in my constituency and across this country than the most affluent. The UK tax regime is designed to control tobacco and the sale of tobacco, but it has had the opposite impact. It has driven up the price of the product and encouraged smuggling of illicit product. Many people have made the wrong choice to purchase that illegal product. Therefore, under the current mechanism, everyone is a loser. It is not working.
On 2 June—just nine days ago—the Northern Ireland Border Force, at the real border in Northern Ireland, which is the land border, seized 4.4 tonnes of illegal tobacco, which, if sold, would have stolen from you, Mrs Miller, and me and our taxpaying constituents £7.24 million in unpaid duty. Tobacco control measures ought not to be about trophy taxation or gimmicks, but should be primarily about reducing consumption by good education and good enforcement, and secondly about minimising crime by directing resources to the tackling of criminality associated with activities related to illegal tobacco.
None of the control measures addresses that issue seriously. Government policy has failed to do that, and I believe that today’s proposals fail to do it. Instead, they are about unnecessary tax and minor tinkering such as putting another written warning on the cigarette stick. When the cigarette is in a person’s mouth, it is too late to put such a warning to them.
HMRC already generates £11.8 billion in tax on tobacco, yet it loses almost £2 billion in revenue annually in illegal sales of tobacco product. That is because the control plan is one-dimensional and, frankly, stupid. It does not work. Since 2000, tobacco smuggling has stolen from you, Mrs Miller, and me and our taxpaying constituents a revenue loss of—wait for it—£47.2 billion. That has been stolen from us by tobacco smugglers. Surely we can have a plan that, instead of punitively taxing a lawful product more, lets consumers see that money being spent on tackling this international, multibillion-pound crime of racketeering. Imagine a control plan that, over the next 10 years, would deliver £40 billion in revenue to hon. Members’ constituencies. Imagine what we could do for hospitals, schools and the defence budget. Imagine what we could do with the overseas aid budget.
I want the Government to be creative and to stand up to people who say, “Just put on more tax,” because clearly that does not work. Frankly, the control plan will not save one life from the effects of smoking, will not stop one smoker from smoking, and will not stop one smuggler from bringing in illegal products. If the Government want, unintentionally, to fill the pockets of organised crime gangs, undermine legitimate businesses and ruin small shops throughout the country, they should stick with the plan, but they should not be smug about it, because the plan is not working.
Adam Afriyie (Windsor) (Con)
It is a pleasure to serve under your strong and stable chairmanship, Mrs Miller. It is a great privilege to speak in the debate, and I thank the hon. Member for City of Durham (Mary Kelly Foy) for introducing it.
We are debating a vital issue, and the UK can be No. 1 in the world for its approach on reducing smoking and the harm it causes. I commend my hon. Friend the Member for Harrow East (Bob Blackman) for his input into the report and his earlier contribution, and my right hon. Friend the Member for Clwyd West (Mr Jones) for his apposite remarks, which I am sure the Minister took on board. I also commend the Minister herself, and the Government, for their approach. I would say that she is mistress of the brief, as we have had many conversations and interactions through correspondence, and there is no doubt that she gets all the issues to do with smoking cessation devices and the tobacco control plan.
The industry in the UK seems to be aligned with the Government’s objectives on reducing smoking, as Philip Morris, British American Tobacco and many of the other firms recognise that this is the end of the game—it is the end of smoking in the United Kingdom, even if that might not be the case in certain far eastern countries, in Africa or elsewhere. The companies accept their responsibilities, and it would be of no surprise to them—they would not be disappointed about this—that they needed to make contributions to a fund to help to secure the goal of a smoke-free Britain, which should certainly be firmly on the table.
I speak as chair of the Parliamentary Office of Science and Technology and a member of the all-party group on e-cigarettes, and it seems to me that we are in an era in which we must be driven by data and evidence. There can be no doubt that the data is completely one way on vaping devices, electronic nicotine delivery systems and all sorts of other technologies to help smoking cessation. Vaping, using an electronic device or even using snus is so much safer than smoking. Smoke is the killer; tobacco is the killer. I urge the Minister not to do what the European Union has done, or what the World Health Organisation seems to be doing, by mangling the two issues. Tobacco is one thing; smoking cessation devices, which in most cases contain nicotine, are a completely different thing, with a completely different scale of harm and risk.
I recognise that other hon. Members will talk about various recommendations from the all-party group on smoking and health, so let me briefly focus on three. Recommendation 5 says that smokers should be advised annually of their options for quitting. Reminding people that they can choose an alternative to smoking is an important step forward. If we ask any smoker—I was a smoker for a few years, some time ago—“Would you like your children to smoke?” they all say no. It is clear that no one really wants to smoke, no matter what their brain says about dopamine levels. In that scenario, I think it a good idea to remind people annually that there are alternatives. Nicotine patches are not the only alternatives. Those have some efficacy, but, to be frank, very little for the money that is paid for them. People should certainly consider vaping devices.
The second recommendation I draw to hon. Members’ attention to is No. 6, which is support for those with mental health challenges. It also says
“for those living in social housing”,
but I will broaden that slightly to those on lower incomes and in lower-paid jobs, among whom there is a far higher incidence of smoking than in the general population. There is work to be done to focus the efforts in those areas.
Recommendation 11 is also important, because there is still an ambiguity about whether vaping is a smoking cessation device or just another way of inhaling nicotine. It is clear from the evidence that it is a smoking cessation device that works, and it is twice as effective—if not more—at helping smokers to cease smoking as the other available treatments. Let us dig into the pockets of the tobacco companies—they are actually happy for their pockets to be dug into—and use that money to publish the relative health benefits of vaping, e-cigarettes and other alternatives to smoking.
Windsor is a lovely seat, and thankfully we have slightly lower smoking rates than the rest of the country, but we still have perhaps 200 or 300 people a year dying of smoking-related diseases, as well as all sorts of other challenges.
In conclusion, we are first in the world for genomics, for the vaccine roll-out, and for FinTech and financial services. Let us make this another one: let us be the first in the world to implement a tobacco control plan that completely takes on board the wonderful innovation of vaping devices, e-cigarettes and all the other technology, and let us not mangle it together in a tobacco directive.
Liz Twist (Blaydon) (Lab)
It is a pleasure to serve with you in the Chair, Mrs Miller. I thank my hon. Friend the Member for City of Durham (Mary Kelly Foy) and the hon. Member for Harrow East (Bob Blackman) for securing this important debate to consider smoking cessation.
I will start with a few figures, just to show why this issue is important to me. It is very difficult to get constituency figures, as I am sure colleagues have found, so we are looking at local authority areas. The covid-19 pandemic recovery makes it particularly important to set out an ambitious national strategy to tackle smoking and to address, once and for all, the tragic health inequalities that smoking causes.
In Gateshead, 17.1% of the population smokes, compared with 15.3% across the north-east. That figure is well above the England average of 13.9%. It is estimated that smoking costs Gateshead around £48.3 million a year through smoking-related health and care needs, lost productivity and premature death. Between 2016 and 2018, there were 1,227 deaths attributable to smoking in Gateshead, which is significantly higher than the per population average for England. Between 2016 and 2018 in Gateshead, there were 515 deaths from lung cancer and 412 deaths from chronic obstructive pulmonary disease. More than 80% of those disease cases were caused by smoking. Between 2016 and 2018, there were, sadly, 29 stillbirths in Gateshead, which is above the per population average for England. Smoking during pregnancy has been shown to double the risk of stillbirth.
Although adult smoking rates have declined in recent years, inequalities in smoking rates between different groups have remained stubbornly high. The next tobacco control plan must go further in providing additional quick support for smokers in communities and groups with high rates of smoking. That is essential if we are to tackle the health inequalities in our society after covid-19, and indeed before that time comes.
I support wholeheartedly the recommendation of the APPG that tobacco manufacturers should pay the costs—on the “polluter pays” principle—of creating a smoke-free 2030 fund and helping to meet that target. Indeed, it is absolutely essential that we achieve that target.
Smoking during pregnancy is the leading modifiable risk factor for poor birth outcomes, including stillbirth, miscarriage and pre-term birth. The Government’s ambition is to reduce smoking in pregnancy to 6% by 2022, but with a rate of 10.4% in 2019-20, that target is unlikely to be met. National rates of smoking in pregnancy have only declined by 0.6 percentage points since 2015, although some regions—such as the north-east, I am glad to say—have seen much larger declines. Clearly, there is much to be done.
Ensuring that pregnancies are smoke-free and that there is greater consistency across the country must be a major focus of the next tobacco control plan, if we are to deliver a smoke-free start for every child by 2030 and give them the best start in life. The highest rates of smoking among pregnant women are in young pregnant women. Nearly a third of pregnant women in England under the age of 20 are smoking during early pregnancy and at delivery, compared to around one in 10 pregnant women overall. As well as being more likely to smoke in the first place, younger mothers are less likely to quit prior to conception, whereas older mothers are more likely to have quit when planning a pregnancy. As such, driving down rates of smoking in the younger population should have a rapid impact on rates of smoking in pregnancy.
A woman’s circumstances also greatly affect the likelihood that she will smoke in pregnancy, with smoking in pregnancy concentrated among those who live in an area of deprivation or high smoking prevalence, those who live with a smoker, those who smoked through a previous pregnancy, and younger women.
There is so much more we could say on this issue, but the key thing is that we need to consider ideas such as financial incentive schemes. Those that have been implemented in Greater Manchester and south Tyneside are highly effective at reducing rates of smoking in pregnancy among women from deprived backgrounds. They are also cost-effective, with an estimated return on investment of £4 for every £1 invested.
To finish, can the Minister assure me that the next tobacco control plan will include a national strategy for reducing rates of smoking in pregnancy, learning the lessons from the areas where the greatest declines in smoking in pregnancy have occurred? Will she commit to introducing a national financial incentive scheme to achieve the aim set out in the tobacco control plan? Will she also commit to consulting on raising the age for the sale of tobacco to 21, to reduce the number of young people who become addicted to smoking?
Kenny MacAskill (East Lothian) (Alba) [V]
It is a pleasure to serve under your chairmanship, Mrs Miller, as others have said.
I also follow others in thanking the hon. Member for City of Durham (Mary Kelly Foy) for securing this debate. I also thank Action on Smoking and Health for providing a briefing for it. I am conscious that most of this debate and this documentation relates to England. There are some aspects that apply to Scotland; indeed, I hope they will be replicated in Scotland and I will do my best to encourage some action to be taken, because some actions are cross-border, if not universal. It is from that perspective that I come to this debate.
As others have said, or confessed to, I do not smoke; I never have smoked and I have discouraged my family from so doing. I come from a generation in which youngsters, such as myself, who were quite interested in sport were told by Jim Watt, the boxer, that he could be caught by a right but never with a fag in his hand. I think that Scotland would be a better place if we had had similar efforts on alcohol, but we only concentrated on smoking. That is where we are coming from. We have made progress from the time of my childhood in the ’60s and ’70s, but there is still a considerable distance to travel, especially when we find smoking rooted in the poorest areas, where there are already underlying health vulnerabilities, and indeed in other sections of our society. There is considerable work still to be done.
The question is this: what action is to be taken? It is not a question of what action per se, because action has to be taken; it is more about the extent and calibration of the action that is taken. I say that because I wish to ensure that the social progress that we need to make, and want to make, in tackling smoking and the social ill that it is does not come at a cost to other communities or, indeed, in the form of other aspects that cause harm in our community.
I come from the perspective of having served as Justice Secretary in Scotland for seven and a half years. I established a serious organised crime taskforce. As other speakers have mentioned, there is a link between illegal tobacco and serious organised crime. Not only is there a link between them; it also turns into other harms that plague our communities. In my interlude between Parliaments, I chaired the Scottish Anti-Illicit Trade Group, which sought to bring together all organisations involved in law enforcement and keeping communities safe, at whatever level and in whatever jurisdiction. Indeed, it also brought in business, because a problem shared is a problem halved.
I want simply to highlight that cost loading has limits. That is not to say that there should not be cost loading. It is quite correct that the “polluter pays” aspect should be considered. I certainly argued that as Justice Secretary in the case of alcohol, and that has been taken up. Equally, to what extent do we load it? I am no free market capitalist, but I recognise, as did Adam Smith, that there has to be some regulation and that we have to ensure that there is some control over the market, because we know that in other aspects of society, if we close down supply, we find it simply results in aspects coming around in other ways.
I am not here to make a special plea for big tobacco. I would not seek to do that. They can fight their own battles, but there is an effect on others. As was mentioned by the hon. Member for North Antrim (Ian Paisley), small grocers—people who pay their taxes—are affected. They employ staff, provide for their communities, work on limited margins and yet they lose out. The tragedy we face is that people view illicit tobacco as simply ripping off big tobacco or, even more likely, ripping off the taxman—they have no love for him either—but the reality is that they are harming their communities and those who pay their taxes and work hard. They are harming their families and, indeed, their neighbours who work in and depend on employment in local stores, whether they purchase from a pop-up Facebook page or from a white van man.
Action has to be taken, and I support calls for an improvement in what we do to tackle the illicit trade. Much more could be done at a governmental level on both sides of the border. In terms of today’s debate, I welcome progress and fully support what has been called for here today. I simply emphasise that we have to ensure that we get the calibration right. In seeking to tackle harm within our communities, we must keep it proportionate and at a level that will not be counterproductive, because we do not want to make further progress in tackling tobacco that at the same time results in fuelling organised crime and in other aspects being abused. It is therefore a matter of balance.
Mr Virendra Sharma (Ealing, Southall) (Lab) [V]
Thank you for calling me to speak in this important discussion, Mrs Miller. It is a pleasure to speak here under such a distinguished Chair. I congratulate my hon. Friend the Member for City of Durham (Mary Kelly Foy) and the hon. Member for Harrow East (Bob Blackman), who secured this important debate.
I should declare an interest as a member of the all-party parliamentary group on smoking and health. We have made fantastic strides in this country to reduce smoking, but black and minority ethnic communities are being left behind. Rates of smoking among Asians are declining more slowly than the national average, so I want to see more done to empower them to choose to go smoke-free. One size fits all does not work anywhere. When I chaired the health scrutiny taskforce on smoking cessation as a councillor in 2003, we knew that differential outcomes were inescapable while we did not offer a range of options. Now, nearly 20 years on, we have gone backwards. Government money for cessation services has dried up.
The report that our APPG launched yesterday says that polluters should pay. That is a principle we all recognise, and I agree with it. Some tobacco companies have been clear that they will fund smoking cessation services for local authorities at this time of massive pressure on local health budgets. I assume that that would be welcome. The real costs of losing smoking cessation services are the years of good health lost, and there is a range of lower-risk options out there right now. Any of them is better than smoking.
I come from a family of smokers, although I do not smoke and have never done so. Personally, I do not see the appeal, but clearly people are addicted, and addiction needs treatment, not moralising. Three million people now vape, and nearly all of them are former smokers. That is 3 million fewer people choosing a less harmful option. This is good news, but BAME communities, and people with manual jobs and without university degrees, are about two and a half times more likely to smoke than their white, office-working and university-educated colleagues. That has to be addressed, and it has to be part of our future plan to support everyone we can to be smoke-free.
Emerging opportunities, such as tobacco-free nicotine pouches and “heat not burn” products, still present a health risk, but it is less than that of cigarettes. I want my constituents, and anyone who wants to smoke less, to know about the opportunities to improve their health. A range of options make it easier to quit eventually, as we noted in the health scrutiny taskforce on smoking cessation. We need an ambitious tobacco control plan that recognises the opportunities and legislates for new products. “Heat not burn” products and tobacco-free nicotine pouches will play a role, just as vaping has persuaded more people to quit smoking or to move to less harmful alternatives.
In Asian communities, we need to offer alternatives to chewing tobacco and betel. There are terrible statistics about the rates of oral cancers, and anything that reduces those rates will save lives. Pretending that millions of people will give up smoking just because we hope they will do so will get us nowhere, but working to move people down a ladder of lower-risk products really would save lives.
Thank you, Mrs Miller, for giving me the opportunity to contribute my few thoughts.
Kate Osborne (Jarrow) (Lab)
It is a pleasure to serve under your chairmanship, Mrs Miller. I thank my hon. Friend the Member for City of Durham (Mary Kelly Foy) and the APPG for securing this important debate.
I must first announce my interest in the debate as a former smoker. I grew up in the ’80s, and most of my peer group smoked. I can recall purchasing cigarettes at the local sweet shop, which was happy to accommodate the limited budget of schoolchildren by allowing us to buy our cigarettes individually. I came from a household in which there were adult smokers, and for me to take up the habit seemed almost inevitable. I have fought a lifelong struggle against smoking to kick the habit, but it was not until I was pregnant with my first son that I felt able to give up. Although I have returned to it once or twice, I am pleased to say that I have now not smoked for more than a decade.
The tobacco industry’s excessive profits are built on establishing an addiction in people like me in their teens, who unfortunately will often not succeed in stopping before it kills them. My hon. Friend the Member for Blaydon (Liz Twist) spoke about the figures in Gateshead, which is one of my local authorities. Smoking is estimated to cost my other local authority, South Tyneside, about £37.9 million every year. That is through smoking-related health and care needs, lost productivity and premature deaths.
I support the recommendations made by the all-party parliamentary group on smoking and health for a comprehensive strategy. It calls for additional regulation and targeted investment, with the full engagement of health and care services and a shared mission to end smoking. The communities where smoking is still part of the daily fabric of life need investment to ensure that the support is there, particularly for those with high levels of addiction. Services need to be much closer to the people who need them—in social housing, mental health services, children’s centres and LGBT service settings. Wherever the need is greatest, we should make the support available. I agree with the APPG that it is not the taxpayer but highly profitable tobacco companies that should foot the bill for these important services. Funding is needed now—we cannot wait—so does the Minister agree that the Government should include provision for a smoke-free 2030 fund in the health and social care Bill and bring this measure into force in 2022?
Funding and investment in communities with the greatest need are important to help more smokers to quit, but we also need to prevent young people from starting. Reducing the availability of tobacco to young people can help to achieve that, and existing laws on age of sale need to be fully enforced. Although retailers need a licence to sell alcohol, no licence is required for the sale of tobacco products. Therefore enforcement action can be slower and more complex and, ultimately, have less impact on retailers that break the law than would be the case if a licensing scheme were in place. Data from both YouGov and ASH, which I thank for their help with my contribution, show that retailers and the public support the introduction of a licence for retailers selling tobacco products.
Introducing a licence need not be costly. The tracking and tracing system is already in place for tobacco retailers. As a result, there would be minimum extra burden for retailers and wholesalers in turning it into a public health licensing scheme; there would be little additional administrative cost. At the same time, it would equip local authorities with more effective powers to protect their local communities from those who sell tobacco products to children. Will the Minister commit to establishing a public health licensing scheme for tobacco retailers to make it easier to prevent underage and illicit sales of tobacco in order to further protect children from taking up smoking?
The NHS has committed to supporting more smokers through the NHS long-term plan, but as with all plans, the proof of the pudding is in the eating. With all the pressures in the system right now, there is a risk that the roll-out is uneven, with smokers who need support missing out. Integrated care systems are responsible for putting in place prevention plans for their populations, and those plans need to meet the needs of smokers and ensure that the commitments in the long-term plan are delivered on. Will the Minister ensure that all ICS prevention plans are published and include as an objective achieving a smoke-free 2030? Finally, I hope that the Minister will consider tasking NHS England with establishing an operational plan to support all smokers in primary care and community mental health settings.
Alex Norris (Nottingham North) (Lab/Co-op)
It is a pleasure to serve under you in the Chair, Mrs Miller. I say a big thank you to my hon. Friend the Member for City of Durham (Mary Kelly Foy) and the hon. Member for Harrow East (Bob Blackman) for their doughty leadership on this issue, for their work in the APPG on smoking and health and for securing this debate, which has been a particularly good one. The points that my hon. Friend made about regional disadvantage and the way in which that links to every indicator of social deprivation and then to smoking were really good ones. It was very interesting and pleasing to hear about the work that has been done in the north-east about closing the gap. That, to me, served as an endorsement of regional approaches and, beyond that, sub-regional approaches, which I think we have lost in recent years and which I hope, through this plan, we can rebuild.
On the regional theme, my hon Friend was joined by a fine array of north-east MPs, who surround me here— I did feel rather out of place. My hon. Friend the Member for North Tyneside (Mary Glindon) made a really strong and compelling case for alternatives such as e-cigarettes and vaping. The thing I took away from that was how unequivocal it was. There is a real danger of being squeamish and equivocal about these new models, and I do not think that serves anyone. That is a theme that I will come to shortly.
That theme was shared by the right hon. Member for Clwyd West (Mr Jones). I agreed with the points he made about the new regulatory framework and the regulations. The review gives us a real chance to look at these things, so I hope we will hear some more from the Minister on that. Similarly, the hon. Member for Windsor (Adam Afriyie) talked about data and evidence. We have a common goal: we want fewer people to smoke and die. It behoves us, therefore, to follow the data and evidence about how to do that and not to be squeamish when they point one way.
My hon. Friend the Member for Blaydon (Liz Twist) made very poignant points about baby loss and smoking during pregnancy. She and other hon. Members will have heard some of the reasons why women smoke in pregnancy, which include perceptions about having a smaller baby and family traditions of doing so. The reasons are complicated and various, so we need ground-level, peer-led services to tackle that. Much of the content of the Leadsom review will help us in that space, so I hope to hear a commitment to that from the Minister.
My hon. Friend the Member for Jarrow (Kate Osborne) talked about regional inequalities and made a point about having services nearer to people. I will return to that shortly. My hon. Friend the Member for Ealing, Southall (Mr Sharma) also talked about inequalities—this time around ethnicity. We should not lose that in this debate. He also talked about localised approaches by service leaders who know their communities and have effective ways to reach different people. I think that is the whole battle here.
The hon. Member for Harrow East spoke with characteristic plainness, but we needed a bit of that. The 2030 target is a stretching one. At the current rate, we are seven years behind, but in the poorest communities it is 14. That means that we need big ideas. The document that he co-authored through the APPG has big ideas, and I will touch on a couple shortly.
I agree with the points that the hon. Member for North Antrim (Ian Paisley) made about organised crime. Again, that can form part of a tobacco control plan. I think there is complete political consensus about that. I do not agree that increasing the cost has not been an effective way of reducing smoking. Over two decades, it absolutely has. I also do not agree that tobacco control plans over the past couple of decades have not had an impact. Clearly, they have, and I will touch on that shortly.
For me, smoking is the ultimate equalities issue. It accounts for half the difference in premature death between the best and the worst off, so if levelling up is to be the theme of this Parliament, post covid, it seems that smoking is a very good place to start. I have similar statistics to those of my colleagues. In Nottingham, where I live, smoking rates are well above the national average: 20.9% of our community smokes, compared with an England average of 13.9%; and 16.5% of pregnant women are smokers when their baby is born, compared with 10% nationally. The cost to us is about £75 million every year through health and care needs, lost productivity and premature death, so tackling this is a really big prize for a community such as mine.
We should be confident that we are building on a platform of two decades of good progress on smoking cessation. Under Labour and Conservative Governments, we have implemented a comprehensive approach to tobacco control, including banning smoking in public places and cars, point-of-sale display bans and standardised packaging. All that has contributed to driving down smoking rates and discouraging young people from starting. We are here in a spirit of cross-party co-operation, and we are in lockstep in support of the goal of being smoke free by 2030.
I very much welcome the APPG’s report, which sets out the bold steps that we ought to take if we are to achieve this extremely challenging ambition. Among other things—this is always a very good place to start—it highlights the strong public support for that ambition: three quarters of the public are in favour, and that includes majority support for key recommendations from voters of all political parties. There is a clear mandate for action. I want to take the opportunity to thank Action on Smoking and Health, both for its work as the secretariat to the APPG and for the support it has given me in developing policy.
In this debate and the one we had a few months ago, colleagues have given the Minister plenty of content for the new control plan—in fact, probably a whole control plan and a bit more—but I want to offer a few points myself. First, the focus must now be on inequalities. Yes, this is a national goal and effort, but to make the most progress, we need locally led, community-sensitive smoking cessation services. The evidence for those is very strong indeed. It is a source of sadness that the Government have lopped away at the public health grant to the point that it has reduced by more than 40% since 2013, and those cuts have of course fallen disproportionately on poorer communities. If we are wondering why progress is stubborn in those areas, that is a significant reason, so I hope to hear a commitment from the Minister today to restore funds lost, with a particular focus on need. The report helpfully suggests an industry fund to cover the cost. Frankly, we should never have disinvested in the first place—cutting smoking cessation services is the falsest of false economies—but if the Government come up with an alternative along those lines, we will of course be supportive.
I want briefly to mention raising the age of sale to 21. We know that the best way to reduce smoking is never to start and we know that young people who start smoking generally tend to regret doing so. Seventy per cent. of adult smokers in England want to quit and an even bigger proportion—three quarters—regret ever having started, which makes an interesting point about raising the age of sale to 21. One of the things that surprised me in the report was the level of public support for that proposal—I did not think it would be as popular as it is—so the recommendation of at least a public consultation is a sound one. I would be interested to hear the Minister’s views on that, because it would be a very interesting public debate to have.
Turning to e-cigarettes, vaping and similar, this must be a feature of the tobacco control plan. I hope that the Minister and the Government more generally, via their role in the World Health Organisation, can push harder for stronger and clearer messages, based on the data and evidence, at the WHO level. I looked at the WHO website yesterday, and while I fancy myself as quite a smart guy—I might hide it well sometimes—I could not fathom what it was trying to tell me. It was incredible. That sort of equivocation makes it really hard for people thinking about alternatives to know whether they are supposed to go ahead or not.
I always rely on the Public Health England position in 2018 that these products represent a 95% reduction in harm, which seems a pretty good place to start. The APPG report says that in 2017 they helped 50,000 people to stop smoking and that concerns around children’s starting have not materialised. The 2017 tobacco control plan included a promise that:
“The Medicines and Healthcare products Regulatory Agency...will ensure that the route to medicinal regulation for e-cigarette products is fit for purpose so that a range of safe and effective products can potentially be made available for NHS prescription.”
This has not happened; it now must happen, and I hope it is a main feature of the new plan. The Government should also seek to regulate this market through the regulations review, to ensure that it promotes quality, safety and protection of young people.
Finally, the 2030 target is a vital and unifying goal, but we cannot wait until 31 December 2030 to look at the stats and see whether we have made it. We know it is a stretching target and we know we are currently not on course, hence the need for a new plan as soon as possible, but that plan has to have interim goals so that we know whether we are making enough progress. Again, the APPG report made some very good suggestions on that.
The report also makes strong recommendations on the data we do not currently have, which is a particular challenge in the case of people living with mental health conditions, who we know have disproportionately high rates of smoking. Data is collected in primary care on smoking status and mental health, but not routinely analysed. Smoking status data can also be collected through the mental health services dataset, but this is not done routinely. As a result, our data for folks with serious mental illness and others in secondary mental health services is not good. Reliable data is an important part of being sure that we are making the progress that we want to in this area, so I hope we will hear a commitment from the Minister on interim targets and better data.
To conclude, if we want a big public policy win—and goodness, this is about as big as they come—whether it is early intervention we are into or reducing inequalities, this is a major chance to make a step change. We need a plan, we need a good plan, and we very much look forward to playing our role in that process.
Mrs Maria Miller (in the Chair)
May I remind everyone that only Members physically present can intervene on the Minister?
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
It is a pleasure to serve under your chairmanship, Mrs Miller. I congratulate the hon. Member for City of Durham (Mary Kelly Foy) and my hon. Friend the Member for Harrow East (Bob Blackman) on securing this important debate. I also thank everybody for the constructive tone in which we have discussed what is an incredibly important subject and for the acknowledgement that if we are to meet what is a very stretching target, we will all need to work together.
The hon. Member for City of Durham has highlighted the excellent work being done through the smoke-free programme in County Durham to drive rates in her area down, and I know that she fully supports that. As she alluded to, the aim is to reach 5% by 2025 through the regional tobacco control plan that Fresh drives forward, but since the launch of that in 2005, the north-east has seen a massive—47%—drop in smoking rates. I know that those rates are still above the national average, but I wanted to highlight how much I agree with that localised approach to delivery, making sure that we can focus services on those living in the local area.
I congratulate people on their successes so far, but as several right hon. and hon. Members have said, we cannot be complacent. Smoking rates at the time of delivery are among the lowest the country has ever seen, and my hon. Friend the Member for Harrow East has a relatively low rate in his area. I appreciate the passion shown through the cross-party work that has taken place to bring together these recommendations, because, as many have highlighted, one of the big challenges is the variation—across different groups in our society, but also across different regions of the country. If we are going to target those with higher incidence, we are going to have to accept that some areas will probably need more help than others.
We need to work together, and yesterday I was incredibly pleased to go to the launch of this report. I found the speech by the hon. Member for Blaydon (Liz Twist) incredibly poignant. I could not agree more: specialist cessation to help young mothers quit is so important, and the hon. Member for Jarrow (Kate Osborne) has said that it was that point in her life that was pivotal in helping her make that decision. Yesterday, we listened to a respiratory consultant who said that she ran out of her office and downstairs to speak to a young mother who was pregnant with twins, to try to get her to stop smoking. I do hope that mother was able to quit, and I assure hon. Members that this is a particular focus of mine. I have already spoken to the chief medical officer about the new Office for Health Promotion making smoking, and particularly smoking in pregnancy, a real focus. As I said yesterday, we get more bang for our buck here: not only do we help Mum but, in this case, we helped twins—that is three people—and as I have seen through some fantastic smoking cessation work in Bolton, we often get a partner, a mother, or someone who is supporting Mum to quit as well. That helps everybody to move forward.
The report and its recommendations are excellent, and I have listened with interest to the remarks made by right hon. and hon. Members today. Smoking prevalence is at an all-time low—just under 14%, and almost half the rate it was back in 2002—and it is right to celebrate where we have come to, but it is also right to say that we have a long way to go. The continued support through stop smoking services across England has been pivotal: since 1990, these services have stopped 4.7 million people smoking. That is more people quitting than the combined populations of Birmingham, Greater Manchester and Leeds, which is quite a remarkable achievement.
Smoking is linked to half a million hospital admissions each year, so the role that the NHS and charities play in helping smokers quit is also essential. The NHS long-term plan commits to supporting smokers admitted to hospital to quit, as well as pregnant smokers—pregnant mums—and their partners. It also commits to helping long-term users of specialist mental health and learning disability services, and we are ensuring that there is sufficient training, with challenge groups making sure that people get the right interventions and the right help when they intersect with these services. Funded early-implementer sites and services are also being stood up, because we cannot be complacent and we cannot wait for these timelines. I heard strongly that people want interim targets, and we will look at that in the strategy. It is important that we try to keep on track and ensure that we keep our focus on 5%.
Smoking is responsible for an estimated 75,000 deaths in England each year. That is unacceptable because it does not just affect the individual; families and everybody around them also suffer. As many hon. Members pointed out, it has a substantial financial impact on the country as well as a health and emotional impact. As my right hon. Friend the Member for Clwyd West (Mr Jones) said, we have to go at things hard if we are to see that success.
I assure everyone that we are considering alternative products in the plan in so far as they are alternatives. Ultimately, we want people to quit, but as the hon. Member for Nottingham North (Alex Norris) said just a few moments ago, the indication is that e-cigarettes, for example, are 95% better than smoking, so let us be sensible about how we take people on this journey. My hon. Friend the Member for Windsor (Adam Afriyie) will be interested to hear that, although snus is currently banned under the regulations, we are undertaking a review and will consider the evidence base.
The Government will publish the new tobacco control plan, which will set out how we achieve this, and I am pushing hard to ensure that the strategy is published as soon as possible; I am ambitious to try to publish ahead of the recess in July. However, as I am sure all right hon. and hon. Members are aware, new data on smoking prevalence will be released in July and I want to have time to ensure that the plan takes appropriate, targeted action on that data. Anecdotal evidence causes me some concern that we may have seen individuals taking up smoking. The new plan, which will expand on the success of the 2017 plan, builds momentum to support communities and groups where rates are not falling enough. As I say, I am exploring many of the issues we have covered to guarantee that the new plan will be bold enough for smoke-free 2030.
We know that reductions in smoking at a national level mask the significant health inequalities that many right hon. and hon. Members have spoken about. Smoking remains very high in certain areas of the country, particularly in deprived areas and among communities who can least afford the financial effects—as if anyone can afford the health effects. For example, prevalence in Blackpool is nearly 24%; in Richmond, it is down at 8%.
Adam Afriyie
I am encouraged by the Minister’s words. Will she confirm that she sees this as part of the levelling-up agenda? Given that particular regions and social groups have more of a challenge than others, it seems to me that it collides well with the Prime Minister’s levelling-up agenda, certainly in terms of health inequality.
Jo Churchill
Indeed I do. Actually, the levelling-up agenda and our manifesto commitment to ensure five more healthy life years must be driven by achieving the targets we have set ourselves. Smoking has such a direct correlation with other illnesses. My right hon. Friend the Member for Clwyd West mentioned his interest with Cancer Research UK, and we know about the link to cancer, but there is also a link to chronic obstructive pulmonary disease as well as other respiratory challenges and so on. As I say, a disproportionate burden is borne by those disadvantaged families and communities.
I thank the hon. Member for Ealing, Southall (Mr Sharma) for making an interesting point. I assure him that we are focused on the need to make these interventions local. The local directors of public health and PHE drive plans in localities. I would like to think that we have taken, and can take, much learning from the successful local interventions of the past 18 months, such as with the vaccination programme. There are also clever uses of technology, where we have prompted people to take a vaccination. That might be interesting to look at in connection with recommendation 11, to which my hon. Friend the Member for Windsor (Adam Afriyie) alluded—I think it was him—requiring people to be prompted annually. They might look at that particular behaviour in order to modify it.
I could not agree more with the person who said that data saves lives—indeed, it does. The more we understand about the data held across the NHS, the more we can use it effectively to target interventions and to ensure that people get not only the right treatment but the right care, at the right point on their life’s journey.
In the new plan, we will ensure that we have a strong focus to drive down rates across the whole country, ensuring that they are level to where rates are the lowest, because everybody deserves to live in an area where we have targeted smoking rates and are achieving success. For too long, the harms from smoking have hit those areas that already face challenges. One in 10 babies is born to a mother who smokes. It is estimated that one in five new mothers smokes in Kingston upon Hull, compared with one in 50 in west London. It is those disparities that we need to tackle.
We must also close the gap seen among smokers with mental health conditions and smokers in routine and manual occupations. Could we be cleverer? Could we work in workplaces, for example? It is vital we continue to support interventions that make the most difference, helping people to cease smoking and encouraging them to move to less harmful products.
Liz Twist
We have not had much time to talk about mental health in any detail. Will the Minister ensure that funding is found to deliver the original NHS long-term plan commitment to provide tobacco dependence treatment to all smokers accessing secondary mental health services?
Jo Churchill
If I have time, I will come on to that—I will try to speed up.
Many Members will be pleased to know that, within the plan, we will recommit to our evidenced approach to e-cigarettes. The products certainly have a role in supporting smokers to quit, and we will ensure that they remain accessible to smokers while protecting non-smokers and young people.
The fight against tobacco is not one we can win alone. It requires a joint effort through the health and care system and working across Government. There are good examples of that, because while NHS England is working to roll out the tobacco dependence treatment and the commitments in the long-term plan—we know there have been some delays—we are putting effort into driving the agenda forward, funding seven early implementer sites across England and establishing services as we speak.
Other Departments, such as HMRC, are tackling illicit tobacco. Her Majesty’s Treasury has taken action to raise tobacco taxation. We have also introduced a ring-fenced grant of £1 million to support an HMRC and trading standards intelligence cell called Operation CeCe. That was operational earlier this year. We are also working with the Department for Environment, Food and Rural Affairs on the suitability of options for littering.
I shall have to come to a close, but I will address the question of my right hon. Friend the Member for Clwyd West about how we are working with the WHO. We are a global leader in tobacco control and were instrumental in the framework convention on tobacco control. We will continue to take our treaty obligations seriously, including the commitment under article 5.3. I was particularly proud that we have been recognised in that work. The recognised commitment to our global prevention work with the WHO is important.
I hope the Chamber is aware that I am determined to protect the population from the harms of tobacco. As we build back better, we must make smoking a thing of the past, to improve the health of the nation and level up society, freeing up the billions of pounds spent on smoking by disadvantaged families and protecting the NHS. Clearly, with investment and with us all pushing in the same direction, we can truly make that target.
Mary Kelly Foy
I thank you, Mrs Miller, the Minister and right hon. and hon. Members for their contributions to the debate. I am so pleased that there is cross-party support. I just want to reiterate that in order to go some way towards reducing inequalities, levelling up and increasing healthy life expectancy—especially in poorer communities—we must implement this plan.
Motion lapsed (Standing Order No. 10(6)).