Tobacco Control Plan

Adam Afriyie Excerpts

Thursday 10th June 2021 Westminster Hall

[Adam Afriyie (Windsor) (Con)]

It is a pleasure to serve under your strong and stable chairmanship, Mrs Miller. It is a great privilege to speak in the debate, and I thank the hon. Member for City of Durham (Mary Kelly Foy) for introducing it.

We are debating a vital issue, and the UK can be No. 1 in the world for its approach on reducing smoking and the harm it causes. I commend my hon. Friend the Member for Harrow East (Bob Blackman) for his input into the report and his earlier contribution, and my right hon. Friend the Member for Clwyd West (Mr Jones) for his apposite remarks, which I am sure the Minister took on board. I also commend the Minister herself, and the Government, for their approach. I would say that she is mistress of the brief, as we have had many conversations and interactions through correspondence, and there is no doubt that she gets all the issues to do with smoking cessation devices and the tobacco control plan.

The industry in the UK seems to be aligned with the Government’s objectives on reducing smoking, as Philip Morris, British American Tobacco and many of the other firms recognise that this is the end of the game—it is the end of smoking in the United Kingdom, even if that might not be the case in certain far eastern countries, in Africa or elsewhere. The companies accept their responsibilities, and it would be of no surprise to them—they would not be disappointed about this—that they needed to make contributions to a fund to help to secure the goal of a smoke-free Britain, which should certainly be firmly on the table.

I speak as chair of the Parliamentary Office of Science and Technology and a member of the all-party group on e-cigarettes, and it seems to me that we are in an era in which we must be driven by data and evidence. There can be no doubt that the data is completely one way on vaping devices, electronic nicotine delivery systems and all sorts of other technologies to help smoking cessation. Vaping, using an electronic device or even using snus is so much safer than smoking. Smoke is the killer; tobacco is the killer. I urge the Minister not to do what the European Union has done, or what the World Health Organisation seems to be doing, by mangling the two issues. Tobacco is one thing; smoking cessation devices, which in most cases contain nicotine, are a completely different thing, with a completely different scale of harm and risk.

I recognise that other hon. Members will talk about various recommendations from the all-party group on smoking and health, so let me briefly focus on three. Recommendation 5 says that smokers should be advised annually of their options for quitting. Reminding people that they can choose an alternative to smoking is an important step forward. If we ask any smoker—I was a smoker for a few years, some time ago—“Would you like your children to smoke?” they all say no. It is clear that no one really wants to smoke, no matter what their brain says about dopamine levels. In that scenario, I think it a good idea to remind people annually that there are alternatives. Nicotine patches are not the only alternatives. Those have some efficacy, but, to be frank, very little for the money that is paid for them. People should certainly consider vaping devices.

The second recommendation I draw to hon. Members’ attention to is No. 6, which is support for those with mental health challenges. It also says

“for those living in social housing”,

but I will broaden that slightly to those on lower incomes and in lower-paid jobs, among whom there is a far higher incidence of smoking than in the general population. There is work to be done to focus the efforts in those areas.

Recommendation 11 is also important, because there is still an ambiguity about whether vaping is a smoking cessation device or just another way of inhaling nicotine. It is clear from the evidence that it is a smoking cessation device that works, and it is twice as effective—if not more—at helping smokers to cease smoking as the other available treatments. Let us dig into the pockets of the tobacco companies—they are actually happy for their pockets to be dug into—and use that money to publish the relative health benefits of vaping, e-cigarettes and other alternatives to smoking.

Windsor is a lovely seat, and thankfully we have slightly lower smoking rates than the rest of the country, but we still have perhaps 200 or 300 people a year dying of smoking-related diseases, as well as all sorts of other challenges.

In conclusion, we are first in the world for genomics, for the vaccine roll-out, and for FinTech and financial services. Let us make this another one: let us be the first in the world to implement a tobacco control plan that completely takes on board the wonderful innovation of vaping devices, e-cigarettes and all the other technology, and let us not mangle it together in a tobacco directive.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Mrs Miller. I congratulate the hon. Member for City of Durham (Mary Kelly Foy) and my hon. Friend the Member for Harrow East (Bob Blackman) on securing this important debate. I also thank everybody for the constructive tone in which we have discussed what is an incredibly important subject and for the acknowledgement that if we are to meet what is a very stretching target, we will all need to work together.

The hon. Member for City of Durham has highlighted the excellent work being done through the smoke-free programme in County Durham to drive rates in her area down, and I know that she fully supports that. As she alluded to, the aim is to reach 5% by 2025 through the regional tobacco control plan that Fresh drives forward, but since the launch of that in 2005, the north-east has seen a massive—47%—drop in smoking rates. I know that those rates are still above the national average, but I wanted to highlight how much I agree with that localised approach to delivery, making sure that we can focus services on those living in the local area.

I congratulate people on their successes so far, but as several right hon. and hon. Members have said, we cannot be complacent. Smoking rates at the time of delivery are among the lowest the country has ever seen, and my hon. Friend the Member for Harrow East has a relatively low rate in his area. I appreciate the passion shown through the cross-party work that has taken place to bring together these recommendations, because, as many have highlighted, one of the big challenges is the variation—across different groups in our society, but also across different regions of the country. If we are going to target those with higher incidence, we are going to have to accept that some areas will probably need more help than others.

We need to work together, and yesterday I was incredibly pleased to go to the launch of this report. I found the speech by the hon. Member for Blaydon (Liz Twist) incredibly poignant. I could not agree more: specialist cessation to help young mothers quit is so important, and the hon. Member for Jarrow (Kate Osborne) has said that it was that point in her life that was pivotal in helping her make that decision. Yesterday, we listened to a respiratory consultant who said that she ran out of her office and downstairs to speak to a young mother who was pregnant with twins, to try to get her to stop smoking. I do hope that mother was able to quit, and I assure hon. Members that this is a particular focus of mine. I have already spoken to the chief medical officer about the new Office for Health Promotion making smoking, and particularly smoking in pregnancy, a real focus. As I said yesterday, we get more bang for our buck here: not only do we help Mum but, in this case, we helped twins—that is three people—and as I have seen through some fantastic smoking cessation work in Bolton, we often get a partner, a mother, or someone who is supporting Mum to quit as well. That helps everybody to move forward.

The report and its recommendations are excellent, and I have listened with interest to the remarks made by right hon. and hon. Members today. Smoking prevalence is at an all-time low—just under 14%, and almost half the rate it was back in 2002—and it is right to celebrate where we have come to, but it is also right to say that we have a long way to go. The continued support through stop smoking services across England has been pivotal: since 1990, these services have stopped 4.7 million people smoking. That is more people quitting than the combined populations of Birmingham, Greater Manchester and Leeds, which is quite a remarkable achievement.

Smoking is linked to half a million hospital admissions each year, so the role that the NHS and charities play in helping smokers quit is also essential. The NHS long-term plan commits to supporting smokers admitted to hospital to quit, as well as pregnant smokers—pregnant mums—and their partners. It also commits to helping long-term users of specialist mental health and learning disability services, and we are ensuring that there is sufficient training, with challenge groups making sure that people get the right interventions and the right help when they intersect with these services. Funded early-implementer sites and services are also being stood up, because we cannot be complacent and we cannot wait for these timelines. I heard strongly that people want interim targets, and we will look at that in the strategy. It is important that we try to keep on track and ensure that we keep our focus on 5%.

Smoking is responsible for an estimated 75,000 deaths in England each year. That is unacceptable because it does not just affect the individual; families and everybody around them also suffer. As many hon. Members pointed out, it has a substantial financial impact on the country as well as a health and emotional impact. As my right hon. Friend the Member for Clwyd West (Mr Jones) said, we have to go at things hard if we are to see that success.

I assure everyone that we are considering alternative products in the plan in so far as they are alternatives. Ultimately, we want people to quit, but as the hon. Member for Nottingham North (Alex Norris) said just a few moments ago, the indication is that e-cigarettes, for example, are 95% better than smoking, so let us be sensible about how we take people on this journey. My hon. Friend the Member for Windsor (Adam Afriyie) will be interested to hear that, although snus is currently banned under the regulations, we are undertaking a review and will consider the evidence base.

The Government will publish the new tobacco control plan, which will set out how we achieve this, and I am pushing hard to ensure that the strategy is published as soon as possible; I am ambitious to try to publish ahead of the recess in July. However, as I am sure all right hon. and hon. Members are aware, new data on smoking prevalence will be released in July and I want to have time to ensure that the plan takes appropriate, targeted action on that data. Anecdotal evidence causes me some concern that we may have seen individuals taking up smoking. The new plan, which will expand on the success of the 2017 plan, builds momentum to support communities and groups where rates are not falling enough. As I say, I am exploring many of the issues we have covered to guarantee that the new plan will be bold enough for smoke-free 2030.

We know that reductions in smoking at a national level mask the significant health inequalities that many right hon. and hon. Members have spoken about. Smoking remains very high in certain areas of the country, particularly in deprived areas and among communities who can least afford the financial effects—as if anyone can afford the health effects. For example, prevalence in Blackpool is nearly 24%; in Richmond, it is down at 8%.

[Adam Afriyie]

I am encouraged by the Minister’s words. Will she confirm that she sees this as part of the levelling-up agenda? Given that particular regions and social groups have more of a challenge than others, it seems to me that it collides well with the Prime Minister’s levelling-up agenda, certainly in terms of health inequality.

[Jo Churchill]

Indeed I do. Actually, the levelling-up agenda and our manifesto commitment to ensure five more healthy life years must be driven by achieving the targets we have set ourselves. Smoking has such a direct correlation with other illnesses. My right hon. Friend the Member for Clwyd West mentioned his interest with Cancer Research UK, and we know about the link to cancer, but there is also a link to chronic obstructive pulmonary disease as well as other respiratory challenges and so on. As I say, a disproportionate burden is borne by those disadvantaged families and communities.

I thank the hon. Member for Ealing, Southall (Mr Sharma) for making an interesting point. I assure him that we are focused on the need to make these interventions local. The local directors of public health and PHE drive plans in localities. I would like to think that we have taken, and can take, much learning from the successful local interventions of the past 18 months, such as with the vaccination programme. There are also clever uses of technology, where we have prompted people to take a vaccination. That might be interesting to look at in connection with recommendation 11, to which my hon. Friend the Member for Windsor (Adam Afriyie) alluded—I think it was him—requiring people to be prompted annually. They might look at that particular behaviour in order to modify it.

I could not agree more with the person who said that data saves lives—indeed, it does. The more we understand about the data held across the NHS, the more we can use it effectively to target interventions and to ensure that people get not only the right treatment but the right care, at the right point on their life’s journey.

In the new plan, we will ensure that we have a strong focus to drive down rates across the whole country, ensuring that they are level to where rates are the lowest, because everybody deserves to live in an area where we have targeted smoking rates and are achieving success. For too long, the harms from smoking have hit those areas that already face challenges. One in 10 babies is born to a mother who smokes. It is estimated that one in five new mothers smokes in Kingston upon Hull, compared with one in 50 in west London. It is those disparities that we need to tackle.

We must also close the gap seen among smokers with mental health conditions and smokers in routine and manual occupations. Could we be cleverer? Could we work in workplaces, for example? It is vital we continue to support interventions that make the most difference, helping people to cease smoking and encouraging them to move to less harmful products.