Tobacco and Vapes Bill

Wera Hobhouse Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Wes Streeting]

My hon. Friend is absolutely right. I am afraid that one of my first experiences of death was watching my grandmother die a very long, slow, painful death from lung cancer as a result of a life of chain smoking. That is the consequence of this cruel addiction. People who start smoking come to regret it. They struggle to stop, and I am afraid that the stolen years that they could have spent with children and grandchildren are only part of the cost. Part of my argument today, particularly to some Opposition Members, is about better use of public money and reducing the taxation burden. Other arguments, too, may have some currency with Members who might be opposed to these measures for libertarian reasons. We should not forget for a moment the impact of this cruel addiction and the harms caused by smoking on people’s quality of life, family life, and memories.

[Wera Hobhouse (Bath) (LD)]

rose—

[Wes Streeting]

I must make progress, otherwise we will not hear from anyone else in this debate—and I think that it will be a debate.

Taking action requires a reforming Government who are unafraid to take on the orthodoxies of both the right and the left. As I said, my right hon. Friend the Work and Pensions Secretary is today proposing radical reforms to the welfare system. Earlier this month, I set out a package of reforms to drive better productivity in the NHS. Today, we are proposing the biggest public health reform in a generation: phasing out smoking for the next generation by raising the legal age at which tobacco can be sold by one year every year, so that anyone aged 15 and under today will never legally be sold cigarettes. That will phase out smoking altogether.

Almost 20 years ago, the last Labour Government introduced the ban on smoking indoors in public places, as my hon. Friend the Member for Harlow (Chris Vince) said. We heard many of the same arguments, frankly, from opponents of that measure as we hear from opponents of the Bill today. They are free to correct me if I am wrong, but I do not think that Opposition Members who oppose the Bill are also proposing scrapping the indoor smoking ban. We have political consensus on the issue because of its success. The year after the ban came into force in 2007, hospital admissions for heart attacks dropped by 1,200. Admissions for children with asthma had been rising by 5% a year before the ban. After it was introduced, admissions fell by 18% in just three years. Since 2007, smoking rates have been cut by over a third, and as our understanding of second-hand smoke grew, the ban sparked a cultural change. People no longer thought it acceptable to smoke in front of their children, and many stepped outside, even in their own homes. It is time to build on that success.

No smoker intends to cause harm to others, but that is unintentionally what they do through second-hand smoke. The harms from second-hand smoke are less than from actively smoking, but the evidence shows they are still substantial. If people can smell smoke, they are inhaling it. Smoke near schools and playgrounds exposes children to smoke. Hospitals, by definition, have high numbers of medically vulnerable people on their grounds. The Bill will allow Government to extend the ban on indoor smoking to certain outdoor settings, and we will consult on banning smoking outside schools, playgrounds and hospitals to protect children and the most vulnerable.

As we act to prevent harms from smoking, we must also tackle the rising problem of youth vaping. It has more than doubled in the last five years, and one in four 11 to 15-year-olds tried vaping last year. A new generation of children is getting hooked on nicotine, and there should be no doubt about the cause, and no illusion that this has happened by accident. On any high street in the country, we can see shop windows filled with brightly coloured packaging for vapes, with flavours like blue razz lemonade and tongue twisters sour apple. Those products are designed, made, packaged, marketed and sold deliberately to children. This industry has cynically targeted its harmful products to kids.

Action is long overdue. We promised to stamp out youth vaping in our manifesto, and the Bill delivers the change that we promised. It will close loopholes that allow vapes to be sold or given away to children, provide powers to regulate the flavours, packaging and display of vapes, and introduce on-the-spot fines of £200 for under-age sales. Just as we took action on the advertising and sponsorship of tobacco products, we will bring the law into line for vaping products, too.

[Wera Hobhouse]

I do not know whether the Secretary of State will still be in the Chamber when I talk about Spice-spiked vapes. I see a gap in the Bill: it does not talk about refills. The harmful practice of spiking vapes with Spice comes from the refills. I hope that the Government will listen to my concerns and be flexible, as they have already shown themselves to be in other places. Perhaps, during the passage of the Bill, we can include something about refills. Would he agree to that?

[Wes Streeting]

We want to work in a genuinely collaborative and cross-party way, and I know that is true right across the House. As I look at the Opposition Benches, including Conservative Benches, I see long-standing campaigners for action on smoking and vaping. We want to listen and engage.

I feel strongly about the matter, as does the Prime Minister. In our manifesto, we set out Labour’s mission to improve the health of the nation. We will be far better served as a country if this is a truly national mission, and if we come together in common cause for action on public health.

--- Later in debate ---

[Dr Cooper]

I wholeheartedly agree. Vending machines are often forgotten, but they are used for sales and marketing, and sometimes in ways we do not understand.

[Wera Hobhouse]

We should also look at online sales. A lot of young people purchase products online. May I ask the Minister what the Bill says about that?

[Dr Cooper]

I do not disagree. The Bill will give the Government far greater control over the marketing side of vapes and the flexibility to adjust regulations in the future. Life evolves outside this Chamber, and we need to be able to evolve with it flexibly.

Alongside the measures in this Bill, this Government have made important commitments to integrating smoking cessation into routine care and ensuring that the most disadvantaged groups are not left behind as we move towards a smokefree Britain. When I was undertaking my training in public health, a director of public health told me that our profession is where medicine meets politics—I am not sure how he would feel about me going into politics, but there we go. In this Bill, I am delighted to see the evidence and data provided by my profession working in synergy with this Government’s policy development to bring forward a Bill that will allow our young people to enjoy healthier futures and allow us all to live in a healthier environment. I thank all Members across the House for their work on this issue, and I offer my wholehearted support for the Bill.

--- Later in debate ---

[Wera Hobhouse (Bath) (LD)]

I congratulate the Government on their very strong stance on tobacco and protecting children, but—the Minister will know what is coming—when it comes to refillable vapes, the Bill is missing the mark. Research by Professor Chris Pudney at the University of Bath discovered that one in six vapes confiscated in schools contained the synthetic drug Spice—a highly addictive and dangerous drug commonly found in prisons. It causes very dangerous health conditions, including damage to vital organs. On our streets, users are often slumped in a semi-conscious state, unable to function. In our schools, children are collapsing. Some are rushed to intensive care; others are left battling lifelong addiction. The highly addictive nature of Spice makes it a gateway to criminal activity, coercion and abuse.

I have spoken about this alarming issue on several occasions, and I have had some assurances from the Government, but so far I have not seen anything on it in the Bill. It will not do anything to stop the trend of Spice-spiked vapes in schools, because the vapes that contain Spice are almost all refillable. Refillable vapes are rechargeable and feature an empty pod that can be filled up with a liquid of choice. Banning disposable vapes will not address that problem. Many of the confiscated vapes containing Spice were made to look exactly like a normal product from a shop, and they are usually sold as containing THC—tetrahydrocannabinol—also an illegal product in this country. Children are inadvertently consuming Spice under the impression that it is cannabis.

Vapes containing THC are widespread in parts of the United States where they are legal, but importing them to the UK is costly and difficult. Spice, however, is cheap, readily available and highly addictive. Dealers exploit that by passing off Spice as cannabis, preying on young people and putting them at serious risk. This drug has the potential to condemn young people, in particular vulnerable young people, to a life of crime and addiction.

When such Bills come along, we have the opportunity to make them as strong as possible. There are other issues associated with Spice-spiked vapes, but I urge the Government to really look at what they can do to strengthen the Bill to address this serious problem. There are opportunities in the Bill, but focusing solely on disposable vapes risks backfiring; it may push demand towards refillable vapes, which are even easier to tamper with for illegal use. Have the Government really prepared for the potential unintended consequences? I hope that they acknowledge the points that I have raised. I look forward to seeing them addressed as the Bill progresses. I support the Government on their very strong stance and on what they want to achieve, but I hope that the Bill can be strengthened.

Oral Answers to Questions

Wera Hobhouse Excerpts

Tuesday 19th November 2024 Commons Chamber

[Karin Smyth]

My hon. Friend makes an excellent point on behalf of Rachel and many other women suffering from this disease. We are looking urgently at gynaecological waiting lists. They are far too high, including for endometriosis. I welcome the new National Institute for Health and Care Excellence guidelines. We will be looking at women’s health hubs and how they work, and future guidelines will help women to get a diagnosis more quickly and help with situations like Rachel’s.

[Wera Hobhouse (Bath) (LD)]

Respiratory health conditions are one of the main drivers of NHS winter pressures, yet only 32% of asthma sufferers in Bath and across the country can access the most basic level of care. What will the Government do to improve access to basic levels of care for the 68% of asthma sufferers who are currently missing out?

[Andrew Gwynne]

NICE is reviewing its guidelines for the diagnosis, monitoring and management of chronic asthma, and an updated version is due to be published in late November 2024. I am happy to meet the hon. Lady to discuss it further.

Breast Cancer: Younger Women

Wera Hobhouse Excerpts

Tuesday 12th November 2024 Westminster Hall

[Martin Vickers (in the Chair)]

I will call Vera Hobhouse to move the motion, and I will then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention in 30-minute debates.

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered breast cancer in younger women.

It is a pleasure to serve with you in the Chair, Mr Vickers. I thank the Minister for being here to respond.

Every woman deserves a fair chance against breast cancer, no matter her age. It is the most common type of cancer in the UK. Most women who are diagnosed are over 50, and it is therefore a disease often associated with older women, but young women are at risk, too. Breast cancer in younger women is often caught later when it is more advanced. That is because there is no routine screening and too often symptoms get dismissed as something less serious. That must change. Awareness and early detection are crucial, no matter your age.

The issue arose for me during a constituency surgery when my Bath constituent Lucy shared her story, which resonated with me because my nephew’s mother died many years ago of breast cancer aged 35. In 2021 Lucy, who was 38, had two young children and was diagnosed with primary breast cancer. She underwent a mastectomy, chemotherapy and radiotherapy before being given the all-clear. In 2024, when she was 41, a self-initiated MRI scan tragically came back showing that her cancer had returned, leading to a diagnosis of secondary breast cancer, which is currently incurable. In both cases she found it a struggle to be diagnosed.

The first time, despite her mother having had breast cancer and Lucy presenting with a lump, at least three different doctors told her that it was likely to be hormones and nothing to worry about. It was not until she requested the biopsy, which ultimately came back showing it was cancer, that the diagnosis was made. The second time she repeatedly voiced concerns about a symptom that she was experiencing, but she was repeatedly assured that it was just a side effect of the treatment. Still concerned, she approached the GP, who did some initial tests but ultimately suggested that her worries were anxiety-driven. After that appointment she came out and sobbed in her car.

Searching for peace of mind, Lucy then paid privately for a breast MRI, which tragically revealed that the cancer had returned, but by then it was too late. In both cases—first by requesting the biopsy and secondly by initiating an MRI—it was up to Lucy to fight for a diagnosis.

[Helen Grant (Maidstone and Malling) (Con)]

I congratulate the hon. Lady on securing this important debate. Because of the age restrictions in accessing NHS mammograms and the importance of early diagnosis, which she highlights, does she agree that self-awareness and self-examination in young women is critical in the battle to beat breast cancer?

[Wera Hobhouse]

The hon. Lady is absolutely right that we need to continue to raise awareness, but I am pointing out that even when young women are aware and go to a doctor, the doctor says, “Don’t worry about it.” However, I agree that we need to continue to make sure that women examine their breasts and are aware of the risks of breast cancer, even when they are young.

[Jim Shannon (Strangford) (DUP)]

I spoke to the hon. Lady yesterday. This is a massive issue for me and my constituents back home, and they bring it to my attention all the time. It was great to attend the Breast Cancer Now “Wear It Pink” event last month to raise awareness of the most common cancer in the UK. Studies have suggested that breast cancer among younger women has a more aggressive pathophysiology, correlating to poorer outcomes compared with those for breast tumours in older patients. Does the hon. Lady agree that consideration must be given to lowering the age requirement for breast screening to ensure quicker intervention for younger women?

[Wera Hobhouse]

I will come to that later in my speech, but I absolutely agree with the hon. Gentleman. We are here to make the case for earlier screening programmes for younger women, because it is becoming such an issue—the rates are increasing. It is because of Lucy’s struggle to get a diagnosis that she felt the need to speak up on behalf of the countless young people who would not question decisions made by medical professionals.

[Clive Jones (Wokingham) (LD)]

I congratulate my hon. Friend on securing this important debate. After I survived breast cancer, one of my many emotional conversations with my daughters was about having the BRCA gene. Currently, there is a postcode lottery for the availability of counselling with proper genetic guidance for those who are identified as having the gene. Does my hon. Friend agree that NHS England should ensure equitable access to information and counselling services, and that fixing the system should be a feature of the Government’s future cancer strategy?

[Wera Hobhouse]

I am sorry to hear that my hon. Friend went through a cancer diagnosis, and I am glad that he recovered. Breast cancer in men is not as well known; people do not necessarily recognise that men can develop breast cancer. Once a diagnosis is made, it is quite traumatic for the whole family. Counselling services need to be adequate, and I agree that there should not be a postcode lottery.

The description of Lucy’s story is in no way meant as an attack on the NHS. Since she was diagnosed, Lucy has received the top-class care for which the NHS is renowned, but she is not alone in having her age used against her. There are countless similar stories of women of a similar age or younger who have found it difficult to receive an initial diagnosis, with concerns often dismissed too early by doctors as hormones, anxiety or tiredness. This is by no means the doctors’ fault; they are forced to make difficult decisions about who to prioritise because of the impossible time and budget constraints that are imposed on them. That does not, however, make it acceptable.

There is a long-standing myth that breast cancer only affects older women, but there has been a global surge in cancers among the under-50s over the past three decades—sadly, the issue is not limited to breast cancer. Last year, a study found that cancer cases in under-50s worldwide are up nearly 80% in the last 30 years. More than a million under-50s are dying of cancer each year, and that figure is projected to rise by 21% by 2030.

I draw attention to the “Jess’s Law” petition, which has more than 350,000 signatures, to improve the awareness and diagnosis of cancer in young adults. It points out the struggles young adults face in getting diagnosed, even though adults aged 25 to 49 contribute around a tenth of all new cancer cases. According to Cancer Research UK, cancer rates in 25 to 39-year-olds in the UK increased by 24% between 1995 and 2019. In 2019 alone, almost 35,000 people in that age bracket were diagnosed with cancer.

The trend is especially alarming in breast cancer. Diagnoses of breast cancer have increased steadily in women under 50 over the past two decades, but in recent years the increase has been even more stark. In 2013, breast cancer cases in women under 50 topped 10,000 for the first time. To the alarm of experts, breast cancer diagnoses in women under 50 have risen by more than 2% annually over the past five years, so the trend is clearly an increase. That is deeply concerning, especially since women under 50 are nearly 40% more likely to die from breast cancer than are women over 50.

It is truly alarming that in the UK, breast cancer accounts for 43% of all cancers diagnosed in women aged 25 to 49. Despite that, we continue to wait until women are 50 or older to begin routine screening. Why are we delaying early detection when the rates of breast cancer in younger women are rising year on year? Cervical cancer screening is available to women from the age of 25, but of the top 10 cancers detected in those aged 25 to 49 in the UK, breast cancer outweighs cervical cancer by more than five times, so that discrepancy simply does not make sense. If we can screen for other cancers earlier, we should do the same for breast cancer. We all know that early detection saves lives, so we must ensure that all women, regardless of their age, have the opportunity to access lifesaving screenings.

Young women are more likely to develop aggressive forms of the disease. Breast cancer is the most common cancer in women, and it remains one of the leading causes of death in women under 50 in the UK. Unfortunately, as Lucy’s story shows, younger women often face more challenges to diagnosis. They are more likely to be diagnosed at a later stage of the disease, with larger tumours and greater lymph node involvement. Cancer in younger women is also more likely to be biologically aggressive: sub-types such as triple negative breast cancer are harder to treat and have poorer outcomes. As a result, younger women have significantly worse prognoses, with a higher risk of recurrence and death than older women. We cannot ignore that stark reality.

Premature death from breast cancer among women in their 40s accounts for the same years of life lost as those in their 50s, and substantially more than those diagnosed in their 60s. That is crucial. A death of a woman in her 40s or 50s represents not just a loss of life, but a tragic loss of potential life years.

Researchers also found an increase in the diagnosis of stages 1 and 4 tumours, which suggests that if stage 1 tumours are missed in younger women, they tend not to be found until they reach stage 4, at which point the cancer is incurable. Early detection can make all the difference. During the previous Parliament, a petition calling for funding to extend breast cancer screening to women from the age of 40 got more than 12,000 signatures. That widespread public support reflects the growing concerns about early detection.

The Government’s response was deeply disappointing. They continue to use the Marmot review as their main reference point, citing the lower risk of young women developing breast cancer and the fact that women below 50 tend to have denser breasts, reducing the accuracy of a mammogram. It is true that the risk of younger women developing breast cancer is lower, but statistics show that rates of breast cancer in women aged 25 to 49 are rising fast, and that upward trend demands urgent attention.

Although mammograms can be less effective in women with denser breast tissue, that should not limit our approach to early detection. We should continue to use modern digital mammography, but the Government should expand the use of automated breast ultrasounds. Ultrasounds are especially effective in detecting abnormalities in dense tissue that might be missed on a mammogram. The technology is not invasive; it is quick and radiation-free, and it is often used for secondary screening for women with dense breasts. Automated breast ultrasounds can detect up to 30% more cancers in women with dense breasts than mammograms alone. By embracing both mammography and ultrasound, we can significantly improve detection rates, ensuring early and more accurate diagnosis.

Last week, in the light of Sir Chris Hoy’s bravery in sharing his story about his struggle with prostate cancer, the Health Secretary asked the NHS to look at the case for lowering the screening age for prostate cancer, particularly for people with a family history of the disease. That is an important and welcome step, but we must look at extending that approach to breast cancer too. Both diseases share a significant genetic link, and a family history often increases the risk. Aligning the screening policies for prostate and breast cancers in recognition of the shared genetic risks would provide a better safety net for those affected.

Various parts of the NHS are competing for investment, but it is clear that short-term investment in this area will save money in the long term, with fewer women needing extensive long-term treatment if breast cancer is caught early. According to Breast Cancer Now, breast cancer will cost the UK economy almost £3 billion in 2024, and the annual cost could rise to £3.6 billion by 2034.

I call on the Department of Health and Social Care to review the national breast cancer screening programme to identify where changes can be made to increase capacity in the system, to ensure that, where appropriate, a woman’s initial screening appointment can happen at a lower age. I also call on the Government to investigate the merits of early optional ultrasound for women aged 30 to 49. Finally, we must educate healthcare professionals and increase resources so that younger women who seek help are always taken seriously and investigated thoroughly, and never dismissed.

It is about not just policy change, but giving people the best possible chance to fight back against cancer and live healthier, longer lives. I hope that the Minister has heard Lucy’s story and will actively look at changing the way we screen for breast cancer for good.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the hon. Member for Bath (Wera Hobhouse) for bringing this debate to the House, as well as other hon. Members for their interventions. I also pay tribute to the hon. Lady for championing the story of her constituent Lucy and others, such as Jessica Parsons, who have done so much to raise awareness. We have a powerful role as Members of Parliament, and I commend the hon. Lady for doing an excellent job.

The hon. Lady is absolutely right that awareness raising is key to catching cancer early, and the most effective way to tackle breast cancer in younger women is to encourage them to check their breasts regularly. The NHS is going through the worst crisis in its history, and this Government will turn it around so that cancer patients are diagnosed and treated on time. The investments we are making now in breast cancer treatment and research are part of our plan to make the NHS fit for the future.

Although women of any age can get breast cancer, it is much more likely to occur over the age of 50. That is why our screening programme sends women their first invitation at 50. However, I will take this opportunity to emphasise that the take-up of breast cancer screening is currently below 70%. That is worryingly low, and we are determined to change that. I make a plea to all hon. Members to help the Government achieve greater take-up of breast cancer screening in women over 50. Women need to come forward for screening.

Taken as a whole, the evidence does not support regular mammograms for women below the age of 50. Decisions on screening, including the age at which to offer it, are made by experts on the UK National Screening Committee, and those decisions are kept under review so that they continue to be based on the best available research. Ultrasound can be used as a diagnostic tool, but it is not appropriate for screening. Mammograms provide a fuller picture of the breast, and are better able to spot early signs of cancer. As the hon. Lady said, mammograms used for screening are less reliable for younger women given their denser breast tissue. Change in the screening age could mean a greater risk of false negatives, where cancer is missed, and there would also be a greater risk of false positives, which may lead to invasive testing when there is no need for it. Our approach is in line with that of most European countries, which screen women between the ages of 50 and 69.

For younger women who have a greater risk because of their family history, we offer screening using mammogram or an MRI scan. As I have said, the most effective way to tackle breast cancer in younger women is to encourage them to check their breasts regularly, and to consult their GP straight away if they have any concerns.

[Wera Hobhouse]

Lucy did that and was dismissed. Today’s debate is particularly important for awareness raising among the medical profession to ensure that women, particularly those who know about a family history of breast cancer—some do not—are not dismissed and are taken seriously.

NHS Dentistry: South-west

Wera Hobhouse Excerpts

Tuesday 12th November 2024 Westminster Hall

[Richard Foord]

The hon. Gentleman is right. We want to move NHS treatment back into primary care and away from the most critical acute care, yet it seems to me that primary care services are moving in the other direction.

[Wera Hobhouse (Bath) (LD)]

Royal United hospitals in Bath saw nearly 260 people last year with serious dental issues such as abscesses, largely because those people could not get a preventive care appointment from a dentist in their community, forcing them to go to A&E. Does my hon. Friend agree that a lack of NHS dentistry drives up costs because people go to A&E when it should only be there for emergency cases?

[Richard Foord]

I agree that emergency care should not suddenly become the routine. It is there for the most critical cases, but we have not seen that, given the drying up of NHS dentistry provision in our towns and villages.

Access to Primary Healthcare

Wera Hobhouse Excerpts

Wednesday 16th October 2024 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

Today I speak as chair of the all-party parliamentary group on eating disorders. Eating disorders are a national emergency. Hospital admissions have risen by 84% in the past five years, while more than 80,000 sufferers are stuck on waiting lists while their condition gets seriously worse.

Eating disorders are treatable, but the treatment must be timely and appropriate if sufferers are to make a full recovery. Early diagnosis is crucial. According to the charity Beat, approximately 1.25 million people in the UK have an eating disorder, and I am sure that many of my colleagues have either a friend or family member or know about a constituent who is suffering from an eating disorder. The sooner a person with an eating disorder accesses the right treatment, the more likely they are to recover. When eating disorders are left undiagnosed or poorly treated, they can be killers.

Eating disorders are the mental health disorder with the highest mortality rate, and there is still a stigma surrounding them. There are still too many who think that having an eating disorder is a choice. What a terrible thing to say about people who are suffering from an illness—that it is a choice. Only 6% of people with an eating disorder are underweight, yet some eating disorder services—and GP services—still only offer treatment to patients depending on their body mass index. Many eating disorder sufferers are told that they are not thin, or not thin enough. Others are told, once they return with an even lower BMI, that they are too sick or their condition is too complex to be treated. That happens only because too many sufferers are left untreated when full recovery was perfectly possible.

[Dr Danny Chambers (Winchester) (LD)]

Will my hon. Friend give way?

[Wera Hobhouse]

I would rather not, because too many people want to speak.

NHS waiting times are one of the biggest barriers to treatment. At the end of 2023-24, more than 10,000 children had entered treatment for an eating disorder, but 12% of those were made to wait over three months for treatment—three times the target for a routine referral. Missing the target waiting time standard can severely harm the progress of a child’s recovery. Even more shockingly, an access and waiting time standard for adults does not even exist.

I will continue to work tirelessly to improve eating disorder care, in particular by fighting for improved access for treatment and for more suitable treatment options for individual patients. We on the APPG have commissioned an inquiry, and I hope the Government will carefully listen to the recommendations. In 2024, no one should be condemned to a life of illness, nor should anyone die of an eating disorder.

[Several hon. Members rose—]