Tobacco Control Plan

Alex Cunningham Excerpts

Thursday 13th October 2016 Westminster Hall

[Alex Cunningham (Stockton North) (Lab)]

I beg to move,

That this House has considered the tobacco control plan.

It is a pleasure to serve under you chairmanship, Mr Brady. I am grateful to the Backbench Business Committee for granting us the opportunity to debate this issue in the depth and detail required. The subject has an impact on all of us, and it is right that time is allocated for a meaningful and thorough debate. I am also grateful to my colleagues from across the House who helped to secure the debate and who will, I am sure, make some incisive and insightful contributions.

I am pleased to have been part of the team that has consistently advocated tobacco control, and I am proud of the achievements we have made. The great thing about those achievements is that they have been built on strong cross-party commitment in both Chambers, with the devoted support and drive of external organisations and charities across the country that are determined to keep the harm caused by tobacco very much in the minds of the public and, of course, Ministers. Those organisations have succeeded.

A recent Action on Smoking and Health survey of more than 12,000 people found overwhelming public support for Government action to limit smoking and strong support for the Government to go further and do more. That is no surprise, really, as tobacco control is an area where Government action is highly effective.

Let me start with a parochial statistic. Back in Stockton, 250 miles up the road, smoking prevalence was estimated at 27.5%—more than one in four people—as recently as a decade ago. However, by last year various policies and interventions had seen that figure fall to 18.4%, which is a decrease of about a third. That means that some 14,000 fewer adults in Stockton now smoke than in 2005. I, for one, am very proud of that achievement.

I speak not only as a member of the all-party parliamentary group on smoking and health, the secretariat for which is provided by ASH, but as an MP who, as a humble Back Bencher, successfully pressed for the legal changes around smoking in cars when young children are present, with the support of groups including the British Lung Foundation, Cancer Research UK and the British Heart Foundation. That is on top of the principled and unwavering support I have received from north-east organisation Fresh, which covers my patch in Stockton North and whose joint conference on the harms of tobacco and alcohol I was pleased to address just a fortnight ago.

The dedication to improving public health and promoting tobacco control runs deep not only in my own psyche but in that of colleagues across the House. Back in 1998, the Labour Government introduced the country’s first comprehensive tobacco control strategy. Legislation has moved on since then to prohibit tobacco advertising, smoking in public places and smoking in cars carrying children, and to implement controls on point-of-sale displays. I welcomed all those measures, but I am only too aware that there is much more to be done.

The most recent measure was the introduction of standardised tobacco packaging, which I repeatedly called for and supported. Although the original form of the Children and Families Act 2014 contained no measures at all to protect children from the dangers of smoking or to avert uptake, the amendment on standardised packaging tabled in the House of Lords by Baronesses Finlay and Tyler and Lords Faulkner and McColl was swiftly taken up by the Government and brought to fruition.

In the spirit of debating the issues and the evidence base rather than the politics of any decision, I thank the previous public health Minister and current Financial Secretary to the Treasury, the hon. Member for Battersea (Jane Ellison), for her consistent support for tobacco control and, in particular, standardised packaging. That was duly recognised by her receipt of the prestigious World Health Organisation director general’s special award to mark World No Tobacco Day earlier this year.

A great deal was achieved under the previous plan, “Healthy Lives, Healthy People: A Tobacco Control Plan for England”. Progressive tobacco control legislation was introduced, and the three key ambitions of the plan have been achieved. Smoking rates among adults and children have fallen below the target levels, and rates of smoking during pregnancy reached the 11% target earlier this year. That illustrates perfectly why Britain is a world leader in tobacco control, with the UK coming top in a European survey measuring the implementation of key tobacco control policies and passing legislation that goes further than the requirements set out in European Union directives—perhaps that is one area in which we can expect no negative impact from Brexit. Yet there is still much to be done.

Smoking is responsible for approximately 78,000 preventable and premature deaths each year in England alone, and nearly 100,000 across the UK. In the north-east, the number of deaths from smoking-related diseases is some 30% higher than the English average. Despite the fact that we have hit the national targets on smoking prevalence laid out in the previous plan, stark variations in prevalence persist regionally and among different groups. A national tobacco control strategy should therefore be introduced without delay.

In her Downing Street speech, the new Prime Minister committed her Government to

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

Half of that difference in life expectancy is solely due to higher rates of smoking among the least affluent members of our society, with smoking rates among those with multiple complex needs reaching as high as 80%. I am clear that we should all share that commitment.

In Stockton, just under 30,000 people smoke—that is just over 18% of the population. However, it has been estimated that 539 children between the ages of 11 and 15 start smoking in Stockton-on-Tees every year, with 964 people dying from smoking-attributable causes from 2012 to 2014. Shockingly, that is the equivalent of almost 5,000 years of life lost due to smoking. That death and disease is disproportionately borne by the poorest people in my area.

Although smoking rates among the adult population fell throughout the life of the previous tobacco control plan, health inequalities have remained stubbornly high. In 2013, for instance, smoking prevalence among people in the routine and manual socioeconomic group was more than twice that among the professional managerial group—28.6% compared with 12.9%. The picture is even worse for those who are unemployed, with smoking rates of approximately 35%. People earning under £10,000 a year are more than twice as likely to smoke as those earning more than £40,000 a year. The higher rates of smoking place a significant financial burden on poorer members of society. If the costs of smoking were returned to households, 1.1 million people, including more than 300,000 children, would be lifted out of poverty.

In Stockton-on-Tees, when tobacco expenditure is taken into account, almost 6,000 smokers fall below the poverty line, including more than 1,300 dependent children. Those innocent children not only suffer from the financial burden of their parents’ smoking but are more likely to be exposed to second-hand smoke and to try smoking themselves. We all know that those who grow up in a household where parents or siblings smoke are far more likely to become smokers themselves.

Those children may experience considerable peer pressure to start smoking, and tobacco is often more accessible to them in the community and at home, thus creating a cycle of inequality and leading to the life expectancy gap noted by the Prime Minister. Perhaps worse still is that when poorer smokers attempt to quit smoking, they are less likely to succeed than their more affluent peers.

To tackle inequalities, support to stop smoking needs to be specifically tailored to meet the needs of those in lower socioeconomic groups. Although the ambitions in the previous plan have been met and smoking rates continue to decline, they remain stubbornly high in disadvantaged sections of society. Further action is needed from the Government and the public sector to reduce smoking rates and associated health inequalities, and the new strategy is necessary to drive that action forward.

With that in mind, and given that the policy development work for a new tobacco control plan was in place for publication this summer, I would welcome the Minister telling us when the new plan will be published. I say to her that there is a standard to live up to, because the last time there was a debate about the plan in this room, the then Minister confirmed the timing of its publication. I hope we will hear about that in depth today.

Perhaps the Minister will also oblige the British Lung Foundation and outline the Government’s plans to prioritise lung health as an area for health improvement. Will she tell the House whether an assessment of respiratory health could be included in the NHS health check?

[Norman Lamb (North Norfolk) (LD)]

I am grateful to the hon. Gentleman for giving way, and I very much agree with what he is saying. He has talked a lot about inequality, which of course spreads beyond this country. I understand that some 80% of smoking deaths, which will rise to 8 million by 2030, are in lower and middle-income countries. Does he share my desire to see the Government publish the plan before the meeting in India in November? We could then see what the special fund for developing countries will be used for, because we need to have an impact there, too.

[Alex Cunningham]

I agree. With the huge proportion of deaths in lower-income countries, which are suffering even more than we are in this country, it is imperative that the report is published so that we can show a lead. We are a leading country, if not the leading country, on smoking control, and we must continue to demonstrate that.

As colleagues will be aware, stop smoking services are one of the most effective healthcare interventions. Smokers are four times more likely to quit successfully with the combination of behavioural support and medication provided by those local services. Significantly, smokers from routine and manual socioeconomic groups are more likely to access the support of stop smoking services, which have real potential and are an effective way of beginning to address health inequalities. In 2014-15, for example, more than twice as many smokers from routine and manual groups set a quit date with a stop smoking service compared with those in professional and managerial occupations. Such services are not only effective in supporting efforts to quit but can prevent the disability and distress caused by smoking-related diseases without the side effects of many of the drugs used to treat such diseases. Indeed, the National Institute for Health and Care Excellence considers smoking cessation treatment to be among the most cost-effective healthcare interventions.

Smoking cessation treatment is also cost-effective for those who already have smoke-related diseases. Take chronic obstructive pulmonary disease, for instance. Some 900,000 people in England have been diagnosed with smoking-related COPD, out of about 3 million sufferers. Some 25,000 people a year die from the disease, and the NHS spent £720 million on treatments in 2010-11. The British Lung Foundation estimates that in my constituency, people are as much as 60% more likely to be admitted to hospital with COPD than the UK average. We also discovered recently that the rate of lung disease in my constituency is the second worst in the country.

Yet COPD is a disease that is almost entirely preventable. Smoke is the cause of more than three quarters of COPD cases, and in this country exposure to such smoke is primarily through smoking. Although it is clearly better to prevent COPD through the provision of smoking cessation treatment to help smokers quit before the disease develops, that treatment can help improve quality of life even after the onset of COPD and is highly cost-effective compared with other treatments. Indeed, it is the only treatment that can prevent the disease from progressing in smokers. The cost of smoking cessation treatment for people with COPD is estimated to be £2,000 per quality-adjusted life year, whereas the cost of drug treatment for those with the disease ranges from £5,000 per QALY at the bottom end of the scale to £187,000 per QALY for triple therapy.

I am mindful that this is a co-operative debate with cross-party support, but I believe it is fair to highlight the impact of some of the Government’s economic measures on smoking cessation programmes. In 2014-15, despite all the evidence of their cost-effectiveness, approximately 40% of local authorities cut the budgets of their stop smoking services, with half of all services being reconfigured or recommissioned. It is not just local authority cuts that are happening; we are now hearing that clinical commissioning groups are also cutting funding for prescriptions to stop smoking medications and refusing to fund smoking cessation services.

Local authorities faced with huge cuts to their budgets are reducing investment not only in stop smoking services but in other areas essential to effective tobacco control. Trading standards staff, who are crucial to tackling illicit tobacco and under-age sales, are increasingly under threat. During the past six years, the total national spend on trading standards has fallen from £213 million in 2010 to £124 million today. Teams have been cut to the bone, with a 12% drop in staff working in trading standards since 2014, on top of the 45% drop over the previous five years identified by an earlier survey.

The importance of trading standards, working in partnership to deliver concerted multi-agency enforcement activity, is shown in my region, the north-east. After setting up a regional illicit tobacco partnership, the region has seen a significantly greater fall in the illicit tobacco trade than has been seen at national level, to the benefit of both public health and Government revenues. Between 2009 and 2015 the illicit market declined by more than a third in the north-east, from 15% to 9%, whereas the decline at national level was less than a fifth, from 12% to 10%.

Without sustained funding, such services are simply unable to continue to operate effectively. The new tobacco control plan therefore needs to prioritise cutting health inequalities rather than budgets, and in so doing must protect public health funding for tobacco control. I hope the Minister will confirm today that the Government will take steps to sustain protected funding for tobacco control, and will outline what those steps will look like.

I would similarly welcome hearing the Minister commit to bringing mass media spending in line with best practice evidence. Research has shown mass media campaigns to be highly effective in promoting quit attempts and discouraging uptake. In the UK, however, we are currently falling far below best practice spending on such campaigns. When funding was cut back in 2010 there was a noticeably negative impact on quitting, with a whopping 98% decrease in requests for quit support packs, a fall of almost two thirds in quit-line calls and more than a third fewer website hits. That should hardly come as a surprise, with year-on-year cuts seeing only £5.3 million spent on mass media in 2015, which is less than a quarter of the amount spent in 2009. Spending has actually declined further this year to £4 million. To make matters worse, it is not even clear how much, if any, of that budget is reserved for televised mass media campaigns.

This year’s annual Stoptober campaign, for instance, is being run without any televised advertising. Yet the evidence confirms that it is precisely such mass media campaigns that are essential to motivate quitting and to inform smokers of the useful resources provided by Public Health England to help smokers quit. Those campaigns, which discourage smoking and encourage quitting, are most effective when they are sustained and sufficient, with the best results being achieved when people are exposed to televised anti-smoking adverts around four times a month.

Again, I draw attention to my own patch and the “Quit 16” mass media campaign co-ordinated by Fresh and Smokefree Yorkshire and Humber, which focused on the damage smoking does to health. Some 16% of those exposed to the campaign, or roughly 53,300 people, cut down on their smoking. A further 8.4% made a quit attempt, and 4% switched to electronic cigarettes. That shows the clear impact that mass media campaigns have on triggering quit attempts and changes in behaviour, and the Government need to take such evidence seriously and commit to investing in mass marketing campaigns without delay.

Members will be aware that the decline in smoking prevalence in the UK since the first comprehensive strategy was published in 1998 has been comparable to that in Canada and Australia, both of which have consistently addressed the harms caused by smoking through comprehensive and sustained tobacco control strategies. Smoking prevalence has declined rapidly among adults and children in England since the Government first implemented such strategies from 1998. The latest figures show that adult smoking prevalence in England has declined by more than a third, falling from 27% in 1998 to 16.9% last year. The proportion of 15-year-olds in England who are regular smokers fell by two thirds between 1998 and 2014, hitting 8%, and the proportion of 11 to 15-year-olds who have ever smoked fell from 47% to 18% over the same period. Those are the lowest figures ever recorded for both adults and children.

None the less, smoking remains the leading cause of preventable premature death and the major reason for differences in life expectancy between the richest and poorest in society. Experience elsewhere shows what can happen if we do not review and renew our tobacco control strategy and ensure that it is properly funded. While the UK has seen a significant decline in smoking because of its comprehensive approach, the prevalence of smoking in France and Germany, which have not had any such strategies in place, has barely shifted over the last 20 years. We cannot rest on our laurels and assume that the long-term declines we have achieved will continue unabated if we do not take decisive action to review and renew our strategy.

On 14 September, Lord Prior committed the Government to publishing a new plan, with renewed ambitions to reduce smoking prevalence further and new ambitions on health inequalities and mental health. However, he would not commit to a publication date, so I repeat my appeal to the Minister to reassure Members across the House by filling that gap today. There is no clear reason to delay publication of a new plan further. If the Prime Minister’s ambition to reduce health inequalities is to be achieved, Ministers need a comprehensive strategy on tobacco control sooner rather than later.

--- Later in debate ---

[Kevin Barron (Rother Valley) (Lab)]

I declare an interest: I speak as a vice-chairman of the all-party group on smoking and health, the secretariat of which is supported by Action on Smoking and Health, a national charity.

I echo the thanks expressed by my hon. Friend the Member for Stockton North (Alex Cunningham) to the previous public health Minister, the hon. Member for Battersea (Jane Ellison), for all the work she did and her commitment to support for tobacco control. I welcome the Under-Secretary of State for Health, the hon. Member for Oxford West and Abingdon (Nicola Blackwood), to her new post; I hope that we can work together on this important issue. The previous four public health Ministers, under either the current Administration or the coalition Government, have worked very well with the all-party group and other Members who want to see progress on this issue. I also welcome my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) to her new role as shadow public health Minister. She is going to have to get used to seeing us, as she is going to be in here quite regularly.

It was in December that I last spoke in Westminster Hall on tobacco control. I was highlighting the fact that the tobacco control plan for England, “Healthy Lives, Healthy People”, was soon to expire, and that a new plan to ensure sustained funding for tobacco control was needed. I rise today for the same purpose. England has now gone 10 months without a comprehensive strategy on tobacco control. The House was assured that a new plan would be published in the summer. I know that some political summers lapse into the autumn, but I stand here in October wondering whether this summer is going to lapse into the spring. I hope that is not the case. The Government have since stated that a publication date will be decided in due course.

I am proud that tobacco control is no longer a partisan issue but enjoys the benefits of support from all parties in this House and in the other place. However, Parliament cannot act alone. We need a Government strategy to ensure that in this period of austerity tobacco control does not slip off the agenda and that local authorities continue to see it as a crucial part of their work. The hon. Member for Totnes (Dr Wollaston) referred to Manchester in her speech. It was deeply worrying to hear what she said, because I have no doubt that, although Manchester is a much bigger place, its socioeconomic profile will be like that of my own borough of Rotherham, where, sadly, a lot of people participate in smoking.

My hon. Friend the Member for Stockton North commented on the impact of smoking in his constituency; my constituency, Rother Valley, is similarly hit by the burden of smoking. Approximately 13,660 people in Rother Valley smoke, and across the three borough constituencies of Rotherham nearly 1,500 people died prematurely from smoking between 2012 and 2014. We know the national figure and I have to say, as I have always said in similar debates, that if we were losing our fellow citizens on such a scale from any other cause—whether it was an intervention in a war or anything else—we would be much more concerned than we seem to be about people tragically dying so prematurely.

Smoking has such a dreadful impact on communities. Surveys of smokers show that around two thirds want to quit smoking and that that desire to quit is the same across population groups. However, only around a third of smokers make a quit attempt each year, and the number of people accessing NHS stop smoking services is declining. A new plan is needed to set out continued support for those people by encouraging them to make quit attempts and to access services that can offer support. Smokers are four times more likely to quit with the help of the expert support provided by stop smoking services, but a new plan is needed to guarantee funding for such services, which are currently under threat.

I have been contacted on this issue by Teresa Roche, Rotherham’s director of public health, and Councillor David Roche, Rotherham Council’s cabinet member responsible for this subject. I do not think they are related, but somebody in my office once asked whether they were. I am not too sure at this stage, but the next time I meet them I shall find out. They are part of the ambitious plan in Yorkshire and the Humber to inspire a generation free from tobacco by 2025. However, their work requires funding. I ask that that be addressed in the strategy, when it is published. The percentage of adults who smoke is falling, but the fall has been even better among teenagers and young children. Back in 1993-94, I introduced a private Member’s Bill against the advertising and promotion of tobacco. At that time, the levels of smoking among both the adult and teenage populations were far higher. Work to discourage smoking is working, and it is saving lives.

International evidence shows that funding for tobacco control activities is crucial. Members who attended the debate in December may recall me describing the situation in New York, where smoking rates declined consistently until 2010, when funding for tobacco control was cut. Smoking prevalence then began to increase until 2014, when funding was reinstated and smoking rates began to decline once more. That is one example of the well-known fact that tobacco control needs sustained funding in order to be effective. As was said earlier, after the change of Government in 2010, the removal of social marketing in the national media was clearly followed by a decline in the number of people stopping smoking. There is a direct correlation.

Funding is needed not only to secure the future of stop smoking services, but for mass media campaigns to encourage smokers to quit. We must keep them up. I understand that this year the Stoptober campaign has moved online, utilising resources such as Facebook Messenger—something on which I have to say I am no expert—to support people who are attempting to quit.

[Alex Cunningham]

It is all very well having online services, but people need to have access to those services. I know that everybody thinks every kid from a poor home has a smartphone, but that is not true. If they do not have access to IT services, they cannot benefit from the services my right hon. Friend is describing.

[Kevin Barron]

I accept that entirely. We hear all the time about people getting online to claim their benefits or whatever else, but it is quite clear that not everybody has access. Nevertheless, we are in the 21st century now and we have moved on a little. We can now sit in this Chamber using our phones for things that would have required an office 20 years ago, so we must remember that things are moving on. I do agree with my hon. Friend, though.

The Stoptober campaign will be delivered at a fraction of the cost by using new media. I await with anticipation the evaluation of its effectiveness compared with previous campaigns that have used a broader range of outlets, including TV and print media. Effective tobacco control needs to be comprehensive, encompassing all these activities to support smokers and to promote systems-wide action to dissuade people from taking up smoking.

Quitting smoking is incredibly difficult. As we have heard, electronic cigarettes are now used by over 2.5 million people in the UK; some people estimate that the figure is 2.8 million. They give smokers access to a significantly less harmful source of nicotine and help individuals to give up tobacco. Evidence from the Royal College of Physicians—I should say here that I am an honorary fellow of that body, before it gets into the newspapers. There is no payment for that. None the less, I ought to say that I use my personal experience in these matters. Evidence from the royal college and from Public Health England shows that vaping is around 95% less harmful than smoking cigarettes.

Two new publications have further supported the argument that electronic cigarettes can make it easier to quit smoking without posing significant health risks. The first is a systematic review of the evidence from the Cochrane Tobacco Addiction Group. Such reviews are generally considered to be authoritative summaries of the current scientific evidence. The results show that electronic cigarettes containing nicotine significantly increased the chance of quitting smoking, while not showing any adverse health effects within two years of use. I know that there are some people outside who say, “We’ve got to see what this is like over decades to make sure they are perfectly safe”. I am afraid that we would have to wait decades to be able to see that. What we should concentrate on is the scientific evidence that we have available since the introduction of electronic cigarettes and make judgments on that.

The second publication has already been mentioned by the hon. Member for Totnes (Dr Wollaston). A number of newspapers have picked up on the researchers’ estimate that in 2015 electronic cigarettes helped an additional 18,000 people to quit smoking. That illustrates how electronic cigarettes have the potential to be a huge public health innovation. There is growing consensus, including charities such as the British Lung Foundation, Cancer Research UK and the Royal College of Physicians, that electronic cigarettes are a very useful tool for smoking cessation.

We all know that smoking is responsible for approximately 96,000 premature deaths across the UK, which is more than the number of deaths caused by the next six biggest causes of preventable deaths in the UK, including obesity, alcohol and illegal drugs. Electronic cigarettes have amazing potential to reduce that burden of death and disease. The Tobacco and Related Products Regulations 2016, which came into effect in May, aim to maximise the benefits from these products within a properly regulated framework. There is a clear role for electronic cigarettes as a form of tobacco harm reduction, but regulation is needed to ensure manufacturing quality and to dissuade non-smokers, including young people and children, from taking up vaping. In the UK, there is no significant evidence that non-smokers are taking up vaping, or that electronic cigarettes are acting as a gateway to smoking. However, it is proportionate to the risks posed by nicotine in any form that these products are regulated.

I wish that people would get over the fact that some of the owners of the companies that make these products happen to be tobacco companies. I do not think anyone has battled more against tobacco in this House than I have for two decades now. However, tobacco companies grow tobacco; tobacco contains nicotine; and nicotine is addictive. It is 90% safer to take nicotine through vaping than through a cigarette, and I wish that people out there who listen to these debates would recognise that fact and stop knocking on about who owns the companies that make these products. The quality of people’s lives is improving in taking people off this drug, which prematurely ends the life of 50% of people who smoke cigarettes. That is what we should concentrate on.

Before the summer recess, on 4 July, Lord Prior announced in a debate in the other place that those regulations would be reviewed within five years to ensure that they were fulfilling the aims of supporting smokers to quit, preventing uptake among non-smokers and young people, and providing appropriate regulation of products containing nicotine, including a route to medicinal licensing. Although I understand that that might be affected by Brexit, I would be grateful if the Minister could confirm that that is still the plan. I know that Brexit is something that nobody knows about, other than it is Brexit at this stage, but these are crucial, potentially life-saving things for many of our citizens and this is an issue that we need to address.

Lord Prior also committed to commissioning Public Health England to update its evidence report on e-cigarettes annually until the end of this Parliament, and to include within that its quit smoking campaign’s consistent messaging about the safety of e-cigarettes. Can the Minister tell us when Public Health England’s review and updating of the evidence for 2016 will be published, and what message about electronic cigarettes has been included in the Stoptober campaign? The one that was published by Public Health England and others in August 2015 about e-cigarettes was truly ground-breaking in showing how people with a nicotine addiction can help to save themselves from dying prematurely by using these products. Do not get me wrong, Minister and Members of this House—I would like to see people off nicotine all together, but that is a difficult thing to achieve, as we all know. We have been debating this issue for years and years, but more than 2.5 million people have voluntarily gone on to this safer system of dealing with their addiction. If we can use that to get them off the addiction all together, we should do so.

We all know that quitting smoking is one of the hardest things a person can do and we have a duty to support these people in any way we can, not only for their own personal health and well-being but for the health and economic well-being of society as a whole. A new tobacco control plan is urgently needed to make sure there is the funding and momentum to ensure that we are successful in making smoking history for our children.

[Bob Blackman (Harrow East) (Con)]

Thank you, Mr Brady, for calling me to speak; it is a pleasure to serve under your chairmanship.

It is also a pleasure to follow the speech made by my right hon. Friend the Member for Rother Valley (Kevin Barron), as I will call him in this context. I thought that it was thoughtful and, as always, well argued in its treatment of the data.

I place on the record my congratulations to the hon. Member for Stockton North (Alex Cunningham) on securing this debate, and I also congratulate my colleagues on the Backbench Business Committee on allowing it to take place. No doubt the Health Department considers itself extremely challenged by having to respond to a debate in Westminster Hall and to two debates in the main Chamber on the same day.

I also put on the record my congratulations to the Financial Secretary to the Treasury, my hon. Friend the Member for Battersea (Jane Ellison), on all the work she did for public health. Indeed, a lot of the reforms that have been made and that we are talking about today came under her stewardship.

I also congratulate the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), on securing her ministerial position. We are all looking forward to hearing her speak later on. As she is a former chairman of the Science and Technology Committee, I suspect that she will examine the scientific data and the important evidence before moving on; we look forward to that taking place.

On that subject, I echo what has already been said, namely that smoking is the No.1 public health challenge in the UK. As has been mentioned, there are almost 100,000 premature deaths every year across the whole country as a result of smoking. The fact that adding together the number of deaths caused by the next six biggest causes of preventable deaths would still not exceed the number of deaths caused by the No.1 cause of preventable death suggests that we have to address this matter. However, there is a risk that, because of the success of the tobacco control programme over the last five years, people will think the job is done. Well, I have to say that it is most certainly not done.

I declare my interest as the chairman of the all-party group on smoking and health and, as someone who has been an avowed anti-smoker all my life, I will continue to oppose smoking. I take the view that there are two categories of people here. We have to help people to stop smoking, but even more importantly we have to prevent people from starting to smoke, because we know that once people are addicted it is a very difficult job for them to give up their addiction.

As the hon. Member for Totnes (Dr Wollaston) said, we have been very successful. In the 1970s, more than 50% of the adult population smoked; that figure is now down to below 20%. That is good news. However, it still means that there is a stubborn minority and we have to get across to them how damaging it is to their health to continue smoking.

Success in this area has not happened by accident. Governments of all persuasion— including the current Government, the coalition Government before that and the Labour Government before that—have done enormous amounts of work to reduce the prevalence of smoking. Health professionals have also contributed to that, as have civil society organisations.

The position now is that the tobacco control programme finished at the end of last year. That is the reality and we need to see the new programme as soon as possible.

On this side of the House it is not unusual to hear people argue that the smoking habit is none of the Government’s business. Of course, it is an important source of tax revenue, but some people say—they are not necessarily employed or funded by the tobacco industry—that those who choose to smoke understand the risks, and have exercised their free consumer choice. I would say that informed choice and people understanding the damage they are doing to themselves is up to them, but that does not mean that we should not increase the pressure on those individuals to understand the damage they are doing to themselves and to others by continuing to smoke. I seek to make sure that we continue with the regulations and ramp up the tobacco control programme. We will soon see a situation where all cigarettes and hand-rolled tobacco are sold in standardised packaging, which has been a huge advance. We should take credit for that. Together in this Chamber, we changed Government policy through the force of our argument and the data that we provided in evidence.

I am sure that my right hon. Friend the Prime Minister is among the group that understands that the state and the Government have to interfere in this process. In her recent speech, she said that

“government can and should be a force for good…the state exists to provide what individual people, communities and markets cannot; and…we should employ the power of government for the good of the people.”

I say that she is absolutely right, and that, on tobacco control, the position is quite clear. In her very first speech as party leader, she promised to fight

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

That injustice is a clear issue for tobacco.

It would be very hard to find a more dysfunctional market than the one controlled by four of the most profitable companies in the world, who make their money selling products that they know will kill half of their lifetime customers—products that have been carefully designed to deliver a highly addictive drug, as fast as possible, to the brains of their users. If anyone were attempting to invent such a drug today, they would not get away with it, but these companies are quite clear in what they set out to do. The estimates by the US National Center on Addiction and Substance Abuse of capture rates for both legal and illegal drugs demonstrate that point powerfully. Capture rates are the percentage of users who report that they have become dependent on the drug at some point. Tobacco has a capture rate of almost a third, more than for heroin, cocaine, alcohol and cannabis. It is clear that the tobacco companies deliberately set out to ensure that their customers are addicted to the drug.

Dependency is a combination of physical and psychological factors. Social and economic factors, such as the relative availability of different drugs, when and where they can be used in a socially acceptable way, and how affordable they are, all have an impact and smoking is therefore a major contributor to poverty and health inequality. As the Marmot review concluded in 2010, smoking in the UK accounts for about half the difference in life expectancy between different social classes, and so the important commitment that the Prime Minister has made to tackling what she rightly calls this “burning injustice” cannot be met without further action on reducing smoking rates.

In my borough, Harrow, analysis based on the 2015 integrated household survey shows that about 13% of the working-age population smoke, which is above the UK average, and equates to about 25,000 people. Of the roughly 15,700 households in Harrow that include a smoker, 2,700 fall below the poverty line. About 1,000 would rise above that line if all smokers in poor households were to quit. A lot of people refer to my borough as a nice, leafy borough, but it is important to understand that there are levels of deprivation all across the country—with respect to the hon. Members opposite, it is not confined to the north and the industrial cities.

Despite that fact, I am displeased that Harrow Council has decided to consult on stopping the smoking cessation services in an attempt to save money, but I am pleased that a large petition has been initiated by consultants at Northwick Park hospital with the aim of combating that and preventing it from happening. As my hon. Friend the Member for Totnes noted, stopping smoking cessation services would be a stupid move and would increase pressure on the health service and on individuals.

I would also add that, whatever one’s views on Brexit, the reality is that over the last five years more than 10,000 adults from eastern Europe have come to live in my constituency and almost all those of adult age smoke. The tobacco control programme needs to include encouraging people to give up by reaching parts that have not been reached previously.

One important lesson that we have learned from previous control programmes is that efforts to reduce smoking must be sustained and progressive; sustained because, as I have said, nicotine is a powerful drug, it increases dependency and requires powerful interventions to persuade people to quit; and progressive because people who continue to use tobacco after the control programmes are in place can be said to have discounted their effect. For example, many smokers quit after the introduction of the workplace ban in 2006, but most did not. The need for progressive steps is particularly important when it comes to tax and price policy, because the economic impacts of tax rises on reducing demand for tobacco products depend not simply on absolute price levels, but on affordability. If taxes rise more slowly than incomes, tobacco will become more, not less, affordable and consumption will tend to rise, not fall.

That point is well understood by the four major tobacco companies, which routinely use what they call “overshifting” as a pricing device. When the Government put up taxes, the companies raise the price of their so-called luxury brands by more than the amount required by the tax increase, while raising the price of the economy brands by less than the tax increase, or in some cases not at all, so that as many low-income smokers as possible are encouraged to continue with their habit or to start smoking in the first place. That has resulted in increasing brand segmentation in the tobacco market, and was cheerfully admitted by the companies in written evidence in their recent unsuccessful court challenge against standardised packaging. One of the most important secondary benefits of standardised packaging, over and above the removal of the last permitted form of advertising and marketing of tobacco products, is likely to be the gradual collapse of this approach to marketing. The brand value of a luxury packet of cigarettes is likely to be greatly reduced when it can no longer be highly designed, but instead must consist of drab, olive colours and large photos of diseased lungs and eyeballs. It is likely to mean that future tobacco tax prices are more effective in encouraging smokers to quit, as the different brand values and prices collapse towards a middle price. If we increased tobacco prices above the escalators and ensured that the money was given to public health for prevention and cessation measures, it would be welcome.

Tobacco control policies work best in combination and should not be planned and assessed in isolation. For example, standardised packaging will no doubt encourage many smokers to try to quit, but most quit attempts fail. Smokers who try to quit have a much greater chance of success if they can get help from stop smoking services and a prescription for nicotine replacement products, whether that is patches, gum or electronic cigarettes. That will all help towards people quitting, and so it is extremely disturbing to see the results from Action on Smoking and Health’s latest survey of tobacco control work in local authorities.

ASH asked control experts from 126 local authorities about their smoking policies and budgets. Its evidence shows that funding is being cut back in two out of five areas and that half of all services are being reconfigured or commissioned, which largely seems to be with the intention of saving money, not saving people’s lives and improving their health. I completely understand the need to control public expenditure, and I know that that often requires local authorities around the country to make difficult decisions, but if that leads to closures and reductions in this vital area of public health work, there is definitely a need for some very urgent rethinking.

[Alex Cunningham]

Colleagues in clinical commissioning groups in my area tell me that they would love to spend much more money on preventative services, but they are too busy spending money on treating and curing people to invest in the longer term. Does the hon. Gentleman think there is a case for providing ring-fenced funding for public health and saying, “Let’s spend this great tranche of money now and do the preventative stuff, and get the benefits 20 years down the road”?

[Bob Blackman]

We should remember that when public health was devolved to local authorities, the money was ring-fenced. I pointed out to Ministers at the time that removing that ring fence would put at risk all public health expenditure, which can be squeezed. I think that is precisely what is happening. We are in danger of undoing all the good work that local authorities have done on public health by allowing that to happen. I, too, would welcome a ring-fencing of money for purposes such as this. We can see clearly that this is a particularly good, important service.

I am also concerned about the progressive reductions in the money spent on mass-media campaigns. As has already been mentioned, the money is going down. In 2015 we spent less than a quarter of the amount that was spent in 2009, and it looks like the spending is going to fall again this year. As has been mentioned, the Stoptober campaign is now only going to be online, with no television advertising. The benefit of large-scale television advertising is that it reaches people who are likely to smoke, so we need to look at that again.

Given the appalling damage that the tobacco industry causes, and given that those major companies are vastly profitable, I cannot see why they should not be asked to make a greater financial contribution to help solve the public health disaster that they worked so hard to create. I cannot imagine a more obvious application of the principle that the polluter should pay. I would very much like to see that commitment included in the new, overdue control plan for England.

Colleagues will remember that last December, when we had a Backbench Business debate on this subject, the previous Health Minister, my hon. Friend the Member for Battersea, announced that the tobacco control programme would be published this summer. I know that spring extends as far as November in some Government quarters, but in this case summer seems to be extending into next year. I am seriously worried, because we have reached the autumn and there is no plan in place and no date for publication. The previous plan was an excellent means of combating the appalling diseases, including cancer, pulmonary diseases, vascular diseases and various other things that are caused by smoking. It helped to improve matters and added many years to the lives of thousands of people across the UK.

Some colleagues may think that an intervention in the market is not required, but I think one is needed more than ever before. Since the programme was first published in 1998, the fall in our smoking rates has been similar to that of Canada and Australia, as has been mentioned. In France and Germany, which do not have comprehensive strategies, the rates have hardly changed in 20 years. The evidence shows that these programmes work, and that where there is no programme there is no movement forward.

The UK has an excellent record on tobacco control. The Department of Health was rightly given the prestigious Luther L Terry award last year by the American Cancer Society for its global leadership on the issue, and the UK was ranked as the world’s most successful country on tobacco control by the Association of European Cancer Leagues. We should never forget that two of the biggest tobacco firms in the world, British American Tobacco and Imperial, are based in the UK, along with Gallaher, which is now an important part of Japan Tobacco International. We simply cannot sit back and watch smoking rates fall in the UK while the tobacco industry puts more time and money into increasing consumption in developing countries.

The next conference of parties of the World Health Organisation Framework Convention on Tobacco Control takes place in India in November—next month. We are in an Indian summer, and the tobacco programme will be published in the summer, so what would be better than publishing the plan in advance of the conference in India? That would set the UK, once again, on the world leadership level.

I hope that my hon. Friend the Minister, in her response, will give a firm and early date for publication. I hope that the plan will set ambitious targets to cut heath inequalities, deal with the funding crisis affecting tobacco control work in local authorities and set specific targets to reduce smoking among vulnerable groups, including, as my hon. Friend the Member for Totnes said, pregnant women and people with mental health problems. The targets for the past five years of the programme seemed difficult, but they have all been achieved, so we should set challenging targets now that will lead to a smoke-free Britain. That has got to be our ultimate aim.

I strongly believe that tobacco control is an essential part of policy. It will enable the Prime Minister to achieve her commitments on good government and reducing health inequality. I pay tribute to the work of colleagues from all parties and in both Houses, who pressed the need for tobacco control legislation on sometimes reluctant Governments, which I consider to be one of the most important political and social advances during my time in Parliament. I hope that that work will continue until the death, disease and misery caused by smoking is finally consigned to the past. I look forward to hearing positive news from my hon. Friend the Minister about when we are going to set out the new challenges for the industry and the Department.

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[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Brady. I thank the hon. Member for Stockton North (Alex Cunningham) for bringing forward this interesting debate. I should say that I have never smoked a cigarette in my life, so if I start coughing, as I have been doing throughout the week, that is purely down to a bug that I have picked up.

When the Scottish Parliament brought in its smoking ban in 2006, I thought it was a birthday present, because it was brought in on 26 March, which is my birthday. Since 2007 my party has been in power in Scotland, where we do things a little bit differently. However, there are many parallels on this issue. The latest figures from Scotland show that tobacco use is associated with more than 10,000 deaths and about 128,000 hospital admissions every single year. It costs the NHS in Scotland £400 million to treat smoking-related illness, which highlights the scale of the problem across the UK.

The Scottish Government have implemented and overseen a number of progressive actions on smoking: increasing the age for tobacco sales from 16 to 18 in 2007; the overhaul of tobacco sale and display law, including legislation to ban automatic tobacco vending machines and a ban on the display of tobacco and smoking-related products in shops; the establishment of the first tobacco retail register in the UK in 2011; and the passing of a Bill in December 2015 to ban smoking in cars when children are present. Record investment in NHS smoking cessation services has helped hundreds of thousands of people to attempt to quit smoking.

This year, the Scottish Parliament celebrated the 10th anniversary of the ban on smoking in public and welcomed comments from the World Health Organisation, which praised the Scottish Government’s

“excellent example of global public health leadership”

for implementing its framework convention on tobacco control. In 2013, the Scottish Government published a tobacco control strategy setting out bold new actions that will work towards creating a tobacco-free generation of Scots by 2034. I hear that in the Humber there are more plans in advance of that, although I think our problem may be slightly larger. Key actions in the plan include setting the target date of 2034 for reducing smoking prevalence to 5% and eliminating it in children; a pilot of the schools-based programme ASSIST—“A Stop Smoking in Schools Trial”; and a national marketing campaign on the dangers of second-hand smoke in cars and other enclosed spaces. I echo the comments on the need for a UK-wide national campaign and media advertising.

Although the Scottish Government have long made clear their aspiration for a tobacco-free Scotland, the strategy sets the date by which we hope to realise the ambition. It is not about banning tobacco in Scotland, though if we were to discover it today we would never licence it. I remember as a child listening to the Bob Newhart radio sketches—some may remember them—and he had one about Nutty Walt and the discovery of tobacco. That was only about the crazy tobacco scene and did not even go into the ludicrous health aspects. Nor is the strategy about stigmatising those who wish to smoke. The focus is on doing all we can to encourage children and young people to choose not to smoke.

In September, the Scottish Government welcomed figures that showed that children’s exposure to second-hand smoke in the home reduced from 11% to 6% from 2014 to 2015, which I think sets us in the right direction. Health inequality is a key theme running through the Scottish National Party’s tobacco control strategy, with explicit recognition that current smoking patterns have a hugely disproportionate impact on Scotland’s most deprived communities. That is no different from anywhere else in the UK or, as we have heard from so many speakers, throughout the world.

Scotland has a proud record on tobacco control. We believe the UK Government need to get their finger out and commit to publishing their promised new tobacco control plan for England. I am a great believer that we can learn from each other and pinch good practice whenever we see it, so a good tobacco control plan for England may well help us in Scotland by exposing a few other ideas and strategies that perhaps we have not considered or pushed as firmly.

[Ms Karen Buck in the Chair]

[Alex Cunningham]

The hon. Gentleman has outlined a great catalogue of activities north of the border, in my own homeland. I appreciate that, but what new, big ideas are there north of the border that could contribute to the plan of colleagues in England?

[Martyn Day]

I thank the hon. Gentleman for that question. I have mentioned some of the key points that we are targeting, and stopping children smoking is the key aspect. The title of the strategy we are working on is “Creating a Tobacco-Free Generation”. That is important. The point has been alluded to by other speakers that stopping people smoking is more important than reducing it, although reduction is important for those who smoke because of the impact on deaths and on the health service.

We encourage the UK Government not to keep the House waiting but to fulfil their promise to publish their new plan. If they are stuck for ideas, they are welcome to look at Scotland’s 2013 plan.

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[Mrs Hodgson]

They certainly do. The situation on children smoking is quite stark. The earlier children start smoking, the more serious the consequences are for their health. Children who take up smoking are two to six times more susceptible to coughs and increased phlegm, wheeziness and shortness of breath than those who do not smoke. It can also impact their lung growth, which can impair lung function and increase the risk of chronic obstructive pulmonary disease in later life. As we heard from my hon. Friend the Member for Stockton North, 25,000 people a year die from COPD. Surely we do not want any child in this country to die in that way. The prevalence of these conditions among smokers shows it is paramount that we seriously tackle smoking among our children and young people. We do not want to see the children of today being the COPD sufferers of the future, as well as having those other conditions.

[Alex Cunningham]

I am really pleased my hon. Friend is framing the issue specifically around children. My wife, Evaline, worked as a school nurse and used to hold classes talking to young people about this. She would put forward the economic argument—“If you smoke so many cigarettes over so many days over so many months it costs £2,000, which could buy you a summer holiday.” She was then told, “No, Miss, you’ve got it wrong; it is only £3.20 a packet from Mrs Bloggs down the road.” Do we not also need to ensure we tackle illicit tobacco and ensure children understand the dangers of that as well?

[Mrs Hodgson]

My hon. Friend raises a very good point. The danger and quality of illicit tobacco can often be far worse for health than just long-term smoking. The substances used in those cigarettes can be life threatening.

I will move on to the dangers of smoking during pregnancy, which was raised by the hon. Member for Totnes. While we know the harms of living in a household with a smoker, for some that harm starts before birth as 10.6% of women are smokers at the time of delivery. That equates to 67,000 infants born to smoking mothers each year, while up to 5,000 miscarriages, 300 perinatal deaths and around 2,200 premature births each year have been attributed to smoking during pregnancy.

Smoking during pregnancy has been identified as the No. 1 risk factor for babies to die unexpectedly. According to research by the British Medical Association, if parents stop smoking, that could reduce the number of sudden infant deaths by 30%. Those are shocking figures that show the heartache and pain a mother and the family around her will go through from the horrific events of losing a baby through, for example, miscarriage, stillbirth or sudden infant death. That is especially pertinent this week as it is baby loss awareness week, which I know some of us are wearing little pins to commemorate. There is a debate currently going on in the main Chamber —there was; it has just finished—in which many colleagues gave heartbreaking accounts of their personal experiences or those of their constituents who have suffered the loss of a baby. I was able to intervene and give a personal account of my own experience.

Baby loss due to smoking is preventable if Government action is taken as soon as possible. Important work has been implemented on smoking during pregnancy that has seen the number of pregnant women smoking fall to its lowest-ever levels, but I welcome the calls from the Smoking in Pregnancy Challenge Group to see a commitment from the Minister today to work to reduce the percentage of women smoking during pregnancy to 6% or lower by 2020. It may be an aspirational figure, but it can be achieved as long as a comprehensive plan is put in place to control the use and sale of tobacco.

Regional variations, including those I mentioned earlier, must be addressed; other colleagues have mentioned them, too. We are seeing 16% of women in the north-east and Cumbria smoking at the point of delivery, compared with only 4.9% in London. This stark figure shows that more regional action and support must be offered by the Department of Health to ensure that regional inequalities are addressed. The regional variations and the other variations mentioned show that the slashing of the public health grants is a false economy when it comes to seriously driving forward the agenda on public health, especially in relation to smoking.

In last year’s autumn statement, the then Chancellor announced further cuts in the public health grant, which amounted to an average real-terms cut of 3.9% each year to 2020-21, and translates to a further cash reduction of 9.6% in addition to the £200 million worth of cuts announced in the 2015 Budget. As we know, specialist support and stop smoking services help to get people off cigarettes and to lead a far healthier lifestyle. However, cuts to public health funding have meant that it has proven far more difficult for local authorities to provide that much-needed specialist support.

In a survey of local tobacco control leads conducted by Action on Smoking and Health and commissioned by Cancer Research UK, a total of 40% of local stop smoking services were being reconfigured or decommissioned in 2014-15. In Manchester, we have seen a complete decommissioning of stop smoking services. This is even more concerning when the initial results of the 2015-16 survey show that the rate of decommissioning and reconfiguring is increasing. Therefore, I hope that the Minister will be able to commit to ensuring that we have a substantial source of funding for specialist services that help to support in particular those in lower social economic groups as well as pregnant women to quit smoking. We must end the intergenerational cycle of health inequality that I have spoken about.

It is important that we have a plan and that we have it now—a plan that continues the work of previous Governments to reduce smoking in our society. We have seen inroads into creating a healthier society, but we all recognise we have a long way to go, as the facts and figures show. The Government’s delayed plan must be published now, and it must have measures in place that will address the many variations, from geographical variation to deprivation and socioeconomic background variation.

We must see further work to address the take-up of smoking by children and young people if we are to ever achieve our goal of the next generation being healthier than the last. We need to address smoking among young people head on. Achieving a smoke-free society is within our reach, but what we do not need is further delay and hesitation by the Government; what we need is bold action.

I hope that the Minister can give us that bold action today and that she does so by finally giving us the date when the new tobacco control plan will be published. The longer we wait, the more children will take up smoking, the more people will get ill and, sadly, the more people will die. The time for waiting is over. We now need bold action.

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[Nicola Blackwood]

I am looking closely at PHE’s expert independent review. I have asked officials to examine that closely, and they are updating the review of the evidence each year. I do not have a date for this year—I know the right hon. Gentleman asked for it—but I will write to him when I find out exactly when that will come forward.

Our approach has been comprehensive and has seen smoking prevalence fall in all age groups for both men and women. As various Members have said, adult smoking prevalence in England is now just under 17%, the lowest rate since records began, and we should take a moment to be proud of that. However, as others have said, we cannot be complacent. Smoking continues to be one of the largest causes of social and health inequalities in this country. It accounts for approximately half of the difference in life expectancy whereby, as the Prime Minister said, those on the lowest incomes die an average of nine years earlier than others. The Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), said it so well: it has an even greater impact on healthy life expectancy, which we also need to focus on.

At national level, smoking prevalence is declining year on year. There remain significant regional and demographic variations—an issue raised by the hon. Member for Stockton North, the shadow Minister and others—with the prevalence in some population groups, such as those with mental health conditions, at more than twice the national average. That point was particularly raised by my hon. Friend the Member for Harrow East (Bob Blackman) and the former Health Minister, the right hon. Member for North Norfolk. I shall certainly look at the report that was mentioned, “The Stolen Years”.

Regional variation means that rates of smoking during pregnancy can range from anywhere between 2% in some areas to 27% in others. That is another issue that we must focus on. Given the wide variation in smoking rates across the UK, it remains crucial that local councils have the flexibility to consider how best to respond to the unique needs of their local population and tackle groups in which prevalence remains high.

[Alex Cunningham]

The Minister talked about local authorities having flexibility. Will she support ring-fenced funding in this area, which we discussed earlier?

[Nicola Blackwood]

Ring-fencing is a highly political question, but I recognise that some difficult decisions have been made right across Government to reduce the deficit and ensure sustainability. Councils have been given £16 billion of public health funding across this Parliament, on top of further NHS prevention funding. The big question is whether that is being targeted at the right public health priorities.

We have been looking at that issue closely in my office. Local PHE centres are working with local commissioners to try to ensure that evidence-based service provision remains a priority. Nationally, PHE has been putting together a range of tools to support local commissioning decisions and has convened a round-table of experts to review the situation and propose a range of actions. However, I recognise that ensuring that the right services are prioritised will require more than just providing data about cost-effectiveness and smoking prevalence. The sustainability and transformation plans are supposed to be part of the answer.

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[Alex Cunningham]

I welcome you to the Chair, Ms Buck.

I hope we have not bored people—many have passed through the Chamber this afternoon, and I am sure others are watching online—because consensus has broken out, at least on most issues. We have had an excellent debate, with the expected comprehensive contributions from colleagues across the House. I thank everyone who has taken part.

Many questions have been posed to the Minister on tobacco control and e-cigarettes, ranging from constituency-level issues all the way through to worldwide issues. I am sure she has much to reflect on. I am disappointed that she has not lived up to her predecessor’s reputation by giving us a date this afternoon. We had a bit of a laugh a few moments ago, but I am a wee bit worried that it may not happen this year. I hope she will go back to her Department and think on that.

As the Minister said, she must get the matter right, and that means focusing on the socioeconomic groups that do not have the benefits the rest of us have. There are also health inequalities to consider.

The Minister can be in no doubt that tobacco control remains very much a focus for many of us in the House and will continue to be in the forefront of our minds. I assure her, as others have, that she will have the full support of the all-party group, and of us as individual Members of Parliament, when she introduces the new plan. I just hope that will be sooner rather than later.

Question put and agreed to.

Resolved,

That the House has considered the tobacco control plan.