Tobacco and Vapes Bill

Debate between Lord Patel and Baroness Fox of Buckley

Committee stage
Thursday 30th October 2025 Grand Committee

[Lord Patel (CB)]

My Lords, I support this amendment. We know that nicotine is highly addictive. In fact, it is one of the most addictive substances there is, even in small quantities. The noble Lord, Lord Kamall, made the point that people use it for cessation of tobacco or cigarette smoking. That is true, but the dosage, even of 20 milligrams, is too high. High doses of nicotine cause serious diseases, as mentioned by the noble Baroness, Lady Grey-Thompson. But apart from that, in older people it causes higher risk of cardiovascular disease, not just by increasing heart rate and blood pressure but by making platelets stickier and leading to higher levels of fibrinogen, which increases the risk of forming a clot. This is a good amendment and there is no reason, to my mind, why the Minister should resist it.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the noble Lord, Lord Kamall, and the noble Baroness, Lady Grey-Thompson, have made some interesting cases probing the issue of the high nicotine content of pouches. However, it is worth noting that Cancer Research does not support these amendments. It says that there may well be a need for a deeper dive into the evidence, but it stresses something that has been missed in some of the debates we have had so far, certainly at Second Reading: it is tobacco that is the cancer-causing ingredient in cigarettes.

Nicotine patches do not contain tobacco. Nicotine is addictive, but the overall evidence does not support a direct causal link between nicotine and cancer: it is not carcinogenic. That is what the scientific evidence seems to show, and it comes from anti-tobacco lobbying groups and people whom I would not necessarily usually cite. It is noted that nicotine products and pouches are being used as recreational products, but they are also helpful for smoking cessation.

We have to consider what we are doing with the Bill. The NHS itself calls nicotine “relatively harmless”, and, in his 2022 review, Dr Javed Khan said that

“the government must facilitate access to the various already available safer alternative nicotine products such as nicotine pouches”.

We therefore have to be careful about demonising these things, because it is not straightforward.

There is a danger throughout the Bill—it will come up in other groups—of a constant slippage between tobacco and nicotine. Sometimes that occurs through a discussion around addiction. I would be interested to know what the Minister thinks about this—she talked about the problems of addiction on our first day in Committee—because the Bill is not necessarily tackling addiction; it is tackling harms. There is a danger that we get confused between that addiction, which, as I say, many people in the health professions do not see as a problem per se, and what we are targeting. I am worried that that slippage between nicotine and tobacco, between vapes and smoking cigarettes, leads to an unscientific mishmash of misinformation that, ironically, can damage public health.

In relation to young people using pouches until they vomit, young people use lots of things until they vomit. They can overuse a range of things, not helpfully, but it does not necessarily mean that the product itself is always the problem: sometimes, it can be youthful lack of restraint, which one might want to intervene in but not necessarily through the law.

Anaesthesia Associates and Physician Associates Order 2024

Debate between Lord Patel and Baroness Fox of Buckley

Monday 26th February 2024 Lords Chamber

[Lord Patel (CB)]

I hope they do find time, because that allows for better scrutiny and better ability to amend, which we always claim to be our key role—to scrutinise and amend. It is a major piece of legislation to go through using SIs, and it is inappropriate to do so. Maybe we must consider how else we could do it in a way that maintains flexibility.

Moving on from that, as the noble Lord, Lord Harris, already mentioned, if this legislation is going to be the template for future legislation to regulate all health professionals, some issues will need to be discussed. This order does not require that health is considered as a category in the regulation of physician and anaesthesia associates. The statistics show that, when the GMC or, I presume, any other regulator investigates, it is a very stressful situation for the person involved. Some statistics suggest that one in three considers suicide; they are depressed by it. If the category of health is removed as a consideration when a person is investigated, as this order does, it is a backwards step. I need to ask the Minister why health has been removed as a consideration. If this is the template, I presume that this will also apply to other regulations in the future.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the noble Lord, Lord Patel, just said many very important things, with which I agree, far better than I would. I thank the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, because this debate has revealed the importance of this order: it is not a minor regulatory matter that can be put through by an SI, in a back room. That it has created so much debate outside the Chamber indicates why it is important that we discuss this and that it is not nodded through behind the public’s back. I am glad of that.

I have been embroiled in discussions about this for some time. The noble Lord, Lord Hunt of Kings Heath, made a good point when he said that the discussion has become quite toxic. I thought it was perfectly reasonable to be worried about PAs and AAs; I did not anticipate this kind of savage attack on them. There has been a real scapegoating of these individuals, which is not how we should resolve this issue. We should also remember that doctors can be guilty of clinical negligence. We do not want to wander around pointing the finger at who is more negligent.

However, if there are preventable never events as a consequence of people not being fully equipped for the roles that they are asked to do—by the way, they are being asked, very often told, what to do when they are not really up to it, through no fault of their own—it is a matter for public concern. That is the way that accountability works and why we need to be very clear and have no muddle over what somebody is supposed to be doing, what they are not supposed to be doing, and what they can and cannot do.

There were a couple of things that confused me in the arguments made in the briefings we received. I lost the will to live in the rows going on about the differences between physician associates and physician assistants, as though “associate” or “assistant” was the key difference. I think the difficulty is when people think that any of them are physicians, because that means that they think they are doctors. That is the confusing bit and it shows that people can get lost in the midst of this.

It is also worth bearing in mind some context when it comes to the public. Most patients would prefer to see anyone at a doctor’s practice than wait for two weeks in pain. That makes the public vulnerable to having a lesser service. I understand that. I also thought that the noble Lord, Lord Patel, was absolutely right about a big team: when you are in hospital, you are surrounded by people wearing a million badges, different colours and lanyards. They all introduce themselves to you in great detail, but you do not care because you are ill. You want to lie back and trust them, and assume that a division of labour is going on.

Sometimes, when I was reading the briefings, it felt as though there might be a bit of vested interest about who was regulating who and what numbers were on the badges. This seemed to miss the point of the real concerns, which are whether there is sufficient clarity about the scope of PAs or AAs, or whatever we call them; that there is not too much mission creep; and that we have a clearly defined set of protocols and specific tasks allocated. I think it important that PAs in GP surgeries have a different set of protocols and scope than in hospitals—they are not the same, even though in both instances they are called PAs.