Covid-19: Response

Lord Faulkner of Worcester Excerpts

Tuesday 19th May 2020 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I thank the noble Baronesses for their penetrating and searching questions. I will go through them systematically.

First, I want to say a few words, partly in response to the appeal for transparency from the noble Baroness, Lady Thornton, and partly in response to some of the suggestions about the performance of the Government in their response to Covid. I assure the House that the Government approach this epidemic in a spirit of openness and transparency, and we would like to work in partnership with other parties. I simply reject the suggestion, consistent in some of the questions, that the projects undertaken by the Government have in any way been characterised by failure or disappointment.

I bear testimony to the huge achievements of those who have worked extremely hard to throw up remarkable schemes which have been enormously successful and massively mitigated the effect of this disease. The testing network, the ventilators, the lighthouse labs and the nightingale hospitals were all hugely ambitious ventures, greeted with scepticism when launched and accompanied by complaints while being thrown up. But their achievements have been enormous: they have had a huge impact.

I would therefore like to turn around the tone of this debate, to be a little more positive, and celebrate the huge achievements of those who have thrown their heart and soul into the response to coronavirus. I pay tribute to their achievements and to the personal sacrifices many of them have made by giving up their time, and even putting their lives at risk, to conduct these important roles.

Quite reasonably, both noble Baronesses asked whether the Government regard isolation as part of the programme. I can reassure them that isolation is absolutely the key point. The way to stop transmission is for those who have symptoms, and especially those who have tested positive, to shield themselves from the rest of society in order to prevent the spread of the disease. Everything that we do in the test and trace programme is ultimately to promote good behaviours by the British public, so that people who have symptoms will distance themselves from the rest of society, putting a brake on the disease. It is absolutely imperative, and at the heart of all our communications.

I pay tribute to the British public, who have made huge personal sacrifices during this lockdown. The culture of isolation will be an essential part of keeping a lid on the disease. The Government are committed to providing mental health support, and practical and cultural support, for those who are in a state of isolation. I thank both noble Baronesses for throwing a spotlight on that.

I want to convey to the House the enormous complexity of identifying the key symptoms of this disease. By any common sense, it would seem incredibly obvious how to spot Covid, but I have sat in numerous meetings running through the data and know how difficult it is to have a consistent set of symptoms that can be understood clearly and communicated simply to the public. The data on this disease is extremely complex. As I have said to the House before, this disease is a very difficult adversary, as characterised by the way in which symptom checking is so difficult. We have moved to a new and upgraded set of symptoms, and we may well have to move again. However, we are seeking to encourage absolutely anyone who has any symptoms to declare them and seek a test.

Perhaps I may move quickly through the questions put by the noble Baroness, Lady Thornton. I reassure her that the NHSX app is very much part of our plans. The Isle of Wight programme has been enormously successful and take-up rates have been huge. But it did teach us one important lesson: that people wanted to engage with human contact tracing first, and quite reasonably regarded the app as a supplementary and additional automated means of contact tracing. We have therefore changed the emphasis of our communications and plans to put human contact tracing at the beginning of our plans and to regard the app as something that will come later in support.

I reassure the noble Baroness that the testing of NHS and care staff is an absolute priority. Testing by the NHS of both groups is well under way. As announced by the Secretary of State, we are looking carefully at bringing in antibody testing to answer the question from staff who may query whether they have had the disease in the past, and to understand better what the role of immunity might be. The science is not firm; the lessons are not clear; but we need to understand the role of antibody testing and find out how it can help us combat this disease.

I advise the noble Baroness, Lady Thornton, to be very wary of private tests. They vary enormously in quality, as I know through my own experience. The time after having the disease when you take the test impacts enormously on the test and the assumptions one can make about a positive test are not proven. You cannot currently share with an employer any impression that you might have immunity, on the basis of a test.

I reassure both the noble Baronesses that our involvement with local groups in the tracing operation is being energetically promoted. We have appointed Tom Riordan, the chief executive of Leeds City Council, to lead this part of the programme. He is running an excellent programme to work with local authorities, directors of public health, environmental health officers and local resilience forums to ensure that our tracing system is as local as it possibly can be. It cannot all be done locally: some of it is better done digitally, and the highly automated routines of the app are very good. Some of it must be done at scale on a national basis by the massive call centres that we are throwing up, but some of it is best done by local groups. Those processes are being put in place energetically and I thank GPs, local directors of public health and all those who are engaged in them. We will be putting together local Covid plans that will be implemented by the relevant local authorities. These will form an important part of keeping a lid on this contagion.

I also pay tribute to those who are helping to organise the major test centres, including Serco, and those who have stepped up to take roles as contact tracers. They are going through complex training at the moment; it is a challenging task. No one wants to hit the phone and tell someone that they have to isolate; it is a tough message to have to deliver. I have no doubt that there will be problems with this complex and difficult task, but I pay tribute to those involved and express my gratitude to those running the programme.

On care homes, as the noble Baroness, Lady Thornton, rightly described, every death is a source of great sadness. However, I pay tribute to all those who have put their safety on the line by delivering tests in care homes. I reassure the noble Baroness, Lady Brinton, that there is a website where any care home that wants a test can register their interest and get a response promptly. Any care home worker who wants an individual test can access a site where, as a key worker, their test will be prioritised. There should be no reason why any care home or care home worker should wait two weeks, as suggested in the question.

I put my hand up and explained that mistakes were made 10 days ago when, due to problems with our Northern Irish test laboratory, some care home tests were either delayed or voided. That was an enormously regretful situation, but, when you put together an operation of this scale at such pace, some mistakes will be made. We have done an enormous amount to rectify those mistakes. Bringing in the noble Baroness, Lady Harding, to run the operational side of our testing regime is a great step forward.

I will also say a word in defence of the volunteers who are working at our drive-in test centres. These are often furloughed workers who do not need paid employment, but they are spending their time usefully and are often committed and have a sense of public service. I bridle at the thought that they would be sneered at or in any way insulted. The role of Boots in recruiting them is entirely honourable, legal and appropriate for the times we are in, and I very much thank those volunteers who have dedicated their time and risked their personal safety to do this difficult and possibly risky job. It is not appropriate to suggest that there has been public outrage at this arrangement—quite the opposite. The British public support this kind of individual public service.

The recruitment of tracers is going extremely well indeed: 21,000 have been put in place, which is way beyond our initial expectations, and the training is going well.

This programme is developing very quickly. We will seek to make announcements about it later this week and there will be a further rollout next week. I am extremely proud of the achievements that we have made, and I thank everyone who is involved very much indeed.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

My Lords, we now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.

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[Lord Bethell]

I reassure the noble Lord that we look at this issue constantly. It is a subject that the British public are deeply concerned about. There is an instinctive human belief that face masks make a difference, but the scientific proof that they do so is not crystal clear. Although some countries have committed to them, we are still in the process of reviewing them. We have a positive attitude towards implementation but we are guided by the CMO and by scientists. As the evidence builds up, and the noble Lord is quite right that in many places it is indeed building up, we will make the right decision on face masks.

[The Deputy Speaker]

I call the noble Lord, Lord Low of Dalston. I do not think he is on the call, so I call the noble Baroness, Lady Randerson.

[Baroness Randerson (LD)]

I have listened carefully to this debate, and the Minister seems to say in every answer how well the Government have done throughout this whole pandemic. If that is the case, how have we come to the point where well over 35,000 people have died? I invite the Minister to tell us now where the Government went wrong.

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[The Deputy Speaker]

I do not think that the noble Lord, Lord Hunt of Kings Heath, is with us this evening, so I call the noble Lord, Lord Bilimoria.

[Lord Bilimoria (CB)]

My Lords, the Minister said that isolation is essential for those who have symptoms. It was only yesterday that the Government finally included the loss of the senses of smell and taste as a symptom. I fell ill with coronavirus on 15 March and lost my senses of taste and smell. At the time, it was not an official symptom. I could not even get tested then—indeed, not even doctors and nurses could—yet the WHO has been saying since the middle of March that we should “Test, test, test”. Eventually we have come around to doing it now and we are ramping it up. As the noble Baroness, Lady Thornton, pointed out, the WHO said eight weeks ago that the loss of taste and smell should be considered a symptom. How many hundreds of thousands of people have now been infected and have infected others because this was not an official symptom? The WHO has also said that social distancing should be one metre, but we say two metres. Why are we not listening to the WHO, or only eventually listening to it? Why are there these inconsistencies?

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[Lord Bethell]

It is very simple. If you have one person from another household meeting your household, the chances are that you will all respect the two-metre social distancing recommendation. The moment a second person is present, the proximity gauges and the way in which you all relate to each other become confused. You all start standing nearer to, and breathing all over, each other, and it becomes easier to catch the disease. That is just a simple human observation and is based on human nature and on the physical science of proximity. The example that the noble Baroness gives is a really good one, and I completely feel her frustration that her two families cannot spend time together. However, the behavioural scientists are absolutely adamant on this point, and to me at least it is common sense.

[The Deputy Speaker]

My Lords, I apologise to the noble Baroness, Lady Coussins, who is the only speaker whom we were not able to call within the 30 minutes. The time allotted for the Statement is now up. The day’s Virtual Proceedings are now complete and are adjourned.

Virtual Proceeding adjourned at 8.12 pm.

Covid-19: Care Home Deaths

Lord Faulkner of Worcester Excerpts

Wednesday 22nd April 2020 Lords Chamber

[Lord Bethell]

The noble Baroness raises what is probably the cruellest and most unkind aspect of this awful epidemic: the circumstances of death where those who love and care cannot necessarily be with those who have died or attend the funeral or mark the moment in the way that they would like. It is a cruel and horrible part of this epidemic.

We have put considerable resources into supporting charities that provide care, particularly around bereavement. If the noble Baroness has any charities that she would like to recommend, I ask her to write to me. I would be glad to make sure that they have the resources they need.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

I have called the noble Baroness, Lady Jones of Moulsecoomb, but we cannot hear her so we will move on.

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[Baroness Jones of Moulsecoomb (GP)]

My Lords, I apologise that I was slow in unmuting. May I come in now?

[The Deputy Speaker]

No, I am afraid not; we have reached 10 minutes and we need to finish. We will try to get you in on another occasion. I apologise to those who were not able to ask a question. As the Lord Speaker said earlier today, account will be taken of that in future sessions.

Vaccine Hesitancy

Lord Faulkner of Worcester Excerpts

Monday 1st April 2019 Lords Chamber

Asked by

[Lord Faulkner of Worcester]

To ask Her Majesty’s Government what assessment they have made of the report in the European Journal of Public Health on 25 February that there is a link between anti-establishment politics and vaccine hesitancy.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, while there has not been a specific assessment on the link between anti-establishment politics and public confidence in vaccination, we take the issue of misinformation about vaccines extremely seriously and are working across government to tackle this. We are aware of global concerns regarding confidence in vaccinations knowing the protection that they give against deadly diseases, and I am pleased to say that in this country confidence in our vaccines is very high.

[Lord Faulkner of Worcester (Lab)]

I am grateful to the Minister for that positive Answer. She will know that the World Health Organization has declared the anti-vaccine movement as one of the top global health threats for 2019. That follows the tripling of the number of measles across Europe and the sixfold rise in the United States. The paper in the European Journal of Public Health, to which my Question refers, says that there is a direct link between the rise in populist politics and vaccine hesitancy, and cites particularly Greece, Italy and France, and of course one would add the United States as well. There is also much disinformation about vaccines spread on Twitter and other social media. Will the Government make vaccination compulsory as their response to this, as over one-third of countries have done and as we did in Britain in 1853 to combat smallpox? Secondly, what progress have they made in forcing the social media companies to take down this misleading information about vaccines?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for an important question. The UK has one of the most sophisticated vaccination programmes in the world and we constantly guard against threats that may reduce vaccination rates. I am pleased to say that 93% of parents trust NHS staff and advice. The Government recognise the threat posed by disinformation and the upcoming online harms White Paper will set out a new framework for tackling this. PHE’s monitoring data on patient and public trust, however, shows that there is no loss of trust in vaccination, which is to be welcomed. On compulsory vaccination, vaccination programmes in the UK currently operate, like all other medical care, on a system of informed consent. At the moment there is little evidence that compulsion would lead to an increased uptake and so the Government have no plans to introduce such a system but instead intend to work with those who have concerns about vaccination.

Mental Capacity (Amendment) Bill [HL]

Lord Faulkner of Worcester Excerpts

Committee: 3rd sitting - (Hansard): House of Lords
Monday 22nd October 2018 Lords Chamber

I also suggest to the Minister that, in the light of our discussion last week, another issue is germane to this. I thank the noble Baroness, Lady Stedman-Scott, for clarifying that the Bill as it stands means that decisions about somebody’s capacity will include risk to others. Under the Mental Capacity Act, best interest decisions are really about the risk to self. It is therefore highly likely, again, that decisions will be made under this legislation which could—and potentially should—be made under the Mental Health Act. It is perhaps the case that this legislation will confuse things and it may well increase the Bournewood gap; it certainly will not decrease it but there is a severe chance that it will increase it. For all those reasons, I believe that the interaction of the Bill with the Mental Health Act really needs some thorough researching and I look forward to some robust answers from the Minister.

[The Deputy Chairman of Committees (Lord Faulkner of Worcester) (Lab)]

I must advise the Committee that if this amendment is agreed to, I cannot call Amendment 56 for reasons of pre-emption.

[Baroness Tyler of Enfield (LD)]

My Lords, I support what my noble friend Lady Barker said about this important set of amendments. Briefly, they look at the interaction between the Mental Capacity Act and the Mental Health Act, which has not been properly thought through at all in how the Bill has been brought forward. The amendments focus in particular on people with fluctuating conditions. We have had a bit of discussion about such people but not nearly enough to understand what the real implications will be for people who may have a severe mental illness that fluctuates. They may have a range of other physical conditions requiring treatment and care. There may be times when they are in a position to give consent to treatment and times when they are not. We really need to think much more about how that is to be dealt with in the new system.

My concern, if I may summarise it, is that this complex interaction between the two Acts will result in a two-tier system, with a considerable imbalance in rights and safeguards between the regimes of the Mental Health Act and the Mental Capacity Act. To pick out one example, I understand that under the Mental Capacity Act everyone is entitled to make a legally binding advance decision to refuse various future medical treatments, but that decision can be overridden under the Mental Health Act in most circumstances. It is complicated. There are people covered by both Acts; it is not a question of having the Mental Health Act and people covered by it over here and having the Mental Capacity Act and people covered by that there.

We really need to think this through and satisfy ourselves that any new system deals with that and, frankly, makes the most of the opportunity to streamline these regimes, in particular to take account of people who are covered by both. I would be particularly pleased if the Minister, in responding, would say something about the needs of people who are severely affected by mental health issues and whose capacity may fluctuate, and about how that has been taken into account in the drafting of the Bill.

The NHS

Lord Faulkner of Worcester Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Faulkner of Worcester (Lab)]

My Lords, like every other speaker I am delighted to congratulate my noble friend Lord Darzi on the brilliant way that he introduced the debate. I thank him for the hundreds—probably thousands—of lives he has saved during his very distinguished career as a surgeon. My contribution will focus on why treating tobacco dependency must be embedded throughout the plan that NHS England has committed to delivering in return for the additional £20 billion it has been allocated. The evidence for this is set out in a major new report published just last week by the Royal College of Physicians. I declare an interest as a long-standing officer of the All-Party Group on Smoking and Health.

Helping smokers quit is not just about prevention. It improves treatment outcomes and helps poorer people in particular to live longer. Take lung cancer. Currently, at diagnosis one-third of lung cancer patients still smoke and their average life expectancy is nearly doubled if they quit, yet fewer than a quarter get advice to quit from their GP and only 13% are prescribed stop smoking medications. Helping to quit smoking costs hundreds of pounds and has a similar impact on life expectancy as the latest lung cancer drugs, which cost tens of thousands of pounds per course of treatment. So why are lung cancer patients not being given the help to quit that they need?

Tobacco dependency treatment is cheap and saves the NHS money. The RCP has calculated that if all smokers were provided with help to quit the NHS could save £60 million annually in hospital admission costs and A&E attendances alone from year one onwards. This includes the cost of the treatment, which is only £182 per quitter. By freeing up beds and saving money, it would ensure the additional £20 billion can be used more cost effectively.

We need only look to Greater Manchester, where the CURE programme will start to deliver treatment for all smokers from September, to see the potential gains. Manchester has almost 53,000 hospital admissions of active smokers every year. Smokers are admitted with cancer, heart disease, mental health conditions, HIV/AIDS—the list goes on. It has been calculated that providing patients with tobacco dependency treatment will save the equivalent of 250 additional beds per day. This will help to tackle the winter bed crisis in Manchester. Smokers are five times more likely to have micro-biologically confirmed influenza. When combined with other smoking-related respiratory diseases, such as chronic obstructive pulmonary disease, this can lead to their admission to hospital at the worst time of the year.

Supporting smokers to quit will also deliver improved maternity outcomes. Every year, maternal smoking in the UK causes 5,000 miscarriages, 300 perinatal deaths and 2,200 premature births. Younger mothers in disadvantaged circumstances who have never worked are more likely to smoke throughout their pregnancy. These are the immediate savings; the benefits in the longer term are even greater, as current smoking costs hospitals almost £1 billion a year, most of which is avoidable.

It is not that smokers do not want to quit—over 60% say that they do—but our hospitals are not providing the help that the most addicted need if they are to succeed. Will the Minister ensure that NHS England takes into account the evidence and recommendations set out in the recent RCP report on treating tobacco dependency as it develops the new plan for the NHS?

Tobacco Control Plan

Lord Faulkner of Worcester Excerpts

Thursday 23rd February 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is quite right to highlight the effectiveness of mass media campaigns, and they will continue to be part of the new tobacco control plan. These include Public Health England’s Stoptober campaign and the health harm campaigns. The noble Lord gives us an example of an effective local campaign. I would also highlight the “16 Cancers” campaign in Yorkshire and Humber, which saw 740,000 smokers recalling the campaign and half of them taking a quit-related action.

[Lord Faulkner of Worcester (Lab)]

My Lords, the Minister will be aware that in her first major speech as Prime Minister Theresa May committed the Government to fighting against the burning injustice that if you are born poor you will die on average nine years earlier than others. Bearing in mind that the difference in life expectancy is due to much higher rates of smoking among poorer people, will the Minister confirm that the target of reducing smoking among poorer people is absolutely at the forefront of the Government’s priorities?

[Lord O’Shaughnessy]

The noble Lord makes an extremely important point. There are big variations in levels of smoking, not just by socioeconomic group. I was disturbed to see that 37% of people with mental health conditions smoke, which is twice the overall prevalence. We also know that there is a huge variation in the number of women who smoke when pregnant. Targeting that variation, which has a number of dimensions, will be a core part of the strategy.

Smoking-Related Diseases

Lord Faulkner of Worcester Excerpts

Wednesday 14th September 2016 Lords Chamber

Asked by

[Lord Faulkner of Worcester]

To ask Her Majesty’s Government what further action they are taking to reduce the incidence of smoking-related diseases.

[Lord Faulkner of Worcester (Lab)]

My Lords, by way of prologue, I should explain that this debate was originally initiated not by me but by the noble Lord, Lord Young of Cookham. His new ministerial responsibilities—I warmly congratulate him on his appointment—preclude him from speaking this evening, but I am delighted to see him in his place on the Government Front Bench, and I know that his lifetime commitment to the cause of tobacco control is undimmed. When he asked me to take on the debate in his place, I was, of course, very happy to agree.

Underlying what we are discussing this evening is the inequality which continues to blight our society. In her initial speech as Prime Minister, Mrs May committed her Government to,

“fighting against the burning injustice that, if you’re born poor, you will die on average 9 years earlier than others”.

Half of this difference in life expectancy is due solely to higher rates of smoking among the least affluent. This is an injustice that we cannot allow to continue.

Throughout my time in this House, I have spoken on tobacco control many times, as, indeed, have many of the other noble Lords contributing to this debate. We started with the Private Member’s Bill to abolish tobacco advertising and sponsorship, and the adoption of a smoke-free environment on the parliamentary estate. The UK has emerged as a world leader in tobacco control, with successive tobacco control plans, starting with Smoking Kills in 1999. Since then, the rate of smoking in England has declined by more than a quarter, to only 16.9% of the adult population in 2015.

Is there anybody, except possibly Mr Farage, who wants to go back to smoke-filled pubs and restaurants, and to coming home stinking of tobacco smoke after a night out? I think not. This fall in prevalence, which has already and will continue to save many thousands of lives year on year, could not have been achieved without commitment from successive Governments to comprehensive tobacco control strategies, which have ensured that we live up to our obligations as a party to the WHO Framework Convention on Tobacco Control. This includes comprehensive smoke-free laws, putting tobacco out of sight in shops, banning smoking in cars carrying children and the passage of standardised packaging legislation, which in Britain came into effect in May and which this House supported overwhelmingly.

I do not intend to say much about the tobacco industry this evening, but I remind your Lordships that the tobacco companies and their apologists opposed every piece of legislation that affected them over the last two decades, using spurious arguments about commercial and individual freedom, and claiming that the measures proposed would not work. Well, as the smoking prevalence figures demonstrate, they could not have been more wrong.

Having said that, there are still 7 million smokers in England, and nearly 80,000 die from diseases caused by smoking each year. That is why we need a new tobacco control plan for England. The last one expired at the end of 2015, and in December the Government committed themselves in the other place to publishing a new tobacco control plan this summer. We have now been without a tobacco control plan for nine months. It is essential that the Government do not delay any further in bringing forward the next tobacco strategy. I hope that the Minister may be able to say something about this when he replies to the debate.

We cannot afford to be complacent. The decline in smoking rates in England has been similar to the decline in Australia or Canada—countries that have comprehensive tobacco control strategies. By contrast, smoking prevalence in France or Germany—countries without such strategies—has barely shifted over the last 20 years. Without sustained action, the decline in smoking rates could plateau or, as has happened in France, start to rise again. Further progress requires further action, and, as the Prime Minister has identified, action to tackle health inequalities.

The new plan needs to set out clear ambitions, recommendations for action and provisions to ensure sustained funding for tobacco control. The ambitions contained in the previous plan, concerning smoking in pregnancy, smoking and young people and adult smoking prevalence, have all been met. Stretching new ambitions are essential to build on this success and highlight areas, especially health inequalities, where more needs to be done. International evidence tells us that cutting funding limits the effectiveness of tobacco control measures; sustained funding will be vital to achieve continued reductions in smoking rates.

The new plan also needs to set clear targets for reducing health inequalities. Smoking rates among people in the routine and manual socioeconomic group are more than double the rates among those in the professional and managerial group. Smoking prevalence is even higher among those who are unemployed, in prison, have a mental illness or are experiencing homelessness. This means that the most disadvantaged members of our society suffer disproportionately from smoking-related diseases. Not only do individuals in disadvantaged communities suffer from a greater burden of smoking-related disease, but children growing up in those communities share that burden through greater exposure to second-hand smoke. Those children are also more likely to try smoking. Those who grow up in a household where their parents or siblings smoke are far more likely to become smokers themselves. Children may experience considerable peer pressure to start smoking, and tobacco is often more accessible in both the community and at home. This creates a cycle of inequality where smoking and smoking-related disease is passed down through generations, resulting in an appalling gap in life expectancy between rich and poor in our country.

This cycle of inequality is reinforced by lower rates of quitting among disadvantaged smokers. Poorer smokers are usually more heavily addicted and, while on average all smokers make a similar number of attempts to quit each year, well-off smokers are more likely to succeed. To reduce inequalities and the impact of smoking-related disease, support for quitting must be tailored to the needs of smokers in the lower socioeconomic groups. This requires mass media campaigns targeted at poorer communities, designed to motivate quitting and discourage uptake. Such campaigns are effective and cost-effective and an essential underpinning of a strategy to reduce smoking prevalence.

In addition, funding for stop smoking services needs to be secured. They are one of the most cost-effective healthcare interventions and smokers are four times more likely to quit successfully with the combination of behavioural support and medication provided by these services compared with unsupported quit attempts. This is particularly relevant for poorer smokers, who are more likely to be successful with this specialist support.

A new tobacco control plan is needed to set out the future of these services and to ensure that local authorities have the resources necessary to pursue targeted smoking cessation work with pregnant women and disadvantaged populations. This is vital to helping vulnerable people to give up tobacco and protect themselves from smoking-related diseases, and we need a clear strategy to help local services deliver on those aims.

Reducing smoking rates among poorer smokers will further support other government health aims, including reducing stillbirths and neonatal deaths. Women in routine and manual jobs are almost three times as likely to smoke during pregnancy as those in professional and managerial roles. The Government have committed themselves to reducing the rate of stillbirths, neonatal and maternal deaths in England by 50% by 2030. Cutting rates of maternal smoking will significantly advance this agenda, and this means cutting smoking rates among mothers from disadvantaged communities.

My Question asks the Government what action they are taking to reduce the incidence of smoking-related disease. As I have explained, the action needed is the publication of a new tobacco control plan for England without delay, with renewed and enhanced ambitions. Under the last plan we achieved a great deal and made large steps towards improving public health and we must not allow these achievements to go to waste. A new plan must build on the progress that has been made, continue to drive down smoking rates and protect our most disadvantaged from the burden of entirely preventable death and disease caused by tobacco.

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[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, I thank the noble Lord, Lord Faulkner, and my noble friend Lord Young of Cookham for enabling us to have this debate today. The fact that there are so many speakers, with only three minutes each, shows how important this subject is to many noble Lords in this House.

I was particularly taken by how many noble Lords addressed the issue of smoking within the context of health inequalities. I had not appreciated that it accounts for maybe 50% of the difference in life expectancy between people from poorer backgrounds who smoke and those who do not. It is one indication of just how serious smoking is. Linking it to Theresa May’s first speech when she became Prime Minister was a clever move. I hope she will read this debate with interest during the Recess.

The noble Lord, Lord Faulkner, said that he has spoken on this issue many times over many years in this House and elsewhere. It was actually back in 1604 that King James wrote a treatise called A Counterblaste to Tobacco, describing smoking as:

“A custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof, nearest resembling the horrible Stygian smoke of the pit that is bottomless”.

He did not mince his words. Slightly depressingly, however, that was in 1604 and here we are over 400 years later, still struggling. Although we have made great progress, 7 million people are still smoking in this country and, as we will discuss later on, I saw a frightening statistic recently showing that by 2030 it is estimated that nearly 500 million people in Africa might be smoking. This is a global problem and it is not going away.

Of course, we have taken action. Many noble Lords pointed out the success that we have had in this country. Over the last 25 years the number of people smoking in England has fallen from just over 28% in 1992 to just under 17% at the end of 2015. Despite this progress, in England smoking still kills around 200 people a day. The noble Baroness, Lady Masham, gave us a moving story of a friend of hers who recently died from lung cancer. I remember when I was chairman of a hospital watching an operation and seeing the inside of a patient’s lung. I am sure that my noble friend Lord Ribeiro has seen similar things. The colour of a heavy smoker’s lungs is absolutely vile. They are blackened.

I want to reassure noble Lords that this Government have always and will continue to take very seriously tackling the great harm caused by tobacco. In the last year, we have introduced a number of important measures to achieve this. First, we introduced a tranche of legislation that has greatly strengthened tobacco control and reduced even further children’s exposure to tobacco branding and second-hand smoke. This included the introduction of standardised packaging, which I am pleased to say is already in shops across England. I am sure that noble Lords have seen the standardised packaging. It represents a big step forward. This measure aims to motivate more people to quit while also deterring greater numbers of young people from ever taking up smoking in the first place. This is a fantastic achievement.

Secondly, we have delivered a range of impactful mass media campaigns which promote quitting. In just two weeks from now, we will launch a fifth ‘Stoptober’ campaign. This campaign has proven extremely successful. In 2015, more than 130,000 people successfully quit for 28 days for Stoptober. That is an impressive figure. Looking ahead, a number of noble Lords raised the issue of a new tobacco control plan. I am unable to commit to a publication date, but I can confirm that a new plan will set out renewed national ambitions to reduce prevalence even further and build on the success of the previous tobacco control plan. I was very struck by noble Lords’ comparison of countries with a tobacco control plan such as Australia and Sweden—

[Lord Faulkner of Worcester]

Canada.

[Lord Prior of Brampton]

I apologise, it was Canada. We can contrast that with the experience in countries such as France and Germany, where there is no control plan. The Government fully support renewing the tobacco control plan. During the last five-year plan, the proportion of smokers in England reduced by more than 10%.

Addressing the inequalities caused by smoking will be a central component of this plan. As has been highlighted in this debate, there remains significant geographical and demographic variation. The noble Baroness, Lady Janke, mentioned the situation in Bristol, for example. Staggeringly, smoking prevalence today in Sevenoaks is 6% and in Corby it is 29.8%, which demonstrates the variation around the country. Reducing smoking rates in populations with comparatively high prevalence will be a priority in reducing this variation and the health inequalities caused by tobacco.

In particular, we are considering what more can and will be done to support those with mental health conditions in quitting smoking. In developing this aspect of the plan, the recommendations set out in The Five Year Forward View for Mental Health, authored by Paul Farmer, are being taken into consideration. The noble Baroness, Lady Gale, mentioned the importance of improving maternity outcomes, and giving children the best start in life is an important priority for this Government. We have already set out an ambition of achieving a 50% reduction in stillbirths and neonatal deaths by 2030.

Supporting pregnant women in quitting smoking will be an important factor in working towards that. This was a priority in the previous tobacco control plan, during which prevalence for this group fell by 3 percentage points. I can confirm that it will remain a priority. Exposure to smoke during and after pregnancy can have devastating health consequences for babies. As well as these immediate health risks, evidence also shows that children who have a parent who smokes are two to three times more likely to be smokers themselves. Supporting adults to quit is therefore vital to ending the cycle of children who take up smoking, in order to cut off the pipeline of new smokers at risk of smoking-related disease. This is a battle we are winning. The proportion of young people smoking continues to fall, as my noble friend Lord Ribeiro pointed out, with prevalence amongst 15 year-olds more than halving in the last decade.

I will touch on a couple of other important elements of tobacco control. First, my noble friend Lord Borwick and the noble Baroness, Lady Walmsley, commented on e-cigarettes. I am well aware of the report by the Royal College of Physicians, which said that vaping was 95% better than smoking. I saw the recent reports in the paper, and I have read the BMJ article that supported them, saying that 18,000 people gave up smoking last year because of vaping.

Clearly, e-cigarettes have an important role to play, but they are not risk free. We do not want to encourage young people to take up vaping. In the UK we are adopting the right approach, which reduces the risks of harm to children and provides assurance on safety for users. In the UK, our e-cigarette policy has been successful, with minimal long-term take-up by children and non-smokers. This is not the case everywhere. In the US, for example, there is an upward trend of children who have never smoked cigarettes using e-cigarettes. This is why the Government have taken a precautionary approach to any possible risk of renormalising smoking behaviours that we have fought long and hard to denormalise. If any noble Lord has seen some of the advertising around vaping, they can see the potential dangers of attracting children who would never have smoked to the habit of smoking.

The UK’s approach to the regulation of e-cigarettes has and will remain pragmatic and evidence-based. The Government will continue to monitor and develop this evidence base, adapting policy accordingly, to ensure that policy on e-cigarettes best supports the protection and improvement of public health.

Secondly, through PHE we will maintain a programme of evidence-based mass-marketing campaigns to encourage more people to quit smoking, and raise awareness about products and services that can help. The noble Lord, Lord Rennard, in particular raised this issue. I can tell him that £4 million has been allocated for tobacco-specific marketing activities, £1 million of which is for the Stoptober campaign launching next month. On top of this there is further funding for multiple-issue campaigns, such as the One You and Be Clear on Cancer campaigns, which also contain messages about smoking. We also need to consider Heat Not Burn and other novel tobacco-containing products that are starting to emerge.

Difficult decisions have had to be made across government to reduce the deficit and ensure the sustainability of public services, as the noble Lord, Lord Hunt, has drawn to my attention on a number of occasions. However, councils will still receive £16 billion over the next five years for public health, on top of what the NHS will spend on vaccines, screening and other public health measures. The noble Lord asked whether I can draw to PHE’s attention its powers in this area to make sure action is taken locally. I certainly will draw that to the attention of my colleague in the other House, Nicola Blackwood, the Minister for Public Health, to ensure that happens.

Tobacco use is, as the noble Lord, Lord Crisp, and the noble Baroness, Lady Northover, pointed out, very much a global issue and an international priority. Tobacco companies are becoming increasingly active in the developing world. By 2030, more than 80% of the world’s tobacco-related mortality will be in low and middle-income countries. The uptake of cigarette smoking in Africa is pretty alarming. The UK will continue to work collaboratively with other countries to reduce the burden that smoking places on individuals, families and economies across the globe.

The Government intend to invest part of the development assistance funds to strengthen the implementation of the WHO’s Framework Convention on Tobacco Control—known as the FCTC. This project will be delivered by the WHO. For a number of years the UK has been rated the best country in Europe for tobacco control policy. Through this project we will share the UK’s experience to support low and middle-income countries in saving lives by putting effective measures in place to stop people using tobacco. This project will involve assistance to implement the “time-bound” measures of the FCTC: to ban tobacco advertising and to require health warnings on tobacco packs. We will also support countries to strengthen tobacco taxation to improve public health and raise new revenues for governments.

In conclusion, I am very pleased that we have had the opportunity to have this debate. It is probably disappointing to some noble Lords that I cannot give a specific date for the new tobacco control plan, but I can assure them that it is coming, that there will be one and that it will build on the success of the previous tobacco plan. The noble Lord, Lord Crisp, and the noble Baroness, Lady Northover, asked a particular question about a new initiative for which we were being given funds by the WHO to deliver. I will have to write to them on that matter if that is acceptable. Obviously, we will reflect on all the points that have been raised this evening. I am sure they will add to the new tobacco control plan.

Tobacco and Related Products Regulations 2016

Lord Faulkner of Worcester Excerpts

Monday 4th July 2016 Lords Chamber

[Baroness O'Cathain (Con)]

My Lords, this has been a very interesting debate so far; it has been good-humoured and full of humour. I was glad to hear the noble Lord, Lord Campbell-Savours, and the noble Baroness, Lady Hollins, talk about the seriousness of this situation.

I and at least two other people whom I see in the Chamber at the moment fought like tigers to make sure that smoking was banned in public places. We did it because all the evidence suggested that it was a terrible scourge on people who were addicted to tobacco and smoking and just could not break the link. From a personal point of view, I come from a family of five, of whom four died prematurely from either smoking or the effects of tobacco. I know of friends who have similarly died and those have not been very pleasant deaths either. I am not saying that vaping will cause that problem, but why do we need it? They say, “Okay, it’s part of a smoking cessation thing”. I really do not believe it; I think that e-cigarettes should be banned totally and more money put into helping smoking cessation programmes. Such programmes have worked, so why not carry on with them?

I should not say this, but I am going to: nobody knows just how manipulative the tobacco industry was during the period when we were fighting it. It was quite disgraceful—I see my fellow in arms, the noble Lord, Lord Faulkner, looking at me and agreeing. I am concerned that, with our having gone through all this and now reducing the amount of money spent on smoking cessation programmes, we will find in another 20 or 30 years—well, I will not be around—that we are doing it all again and people will be smoking. So I just say: please take care.

[Lord Faulkner of Worcester (Lab)]

My Lords, I am grateful to the noble Baroness for referring to me and the part that a number of us played in making the United Kingdom a leader in attempting to reduce the prevalence of tobacco smoking. As your Lordships will recall, it was this House which passed the amendments to the then Children and Families Bill which led to the UK being the first country in Europe to introduce standardised packaging in 2014. Incidentally, it is my understanding that, if the regulations being debated today were annulled, that legislation on standardised packaging would be badly damaged. I would be grateful if the Minister would comment on that.

As the noble Baroness, Lady Walmsley, said, the regulations are an important part of the way in which the United Kingdom should meet its obligations to the international tobacco treaty, one requirement of which is that we take continuing action to cut smoking prevalence through “comprehensive tobacco control” strategies. The regulations include other important measures such as the prohibition of flavours in cigarettes, including menthol, designed to attract young people to start to smoke. There are new reporting obligations on the tobacco industry, and rules on notifying new tobacco products. These provisions are important and should not be lost by way of some attempt to make the climate easier for vaping.

--- Later in debate ---

[Viscount Ridley (Con)]

Surely the tobacco industry looked around the world and saw—like Kodak looking at digital photography coming along—a huge threat to it. Of course it is now trying to muscle in on the act, but this is a good thing. If it starts making electronic cigarettes and becoming more profitable, it will give up on other cigarettes. The reason it got into this industry was because it saw it as a threat.

[Lord Faulkner of Worcester]

My Lords, I would be a little more convinced if the tobacco industry took its responsibilities seriously in countries where the restrictions on smoking were not the same as in the western democracies. The attempt to promote, advertise and sponsor tobacco smoking, particularly in the Far East, is utterly deplorable. The industry views the whole tobacco and vaping market in a very cynical way, so I am afraid I do not agree with the noble Viscount.

[Viscount Ridley]

In South America, vaping is banned altogether. Why? Because the tobacco industry is big and powerful in that part of the world.

[Lord Faulkner of Worcester]

It is very interesting, because in countries which take tobacco cessation seriously, the tobacco industry is switching to vaping, as it knows its traditional market is largely lost. Only last month, in this country, it attempted to undermine public health by trying to overturn the standardised packaging regulations. It cannot be trusted.

Finally, I share my noble friend Lord Hunt’s call for continued funding for stop smoking services, making them accessible and available to all smokers, and for such services to work with electronic cigarettes. It is wrong that these services are being cut back while the regulations are being introduced.

Our aim must be to be as ambitious as the most committed nations are in achieving a tobacco-free society over the next few decades. Over the last 10 years, we have already come a huge distance in changing public attitudes towards smoking, which is now largely seen as a socially unacceptable behaviour. My concern over vaping is that it must not in any way renormalise the smoking habit.

[Lord Lansley (Con)]

My Lords, from my point of view, my noble friend Lord Callanan chose to talk very selectively about the record of the Conservative Party and the coalition Government in relation to tobacco control. I think he should bear in mind that Conservatives—myself, my noble friend Lord Young of Cookham—worked hard from the Opposition Benches in another place, and succeeded in securing the ban on smoking in public places. When we came into the coalition Government together, we implemented the ban on sales through vending machines and a progressive ban on displays in shops. I also initiated the consultation on standardised packaging, following discussions with Nicola Roxon, who was then Health Minister in Australia, which my successors have taken forward. The product of all that is that we have not only secured continuing reductions in the overall prevalence of smoking—albeit I could wish this rate was faster—but we secured, I think three years ago, recognition that we had among the toughest tobacco-control regimes anywhere in the world. That is right and we should strive to make that the case.

I know it would not be the effect of the Motion in the name of my noble friend Lord Callanan, but were it passed it would indicate your Lordships’ desire to withdraw the regulations if they could. That would be an entirely retrograde step. I will not go through all the ways in which the tobacco products directive helps to strengthen the tobacco control regime other than in relation to e-cigarettes, but it certainly does.

I will isolate one important point which has not yet been mentioned. Much of what we have done in recent years, from my point of view and that of my colleagues—Anne Milton when she was Public Health Minister, and I believe it was among Anna Soubry’s and Jane Ellison’s objectives subsequently—was to focus on reducing the initiation of smoking among young people. We have some 200,000 young people a year initiating smoking. That is what we have to bring down. We want to arrive at the point where the initiation of smoking is minimised. As part of that, we have to look frankly and critically at how electronic cigarettes and vaping can contribute to the reduction of smoking, through access to smoking cessation services. It is absolutely right and I do not have any brief against e-cigarettes in that respect. But, to pick up the final point made by the noble Lord, Lord Faulkner of Worcester, we have to understand what the social and behavioural impacts of large numbers of people continuing to smoke e-cigarettes in the long term look like. I am not sure that promoting it through advertising is necessarily the right way to go.

We should enable smokers to access e-cigarettes and vaping, and do everything we can through the public health budget. Noble Lords will know—I will go into it on another day when more time allows—that my objective in creating a separate public health budget with local authorities was to maximise and protect our preventive activity, not to see it subsequently reduced. I deplore that fact because we were making considerable progress with smoking cessation services, as we should. But we also have to ensure, in addition to the use of e-cigarettes in a way that reduces smoking, that we do not create a new mechanism which might entrench in young people an expectation that they should initiate any kind of smoking, be it through vaping and using e-cigarettes or, even worse, through smoking tobacco. For that reason I agree entirely with many other speakers that it would be undesirable to support my noble friend’s Motion, and I hope that the Minister will agree that we should reject it.

Wheelchair Users

Lord Faulkner of Worcester Excerpts

Thursday 21st April 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is absolutely right. Getting the wheelchairs fitted properly and making the right assessments can save the NHS a fortune. It is outrageous that we have not tackled this before. The tragedy of the NHS is that if you do not have a tariff or target, you do not get the money. We are developing a tariff. The charter developed last year by the wheelchair alliance is an outstanding document.

[Lord Faulkner of Worcester (Lab)]

My Lords, can the Minister indicate how much progress his honourable friend the Minister for Disabled People has made in persuading Britain’s sports governing bodies, particularly the football authorities, to make sure that all their stadia comply with the accessibility guidelines, which are of course of particular importance to wheelchair users? I declare an interest as a vice-president of the Level Playing Field charity.

[Lord Prior of Brampton]

My Lords, I am afraid that I cannot answer that question as I do not know the answer. If it is all right to do so, I will write to the noble Lord and place the answer in the Library.

Opticians Act 1989

Lord Faulkner of Worcester Excerpts

Monday 8th February 2016 Lords Chamber

[Lord Faulkner of Worcester (Lab)]

My Lords, I congratulate the noble Lord, Lord Newby, on securing this debate. He has raised a number of interesting and very important points, and I hope that the Minister—if this is how he responds to the debate—will be able to offer some convincing reasons for not acting in the way the noble Lord proposes.

The only interest I have to declare is that I am someone who is very short-sighted. I have worn glasses continuously since the age of seven, apart from a brief and unsatisfactory period in middle age when I tried contact lenses.

Like the noble Lord, Lord Newby, I have visited the Adlens operation in Oxford, and got to know a number of its senior people. He has described very well what the product is, how it works, and how an amendment to the Opticians Act 1984 allowing adjustable-focus glasses to be sold over the counter without a prescription would be of immense value to the millions of people who need to wear spectacles. It would give them the chance to buy a back-up pair and put them in the glove box of the car for emergency use—the noble Lord pointed out that they are safe when driving. People would also regard them as a reassuring presence about the house, perhaps offering different pairs for different tasks, such as reading in bed or working on the computer.

I found the account of the noble Lord, Lord Newby, of how he attempted as a Minister to get the law changed particularly interesting. It seems to me that the arguments used by the General Optical Council in blocking the change and repeated in the briefing it has sent us for this debate are examples of protectionism of the very worst kind. I understand that they are similar to the arguments it employed when it attempted to block the removal of restrictions on the sale of reading glasses in supermarkets and pharmacies nearly 30 years ago.

The GOC is right in stressing the importance of encouraging customers regularly to take eye tests. These tests not only identify the strength of glasses that may be needed to correct sight, but are also an important way of spotting incipient eye diseases such as glaucoma and other life-threatening conditions such as brain tumours and high blood pressure.

The GOC’s case against amending the Opticians Act to allow retail sales of adjustable-focus glasses could have some validity if the number of eye tests carried out following the deregulation of reading glasses in 1989 had fallen. However, as the noble Lord, Lord Newby, has correctly observed, they have been rising steadily. I have no doubt that this would continue to be the case following the change we are debating this evening. What matters is that eye tests are promoted as part of an essential health screening and education programme, not as the manifestation and continuation of a restricted practice which is no longer of much benefit to consumers.

Before I conclude—I am speaking very briefly tonight—I would like to say a word about one particular market in the world where Adlens glasses can be bought over the counter. The noble Lord, Lord Newby, referred to the huge sales in Japan and the United States, and there is also a strong market for them in Mexico and Norway. Its briefing says:

“Adlens has supplied over 1.5 million products to consumers in 57 countries around the world”.

There is a remarkable philanthropic side to the company as well. Alongside the commercial operation is a charity called Vision for a Nation, started in 2009 by one of Adlens’s co-founders, James Chen, whom I met on my visit to the company in Oxford. This is a programme which aims to address the unmet need for affordable glasses in low-income countries.

The first pilot study was in Rwanda, a country where, Mr Chen estimated, up to 1 million of the 11 million population need glasses. Most of them will require standard reading glasses but between 5% and 10% will benefit from the Vision for a Nation adjustable lenses. Over 18,000 have been supplied free to the Rwandan health authorities and the charity is also funding a training programme for nurses to conduct eye tests. I gather that the plan now may be to expand the service to Bhutan. It will make a real difference if these services can become a central component of a nation’s non-communicable disease strategy.

In echoing the call from the noble Lord, Lord Newby, for an amendment to the Opticians Act 1989, I make the additional point that if Adlens were able to develop a successful retail business in the UK, comparable to that in Japan or the United States, not only would British consumers benefit from increased customer choice but the profits generated would allow the company’s marvellous work through its Vision for a Nation charity to be expanded into more third-world countries. I find that a pretty irresistible argument and I hope that the Minister will agree when he replies.