E-cigarettes

Gareth Johnson Excerpts

Thursday 31st October 2019 Westminster Hall

[Gareth Johnson (Dartford) (Con)]

I agree with everything that the right hon. Gentleman has said. Does he agree that the Government could reach their ambitious target, which he alluded to, by embracing vaping, getting more information out there to those clinicians and working through the law, particularly post Brexit, to ensure that people who want to give up smoking have all the information they require in order to take up vaping instead?

[Norman Lamb]

I totally agree. The statistics that I am citing make the point about raising awareness, even among clinicians. We thought that it was just the general public who needed to understand better the relative risks, but clearly clinicians also need to understand the relative risks so that they can advise their patients more effectively.

Two in five clinicians feel uncomfortable recommending e-cigarettes to their patients who smoke. Again, that is an extraordinary finding. Fewer than three in 10 agree that their current knowledge is enough for advising patients about e-cigarettes. That extraordinary data reveals a clear need for the awareness raising to which the hon. Member for Dartford (Gareth Johnson) has just referred.

What assessment has the Minister made of the number of smoking cessation services in the NHS that are actively promoting e-cigarettes as alternatives to conventional cigarettes? It ought to be every single one throughout the country, but are they actually doing it? Do we know? Can the Minister tell us what work the Government are doing with NHS England on increasing knowledge among clinicians of the uses, benefits and risks of e-cigarettes for current smokers?

Our report recommended that NHS England should create a post for someone who is responsible for implementing the Government’s tobacco control plan. The response said:

“The Government broadly accepts this recommendation.”

However, no specific steps to implement our recommendation were set out. We pursued that with NHS England, which in January told me:

“It is our intention to appoint an individual with lead responsibility for this role. This will be an important part of our delivery programme for the NHS Long Term Plan.”

We would all assume that that person was appointed long ago and that active work is now underway to pursue this vital agenda, which will save lives, but can the Minister confirm that NHS England has created that post and, if so, is someone actually in post and doing the job?

The Government say that, in their long-term plan, provision is made for

“all smokers who are admitted to hospital being offered support to stop smoking”.

That is not due to be fully implemented until 2023-24. Again, given the extraordinary health benefits of stopping people smoking, I would have hoped for a tighter timescale than ’23-24 to implement that. Will the Minister tell us how implementation of that proposal is going and whether consideration is being given to implementing it fully before 2023-24?

Our report recommended that the NHS should have a clear policy on e-cigarettes in mental health facilities that establishes a default of allowing e-cigarette use by patients. This comes back to my point that approximately 40% of those with severe and enduring mental ill health still smoke. The attitude and culture within mental health trusts is critical if we are to enable and help people with severe and enduring mental ill health to give up smoking. We said that it should be the default that e-cigarettes should be made available in mental health facilities unless there are clear evidence-based reasons for not doing so.

The Government response said:

“NHS England will provide guidance to mental health trusts that sets out that existing vapers should be permitted to use e-cigarettes as part of smoking cessation programmes, and…tobacco smokers should be supported to stop smoking through smoking cessation programmes”.

Can the Minister tell us whether that guidance has been issued? I very much hope that it has. If not, when will it be issued and what is the reason for the delay in issuing such important guidance? If it has been issued, what assessment has been made of how it is working?

The UK is making good progress in getting people to stop smoking and use e-cigarettes to achieve that, but that is at risk from recent concerns about e-cigarette use. Those concerns have been expressed particularly in other countries. We have put the concerns to Public Health England. The first is the claim that deaths in the US have been linked to the use of e-cigarettes and vaping products. The reality is that the US operates in a totally different regulatory context and “illicit products” were

“implicated in this outbreak…including vaping cannabis derivatives.”

That is from Public Health England. It has also explained that

“the suddenness of the outbreak across many USA states in just a few months, suggests that this is not a gradual effect of long-term use, but because of a specific agent coming into use in the affected population.”

Next are the concerns that flavoured e-cigarettes are “luring” children into vaping. Public Health England’s response explained that the data it had seen so far was reassuring that e-cigarettes were not re-normalising smoking. Furthermore, the UK and the US have different rules on advertising, nicotine concentration and education on vaping, which explains why flavours of e-cigarettes are less impactful in the UK compared with the United States.

The next issue is the introduction of a ban in India on the production, import and sale of e-cigarettes because of concerns about the risks that they pose to health and to the young. Again, an assertion has been made that is at risk of infecting the debate that we have in this country. However, Public Health England has explained:

“India is one of several countries that appears to be responding to the outbreak of lung disease among cannabis”

vapers

“by proposing a ban on nicotine inhalers.”

It has also explained that smoking is far more prevalent in India and causes 7 million deaths a year there.

--- Later in debate ---

[Gareth Johnson (Dartford) (Con)]

Unlike the three previous speakers, I rather hope that this will not be my last speech in Westminster Hall—but that is up to the people of Dartford, not me.

I am pleased to contribute to the debate, because I feel strongly that vaping is something that we should embrace as a country. It has been mentioned that Public Health England says that vaping is 95% risk-free; that is really significant, and it is not just Public Health England making such statements. Cancer Research UK says that there are significant benefits from vaping in comparison with tobacco consumption. ASH, the British Heart Foundation and the British Lung Foundation—organisations that understandably have traditionally frowned on anything associated with smoking—recognise that vaping saves lives. That is what we are talking about, and the sooner the country recognises that we have an invention that could save thousands of lives in the UK, let alone the rest of the world, the sooner we can start saving the maximum possible number of lives.

It was with great regret that we heard the stories coming out of the United States. It was only when we starting drilling down and saw that the deaths were potentially linked to acetates, cannabis oil and so on—those are the irritants actually causing the deaths—that we recognised that we should not allow those tragic circumstances to cloud people’s image of vaping. It is not only clinicians who are unsure about vaping, and whether they can recommend it to patients; the general public are also unsure whether vaping is as safe as some experts have said. We need to educate people, and say that it is a well-known fact that tobacco seriously damages health and therefore is highly risky, but that with vaping the risks are substantially smaller.

Nobody in this debate, or anywhere in the House of Commons that I am aware of, is suggesting that people who do not smoke should take up vaping. The suggestion is that it is people who smoke, and who are addicted to tobacco and nicotine, who will benefit from vaping. There are risks associated with pretty much anything, and vaping is no exception. The message should go out loud and clear that people who do not smoke should not start vaping, but people who smoke may wish to try that alternative as an effective way of reducing their tobacco consumption, or helping them to come off tobacco completely.

I welcome the fact that some tobacco companies have embraced vaping; they realise its potential. Japanese Tobacco International has highlighted to me some of the dangers associated with products that do not contain nicotine, and so do not come under the Tobacco and Related Products Regulations 2016 and can be targeted at children. They can be marketed to look like food, or something trendy that people will want to get involved with, and as they do not have to comply with the tobacco regulations, their ingredients are not known. We need to look at that.

The Science and Technology Committee, chaired by the right hon. Member for North Norfolk (Norman Lamb), has looked at the 2016 regulations, which have serious flaws. For a start, they should not lump together tobacco and vaping products; they should be covered by separate regulations. That would bring an end to the ridiculous situation whereby a vaping product that has no nicotine in it must have a warning on its front saying, “This product contains nicotine”. If the vaping company does not put that warning on its product, it will fall foul of the regulations, but if it does, it might fall foul of other regulations. It is a crazy situation that has developed.

We need to consider whether it is right to allow more advertising of vaping products. I believe that it is, but regulations seem to prevent that. I think it is right that we should enable people to be educated, and aware of the products available and their potential benefits.

I do not want to turn this into a debate on Brexit, but there is no getting away from the fact that once we leave the European Union, we as a country can look at the regulations ourselves, and see what best suits our needs and what would be a sensible approach to vaping. We can ensure that people are aware of vaping and can benefit from it, so we should do so.

I have met a number of organisations that are trying to push forward a change in vaping regulations. Imperial Brands—formerly Imperial Tobacco—is doing a lot, and there is also a company called Blu, whose products are pioneering. That is a key part of the process. Companies are investing a lot in developing products that will be attractive to smokers, in that they will satisfy their cravings, so that they feel less necessity to smoke cigarettes.

I do not want to demonise smokers. If an adult chooses to smoke, knowing the risks, that is their decision. However, it is incumbent on the Government to ensure that people are aware of the alternatives to smoking, of the risks, and that there is comparatively less risk associated with vaping.

The Government are rightly pursuing a target of reducing the number of people who smoke and eventually eliminating smoking in this country. That is very ambitious, and if we are to achieve that, it will be necessary to introduce people to vaping through their GP.

[Sir Kevin Barron]

On this idea that smoking is an adult thing, very few people start smoking after the age of 21. The hard reality is that for most people, the starting point comes when they are quite young. I think I was about 11 or 12 when I started getting addicted to nicotine. I think we have to be very careful about this. It is not really an adult choice; it is just something that adults have done from a very early age.

[Gareth Johnson]

I totally agree. I take the view that if adults want to smoke, knowing the risks, that is up to them. However, there is a duty of care on the Government to ensure that tobacco products are not consumed by children. That is absolutely clear, and it is right that we keep the age at which people can start vaping at 18; we do not want vaping products targeted at children. In my experience, no responsible vaping company would do that or has done that.

The Government approach is sensible. I believe that they can embrace the potential of vaping to save lives. There are so many measures that could be taken—through the taxation system, through advertising, through education, and by making people aware of these products and making them more accessible to smokers.

We must recognise that for the first time in my life, there is something that genuinely can help people to get off tobacco—something effective that works. If we look at a graph of the number of people smoking and a graph of the number of vapers in this country, we can see a direct correlation: the more people vape, the fewer people smoke. We need to highlight that and celebrate it, and the Government should take that forward.

Vaping

Gareth Johnson Excerpts

Wednesday 1st November 2017 Westminster Hall

[Gareth Johnson (Dartford) (Con)]

I beg to move,

That this House has considered the matter of vaping.

I was pleased to secure this debate, because I have been interested in the phenomenon of vaping for some time. There are now millions of people vaping in the UK and many of them are former smokers. This is an important issue because if many of the reports and studies carried out on vaping are correct, it has the potential to save thousands of lives in the UK, and millions worldwide. It therefore has to be worth looking at very carefully. We all know that smoking is bad for a person’s health—indeed, more than half of smokers will die from smoking.

[Gloria De Piero (Ashfield) (Lab)]

I thank the hon. Gentleman for securing the debate; he is making some excellent points. In my constituency in Nottinghamshire, there is a class dimension to this. Of those in managerial and professional occupations, 8% are still smoking cigarettes; that rises to 26% of those in routine and manual occupations in the Nottinghamshire population, so this is a social justice issue as well as a health issue. Vaping is much cheaper and safer, so it should not be taxed, and people should stop deterring it in public places. The hon. Gentleman is right: we have finally found a way to stop smoking. We should celebrate it, and I say that as somebody who has stopped smoking and now vapes.

[Gareth Johnson]

It is good to see some enthusiasm for this subject. The hon. Lady is absolutely correct: it tends to be more vulnerable people, if I can put it that way, who are affected by smoking, but smoking affects the whole of society. Almost everybody knows somebody who has died from smoking or has been seriously affected by the consequences. As she rightly says, we have potentially found what is almost a silver bullet that will allow us, at long last, to tackle the issue of smoking among those who want to stop.

[David Simpson (Upper Bann) (DUP)]

Does the hon. Gentleman agree that more needs to be done with our young people in relation to vaping and the dangers of smoking? How can we achieve that?

[Gareth Johnson]

Importantly, over the last 20 or 30 years we have moved away from the James Dean image of smoking. For many people, it is no longer seen as being cool, although it was when I was growing up; it was somehow seen as being acceptable. An increasing number of people look to vaping rather than smelly tobacco, if I can put it that way. It is increasingly recognised that there is huge problem with smoking.

Unfortunately, statistics show that more and more people are viewing vaping as more dangerous than smoking. Vaping is clearly a lot safer than smoking tobacco, but unfortunately the public perception is different from the facts presented by reputable organisations. Some 7 million people smoke in England alone, and some 8 million people do so across the whole UK, so potentially a large number of people can benefit from vaping. Although we have spoken briefly about smoking, my approach is not at all nannying. If an adult wants to smoke, that is their choice; I do not seek to lecture people on their tobacco use. It is an individual choice, but it needs to be an informed choice. We should therefore not obstruct people who want to access smoking cessation products, and vaping forms an important part of that.

I do not claim that vaping is risk-free; indeed, I would urge anybody who does not smoke not to take up vaping. There are risks, and it is unnecessary for non-smokers to take them. I also urge that our approach to vaping be evidence-based. When the Government make decisions on issues that affect vaping, they should base them on the best evidence available. Vaping should not be treated in the same way as tobacco simply because the term “e-cigarettes” has been adopted to describe vaping products.

We also need to be open-minded and objective about the pros and cons of vaping. Our views may change as more research is carried out, and that is fine. We may, over time, become more negative or more positive about vaping, but that should always be based on the facts available and not on a general dislike of smoking.

I am not a medical man at all, and I certainly do not claim to be an expert on health issues, so I have looked at what reputable organisations have to say about vaping. It makes incredibly interesting reading. For example, Cancer Research UK has said:

“the evidence so far shows that e-cigarettes are far safer”

than tobacco, even in the long term. It also says that

“Growing evidence shows e-cigarettes are helping people stop smoking”.

That is a pretty clear position. The British Heart Foundation has also looked into vaping and said:

“e-cigarettes are not harm-free.”

It has said:

“We would not advise non-smokers to take up e-cigarettes, but they can be a useful tool for harm reduction and to stop smoking.”

It also points out that long-term studies are, of course, not available just yet. That point is frequently brought up in this debate: because of the relative newness of vaping, we do not have the long-term studies that many people want to see. As I say, we need to be open-minded about vaping, but we should not turn our backs on the opportunities that it offers simply because we do not have long-term studies. It would be wrong for us not to engage with vaping for the next 50 years while we wait for long-term studies to be carried out. The opportunities are in front of us today.

[Sandy Martin (Ipswich) (Lab)]

Is the hon. Gentleman aware of the first major study on whether vaping helps pregnant smokers to quit, which is being led by Professor Hajek of Queen Mary University of London, working in conjunction with Barts and the London School of Medicine and Dentistry? Does he accept that although there are apparent health benefits to switching to vaping if people are otherwise unable to give up smoking traditional cigarettes, it would be sensible to wait for the report to be published in three years’ time before making major interventions that might encourage pregnant women to start vaping when they are not already smoking?

[Gareth Johnson]

I am not aware of that report, but I think there is an inherent problem with pregnant women today having to wait three years to make that decision. My gut feeling is that the best approach would of course be for pregnant women not to smoke anything at all—not to smoke any tobacco products, and not to vape. I am not qualified to say whether it is beneficial for pregnant women to vape instead of smoking if they are unable to give up tobacco, so I would not want to comment on the report the hon. Gentleman mentions, but it throws up interesting questions. That is why I believe that this whole debate should be based on facts and evidence, rather than on an instinctive dislike of tobacco products that leads to lumping vaping in with them.

The British Lung Foundation has also commented on vaping:

“Given half of long-term smokers die as a result of their habit, using vaping to help someone quit smoking could literally save their life.”

The British Lung Foundation is also clear that vaping should not be seen as a permanent alternative to smoking or promoted to non-smokers, but nor should it be banned in public in the way that smoking is.

Public Health England famously—or famously in the vaping world—said clearly that it believes vaping to be 95% safer than smoking tobacco. The Royal College of Physicians and Action on Smoking and Health have chipped in with similar comments, so there is plenty of evidence that such products have potential, but they have to be judged on their own merits and should not be in the shadow of tobacco products. That is why, in my view, the EU tobacco products directive was wrong to incorporate vaping, which should have been dealt with separately.

That ludicrous approach is illustrated in the regulations that companies have to follow. If someone buys a vaping machine, the machine has to have a warning on it that it contains nicotine. The one I have here, which was sent out by a company called Totally Wicked, says,

“This product contains nicotine which is a highly addictive substance”.

They all have to comply with that requirement. The silly thing is, of course, that the machine does not contain nicotine—but it says it does, because it has to as a consequence of the EU directive. It contains nicotine only when e-liquid is added to the product; it is not included in the product. Companies have to put a caveat at the bottom of the product to say that the statement is not true, so that they do not get prosecuted under the Trade Descriptions Act 1968. That is one illustration of the ludicrous nature of an approach that lumps vaping products in with tobacco products, and that expects vaping organisations to act in exactly the same way as those involving tobacco.

The EU directive also imposes a requirement to sell e-liquid only in small quantities with a maximum of 20 mg of nicotine, which I understand some heavy smokers find insufficient. I do not want to turn this into a Brexit debate—we have enough of those taking place in the House of Commons at the moment; there are plenty on today and tomorrow, if anybody is interested—but we have to recognise that there is an opportunity after Brexit to depart from some regulations, where appropriate. I ask the Minister to put March 2019 in his diary, so that he can consider which of the regulations can be looked at again, are unnecessary or can be altered.

The rules on advertising are also inconsistent. An advert on a bus is fine, but an advert in a magazine or newspaper is not. The trouble is that it sends out a mixed message, which helps neither the public nor the industry and adds to the problem whereby increasing members of the public believe that vaping is potentially more harmful than smoking tobacco. That ultimately stops the benefits that do seem to exist, according to people far more qualified in the medical field than me.

Most people agree that there is a necessity for more evidence, and I am pleased that the Select Committee on Science and Technology is about to carry out an inquiry on vaping, which aims to collate the available information and give recommendations. I hope that it will look at studies on the health implications and give its view on which studies are the most and least credible. The public should not have to rely purely on whichever report is given the greatest prominence in the press. The inquiry will be important, but what is ultimately needed is more fully independent assessments of the health considerations around vaping.

The Government have launched a tobacco control plan, which I am sure the Minister will mention. I welcome the aim in that plan to reduce the number of people smoking in the UK, and it is to be welcomed that the usefulness of vaping is recognised in the plan.

To conclude, although vaping is not risk-free, it has been found to be a useful tool for millions of people who want to stop smoking. It should therefore be given the recognition it deserves. It has huge potential to save lives. I therefore ask the Minister to meet the vaping industry as soon as his diary allows, to discuss how vaping can be best utilised.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Gentleman on securing the debate. Before he comes to a conclusion, would he agree that part of the traditional problem with smoking has been that when the number of smokers declined and we got down to about 20%, it was then difficult to make further inroads? Similarly, if a third of smokers have still not moved to vaping, again we have the problem that we have reached the hard core of people on whom more work is needed. I also congratulate him on taking a responsible attitude to the issue of vaping, rather than endorsing people moving from non-smoking to vaping.

[Gareth Johnson]

The hon. Gentleman’s point does seem to be correct. Ultimately, if people want to smoke, are aware of the risks and are happy to take them, that is entirely their right as adults. I do not seek to dictate how people should lead their life. However, in my experience, most smokers do want to stop but find it very difficult to do so. That is why we should embrace the potential of vaping as an important tool in enabling people to give up. Patches, chewing gums and all those things—even a bit of willpower every now and then—are all very useful, but vaping potentially offers the most successful method for people to stop smoking, should they wish to do so.

We need an objective, logical and fact-based approach to vaping. In short, we should follow the evidence, which at present shows that it is an opportunity simply too good to ignore.

--- Later in debate ---

[Sandy Martin (Ipswich) (Lab)]

I was only going to intervene today, but there are other things that I wish to say. Thank you for calling me to speak, Mr Howarth.

The hon. Member for Dartford (Gareth Johnson) said that vaping is the most successful way to stop smoking. I absolutely and fully support his contention that vaping is a valuable way of persuading people who have failed to give up smoking through other methods, and I support any attempt to use vaping to crack the hard nut of breaking addiction to nicotine. When he sums up, however, will he confirm that vaping induces a certain degree of nicotine addiction if there is nicotine in the substance that is vaped?

The reduction in smoking in this country over the past 20 years is one of the best possible advertisements for health education and smoking prevention measures. The number of people who have managed to give up smoking is fantastic. I gave up in 2013 and have not touched a cigarette since. I gave up lots of times before that, but when I gave up in 2013 it was conclusive. I have never used any substitution products, because the problem for me was breaking the addiction to nicotine, rather than to the smoke itself. Now that I have broken my addiction to nicotine, I have absolutely no intention of going back to any form of smoking product.

I believe that there is an issue with the nicotine addiction element of vaping. I look forward to seeing all of the studies, including that of pregnant women.

[Gareth Johnson]

The hon. Gentleman is absolutely right that nicotine is an addictive substance. There is no doubt that if someone stops smoking and moves on to vaping, their addiction continues. One of the benefits of vaping is that the substances can have a reduced amount of nicotine or no nicotine at all, which some vapers have found useful when they want to overcome their addiction to nicotine.

[Sandy Martin]

I fully accept that and I thank the hon. Gentleman for that intervention. Vaping is clearly a valuable tool in the attempt to reduce further the number of people who smoke, but I urge caution. Health education measures that enable and encourage people who are hard-nut smokers to move on to vaping should be fully supported, but we should wait until the studies report before introducing measures that make it easier for people who do not already smoke to start vaping.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is an honour to serve under your chairmanship, Mr Howarth. I thank the hon. Member for Dartford (Gareth Johnson) for securing this debate. It is timely and important, especially because we have just seen the end of Stoptober, which vaping played a role in advertising. I thank all hon. Members for their thoughtful contributions, and I welcome the array of views and opinions they conveyed. It is clear that there is strong interest in the House in this topic. Although we are small in number here, the quality of the contributions made up for that.

E-cigarettes have been around since the mid-2000s, but in recent years we have seen them boom. Recent figures estimate that 2.9 million adults now use e-cigarettes, compared with only 700,000 in 2012. That increase is expected to grow as more people turn to e-cigarettes to reduce their tobacco consumption or to quit tobacco completely.

The interest in e-cigarettes can also be seen in the rapid growth in availability of such products and the advertising around them. In 2014, it was estimated that there were 460 brands and more than 7,500 flavour solutions. The BMJ highlighted that the advertising and promotion of the products had grown from £1.7 million in 2010 to £13.1 million in 2012—if we had the figures for 2017, they would obviously be a lot higher.

Labour Members welcome e-cigarettes as part of our drive towards a smoke-free society and because of the role they can play in the smoking cessation landscape. What remains important, however, is that e-cigarettes are regulated correctly to ensure that the health of our country is improved, not diminished—which, at the end of the day, is our main goal when it comes to smoking cessation. I will also use my contribution to this debate as an opportunity to further discuss smoking cessation, which is a crucial aspect of the debate around vaping, and the importance of continually looking at this market as we move towards a smoke-free society.

Smoking cessation is crucial. It improves the health of individuals and our nation significantly, and reduces the prevalence of cancer, lung disease and COPD—chronic obstructive pulmonary disease—diseases which we know are all too persistent. If smokers quit smoking when diagnosed with lung cancer, it is estimated that even at that late stage they will live nearly a year longer than if they continued to smoke. For those living with COPD, smoking cessation is the only treatment that can prevent the progression of the disease in smokers. It is also the most cost-effective one. The cost per QALY, or quality-adjusted life year, for smoking cessation in COPD patients is around £2,000, compared with between £7,000 and up to £187,000 per QALY for drugs to control the symptoms of COPD. The National Institute for Health and Care Excellence, NICE, has estimated that for every £1 invested in specialist stop smoking services, a return of £2.37 will be generated in savings on smoking-related diseases and in ending loss of productivity.

I hope that such issues will be addressed as the Government implement their recently published tobacco control plan, and it is welcome that e-cigarettes have been included as part of that work. E-cigarettes, however, must never be seen as a silver bullet to achieve our vision of a smoke-free society. E-cigarettes are a crucial player in the cessation landscape, but they are not the only player. It is important that we maintain the position set out by research and evidence from the World Health Organisation and in the tobacco control plan that nicotine replacement therapy is four times more effective when prescribed by a doctor and monitored than when simply bought over the counter, which is how e-cigarettes are acquired.

It is important that smoking cessation is a wide-ranging package that reduces smoking in society. Sadly, however, I have to say that the Government’s actions are undermining that approach. As the King’s Fund and the Royal Society for Public Health have identified, public health cuts will reach £800 million in the five years to 2021 and, in 2017-18, spending on tobacco control services faces cuts of 30%. That is concerning, because ASH has identified that a growing number of local authorities no longer have a specialist stop smoking service accessible to all smokers.

Even across the wider health service, it is clear that there are failures to implement NICE guidance on smoking cessation. An audit by the British Thoracic Society of 146 hospitals found that 27% of hospital patients were not even asked if they smoked, and provision of NRT and other smoking cessation treatments in hospitals was classed as poor. Is the Minister aware of that and is he ensuring that action is taken?

What is the Minister doing to address those genuine concerns? I would also welcome knowing his thoughts on promoting vaping and other smoking cessation treatments for in-patients during their stay in hospital, which is championed by Professor John Britton and chimes well with the position set out in the tobacco control plan:

“Promote links to ‘stop smoking’ services across the health and care system and full implementation of all relevant NICE guidelines by 2022”—

I am sure the Minister knows the quote well, as he published the plan, which I am pleased about.

That all shows the serious concerns within the smoking cessation landscape, and the worries for its future and for our move towards a smoke-free society. It is important to include vaping as part of the landscape, but it cannot detract from the other treatments available, which we cannot allow to wither on the vine because something new and shiny has come along. That is partly because the evidence for the impact of e-cigarettes on our health is still not definitive. Public Health England’s review of vaping products showed that they were 95% less harmful than tobacco products—which is excellent—because of the lack of carbon monoxide being inhaled and the reduction in the many other health implications that come with smoking tobacco, but that does not mean there are not concerns or split opinions over the health, harm and safety of such products.

It is paramount that such views are continually looked at and that we review our positions on the products regularly. That is why it is welcome that Public Health England will publish its update on vaping research and evidence by the end of this year. Will the Minister also outline plans to evaluate heat not burn? Although not vaping, such products are something else on the market seen as a way of limiting and reducing harm from smoking. The impact of those devices needs further research.

[Gareth Johnson]

I did not mention the available heat-not-burn products simply because I could not find any independent information on whether they were beneficial for health or still dangerous. I would be grateful if the hon. Lady enlarged on any information that she has found out about those products, because I found it difficult to find anything.

[Mrs Hodgson]

I do not think that I know much more than the hon. Gentleman, which is why I mentioned heat not burn. I have asked some questions about it because some independent research is needed. The manufacturers of heat-not-burn products have done their own research and make quite strong claims that although they are still tobacco products, they are far less harmful, but we need independent research to back that up before anyone can substantiate the claims. Will the Minister update us on when research into vaping and perhaps heat not burn will be happening?

As we come to the end of the year, the Minister will be aware that if we see any delays in publishing reports or plans, I will of course be on his case. I welcome the Science and Technology Committee also looking into this matter, and I will keep a close eye on the developments of that inquiry while looking forward to its findings. It is important that we take a pragmatic approach to e-cigarettes, which is reflected in Public Health England’s 2016 statement, which had the support of 12 health charities:

“We all agree that e-cigarettes are significantly less harmful than smoking…but we must continue to study the long term effects.”

The Opposition agree, as it is clear from the evidence so far that e-cigarettes are far less harmful than tobacco smoking, but the evidence remains inconclusive. That is why monitoring must be maintained to ensure that we fully understand the impact of such products in the short and long term.

The Minister has had a lot to think about during this short debate, and I am sure that in his response he will address each and every one of the points made. I implore him in that response to remember the wider smoking cessation landscape and how important it is to ensure that vaping is included as part of that wider package, which is sustainable and effective in reducing smoking in society and thereby improving the health of the nation.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Like the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), I congratulate my hon. Friend the Member for Dartford (Gareth Johnson) on securing another timely debate. Only a couple of weeks ago we had an excellent three-hour debate in the main Chamber on the Government’s new—I suppose it is still new—tobacco control plan. I want to say a little about the state of the evidence as we see it on e-cigarettes and how they fit into our plans to cut smoking further. I will touch on vaping by young people, which a few hon. Members have mentioned, and our approach to regulation.

E-cigarettes were a popular subject during the debate in the main Chamber on the TCP. Every speaker bar none mentioned them in one way, shape or form, so there is a lot of interest in them across the House. That reflects the radical changes in popularity of alternative nicotine delivering products in recent years. We have moved from a position where the nicotine delivery market—if I can call it that; I think we need a better term—is dominated by the traditional cigarette, to one where we have a much wider range of nicotine delivering products.

About 2.4 million people in England use e-cigarettes. That represents huge growth over the past decade. However, we cannot be complacent. My hon. Friend referred to the number of smokers; there are still 7.3 million smokers in this country. Two hundred people die every day due to smoking and it is still the biggest preventable killer in our country. The financial burden that that puts on the NHS in England and other public services is obviously huge, but that is dwarfed by its impact on people’s lives and the unnecessary loss of loved ones. Let us remember that a regular, long-term smoker loses an average of 10 years of their life due to their habit. It is a high cost.

The tobacco control plan sets out stretching ambitions to reduce, during this Parliament, adult prevalence to 12% or less; the prevalence of 15-year-olds who regularly smoke to 3% or less; and that of pregnant smokers—an issue rightly raised by a number of hon. Members—to 6% or less. We have been somewhat criticised for that not being ambitious enough, which is why I stress the words “or less”. They are not targets; they are the absolute maximum that I expect, and we want to do better and beat them. We want to reduce the burning injustices that see some of the poorest in our society die significantly earlier than the richest in our society, so the plan will focus on people in routine and manual occupations, where rates are higher. We want to focus on other groups particularly affected by smoking, such as people with mental health conditions, those in prison and pregnant women.

In the previous debate on smoking, colleagues on both sides of the House highlighted the increasing role that e-cigarettes play in helping people to quit smoking. We heard all sorts of examples from right hon. and hon. Members of parents, friends and family members who have used e-cigarettes to wean themselves off smoking, which is always good to hear. Let us be clear that quitting smoking and nicotine use completely is the best way to improve health, as was said in the opening remarks of that debate. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco. The Government outlined in the new plan that we are committed to supporting consumers to stop smoking and to use less harmful nicotine products.

E-cigarettes have become by far the most popular smoking quitting aid in the country. The evidence shows that they can help smokers to quit, particularly when combined with additional support from local stop smoking services. That is why, as part of the TCP, the Government asked Public Health England to include messages about the relative safety of e-cigarettes in its quit smoking campaign for Stoptober. I look forward to seeing how that played out when the data are available. There has never been a better time to quit and I am hopeful that many people took up the challenge this Stoptober. I am pleased to say that the Stoptober campaign highlighted e-cigarettes for the first time among the array of tools that smokers can use to improve their chances of successfully quitting. Public Health England, for which I am responsible, is already preparing its new year quitting campaign, and I am sure that hon. Members will be pleased to know that it will reprise those messages. It is through consistent messaging that we hope to reverse the harmful, mistaken and increasingly widespread belief that vaping is no safer than smoking.

My hon. Friend rightly raised the issue of independent evidence on e-cigarettes. I reassure him that the Government are utterly committed to rigorous scrutiny of the evidence on e-cigarettes. We do not do non-evidence-based policy making and nor should we. In that spirit, I highlight highly reputable organisations such as Cancer Research UK, led by the brilliant Sir Harpal Kumar, and the Royal College of Physicians, which hon. Members have mentioned. They rightly support e-cigarettes as a measure to stop people smoking, to ultimately move to no nicotine dependency.

I commend the work of the UK e-cigarette research forum, an initiative developed by Cancer Research UK in partnership with Public Health England and the UK Centre for Tobacco and Alcohol Studies. The forum brings together policy makers, researchers, practitioners and the non-governmental organisations to discuss the emerging evidence and knowledge gaps on e-cigarettes. There are big knowledge gaps, which the hon. Member for Ipswich (Sandy Martin) mentioned a number of times. Such groups will allow us to keep strengthening the evidence base on e-cigarettes, which hon. Members have called for. We look around the world for our evidence base, and I note with interest that the New Zealand Ministry of Health recently published a position statement on e-cigarettes that recognises their potential contribution to achieving its “Smokefree 2025” goal.

The public rightly have genuine concerns, however, about the benefits and potential long-term dangers of e-cigarettes and new, so-called novel tobacco products. We take those concerns seriously, as any responsible Government would, and we outline in the plan that the Department will monitor the impact of regulation and policy on e-cigarettes and novel tobacco products in England, including evidence on safety, uptake, the health impact and effectiveness of these products as smoking cessation aids, to inform our actions and regulate their use. That has to be the right thing to do. Public Health England will also update its evidence report on e-cigarettes and other novel nicotine delivery systems annually until the end of the Parliament in 2022.

In the spirit of independent scrutiny, I warmly welcome the recent announcement by the Science and Technology Committee, which hon. Members have mentioned. It is chaired by the right hon. Member for North Norfolk (Norman Lamb), who I spoke to recently but who is unable to be here, and will hold an inquiry to examine the impact of electronic cigarettes on human health, the suitability of regulations guiding their use, and the financial implications of a growing market, both for business and for the NHS. This is an excellent opportunity for an independent view of the risks and benefits of e-cigarettes. What is there not to like about that? I say that as a Minister: people are doing the research for me and paying for it. The Government have a statutory duty—we will not leave it all to everyone else—to conduct an implementation review of the Tobacco and Related Products Regulations 2016 by the end of May 2021, to assess their impact, and we will do that.

I will touch on the regulatory framework introduced by the EU tobacco products directive, which my hon. Friend the Member for Dartford mentioned. The directive has enabled us to regulate e-cigarettes to reduce the risk of harm to children, protect against any risk of re-normalising tobacco use, and provide assurance on relative safety for users and legal certainty for businesses. The inclusion of e-cigarettes in the directive ensures that we can sensibly regulate these products. The directive is not perfect and nobody pretends that it is, but it gives a sensible basis for regulation. My hon. Friend asked me to put March 2019 in my diary—it is inked in. With one leap we will be free and we will be able to take back control, as the phrase goes. It will be an opportunity for us to look at every regulation that we are subject to, review them and go through them with a fine-toothed comb, and he has my assurance that I will do so in every area for which I am responsible.

I recognise that there are real concerns that vaping is a gateway for youth smoking, as my hon. Friend the Member for Gordon (Colin Clark) touched on. However, there is no great evidence in the UK that vaping is leading young people to smoke. There is some evidence that some young people experiment with e-cigarettes, but that regular e-cigarette use is confined almost entirely to young people who have smoked, so it is the gateway out as opposed to the gateway in. To ensure that that remains the case, we have implemented domestic age-of-sale legislation that prevents the sale of e-cigarettes to under-18s and we have prohibited the advertising and promotion of e-cigarettes in the major media streams, including TV, radio, newspapers and the internet. By and large, the banned media streams are those with the largest reach, and by controlling them we have significantly reduced children’s exposure to marketing and images of those products. The Government have no plans to ban advertising in other media, but we keep everything under review.

There is a vibrant e-cigarette market in the UK—in many ways it is a business success story—with nearly 2.4 million users. The industry is worth nearly £l billion to the UK economy. It started out as small, independent, non-tobacco-industry organisations—a cottage industry—intent on designing solutions for people to get the benefits of nicotine delivery without the harms of smoking.

My Department will continue to work closely with the vaping sector through the Independent British Vape Trade Association. The Department does not work with the UK Vaping Industry Association because of its links to the tobacco industry. Her Majesty’s Government take their duties seriously, as they should as a signatory to the World Health Organisation framework convention on tobacco control. I feel that I should put on the record that, under article 5.3 of that convention, we have committed to protect our public health policies from the commercial and other vested interests of the tobacco industry. The guidelines for the implementation of article 5.3 permit parties to engage with

“the tobacco industry only when and to the extent strictly necessary to enable them to effectively regulate the tobacco industry and tobacco products.”

I will briefly mention another innovation, namely heat-not-burn products, which the shadow Minister asked about. Two heat-not-burn products have been notified for use on the UK market as novel tobacco products. It is important to stress that, even in comparison with e-cigarettes, that market is relatively new and very small-scale in the UK. We simply do not know enough about those products. We will continue to adopt a pragmatic, sensible and cool-headed approach to regulation, based on the best possible public health advice, which I receive from advisers including Public Health England. As part of that approach, my Department has asked the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment to give a view about those products’ potential harm reduction in comparison with conventional smoking. The committee is due to respond later this year. I hope that that helps the shadow Minister, who I know will remain on my case—that is not in doubt.

We will discuss Brexit today, tomorrow, the day after and probably the day after that, too. There are concerns among people in the industry and e-cigarette users about the introduction of the EU tobacco products directive impacting on e-cigarette innovation and consumer choice. As stated in the tobacco control plan, the Government will review where the UK’s exit from the EU offers opportunities to reappraise tobacco and e-cigarette regulation to ensure that it continues to protect the nation’s health.

The hon. Member for Ipswich spoke excellently, as always. I congratulate him on quitting and not going back; that is excellent. The hon. Member for Linlithgow and East Falkirk (Martyn Day) talked about innovation and, as always, made a calm and sensible speech. I congratulate him on getting his birthday on the record—that, too, is now inked in our diaries.

The shadow Minister referred to “something new and shiny”. This is literally something new and shiny, but it is not for Ministers to get carried away by new and shiny things in any way, shape or form. The Government have been criticised both for being too tough on e-cigarettes and for being too lenient. That suggests to me that we have the balance about right while we look for more evidence. We have proportionate regulation that allows us to protect children, and that is absolutely right. We keep the evidence under constant review.

[Gareth Johnson]

I mentioned previously to the Minister that he may wish to meet the vaping industry. I am glad that he has the Brexit date in his diary, but I wonder whether he will be kind enough to indicate whether he is willing to put in his diary a meeting with the vaping industry.

[Steve Brine]

I mentioned that we work closely with the Independent British Vape Trade Association, which I am perfectly happy to meet, but I also mentioned that we take the WHO framework convention seriously. The door is always open to people we can meet. That is all part of us trying to understand the evidence base.

To conclude, we are clear that e-cigarettes can play a useful role in helping people to quit smoking. As my hon. Friend the Member for Dartford said, the majority of smokers want to quit, and we should help them. E-cigarettes are one of a variety of stop-smoking tools available to support them.

[Gareth Johnson]

I will briefly reiterate what I said at the end of my opening speech. No one pretends that e-cigarettes and vaping are without risk, but they may be the best hope we have ever had for helping people to quit smoking, which is what this debate is all about. Vaping could save millions of lives worldwide. It should therefore be looked at very seriously, with an open mind and an evidence-based approach. If we do that and take advantage of the opportunities that vaping brings for the health and wellbeing of people in this country and worldwide, the whole world will be better as a consequence. I thank the Minister for his response, the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), for her contribution, and all other Members who contributed to the debate.

Question put and agreed to.

Resolved,

That this House has considered the matter of vaping.

Autism Diagnosis

Gareth Johnson Excerpts

Wednesday 13th September 2017 Westminster Hall

[Bambos Charalambous]

I thank the right hon. Lady for that helpful intervention; we look forward to seeing how that progresses.

The autism diagnostic assessment should start within three months of referral to the autistic team. That standard was set by independent experts, and for good reason. It is a fact that autistic people who are not diagnosed early enough are also highly likely to develop other neurodevelopmental conditions, such as attention deficit hyperactivity disorder—ADHD—dyslexia or dyspraxia. Early diagnosis and intervention could help to reduce the prevalence of those additional conditions.

[Gareth Johnson (Dartford) (Con)]

I congratulate the hon. Gentleman on securing the debate. Does he agree that the NICE guidelines he alluded to are not figures simply plucked out of the air, but are carefully considered? What is vital is that if they are implemented people can get the support and assistance that they often need for this condition.

[Bambos Charalambous]

The hon. Gentleman makes an excellent point. The NICE guidelines are drawn up by experts who are qualified in their field, and it is only with the collaboration of the experts that the guidelines are set. They are set by experts and should be strictly adhered to.

The delay between referral and diagnosis not only causes more potential harm to children, but leads to untold stress and anxiety for parents and carers who cannot understand their child. If the delay was a matter of weeks, that would be bad enough, but thanks to research done by Dr Laura Crane at Goldsmiths, University of London we now know that in a sample of 1,047 parents who were surveyed, the average delay from referral by a health professional to diagnosis was three and a half years. The delay was more than four years for children diagnosed with Asperger’s syndrome.

The delay is alarming, and I have had difficulty corroborating it with any Government data. That is because data on the length of time from referral to diagnosis of autism are not collected by NHS trusts or clinical commissioning groups, so there is no way of holding the NHS to account for that failing. Since this debate was made public, I have had numerous tweets and emails, as have colleagues, that support the findings of Dr Laura Crane’s study and suggest that the delay in diagnosis is taking years, not months.