Health and Care Bill

Baroness Garden of Frognal Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, this is a very broad group. As part of the Government’s obesity strategy, Clause 144 and Schedule 17 introduce advertising restrictions on less healthy food and drink, a 9 pm watershed for TV and on-demand services and the prohibition of paid-for advertising online. I declare my interest as chair of the Commission on Alcohol Harm. I will speak only to my amendment, which addresses the problem that currently, the definition of “less healthy food and drink” does not include alcohol beverages as it was drawn from the 2001 Nutrient Profiling Technical Guidance.

The amendment requires the Government to consult on including alcohol in the proposed advertising restrictions, because alcohol is the leading cause of death and ill-health among 15 to 49-year-olds in England. Under the Bill, adverts for sugary soft drinks will be restricted but adverts for alcoholic drinks will not, even though they can be very obesogenic. To quote from the Government’s own obesity strategy, they recognise that

“alcohol is highly calorific … It has been estimated that for those that drink alcohol it accounts for nearly 10% of the calories they consume … each year around 3.4 million adults consume an additional day’s worth of calories each week from alcohol, that is nearly an additional 2 months of food each year.”

The calorie load of 100 millilitres of 40% spirit is 244 calories, compared to just 42 calories in 100 millilitres of coke. A pint of beer has the same calories as a Mars bar and a glass of wine equates to three Jaffa cakes.

Some sweet alcohol products contain more than 100% of the daily recommended sugar intake in a single serving. There is significant evidence that children exposed to alcohol marketing drink more and drink earlier than they otherwise would, and early-age drinking is linked to higher risk drinking and even alcohol dependence in adolescence and early adulthood.

Existing advertising codes are failing. In the past month more than 80% of 11 to 14 year-olds have seen alcohol advertising. Almost 60% of 11 to 17 year-olds had seen alcohol adverts on television and more than 40% saw alcohol adverts on social media platforms. One-fifth had interacted with alcohol marketing online in the past month, despite being underage and therefore not allowed to buy alcohol. These adverts achieve their aim. Children as young as 11 can identify, reference and describe brands and logos of various alcohol companies—which leads them to start drinking more and earlier—making these images most attractive. Ten to 15 year-olds are exposed to more TV alcohol marketing than adults.

Alcohol itself is linked to more than 200 diseases and conditions, including seven cancers, is obesogenic and should be classified as a less healthy product. It should be included in the advertising restriction codes proposed, because the current self-regulatory codes are clearly failing. Children would accept this. The Children’s Parliament investigators and the Young Scot health panel have recommended a TV watershed for alcohol advertising. I beg to move.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

The noble Lord, Lord Howarth of Newport, should be taking part remotely. If the noble Lord is there, would he like to speak? We will continue with the debate and when we can get hold of him, we will bring him in.

[Baroness Boycott (CB)]

My Lords, I declare my interests—there are a lot of them in terms of food, but this is for a specific reason: I am a trustee of the Food Foundation, chair of Feeding Britain, a patron of Sustain, an adviser on the national food strategy and chair of VegPower. I also work with Cancer Research and the Obesity Health Alliance.

We welcome the Health and Care Bill, which contains provisions to limit adverts of unhealthy food and drink on TV and online to protect children’s health. I also support the amendment tabled by the noble Baroness, Lady Finlay, on alcohol, which is not covered in my amendment. She is completely right about the fact that such advertising encourages people to drink—something I know a lot about, to my cost—and put on weight.

These provisions are found in Schedule 17 of the Bill. All the different charities and NGOs I have worked with have argued for this for many years and we are incredibly pleased that the Government have made these provisions part of the Bill. They have been supported by all of us, and the Obesity Health Alliance and all cancer charities. So, I am shocked—we all are—and puzzled that during this Committee, quite a lot of amendments have been tabled in the names of the noble Lords, Lord Moylan and Lord Vaizey of Didcot, that would directly weaken or delay these proposals. As far as I know, and I have worked in the food business for a long time, I have not seen their names associated with campaigns to do with children’s health—in particular, around obesity.

I want quickly to explain what these amendments would do. Amendments 245, 255, 256, 257 and 317 would delay implementation of the various restrictions—for example, blocking the 9 pm TV watershed until a full calendar year after Ofcom publishes the technical guidance. This would delay the planned implementation by at least six months. We all appreciate that the food and advertising industries will need time to review the technical guidance, but this is just too long.

Amendments 245A and 250ZA would limit the restrictions, so that they apply only at weekends, but kids do not watch TV only at weekends. Amendments 247, 250A and 253A would enshrine exemptions for brand adverts if specific products are not displayed; for example, McDonald’s could advertise lettuce. The Government have already stated that brand advertising will be exempt from some of these restrictions, so why do we have to go further?

Amendments 248 and 251 would exempt certain unhealthy products from the restrictions, including

“chocolate confectionery in portion sizes smaller than 200 kcal”.

The amendments conflict entirely with the purposes of the policy, which is to limit children’s exposure to the advertising of products that are high in fat, sugar and salt. Quite frankly, some products of under 200 calories can contain more than half of a child’s recommended daily sugar limit.

--- Later in debate ---

[Lord Faulkner of Worcester (Lab)]

My Lords, I move Amendment 270, and add my support to Amendments 271 to 279 in this group. I have added my name to each of these, and they will be spoken to by noble Lords in all parties in the Chamber and by the noble Baroness, Lady Masham. I pay particular tribute to them for all being present at this late hour on a Friday—but this is an important issue.

We have signed these amendments because we see them as important steps on the journey towards a smoke-free Britain by 2030, which is the aspiration the Government have identified. They are in line with the approach that has been repeatedly taken in your Lordships’ House in recent years, to reduce harm caused by tobacco smoking and which has been consistently supported by the noble Earl, Lord Howe, when he was answering for the department of health in earlier debates. His support for tobacco control measures has always been appreciated.

As recently as 14 July, your Lordships approved the Motion to Regret that I tabled, regretting that the draft pavement licences regulations were not revised to take into account the evidence of benefits of 100% smoke-free pavement licences. That was agreed by a majority of 30 in a Division.

The amendments in this group are based on the recommendations in the 2021 report of the All-Party Parliamentary Group on Smoking and Health; I declare an interest as an officer of it. The Public Health Minister in the other place has committed carefully to review these recommendations as she develops the forthcoming tobacco control plan. I suspect that we may hear a little more about that from the noble Earl.

The rationale for Amendment 270 is clear. Raising the age of sale would have a larger impact in reducing smoking rates among young adults than any other single intervention. Experimentation has been found to be rare after the age of 21, so the more we do to prevent exposure and access to tobacco before this age, the more young people we can stop from being locked into a deadly addiction from which they may never escape. Two-thirds of those who try smoking go on to become regular smokers and only a third succeed in quitting during their lifetime, with the remainder at serious risk of smoking-related disease, disability and premature death.

When the age of sale was raised from 16 to 18 in 2007, smoking rates among 16 and 17 year-olds declined by 30%. When the age was raised to 21 in the United States, there was a similar reduction there, which in the UK would equate to 100,000 fewer smokers aged 18 to 20, simply by making it harder for young adults to buy tobacco.

Raising the age of sale would also help to reduce inequalities. Compared with non-smokers aged 18 to 20, smokers in this age group are more likely to be from lower socioeconomic backgrounds. This means that the effect of increasing the age of sale would be particularly beneficial in poorer and more disadvantaged communities. The Government’s levelling-up White Paper, published earlier this week, rightly states on page 203:

“Tobacco is still one of the single largest causes of preventable mortality, and smoking rates remain high in some areas of the UK. In 2019, the UK Government set the ambition for England to be Smokefree by 2030. A new Tobacco Control Plan for England is due to be published in 2022, setting out how the UK Government will deliver on this commitment, with a focus on reducing smoking rates in the most disadvantaged areas and groups.”


Elsewhere, the White Paper states:

“These and other changes will contribute to narrowing the gap in Healthy Life Expectancy … between local areas where it is highest and lowest by 2030, and increasing Healthy Life Expectancy by five years by 2035”.


I hope that, with those very desirable aspirations, the Government may be able to accept these amendments or propose similar ones of their own on Report. These amendments are designed to help them to achieve what they want to do.

Raising the age of sale is simple and inexpensive to implement and enforce, as retailers are already required to check the age of young people trying to purchase tobacco, so it is not an additional regulatory burden. Raising the age to 21 would do more than any other measure to help achieve the Government’s ambition of a “smokefree generation” and has already proved effective in the US.

I shall conclude with a brief word on Amendment 271. This requires the Government to prohibit the free distribution of nicotine products to under-18s and to regulate the marketing of any novel nicotine products, not just e-cigarettes. Unsurprisingly, tobacco companies have shown themselves more than willing to exploit this loophole. Free vapes have reportedly been handed out without age checks in cities all around the country. After all, it is not illegal to do so, although it clearly contravenes the spirit of the existing regulations, which set the age of sale at 18. I hope the Minister will agree that the current situation is unacceptable and will take action now to prevent e-cigarettes and other nicotine products being promoted to children. Including all nicotine products, not just e-cigarettes, will ensure that any new nicotine products introduced into the UK in future will be properly regulated from the outset.

I commend all the amendments in this group to the Committee, and remind the Minister that all that Amendment 270 requires at this stage is a consultation and a report back to Parliament. Surely that is not too much to ask for a measure which has majority support among small tobacco retailers as well as the adult population, makes a major contribution to public health and reduces health inequalities. I beg to move.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Masham of Ilton, is taking part remotely and I invite her to speak.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I support all these amendments but will speak to Amendments 276 and 277, to which my name is attached, requiring health warnings on cigarettes and inserts in cigarette packs containing quitting advice.

My father used to smoke, as very many people did in the war. At the age of 52, he died of coronary thrombosis; I always felt that smoking caused his death. In addition, one of my best friends who smoked died early. At this very time, my housekeeper is in St James’s University Hospital in Leeds receiving treatment for cancer. The other day, she scolded herself for having smoked. Smoking causes serious disability as well as premature death; far too many people have died because of smoking.

I strongly support the Government’s Smokefree 2030 ambition. The measures in the amendments will help put us on track; they are well-evidenced, cheap to implement and easy to enforce. Health warnings on cigarette packs have progressively increased in size over time and, most recently, their impact has been enhanced by the removal of colourful banding. Warnings on cigarettes is the logical next step, and it will have particular impact in preventing children and young people starting to smoke. Hundreds of children start smoking every day in the UK. Children are much more likely to have access to individual cigarettes than full packs, meaning that warnings on cigarettes are likely to be particularly effective in preventing youth uptake. This measure has strong public support. Adding health warnings to cigarettes and cigarette papers is a simple measure with minimal cost which would help deliver the Government’s Smokefree 2030 ambition.

Amendment 277 would give the Government powers to require that health information messages be inserted in cigarette packs. This is not a novel idea; it has been a legal requirement in Canada since 2000. They are proven to work, and there is already good evidence from Canada on which messages are most effective. If the Government could give an assurance today regarding the increased use of health warning inserts—they already have the power to do this—these amendments might not be necessary and we could save time on Report. If not, Amendments 276 and 277, which are by no means the only measures needed to address this terrible addiction, would be a small and significant step in the right direction. I commend them to the Committee.