Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 5th December 2023 Commons Chamber

[Helen Whately]

I assure the hon. Member that we are investing in the national health service and, in particular, supporting it to prepare for this winter, ensuring there is more capacity in the system. There will be 5,000 more beds in hospitals around the country this winter, as well as 800 new ambulances on the road. But we are also doing things differently. The future of healthcare is not just about hospitals, but about caring for more people out of hospital. For instance, we are investing in proactive care, so that in every neighbourhood, the people who are more likely to go into hospital are known and reached out to, and the care is available for them. That is one of the things we are doing to ensure that people receive care when and where they need it.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Sleaford and North Hykeham is a beautiful rural constituency, but living in a rural area means people are further from specialist medical services, which is a particular challenge in the winter months when the roads can be difficult to travel on. As the winter approaches, what is the Minister doing to ensure that constituents in rural areas are well looked after?

[Helen Whately]

My hon. Friend makes a very important point about the additional challenges in rural areas. I want to ensure that this winter people get care when they need it and get it faster. We are already seeing progress on that. For instance, we are investing in making sure there are more ambulance hours on the road, and we are seeing ambulances get to people quicker—in fact, this October, they got to people 20 minutes faster than last October. Ambulance handover delays are reducing and we are already seeing progress in A&E, where people are being seen faster, too.

Building an NHS Fit for the Future

Caroline Johnson Excerpts

Monday 13th November 2023 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Waiting lists are rightly one of the Government’s top priorities. To the best of my knowledge, Mr Deputy Speaker, you could not perform a knee replacement—one of the most waited-for operations—and if I were to give you £1 billion, I suspect that you would still be unable to do so. Too often, debates focus on money and how much has been put into the NHS—the Government have put record amounts into the NHS—but it is about more than money; it is about people.

On this, the 75th year since the NHS was founded, the workforce plan is a milestone in the NHS’s history, and one that I am very pleased to see. It is an essential step towards creating a more productive health service where we can expand training and recruitment while retaining the amazing pool of talent that we have in the NHS. My constituents will be particularly pleased to see the plans to increase the number of dentistry students by 40%, because many are struggling, as has been said, to see dentists. We will also double the number of GP training places by 2031, which is welcome.

These changes will take time, because doctors take a long time to train. One of the first things that the Conservative Government did was to put in place steps to open the new Lincoln medical school. It has opened and is training doctors, and it will not be long before the first new doctors will graduate, which is excellent news for my constituents. I am also pleased for my constituents that we have got a new diagnostics centre opening in Grantham, which will accelerate patients’ diagnoses and treatment.

I have been pleased to hear in the last few days about the streamlining of processes for clinical trials. That will help us to find the new treatments and diagnoses that will be the miracle cures. The Health and Social Care Committee recently visited Singapore, where we met a professor who had identified the benefits of chimeric antigen receptor T-cell therapy and treated Oscar, the little boy from Worcester whom many of us will remember from the news. Thankfully, he has recovered from his leukaemia. Such groundbreaking, world-beating discoveries will be made only if we make it easier to conduct safe clinical trials. However, we also need to look at how we incentivise people to do them.

The NHS has advertised roles for equality and diversity staff at more than £90,000, yet there is currently an advert for a professor of synthetic biology at Cambridge University—they will lead global clinical research—for a little over £67,000. We need to look at how the state values the people who will bring about world-leading discoveries and how it can support them in their quests so that our brightest children will want to do that not just through moral desire but, essentially, to turn their A-levels into cash.

The NHS has been crippled by strikes this year, and more than 1 million appointments have been cancelled. That is not helping with waiting lists, and patients are being left to suffer. Cancer diagnoses are being delayed, and patients’ conditions, when they are in pain, are being left unrelieved. As a paediatrician, I understand the desire for better working conditions and more money, but I cannot understand morally the desire to leave patients behind in order to achieve that. Morally, I do not agree with the strikes and I support the Government’s prioritising patients and their commitment to maintaining minimum service levels during industrial action.

[Mr Ranil Jayawardena (North East Hampshire) (Con)]

Does my hon. Friend agree that people often forget about the huge amount of pension rights quite understandably provided to people in public service? Junior doctors who are continuing their action do not take account of the huge benefits that they will accrue in later life.

[Dr Johnson]

I should mention that I have an NHS pension, but my right hon. Friend is right. The Government took a big step earlier this year to improve pensions, by changing the tax regime to make it easier for more senior doctors to remain at work and not feel they have to give it up because of punitive tax levels. Ultimately, doctors are paid well—they could be paid better, of course—but for me it is a moral question: morally, I do not think it is right to leave patients in order to advocate for more money.

I am pleased by the steps that the Government are taking to crack down on tobacco products. The proposal will not please everyone, but it shows the Government’s boldness and earnestness when addressing public health issues. Prevention is better—and usually far cheaper—than cure. A preventive approach to smoking will reduce the burden on our healthcare system and improve people’s quality of life. Colleagues will not be surprised to hear that I am especially pleased by the Government’s commitment to restrict the sale and marketing of vapes to children. I am glad that the Government have included some of my proposals in their upcoming consultation on vaping, including regulating their flavours, branding and visibility in shops, as well as giving local authorities the power to issue on-the-spot fines for those selling them to children.

I am glad that the Government are consulting on banning the sale of disposable e-cigarettes, which time and again have been the vape of choice for children. I was shocked by figures published last year that found that 1.3 million vapes are thrown away every week in the UK. Subsequent figures released in September show that, staggeringly, in the space of just one year that number has more than tripled to 5 million every week. Those disposable vapes would fill this Chamber from top to bottom twice over every single week—heaven forbid, Mr Deputy Speaker. That is the scale of the problem we are dealing with.

The UK risks falling behind if it does not seize the agenda quickly. I eagerly await the results of the Government’s consultation, as I know many colleagues do. Sometimes, it can be difficult to find issues on which figures from across the political spectrum are strongly aligned, but I am confident that the House will unite behind the Government’s recent proposals on vaping.

[Jackie Doyle-Price (Thurrock) (Con)]

My hon. Friend is making some compelling points. It strikes me that disposable vapes are often available at the point of sale where we used to find things such as chewing gum and packets of Polo mints. That makes it very easy for children to access them. Does she think that regulating point-of-sale products is a massive tool to tackle the problem? Let us remember that established tobacco companies have to have their multi-use vapes on sale behind the screens that tobacco is sold behind.

[Dr Johnson]

I completely agree that putting vapes where children can see them makes them more available and makes children want them more. That is why they need to be in plain colours and flavours and out of the sight and reach of children. My understanding is that that is part of the Government’s consultation, and I hope they legislate and make regulations as soon as they can.

Overall, the King’s Speech is a good one, and I am proud to support it.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 17th October 2023 Commons Chamber

[Will Quince]

We are continuing to support NHS England in increasing cancer treatment capacity. As I say, I recognise the importance of early diagnosis and treatment of cancer. NHS England has instructed integrated care boards to increase and prioritise the diagnostic and treatment capacity for cancer. As of the middle of this year, we have 93 additional surgical hubs that are currently operational and 123 additional community diagnostic centres, which have delivered more than 5 million additional tests since July 2021, but we know and recognise that we need to do more.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Members will know from my entry in the Register of Members’ Financial Interests that I am an NHS consultant and a member of the British Medical Association. I congratulate the Minister on the work he is doing to reduce waiting lists, but BMA strikes have led to the loss of more than 1 million appointments, have delayed the reporting of scans, including scans for cancer, and have disrupted people’s chronic long-term condition treatment. What is he doing to ensure that there are no further strikes? What talks is he having on minimum service levels to expand the provision if further strikes do take place?

[Will Quince]

I thank my hon. Friend for her question, which is better directed at the BMA. However, she is right to suggest that we are taking action on minimum service level legislation. We recognise that industrial action means that services are under increased pressure, with appointments and treatments being cancelled because of the strikes. The NHS is taking action, prioritising urgent and cancer care, and will of course continue to do so. It will do its best to maintain appointments and elective procedures, wherever possible, but she is right to say that these strikes and the actions of the BMA are having a devastating impact on patients.

Countess of Chester Hospital Inquiry

Caroline Johnson Excerpts

Monday 4th September 2023 Commons Chamber

[Steve Barclay]

Again, I agree. It is extremely important that we have the right levels of escalation and the right routes available to those raising concerns. I have already signalled to the House a number of safeguards that have already been put in place following various reviews, including the Francis review. Indeed, I spoke to Sir Robert about the lessons from his report, as I have with a number of other chairs in recent weeks. It is important and a number of safeguards are already in place, but of course the inquiry will look at how those fit together and whether any further steps are required.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I welcome the dashboard the Secretary of State has announced, which will identify outliers so that trusts that have abnormal events can be looked at, but in this particular case the fact that events were happening unexpectedly was identified, staffing analysis was done and seven consultants raised that this was a problem. They identified Lucy Letby as potentially causing this harm and they were repeatedly, repeatedly and repeatedly ignored. We also need to bear it in mind that, if they had not been ignored, some of these babies might not have died, and that is not good enough. As the Secretary of State seeks answers to how this can be prevented, I urge him to focus on three things: how he can develop clear lines of medical, nursing and managerial accountability; how he can prevent poor managers from moving from trust to trust to evade such accountability; and how, if seven consultants find themselves in a similar position in future, they can escalate beyond their trust—outside their trust—to get some attention.

[Steve Barclay]

A number of steps have already been taken; I am thinking, for example, of the role of medical examiners working in conjunction with the role of the coroner. Those are the sort of areas that the inquiry will look at: the roles of the coroner, the medical director, the Royal College of Paediatrics and Child Health report in 2016, who had sight of that and what action was taken, and the role of the board, including the non-exec lead, in terms of issues around patient safety. So a range of areas will be looked at, which is the whole purpose of having this inquiry. A number of steps have already been put in place, but it is important that we learn the lesson where clinicians have raised concerns and those concerns were not acted on.

Under-age Vaping

Caroline Johnson Excerpts

Wednesday 12th July 2023 Commons Chamber

[Kirsten Oswald]

I am grateful to my hon. Friend, and am delighted that he is as enraged as I am about the harm that these products are causing. I know that in his community people are equally as concerned as in mine. His comment bears reflecting upon, because how realistic is it that children will find ways to recycle this disposable product, or so-called disposable product, which is undoubtedly targeted at children, given that they are probably hiding it from their parents in the first place? There are no positive grounds for keeping these things about. I secured a debate last year focusing on the environmental impact, which bears reflecting on. My hon. Friend is right, so I am glad that he made the points that he did.

I am also deeply concerned about the impact on children and young people, because these vapes are so available, so inviting, and so increasingly used by younger people. I am particularly concerned about under-18s. The hon. Member for Denton and Reddish (Andrew Gwynne), who opened the debate very powerfully, talked about the Health and Social Care Committee having heard from a headteacher about the significant proportion of children vaping regularly. If we speak to headteachers in any of our constituencies, they will say the same thing. I was also alarmed, though unfortunately not surprised, to hear him highlight issues of primary-aged children vaping. That is terrifying. It is why today’s motion needs to be taken seriously.

The Advertising Standards Authority says that

“adverts for e-cigarettes must be targeted responsibly”.

I am not sure that that is what is happening. Such ads must, apparently,

“not be directed at under-18s”.

Again, the ASA has a job of work to do there. I wonder, although I suspect that it is perhaps unable to, whether it would want to look at issues such as sports advertising. Blackburn Rovers—other teams may do this, but this is the only team that I am aware of that are doing it—are being sponsored by a vaping retailer, Totally Wicked, for the sixth season in a row. We would find it unacceptable if our football club came out with cigarette branding on their shirts. I cannot understand why it is any more acceptable for a football club to come out with vaping advertising. I am keen for the Minister, or Government Members, to address that.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Would the hon. Lady be similarly outraged to know that the same company supports St Helens rugby football club, and called the stadium Totally Wicked?

[Kirsten Oswald]

I would be equally outraged. I know how much work the hon. Lady does in this regard. I am unsurprised to find that we are both enraged by the same thing. This is really unacceptable. If we are serious about dealing with the harms to children and young people, we really should expect sports clubs to be somewhere that they can see positive imagery and have positive influences. I recently visited a vaping shop near to where I live. I know they are sold in other outlets too, in corner shops and supermarkets, on Amazon and eBay, and we have heard about them being sold in a barbershop as well. They are not difficult to find, and they are so inviting. When I went into the shop, it looked lovely: the display was beautiful, with nice colours and names and all kinds of fancy shapes that looked like highlighters or lipsticks. I have seen some online that look like brightly coloured fidget spinners. These things are quite enticing, are they not? They are very attractive, and that is obviously deliberate.

I was interested to hear about the King’s College study on plain packaging, because anything that makes vapes less attractive to young people is obviously worth considering. I say that for many reasons, one being that I heard recently about young people purchasing disposable vapes to match their outfits. I must say that that had never occurred to me before, but why not? If they are purchasing them, they might want them to match their outfits, just as they might think about what flavour they would like, such as bubblegum or grape soda. The hon. Member for Denton and Reddish talked about them looking like an old-fashioned sweet shop, and he was right about that.

Disposable vapes are designed to be enticing, to draw young people in. They are throwaway and they are affordable. The right hon. Member for Romsey and Southampton North (Caroline Nokes) was absolutely right to describe them as pocket-money purchases. Parents will not always know what their children are purchasing with pocket money; presumably children throw disposable vapes away, as I have said, before the parents find them. As parents, we have no idea whether our children are using them. I hope mine are not, but none of us can know that, because they are so easy to find and so easy to throw away that we must be alive to the fact that we might not have the full picture.

Presumably we cannot all have the full picture, because, if we look at the statistics, in a recent YouGov/ASH survey the proportion of children aged between 11 and 17 who vape has gone up from 4% in 2020 to 7% in 2022, and the proportion of children who have tried vaping overall is now sitting at 16%. We have heard significantly higher figures than that cited in this debate.

I think it is reasonable to look for disposable vapes to be removed from sale. That is certainly what I would like to see. I am pleased to hear calls for retailers to ban single-use vapes in Scotland, where environmental and health charities have joined forces to call for an end to the sale of disposable vapes. Groups such as Keep Scotland Beautiful, ASH Scotland and the Marine Conservation Society are urging retailers to follow the good example of Waitrose, who I take my hat off to here, in banning the sale of those single-use products.

Waitrose did that because of reports suggesting that their popularity was soaring among people who had not previously smoked, as we have heard already, including the younger generation. It is really important that we examine the subject. I am pleased about the Scottish Government’s action in that regard and I echo Barry Fisher, the chief executive of Keep Scotland Beautiful, who also talks about a “litter emergency” and emphasises that the time to act is now.

The time to act is now also on the illicit vapes we have heard about already—the dodgy vapes and the chemicals within them. Lab research shows that they have up to twice the daily safe amount of lead and nine times the daily safe amount of nickel. There is also chromium in there. We do not want our children to be ingesting those substances, and those studies are based only on some vapes confiscated from a school in England, so we do not know what else is out there; we just know it should not be. Dodgy vapes have deeply concerning health impacts. In Scotland, there have been reports of illegal vapes confiscated from a school that left children coughing up blood. Which of us wants that for our children? We need to act.

It is deeply concerning—and that is before we even get into the notion of young people who have never previously smoked using disposable vapes and then graduating on to smoking cigarettes. We know that is an issue. The producers of vapes would have us believe they were intended to rectify and remedy that very problem, but it turns out to be the opposite that happens. The World Health Organisation has expressed significant concern about that, stating that children who use such products are three times more likely to use tobacco products in the future. If the Minister is looking for evidence, that is the kind of statistic he ought to bear in mind.

Huge profits are being made on the back of all those sales of vapes to children. Big business is being done here, but it is not always being done by the rules. The most popular brand for children is Elfbar, but in July an Observer investigation found that Elfbar had flouted the rules to promote its products to young people in the UK. Advertising videos and promotions on TikTok, for instance, were felt to be of concern. Some of those videos attracted hundreds of thousands of views, on a platform that is used by three quarters of 16 and 17-year-olds.

We have already heard about children’s doctors calling for a complete ban on disposable vapes. The hon. Member for Sleaford and North Hykeham (Dr Johnson), who is herself a children’s doctor, has spoken out about that. If we will not listen to the views of children’s doctors about the impact of vapes on children’s health, who will we listen to?

I am heartened that Humza Yousaf, our First Minister, says that a ban on disposable vapes is under consideration, and by the incredible hard work being done by the campaign group ASH, which absolutely deserves our thanks. I also thank the organisers of the TRNSMT festival, which took place in Glasgow last weekend, because they did not permit disposable vapes there, and I absolutely applaud them for that.

Less positively, however, I cannot thank the administration of East Renfrewshire Council, which is where I live. The motion, which I think is a good one, includes a passage about working with councils, and that is absolutely right. Of the 32 councils in Scotland, 28 supported motions calling for a ban on disposable vapes. Regrettably, East Renfrewshire Council was not one of them. It did not support the ban, seemingly because a ban was supported by the SNP. I am really unimpressed by that. It is a poor show from that Labour Administration and their Conservative enablers that they could not bring themselves in step with the whole of the rest of the country and, I suspect, with the Members who are present in the debate. That seems somewhat ironic given the motion that is before the House. I hope that they will reflect on that and change their mind, and that we will get a full set of councils to support the ban—although the numbers so far are pretty impressive.

I hope that the Scottish Government come to the conclusion that these things are too dangerous and damaging, although I am grateful for their sterling work so far. I hope that the UK Government will listen to what is being said to them. Like my hon. Friend the Member for Angus (Dave Doogan), I was not entirely convinced that a huge degree of listening was going on, but I hope that I am wrong about that and that we will hear about a very serious focus on the matter. The industry will not take the steps that are needed; politicians need to do that. Disposable vapes are a danger to the environment and to our young people. It is high time that we took them off the shelf.

--- Later in debate ---

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I thank the Labour Front-Bench team for a great choice of debate today. I thank, too, all those Members who have made nice comments about me today. I agree with the Chair of the Health and Social Care Committee, my hon. Friend the Member for Winchester (Steve Brine), who said that it is a shame to see children’s health being made a party political issue, because surely everybody in this House, from every party, wants children’s health to be as good as possible. In that vein I declare an interest as both a consultant paediatrician and a member of the Royal College of Paediatrics and Child Health.

I was pleased to see the shadow Minister talk about Laranya Caslin, the headteacher of St George’s Academy in Sleaford, who spoke so eloquently at the Select Committee about her experiences of children vaping in her school. Let me reflect on some of the things that she said. She said that there was heavy peer pressure in school encouraging children to vape. She said that vaping was seen to be cool and that children had to vape to feel that they were part of the in-group. She also talked about how it has a higher burden of addiction. She said that, sometimes, children would go out at break time to have a cigarette, or to share a cigarette with friends, but now they vape not just during break times but need to top up during lessons. That continual top-up is something that we see in Parliament, too. Yesterday, while eating in the Tea Room, a Member of the House was vaping at the table. It must be said that we did have quite a long session of votes yesterday. During voting, in the Labour Members’ cloakroom, a Member of the Opposition Front Bench was sat vaping. We are seeing people topping up anywhere and everywhere it would seem, and that is something that I would like to see stop.

As many Members have mentioned, the flavours and colours of vapes are very child-friendly: there are even unicorn flavours, which I struggle to believe are directed at teenagers, never mind adults. My 12-year-old would not thank you for anything with a unicorn on, because that is very much for younger children. Indeed, we saw in the Healthwatch survey that 11% of 10 and 11-year-olds are already vaping. That grew to 42.4% of 16 to 17-year-olds, with a gradual increase during the teenage years. Laranya Caslin also told us that flavours are important to the peer pressure on children to vape. She talked about how children would discuss, “Have you tried the cherry cola? Have you tried the unicorn milkshake? Have you tried the green gummy bear?” It is the flavours that enable that discussion to take place among peers, which encourages children.

I asked the industry representative, “Why do you need these flavours? Why can’t you make them basic mint flavour, no flavour at all, or tobacco flavour?” He said that when people smoke they lose their sense of taste to an extent. Indeed, the NHS website says that one of the benefits of stopping smoking is that after 48 hours a sense of taste will start to return. What the industry has found, it told me, is that if it has tobacco or plain flavoured vapes, people will move off smoking on to the vape, but when their tastebuds return they will not like the vape anymore and will discontinue their vape use. That is of course what we want them to do, but it is perhaps not what the industry wants them to do. Making it cherry cola flavoured, bubble gum flavoured, or whatever flavour the person likes to inhale means that they will continue to be addicted to that product and continue to use it. I encourage the Minister to consider that when she considers banning flavours, or which flavours should be allowed to be used.

The ten-minute rule Bill that I introduced on 8 February this year would have banned disposables. I understand that the Minister has challenges in defining a disposable in a way that the industry, which has such a heavy financial interest in the product, cannot get around and make the legislation weak quickly. I look for an update in how that is going, but 1.3 million are disposed of every week. We have heard already about the fires that they can cause, and the fact that most of them are not recycled. I understand that they are very difficult to recycle, because the nicotine salts leak into the plastic. It is not like a plastic water bottle, which can be easily recycled if it is disposed of properly. These vapes cannot be, because they become a hazardous waste, because the nicotine has leaked into the plastic itself.

[Kirsten Oswald]

The hon. Lady is making an excellent speech. Does she agree that the whole way these things are designed seems as if it is to prevent them from being recycled? They are impossible to take to bits. They contain, as she said, plastic, which is then infused with other substances. There are lithium batteries, and all manner of things. How would one possibly go about recycling that properly? I think that the answer is that one could not unless one were a specialist.

[Dr Johnson]

The hon. Lady is right: these things are incredibly difficult to recycle, and since 70% of children use disposable vapes, and they are the most attractive and cheapest for children to use, it is increasingly important that we ensure that they are not available. The call to ban disposables has been backed by a wide variety of people, including the Royal College of Paediatrics and Child Health, of which I am a member, the Children’s Commissioner, and the Royal Society for the Prevention of Cruelty to Animals. There is a widespread desire across all parties, and across communities, to see these products banned.

The industry said at the Select Committee that a ban will drive the industry underground and make things illicit, but as we heard from the hon. Lady earlier, that is already happening. There are already illicit vapes. When a school in my constituency confiscated five vapes and the police tested them, they found antifreeze and all sorts of products, including trichloroethylene, which was banned before I was born. All those types of products are contained in vapes already, so that cat is very much already out of the bag and should not dissuade us from getting rid of these disposable products.

We also heard on the Health and Social Care Committee about the health challenges. We hear that vapes are 95% safer than smoking. The industry continues to repeat that statistic. Where does it come from? How could anyone possibly quantify that? It comes from 2013, when a group of people who were not specifically experts in tobacco control got together and had a discussion. They then published a paper. Let me read something that was published in The Lancet at the time, which was more than 10 years ago. The editorial of The Lancet said:

“But neither PHE nor McNeill and Hajek report the caveats that Nutt and colleagues themselves emphasised in their paper. First, there was a ‘lack of hard evidence for the harms of most products on most of the criteria’. Second, ‘there was no formal criterion for the recruitment of the experts’. In other words, the opinions of a small group of individuals with no prespecified expertise in tobacco control were based on an almost total absence of evidence of harm. It is on this extraordinarily flimsy foundation that PHE based the major conclusion and message of its report.”

The Lancet also noted that

“one of the authors of the Nutt paper…reports serving as a consultant to…an e-cigarette distributor”,

and that another

“reports serving as a consultant to manufacturers of smoking cessation products.”

In the Westminster Hall debate on 29 June I asked the Minister to look further into the veracity of the claim that vaping is 95% safer, and whether, given that that study was 10 years ago, the modern evidence for that still stacks up. I look to the Minister for an update on how they are getting on with that, because we heard in the Health and Social Care Committee that there are significant health impacts for children, with eight children hospitalised from St George’s Academy in Sleaford alone.

We also heard about children being frightened to go into toilets, as the Select Committee Chair said. Some of those children were frightened to do so because they found that when they did, it triggered their asthma symptoms. Those are children who do not vape, but who have asthma and are frightened to go into the toilets because there is so much vaping vapour left in the toilets by other children that it is triggering their asthma and making them unwell. Some of these children are unable to go to the toilet all day, which leads them to have problems not only with asthma, but with urinary retention, which potentially leaves them at risk of urinary infection and incontinence issues in later life. It is for that reason that Dr Stewart from the Royal College of Paediatrics and Child Health told us that she supported a ban on the use of vaping in public places.

I would also like the Minister to look at the use of accessories. On Etsy.com today, under the categories “girly smoking accessories” or “cute smoking accessories”, for £7.78—within the pocket money range—one can buy a teddy bear vape stand. It is a tiny teddy bear that people can stand their vape in when they are not using it. Will the Minister look at whether such items are suitable for sale, given that they are essentially there to attract children to this activity?

Moving on to advertising, we have a bizarre situation where Transport for London banned an advert for “Tony n’ Tina’s Wedding” that initially featured a picture of a three-tier wedding cake, because it would encourage people to eat fat, salt and sugar and that might drive the obesity crisis. That was on the tube, yet TfL buses have many adverts for vaping, including ones that appear to me personally to make vaping look cool and something to be aspired to.

I think TfL’s priorities are all wrong. The London Bus Advertising group states, as part of the group’s advertising to encourage people to put their adverts on the buses, that 5.8 million people would see the buses per week. I would ask those on the shadow Front Bench to use their good offices with the Labour Mayor of London to consider whether he can influence the chair of TfL to remove not just cake adverts, but vaping adverts from places such as tubes, buses and taxis, where they may be seen by children.

In the Minister’s opening remarks he talked about tobacco track and trace, and I wonder whether he is planning to bring in the same for vaping.

The other thing I want to talk about is taxation. Other hon. Members have talked about the price of disposable vapes and how they are accessible with pocket money. Very rarely comes an opportunity for a Chancellor to bring in a tax that will promote the public’s health, still make vaping cheaper than smoking, protect our children’s health and be relatively popular, yet raise revenue. While we wait to ban the disposable versions, I encourage the Chancellor to consider adding at the next fiscal event perhaps £5 to the price of a vape, to move them out of the pocket money range.

In summary, the Minister needs to look at a whole range of measures to challenge children’s vaping, including price, location, sale and use, colours, flavours, disposable items, advertising, education and enforcement.

--- Later in debate ---

[Jerome Mayhew]

As the hon. Lady says, that is what they all say. Obviously that is wholly inappropriate, but part of the problem in reaching the correct solution to this shared concern has been demonstrated by the richness of the debate we have had today.

All sorts of suggestions have been made. My non-exhaustive list indicates that some hon. Members said that we should ban flavours. Some of them said that we should ban all flavours; others said that we should ban only flavours that are targeted directly at young palates. There have been suggestions that we should ban disposable vapes, or that we should require bland packaging for vapes, although others suggested that the issue is not so much the packaging as the fact that they should be hidden behind closed doors. There has been a suggestion that we should increase the cost of vapes, but that was controversial—the hon. Member for North Tyneside (Mary Glindon) rightly pointed out that for adults seeking to give up smoking who are on very limited means, the cost of vapes is a very relevant consideration.

[Dr Caroline Johnson]

The cost is indeed important, both in pricing children out of the pocket money market and in ensuring that smokers who are seeking to quit can do so. However, to a smoker who can afford a packet of cigarettes, even if £5 is put on the cost of a disposable vape, as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) described, the vape is still cheaper.

[Jerome Mayhew]

I am grateful for that intervention. I do not have skin in the game about whether it is better to have a higher cost or a lower cost, but my hon. Friend’s intervention has highlighted my fundamental point, which is that this is a complex area where we need evidence to base our policy on.

It has been suggested that we should crack down on marketing. Others have suggested that we should increase education in schools, and there is a wider debate about schools policy and the use of loos in schools. There are other concerns, overriding all of these, about what impact our actions in relation to vapes—including single-use vapes—could have on the ability of adults to give up smoking, in order to continue the downward trend of smoking addiction in this country. These are serious and interrelated issues. If this debate were to result in a Division, there is no way that I could support the Labour motion, which focuses solely on banning branding and advertising for the young, because it may not go far enough. It may just focus on one little area, when the richness of the debate on both sides has highlighted how much wider and more complex the issue is.

As such, what we are really talking about is not so much our concerns about vaping, including by children: the main issue is, “How should we make our law?” It is a given on both sides of the Chamber that action should be taken, and the first speech on behalf of the Government, made by the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien) made it clear that the Government have already acted and are intending to go further. In fact, the Secretary of State said at Health questions yesterday that the Government were looking to go further, particularly on single-use disposables. It is not a question of whether we are going to act: the question is, on what basis do we act? For my money, we should act on the evidence and not solely on anecdote, important though that is.

--- Later in debate ---

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I am grateful to all right hon. and hon. Members who have taken part in what has been a largely consensual debate. We have heard from colleagues across the House about the growth in the number of children who are vaping, concerns about physical and mental health impacts, the disruption to education and the drain on staff time in schools.

The Chair of the Health and Social Care Committee, the hon. Member for Winchester (Steve Brine), spoke of the evidence that the Committee has heard on the impact of vaping on the education of students, including interruptions to exams. My hon. Friend the Member for Ealing, Southall (Mr Sharma) highlighted the ongoing prevalence of smoking and the need for further work to tackle illegal tobacco sales as well as work to tackle vaping. The right hon. Member for Romsey and Southampton North (Caroline Nokes) spoke about the important role of vapes in smoking cessation. There is no disagreement from the Opposition on that. I am not so grateful to her for taking me back to the revolting smoke-filled environment of the toilets in my secondary school in the 1980s, which is a memory that I had long since sought to banish.

My hon. Friend the Member for North Tyneside (Mary Glindon) spoke about the need for better enforcement of the existing age verification regulations regarding vapes. The hon. Member for Erewash (Maggie Throup) highlighted the sophistication of the packaging, design and presentation of vaping products in retail outlets and how attractive that makes them. My hon. Friend the Member for City of Durham (Mary Kelly Foy), who has a long track record of work on this issue, highlighted the extent of the evidence on vaping that is already available to the Government. The hon. Member for Darlington (Peter Gibson) highlighted the impact of disposable vapes on the environment and the increase in plastic pollution. My hon. Friend the Member for Birmingham, Erdington (Mrs Hamilton) spoke from her experience as a former nurse and highlighted the serious problem of vaping equipment being used to distribute more dangerous substances by young people.

The hon. Member for Sleaford and North Hykeham (Dr Johnson), who spoke from her extensive work on this subject, highlighted concerns about the accuracy of data on the safety of vaping. The hon. Member for Tiverton and Honiton (Richard Foord) spoke about work in his constituency that shows it is possible for retailers to take a different approach to vapes. My hon. Friend the Member for Stockton North (Alex Cunningham) highlighted the Government’s failure to act on advertising. My hon. Friend the Member for York Central (Rachael Maskell) spoke about the lessons that can be learned from the anti-smoking measures that have been so successful as well as the need to recognise this issue as one of addiction and to locate it in the wider landscape of the addiction economy.

Vaping has shifted from a smoking cessation tool to a recreational activity in its own right, driven by the rapacious desire of tobacco companies—which fund many of the largest vape suppliers—to keep making a profit from the highly addictive substance of nicotine. The growth in the use of vapes by 11 to 15-year-olds has been rapid, increasing by 50% in the past three years. One in five 11 to 15-year-olds in England used vapes in 2021. The figure will be higher now.

The important role of vaping in smoking cessation has led to a widespread perception that it is a harmless activity, rather than a less harmful activity than smoking. Last year, 40 children were admitted to hospital for suspected vaping-related disorders. Young people using e-cigarettes are twice as likely to suffer from a chronic cough than non-users. There are reports that nicotine dependency contributes to cognitive and attention deficit conditions, and worsened mood disorders.

[Dr Caroline Johnson]

The brain develops gradually over time, and is thought to continue developing in people until they are 25. Some countries have different age limits for different things. Does the hon. Member think that 18 is the right age limit for vaping?

[Helen Hayes]

The hon. Member speaks from her experience on this issue. We have set out a motion containing some immediate actions that the Government can take, which are well-evidenced, particularly from the approach taken to combat smoking. I agree that the Government should look urgently at other aspects of the regulatory framework on vaping, some of which we have heard about today.

Vaping products are marketed directly to children, named after sweets such as gummy bears, Skittles and tutti frutti, in brightly coloured packaging decorated with cartoon characters. There is also evidence, including from research undertaken by one of my constituents who I met during evidence week last week, of the burgeoning growth in vaping among 18 to 25-year-olds, almost entirely unrelated to smoking cessation. A new generation of vaping products has been designed to be desirable objects in their own right. If action is not taken to tackle the accessibility of vaping to children, we can only expect vaping among young adults to continue to grow.

--- Later in debate ---

[Maria Caulfield]

That is the balance we have to create. We do not want unintended consequences whereby we reduce the use of vapes in under-18s but also stop their use among those who are quitting smoking. We know from our evidence that vaping is much safer than smoking. For those communities, very often in deprived areas, where there are higher rates of smoking, we do not want the cost of vapes to be prohibitive and for people not to switch to them instead of smoking.

Our current laws protect children by restricting the sale of vapes to over-18s and limiting nicotine content, and there are regulations on refill bottles, tank sizes, labelling requirements and advertising restrictions. It is important that we remember that regulations are in place, and it is important that they are enforced.

[Dr Caroline Johnson]

The Minister is talking about evidence that vapes are much safer, but I notice that she has not used the 95% figure that is used by the industry. Clearly, the absence of evidence of harm and evidence of the absence of harm are different things, so will the Minister clarify whether she has evidence that vaping devices are much safer? Or does she just not have evidence yet, because they are so new, that they are not dangerous?

Electronic Cigarettes

Caroline Johnson Excerpts

Thursday 29th June 2023 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I beg to move,

That this House has considered electronic cigarette use.

E-cigarettes were introduced as a stop-smoking device, but in my opinion they have moved from being a stop- smoking device to an alternative addiction. Indeed, they are attracting many non-smokers. In 2007, there were around 10.6 million smokers, according to official figures. The number fell to 6.6 million in 2022, so 4 million smokers had stopped. Sadly, it is estimated that around 1 million of those people died, which means that around 3 million quit smoking. That is undoubtedly a huge success, although it cannot be attributed entirely to vapes.

In the Health and Social Care Committee yesterday, we heard from the industry that it estimates that around 5 million people currently vape in the UK, which means that, even by the most generous estimates, 2 million of them were not smokers beforehand—a significant proportion of the vaping market. With the market estimated to be worth £4 billion a year, these products clearly have huge profit margins. Vapes have been available for a long time, but if they are genuinely safe, healthy devices that save lives by stopping people smoking, why does the NHS not provide any on prescription? I wonder whether it is because they are not safe and the NHS has been unable to develop the safety profile as well as it might wish.

The idea that e-cigarettes are 95% safer than smoking was quantified by Public Health England. Members will no doubt have heard the figure before, because the vaping lobby never tires of repeating it, but if we look into its origins, its veracity seems to suddenly disappear. The figure originated in a 2014 paper in a journal called European Addiction Research, but it comes with some important caveats. The study was partly funded by the Italian Anti-Smoking League, and one of its authors was a member of that organisation and served as a consultant to an e-cigarette distributor at the time. That blatant potential conflict of interest did not escape the journal’s editors, who added a warning note at the end of the paper, but it certainly escaped subsequent reporting of the figure.

The scientific journal The Lancet was even more excoriating of the original article, accusing it of having

“an almost total absence of evidence”

and of being based on

“the opinions of a small groups of individuals with no prespecified expertise in tobacco control”.

Furthermore, it is worth noting that the paper is seriously outdated. Since 2014, a plethora of evidence has emerged about the negative effects of these novel and fast-evolving devices, in studies that were never considered when the figure of 95% was reached. I am concerned that the statistic will age about as well as the claims made to past generations about the health benefits of smoking.

As we delve deeper into the topic, it becomes evident that a growing body of evidence links vaping to severe complications. Chronic bronchitis, emphysema, increased blood pressure and significantly worse physical performance are just some of the adverse effects associated with vaping that scientists have found. Furthermore, the high nicotine content, which some say is roughly equivalent to between 40 and 50 cigarettes in a disposable vape, poses a grave risk to the health and wellbeing of young people. We heard yesterday in the Health and Social Care Committee from Dr Helen Stewart of the Royal College of Paediatrics and Child Health—I should declare my interest as a member of that college and a consultant paediatrician—who told us about the difficulties that children are facing. Some of them are not going to the toilet during school time because the clouds of vapour they experience there trigger their asthma and make them unwell. We heard about children collapsing, too.

The number of children vaping is increasing. The evidence submitted to the Health and Social Care Committee by the vaping industry suggests that over 83% of children have never vaped or are unaware of vaping, but that flies in the face of the experience of most of the children, teachers and doctors I have spoken to. Indeed, a report on Blackpool published by Healthwatch in May found that a staggering 31% of children and young people claim to vape or sometimes vape. More disturbingly still, when I asked Healthwatch if it could break down its figures by age, it said that one in ten 10 and 11-year-olds vapes. These are children in year 6. That rises to nearly one in five 12 to 13-year-olds, while for 16 to 17-year-olds the figure was almost one in two. We have also noticed that the number of children vaping is rising extremely quickly.

I would like share a distressing incident from my constituency. In just one school, St George’s Academy in Sleaford, there have been eight reported cases of children collapsing after vaping. Those incidents occurred at different times with different children. I was deeply troubled to hear about this, so I went to visit them and met with one of the intelligence officers from Lincolnshire police, who had collected five vapes from another school.

In just those five vapes they found Velvana Fridex Eko, a modern non-toxic coolant intended for cooling cast iron and aluminium engines, as well as Avanti coolant antifreeze, Steol-M, which is designed for filling hydraulic devices, and Rauvolfia serpentina, or Indian snakeroot. Also found was Agip antifreeze, trichloro- ethylene, and poster and watercolour varnish—1-methoxy-2-propanol—along with diethylene glycol diacetate and 2-methoxyethyl acetate, a substance that may damage fertility and unborn children and is harmful to the skin if inhaled or swallowed. They also found aviptadil, a synthetic vasoactive intestinal peptide that is used to treat certain medical conditions.

These vapes do not contain what the children think they do, and they can be very dangerous. The police found that some children had significant health issues. The eight children who collapsed in Sleaford were taken to hospital. Thankfully, they have all recovered, but in one description given to me, a child taken to hospital in the back of a car had one side of his face drooped down as if he had had a stroke. His mother was clearly terrified by this. Another young boy said that he thought he was walking along through the marketplace in Sleaford when he realised that people were gathered around someone who had collapsed. Then he realised, as if looking from above, that that person was him. We have heard some really scary stories about what has been going on.

We hear that vaping is a good route to quitting, but we should balance the fact that it may help adults to quit with the need to keep these devices away from children. One of the things that makes vapes attractive to children is how inexpensive they are. We have seen them at £4 each, three for a tenner and those sorts of prices, which is clearly within pocket money range. When children can get disposables so cheaply, they are easy to discard. If a child finds that mum or dad is coming down the corridor or up to the bedroom, they can dispose of them quite quickly. When teachers come into the toilet, they can be disposed of, including in sanitary waste bins, which poses other hazards, too.

How much nicotine is in vapes? The average disposable contains 2 ml of e-liquid at 20 mg/ml nicotine strength, which I am told is the equivalent of 40 to 50 cigarettes. The reason for that is that people only take about 10% of the nicotine from cigarettes into their lungs—the rest of the time it just goes into the air—so vapes are stronger in many cases than cigarettes.

The other issue I want to raise with the Minister today is marketing tactics. We heard yesterday from the chief executive of Totally Wicked, who I challenged on his marketing techniques. Totally Wicked sponsors Blackburn Rovers and a rugby team as well, so the stadium is called Totally Wicked. The young men on the pitch—the heroes, as he called them, who those young men and women admire so much—are running around with T-shirts emblazoned with “Totally Wicked”. He said that the young people’s ones do not have that logo on. I checked this morning and found no evidence of them selling any junior shirts, which begs the question of what happened to them all. The suspicion might be that they have disappeared off sale—we do not know.

The Online Safety Bill offers an opportunity to ensure that vapes are not advertised on platforms such as TikTok. Vapes have bright, attractive packaging, with colours and flavours such as bubble gum. Why does an adult smoker need a unicorn milkshake-flavoured vape to quit? My 12-year-old daughter is too old for unicorns, she would tell me now, so why an adult would need a unicorn, I do not know. These vapes have become fashion accessories, and are being matched to outfits. Walk into any corner shop and we can see a whole rainbow from which to choose. There are understandable concerns that some manufacturers are deliberately doing that. They would all deny it, of course, and I hope that it is not the case, but with flavours such as unicorn milkshake, bubble gum, candy floss and green Gummy Bear, it is clear that these things are far too attractive to children. I ask the Minister to consider whether, if these are truly stop-smoking devices and not lifestyle products that are attractive to children, they really need to be coloured and flavoured. I do not think they do.

The environmental impact of disposable vapes has been highlighted by a number of my colleagues in the House on a number of occasions. Some 1.3 million disposable vapes are discarded in the UK every week. The vast majority are not recycled. Their complex construction and high nicotine concentration make proper disposal challenging. They also contain lithium batteries, a precious and vital resource in our transition away from fossil fuels that is being discarded willy-nilly, sometimes into rivers and water courses. That further exacerbates the environmental consequences.

Vapes have also been known to cause fires in bins, bin lorries and recycling centres. They pose a danger. I am also advised that the plastic, because the nicotine salts leak into it, becomes hazardous waste and is non-recyclable in any case. I urge the Government to back my ten-minute rule Bill and to ban these devices. A ban has been backed by the Royal College of Paediatrics and Child Health, and by the Royal Society for the Prevention of Cruelty to Animals. It is a widely supported measure.

As well as the issue with colours and flavours, we need tougher regulations on the advertising and marketing of vaping products. Health warnings should cover 65% of the front and back of the pack, in the same way as for tobacco. Sports club sponsorships should be banned. I cannot see why these products need to be advertised on sporting shirts; there is also the worry that that will make them more attractive to children.

When the former Government brought in bans on where people could smoke and where cigarettes could be displayed, the number of smokers dropped dramatically. I appreciate that that is a nanny state measure and, as Conservatives, we are reluctant to bring in nanny state measures. Nevertheless, it did work. If we were to ask people now whether we should reverse that measure, I do not think that many, if any, would agree. I suggest that as a sensible step forward.

At the moment, we are banning sweeties at the till because we think that will help to stop people becoming obese, but I have been into shops where those sweeties have been replaced with vapes. I am sure most people would much prefer that their child had a packet of Rolos than a vape.

My third point is about regulation. The industry is actually quite positive on this issue, and is keen for regulation—at least, that is what they say. At the moment, anyone can sell a vape. When I take my son for a haircut, we could get three lemon-flavoured vapes for £1 while we are there. He is only eight, so he will not be getting any, but we could. If we go to the sweetie shops on Oxford Street, we can buy them along with the candy.

Having the same sort of regulations as for tobacco or alcohol would mean that people would have to be licensed and would be challenged to make sure that vapes did not get into the hands of children, and there would be bigger fines. I saw an example of someone being fined £200 for selling these things to children. That is clearly no disincentive. A proper regulatory framework, where people lose their ability to sell these fairly lucrative products in the event that they break the regulations, will reduce the supply to children.

I also wanted to raise taxation. I appreciate that it is not the Minister’s responsibility, but he can raise it with the Chancellor and other colleagues. This measure was supported by Action on Smoking and Health in the Health Committee yesterday. If vapes are around £4 and a packet of cigarettes is £12, we could add considerable amounts—ASH is asking for a £5 tax on every disposable vape—as a way of taking them out of the range of children’s pocket money, while making sure that they are still cheaper than a packet of cigarettes for those adults who genuinely are smokers who wish to quit. Children are very price-sensitive and we need to deter them from this harmful habit.

My final point is about education. We heard from the headteacher of St George’s Academy yesterday in the Health Committee. Children need to know about vapes, and understand that they are not lifestyle products for them to use but aids for adults to stop smoking. The relationships, sex and health education curriculum review that is being done at the moment offers Ministers an opportunity to ensure that that happens. I am interested to hear what the Minister has to say.

--- Later in debate ---

[Dr Caroline Johnson]

I thank everyone who has contributed to this debate. It was interesting to hear that my right hon. Friend the Member for Calder Valley (Craig Whittaker) has given up smoking, on which I congratulate him. I hope he will soon be able to give up heated tobacco as well; I am sure his health will benefit.

I also thank the SNP spokesperson, the hon. Member for Paisley and Renfrewshire North (Gavin Newlands), and the Opposition spokesperson, the hon. Member for Ilford North (Wes Streeting), for their support. I think I am correct in saying that there was support from all corners of the House for doing everything possible to ensure that children cannot get their hands on vapes.

I welcome the measures in the Minister’s speech, particularly those on education, preventing the distribution of free vapes, the introduction of the enforcement team and nicotine-free vapes. I also welcome the consultation, but we need to be quick about this because more children are vaping every day. That means that every day more children are becoming addicted and developing a nicotine habit that they will find difficult to break.

One of the challenges of quitting smoking is giving up nicotine, and giving up the nicotine in vapes is no different; in fact, it may be more difficult. I urge the Minister to look very closely at banning disposables and at marketing. He did not mention this in his speech, but I do not think that vapes should be advertised on the kits of any sports team. In shops, vapes are often positioned in the front of display cabinets where children can see them. I have seen advertisements for vapes on taxis and things like that—they should not be there.

The Minister’s review should look closely at flavours and colours, because I do not think they are necessary for stop-smoking devices. He should regulate where they can be sold and increase the penalties for those that break the rules. The Minister did not mention tax. I appreciate that that is a matter for the Treasury, but vaping companies should be taxed heavily to lift their pocket money. That is the right way to go.

As well as education, children need support. A huge number of children are already addicted to vaping products, and they need support. When they realise and are educated about the harms and wish to quit, they will need support and help to do so.

Perhaps my most important ask of the Minister is for him to look at the latest evidence. The 95% safer approach was predicated on evidence that is not terribly robust and on a study that is nearly 10 years old. It was based on an apparent absence of evidence of harm, but we are now seeing evidence of harm. I urge him to review the evidence. We are in a situation in which our headteachers are telling us that children must be able to vape so that they can discuss the flavours to fit in with their peer group, and we must get away from that. This issue is urgent and I urge the Minister to act quickly.

Question put and agreed to.

Resolved,

That this House has considered electronic cigarette use.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 6th June 2023 Commons Chamber

[Maria Caulfield]

I thank the hon. Gentleman for his question. We take this issue very seriously, and we have already made interim payments to those infected. The Minister for the Cabinet Office came to the Dispatch Box in April when Brian Langstaff’s review was published, and we are working night and day to respond to those recommendations and get that plan out as soon as possible. We recognise the impact on families, and on those infected and affected.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I refer Members to my entry in the Register of Members’ Financial Interests. Today Dr Mike McKean, a respiratory consultant and vice-president of the Royal College of Paediatrics and Child Health, said that vaping is “fast becoming an epidemic” among children. The Royal College of Paediatrics and Child Health said that we should ban disposable cigarettes—e-cigarettes—“without a doubt”. Will the Minister do all he can to prevent children from starting vaping, and will he back my ten-minute rule Bill, which was first introduced in this place in February, to ban disposable e-cigarettes?

[Neil O’Brien]

I pay tribute to my hon. Friend and her leadership on this issue. Many of the ideas that she has been putting forward are already in the plan that we set out to tackle youth vaping, including the creation of the “flying squad”, the ongoing call for evidence on youth vaping, and all the different things we could do to continue to drive it down.

Recovering Access to Primary Care

Caroline Johnson Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

I have touched on the numbers a few times, but let me give the hon. Gentleman the precise figures. There are 335 more pharmacists than there were in 2010, so it is simply not the case that there are fewer. There are 2,000 more doctors in general practice, and there are also the extra 25,000 in additional roles. As I have said, someone who wants a prescription review should see a pharmacist, and someone with back pain should see a physiotherapist; not everything has to go through a GP, and it is better for GPs’ time to be used more effectively. There are also more doctors in training: 4,000 are receiving training in primary care, as opposed to 2,600 in 2014. So we are seeing more staff, more effort on recruitment, more effort on retention through the pension changes, and better use of the additional roles.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I am pleased that the Government are looking at how they can best support GPs and improve access to primary care, but how will these plans protect and enhance the role of GPs who dispense in their own practices? How will my right hon. Friend deal with concerns about antibiotic resistance, and how will he solve the root cause of the problem, which is the fact that there are not enough GPs?

[Steve Barclay]

In respect of my hon. Friend’s first point, these plans will not make any changes. As for the second, about prescribing, that will be part of the consultation, and we will be learning lessons from what is being done elsewhere: for instance, Pharmacy First is already up and running in Scotland. We are looking into what tests can be performed alongside those prescribing rights so that antimicrobial resistance is targeted effectively.

Vaping: Under-18s

Caroline Johnson Excerpts

Tuesday 2nd May 2023 Westminster Hall

[Dr Hudson]

I completely agree, and I want to stress that key point: it is illegal to sell vapes to under-18s. I will be asking the Minister about that. I know that the Government are moving on it, and we need to address it going forward.

Similarly, an NHS survey in 2021 said that 9% of 11 to 15-year-olds, and 18% of 15-year-olds, had used vapes. Those are alarming statistics. ASH England also noted that the most frequently used e-cigarettes among young people are disposable vapes, with an astonishing increase from 7.7% in 2021 to 52% in 2022. Although this is not the main focus of my speech, I will point out that, quite aside from the health concerns associated with such a marked rise in the sale and consumption of disposable vapes, they are a major environmental concern, with over 1 million of them thrown away every week. It is estimated that the lithium used in those batteries equates to about 10 tonnes of lithium per year, which is equivalent to the lithium used in approximately 1,200 electric vehicle batteries.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

My hon. Friend will be aware of my ten-minute rule Bill to ban disposable vapes for exactly the reasons he has described: the effects on children’s health particularly, and on the environment. Does he agree that the Government should support the Bill?

[Dr Hudson]

I very much agree with my hon. Friend. I thank her for intervening and I welcome her medical expertise in this debate.

I have touched on some of the environmental concerns, and there are also concerns about fires related to disposable vapes. However, at the heart of my speech is the impact that such a frightening level of vape use is having on our young people, even as young as primary age. I urge our policymakers not to underestimate it. There are increasing reports suggesting that the use of vapes has negative effects on heart and lung health, and may be associated with tooth and gum disease. Other issues reported include coughs, shortness of breath and headaches. Nicotine, which these products often contain, is highly addictive with potentially harmful effects on the adolescent brain, which is still developing.

--- Later in debate ---

[Dr Hudson]

I agree with the hon. Member. The industry needs to take a close look at itself, but it is also the case that a lot of the vapes that are ending up with children are coming through illicit means. We need to have a targeted approach to look at how best we can prevent our young people from accessing those products.

[Dr Caroline Johnson]

My hon. Friend made a very good point about advertising. We need to get across the nuanced message that vaping may be beneficial to people who want to quit smoking—although I would argue that it could become an alternative addiction rather than a stop-smoking aid—but we must also prevent children from using vapes. In the past, nuanced advertising for formula milk stated that breast milk was better at the beginning but that formula milk was a reasonable alternative for six month olds. Could a form of words be used in vaping adverts to make it clear that the products should be for people who smoke, not for those who do not?

--- Later in debate ---

[Neil O'Brien]

Absolutely, and I will touch on that in just one moment. Vapes—

[Dr Caroline Johnson]

Will the Minister give way?

[Neil O’Brien]

I think I should try to answer the last intervention before taking another one; I will come back to my hon. Friend in a second. Vapes are not yet being used widely enough to reach their full potential as a quit smoking aid, so on 11 April, I announced new funding for a new national “swap to stop” programme—the first of its kind anywhere in the world. We will work with councils and others to offer 1 million smokers across England a free vaping starter kit. Smokers who join the scheme, which will run initially over the next two years, will join on one condition: they must commit to quitting smoking, with support. We will provide additional support to help them quit vaping after they have quit smoking. We will target the most at-risk communities first, focusing on settings such as jobcentres, homelessness centres and social housing providers. I do not know whether my hon. Friend still has a burning question.

[Dr Johnson]

Yes, and I thank the Minister for giving way; he has been extremely generous with his time. He has talked about the importance of educating children about the risks. Does he agree that a key problem is that many young people and children who use vapes do not believe that they are harmful at all?

[Neil O’Brien]

My hon. Friend is quite probably right. There is a lack of understanding of some of the risks, and of the effects on mental health and wellbeing. I am very, very worried when I hear about young people at school smoking, and about the disruption that various hon. Members have raised in this debate.

I conclude by thanking all Members here for highlighting concerns about these issues, and for their contributions, not only in the debate but over a longer period. That has had an effect on Government policy, and will continue to. The Government are committed to doing all we can to prevent children and young people from vaping, while also ensuring that we use the full potential of vaping as a tool to help smokers quit.

Question put and agreed to.

NHS Strikes

Caroline Johnson Excerpts

Monday 17th April 2023 Commons Chamber

[Steve Barclay]

I share my hon. Friend’s concern. We have worked constructively with the Royal College of Nursing and, as I say, I was happy to put on the record my acknowledgment of the exemptions it had previously granted. I hope that between now and the end of the month, it will further reflect on the fact that the 48 hours of continuous strike action will happen without consultation with other staff council members and without waiting for the decision of other trade unions that are currently balloting. He will know that “Agenda for Change” is a deal that covers all the trade unions, not just the RCN in isolation, and I think it is right to wait for all the trade unions to vote and for the staff council to meet.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I draw the attention of Members of the House to my entry in the Register of Members’ Financial Interests.

On Friday, I was working at the hospital and my usual clinic had cancelled all but one patient. I spoke to the secretaries about the various cancellations they had had to make as result of the strikes, and I was really sad to hear not only that they had often been verbally abused by people who were upset, but that they have had to cancel some patients on two occasions because of the earlier strikes and the more recent ones. I was also sad to hear that we are looking at further strikes in the next few weeks.

Will the Secretary of State join me in thanking the members of staff who came into work, who did not strike and who continue to deliver a very important and valuable service? What is he doing to expedite the legislation on minimum service guarantees, so that we do not have any implications from strikes on emergency and intensive care in particular?

[Steve Barclay]

First, I thank my hon. Friend for her service and for the work she was doing on Friday. I join her in putting on the record my thanks to all those staff who did provide cover, as I said in my opening remarks. She is right to highlight the minimum service legislation, and we will obviously need to reflect on recent events in that context. She also points to the fact that the decision by the BMA junior doctors committee to advise members not to notify hospital management about whether they were striking obviously made it more likely that clinics would be cancelled, even when it then transpired that doctors could have provided cover. That is clearly regrettable and indicates the need for resolution, and we want to work constructively with the junior doctors on this.