Smokefree 2030

Alex Cunningham Excerpts

Tuesday 26th April 2022 Westminster Hall

[Bob Blackman]

I thank the hon. Member for that intervention. Clearly, people start smoking when they are young. They continue to smoke well into their later life, and it is very hard for people to give up if they have already committed to smoking cigarettes, because nicotine is the most addictive drug that we know of. Therefore, it is very hard for people to get off it once they have started, so it is far better that we prevent people from starting to smoke in the first place. At the moment, I believe that around 200 to 300 young people start smoking every day, which is why it is imperative to stop them doing so right now. Indeed, Cancer Research UK has estimated that we will have to wait until 2047 for the smoking rate in disadvantaged communities to reach 5% or less, which is the smokefree ambition.

[Alex Cunningham (Stockton North) (Lab)]

I wish the hon. Member a happy birthday and congratulate him on securing the debate. One of the problems that we have is that some deprived communities are in larger areas where the smoking rate has actually come down, but it has remained high within those communities. We also have a high incidence of smoking in pregnancy, which causes other tremendous problems. Does the hon. Member agree that we need specific action to help people who are pregnant to quit smoking, and that we also need to tackle the whole community at the same time?

[Bob Blackman]

I thank the hon. Member for his intervention and for the work that he has done on combatting smoking over many years. He raises the issue of smoking in pregnancy, which is the one target that the Government came closest to missing at the time of the last review. The target was 11%, and the Government just about achieved it. I am very clear that, for young women who are pregnant, we need to ensure that, if they smoke, they should be referred immediately to quitting services at the first meeting to discuss their pregnancy through the health service, and not just them but their partner as well. If both give up smoking, there is a strong chance that they will continue to not smoke. They need to understand the damage that they will do to their unborn child and the damage that they are doing to themselves. If we get to that point, it will improve the position no end. That is in the NHS plan, but for future years. I see no reason at all why that could not be introduced now. That is a management decision by the NHS, and I would ask my hon. Friend the Minister to encourage the NHS to do precisely that.

The all-party parliamentary group had an excellent meeting with the chairman of the independent review, Javed Khan. It was a very encouraging meeting, and we expect his recommendations to match the scale of the challenge, but unless his review is turned into a meaningful plan of action that is backed up by funding, it will not be worth the paper it is written on. We need new sources of funding, and the 2019 Green Paper recognised that we would need funding to end smoking, that there was pressure on budgets and that existing sources of funding were not sufficient. Three years and one pandemic later, the pressure on budgets in even greater. In its submission to me, the Local Government Association said that local authorities are paying some £75 million for quitting services overall. Clearly, they need additional funding to achieve what is required.

We are talking about disadvantaged communities, and levelling up is quite rightly a flagship policy for the Government, but there is no new funding to deliver on the bold ambitions set out in the levelling-up White Paper. The Institute of Fiscal Studies says that

“instead, departments will be expected to deliver on these missions from within the cash budgets set out in last autumn’s Spending Review. Departments and public service leaders might reasonably ask whether those plans match up to the scale of the government’s newfound ambition—particularly in the face of higher inflation.”

The levelling-up White Paper missions include narrowing the gap in healthy life expectancy between the local areas where it is highest and lowest by 2030, and increasing healthy life expectancy by five years by 2035. Smoking is responsible for half of the 10-year difference in life expectancy between the most and least disadvantaged in our society, so achieving the Government’s levelling-up mission on life expectancy will depend on delivering the smokefree 2030 ambition.

The Under-Secretary of State for Levelling Up, Housing and Communities, my hon. Friend the Member for Harborough (Neil O'Brien), has said that the Government must “floor it” when it comes to prevention and public health, but we cannot floor it unless there is gas in the tank. Gas in the tank is what we are lacking right now. Funding for public health is in a parlous state. We must face up to the fact that funding for smoking prevention has been particularly hard hit.

After the spending review was published, the Health Foundation estimated that funding for smoking cessation and tobacco control had been cut by one third since 2015. The cuts in budgets for tobacco control are the falsest of false economies. Unlike most pharmaceutical drugs, smoking cessation saves money, and with no negative side effects. The National Institute for Health and Care Excellence has estimated that, for every pound invested in smoking cessation services, £2.37 will be saved on treating smoking and smoking-related diseases, as well as increasing productivity.

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[Alex Cunningham (Stockton North) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Nokes. For the record, I confirm that I am vice-chair of the APPG on smoking and health.

The Minister may know that in health debates and in correspondence I spend much of my time banging on about health inequalities and the need for a new hospital in Stockton. Although we still need one, this morning I want to address another major health inequality. According to the most recent data from the Office for National Statistics, the average gross disposable income in the north-east is the lowest in the United Kingdom, at £16,995 per household—a full 43% lower than in London, where it is the highest.

Analysis of national data published by ASH has shown that the proportion of smokers living in poverty is also highest in the north-east. In our region, 42% of households containing smokers live in poverty, compared with only 17% in London. That is 112,000 north-east households. The average annual spend on tobacco per smoker is £2,000, so helping my constituents quit smoking will not only improve their health and wellbeing, but put badly needed money into their pockets. Smoking is an addiction. It is not a lifestyle choice. Smokers living in poverty tend to be the most addicted and need the most help to quit.

The Government’s arguments against the “polluter pays” levy are unconvincing. When we considered the Lords amendments to the Health and care Bill on 30 March, the Minister for Health, the hon. Member for Charnwood (Edward Argar), said that the Government

“cannot accept these Lords amendments, because the proposals would be very complex to implement, take several years to materialise and risk directing a lot of Government resource into something that we do not see as a sustainable or workable way to fund public health. This would also rightly be a matter for Her Majesty’s Treasury.”—[Official Report, 30 March 2022; Vol. 711, c. 866.]

I will address each of these arguments in turn.

First, on the Treasury, as my hon. Friend the Member for Harrow East (Bob Blackman) said, the Department of Health and Social Care already oversees a similar scheme for pharmaceuticals, put in place by health legislation that is a model for our proposals, so there is already a precedent for the Department to take the lead. It is clear that the Treasury would need to be involved, but the scheme we propose is not an additional tax. Rather, it is a pricing and profit control scheme put in place by health legislation and overseen by health Ministers.

The Minister for Health provided no evidence to justify his statement that the proposals would be “very complex to implement”, would need

“a lot of Government resource”,

and would not be a

“sustainable or workable way to fund public health.”

Indeed, evidence provided to the APPG by independent export analysts and economists demonstrates the opposite. The Department of Health and Social Care has a track record of more than 50 years of overseeing the pharmaceutical scheme. The expert analytical, finance and economic skills needed to run the tobacco levy are no different and the Department already has a team in place.

Let us not forget that the pharmaceutical market is complex. It has an enormously varied range of products, is constantly evolving and has heavy research and development costs that have to be taken into account by the analysts. More than 60 pharmaceutical manufacturers operate in the UK. Indeed, some of them are in my Stockton North constituency. Tobacco manufacturing is far simpler. Cigarettes and rolling tobacco are commodity products, cheap as chips to make. Only four manufacturers account for more than 90% of the market. Selling cigarettes is highly profitable, far more than pharmaceuticals or consumable staples. Imperial Brands sells around four in 10 cigarettes smoked in the UK and made a 71% operating profit in 2019, which is £71 in pure profit for every £100 of sales. It is not alone. The average for the big four manufacturers was 50%. By way of comparison, a 10% operating profit margin is considered average and Associated British Foods, Britain’s largest food manufacturer, made only 6% in 2021.

Clearly, some Government resource and expertise would be needed to develop a tobacco-specific scheme, but the potential returns, which would vastly outweigh the running cost, make it a no-brainer. As we have heard, £700 million a year could be raised from the four major tobacco manufacturers on sales of £14 billion, provided we could cap their profits at no more than 10%. At last, we have a Brexit dividend for the NHS, though it falls well short of the £350 million a week promised on the side of a bus not so long ago.

Market failure justifies the scheme, for this is an industry dominated by four big companies making eye-wateringly high profits from selling lethal products that kill most of their consumers. The extremely high profitability of cigarettes makes them as addictive to the companies as to the smoker. Big tobacco says it wants to turn over a new leaf and move out of cigarettes but shows no signs of doing so. Why would it? Selling cigarettes is far more profitable than any of the alternatives. The levy would provide the incentive the industry needs to deliver the Government’s ultimatum. That is a crucial function of the levy—a point Ministers seem not to have taken on board.

Lastly, the Minister for Health said it would

“take several years to materialise”.

That is not the case. The Government have already wasted three years when they could have put the scheme in place. I join my colleagues in inviting the Minister to meet the APPG officers and our independent experts to discuss our proposals. However, let me say in closing that if the levy had been implemented three years ago, we could already have invested £2 billion in smoking cessation and be well on our way to being a much healthier nation.

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

It is a pleasure to serve under your chairmanship, Ms Nokes. I thank my hon. Friend the Member for Harrow East (Bob Blackman) and the hon. Member for City of Durham (Mary Kelly Foy) for securing this important debate. I wish my hon. Friend a very happy birthday—it is probably one of the best birthdays he has had, given that he has started his day this way.

I am grateful to all hon. Members for their participation. We debate smokefree 2030 regularly, which indicates how important it is. We are all passionate about making England smokefree by 2030, and the devolved authorities have the same passion. The personal circumstances expressed by my hon. Friend the Member for Harrow East no doubt drive his passion, and I am sure that the personal circumstances of other hon. Members drive their passion too. I appreciate the passion and dedication shown by Members from all parties, who work together to tackle the harms caused by smoking. I am pleased to update the House on our progress towards achieving the Government’s smokefree 2030 ambition.

Over the past 20 years, through successive and progressive policies, as the hon. Member for Denton and Reddish (Andrew Gwynne) indicated, and regulatory measures, we have made progress in reducing smoking rates. Smoking prevalence in England is now 13.5%—the lowest on record. That is a fantastic public health story, but there are still nearly 6 million smokers in this country.

[Alex Cunningham]

Over the years, we have seen smoking in public places and all sorts of other things change under Labour and Conservative Governments. That reduction is a tremendous achievement, but in communities such as Stockton Town Centre ward in my constituency, smoking rates are still several times higher than that, and there are very high figures for smoking during pregnancy—way above the Government target. I hope the Minister recognises that, although we can cheer and say, “This is wonderful,” it is not wonderful in a lot of our communities.

[Maggie Throup]

I think the hon. Gentleman must have read the next page of my speech, because I was about to come on to that. He makes a really important point. As has been mentioned by the hon. Gentleman, my hon. Friend the Member for Harrow East and the hon. Member for East Londonderry (Mr Campbell), who is no longer in his place, smoking rates are far higher in poorer areas of the country, among those socioeconomic groups. We see smoking rates of 20% in more deprived areas, compared with 5% in wealthier areas, and nearly one in 10 pregnant women still smokes, which increases the risk of health problems for their baby. Smoking prevalence for people with long-term mental health conditions is over 25%, so the burden of tobacco harm is not shared equally.

We cannot let that continue, so the Government are committed to doing more. Over the past decade we have made significant steps towards making England smokefree—a bold and ambitious target that we committed to in 2019. We continue to enforce high taxation to reduce the affordability of tobacco. As part of the annual Budget process, Her Majesty’s Treasury will continue the policy of using tax to raise revenues and will encourage cessation by continuing with duty increases on tobacco products above the retail prices index. We continue to invest in local stop smoking services and our high-impact marketing campaigns such as Stoptober—I hear it is VApril this month.

Between 2010 and 2021, almost 5 million people set a quit date with stop smoking services, and 2.5 million reported quitting after four weeks. We continue to enforce a strong regulatory framework, and we have introduced policies such as smokefree legislation and standardised packaging. All these measures, and many more, have been instrumental in helping smokers to quit and protecting future generations from starting this lethal habit.

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[Maggie Throup]

The hon. Gentleman makes a very good point. The hon. Member for Arfon (Hywel Williams) also mentioned discussions with the devolved nations, and I am very happy to have discussions with my counterparts in the devolved health authorities.

As we have heard from my hon. Friend the Member for Harrow East and others, many in this room are supportive of a “polluter pays” levy. As they will be aware, tobacco taxation is a matter for Her Majesty’s Treasury, and the tobacco industry is already required to make a significant contribution to public finances through tobacco duty, VAT and corporation tax. As part of the development of the tobacco control plan, the Department will also continue to explore and review with the Treasury the evidence base on the best options to raise funding in support of the Government’s ambition to be smokefree by 2030. As a number of Members asked, I am happy to meet the APPG to discuss funding matters and the levy in detail, while the Khan report is being published. I have met the APPG before and am happy to continue having those meetings.

[Alex Cunningham]

Surely the Minister has not lost sight of the fact that the “polluter pays” levy is a levy and not a tax, and the Department of Health and Social Care can introduce it, as it has for the pharmaceutical industry. Will she give a further explanation of that, rather than just saying that it is a Treasury matter?

[Maggie Throup]

I fully appreciate the hon. Gentleman’s point. I enjoyed listening to his dissection of the issue, and I look forward to continuing discussions with the APPG.

The UK will continue its role as a global leader in tobacco control and remains fully committed to the World Health Organisation’s framework convention on tobacco control. The Department has received global recognition for its support of the official development assistance FCTC 2030 project over the past six years. This project helps low and middle-income countries improve their tobacco control and, ultimately, their population’s health. We will continue to support the project for a further three years under the current spending review settlement.

I turn to the questions raised during the debate. My hon. Friend the Member for Harrow East raised the point that the independent review is late. The review is on track to be published in advance of the health disparities White Paper, which it was set up to help inform, this summer. The review was originally intended to be published this month, so it is just a short delay that will not compromise the review’s impact.

The hon. Members for Stockton North (Alex Cunningham) and for Blaydon (Liz Twist) talked about smoking in pregnancy. The Department continues to explore options to support smoking cessation among pregnant women, which will be set out in our new tobacco control plan. Already, as part of the NHS long-term plan, we have made commitments for a new smokefree pregnancy pathway providing focused sessions and treatment to support expectant mothers and their partners to be smokefree. It is important that partners are involved.

The hon. Member for City of Durham mentioned the breaches of menthol regulations. The Office for Health Improvement and Disparities is investigating a range of cigarettes to determine whether the flavour is noticeable. Once that is complete, we will explore whether further action needs to be taken against companies who are in breach of the regulations.

My hon. Friend the Member for Harrow East and the hon. Member for Denton and Reddish talked about stop smoking services, which provide support to help smokers quit and are highly cost-effective. Local stop smoking services continue to offer smokers the best chance of quitting. They produce high quit rates of 59% after four weeks, and they have helped nearly 5 million people to quit since 2000. The services are a key part of the Government’s tobacco control strategy, and will remain so in the new tobacco control plan.

On any regulatory reforms the Government wish to take forward, we will review what legislative powers we have available to us, either through secondary legislation or exploring whether a Bill is required. I was asked why we rejected the tobacco amendments to the Health and Care Bill. We were grateful to Members for suggesting the amendments, which showed their strong support for tobacco control, but it is only right for my Department to fully consider the issues they raised—I am sure those issues will also be raised in Javed Khan’s report—before publishing the new tobacco control plan. We felt that was the right place for the suggestions made in debates on the Health and Care Bill.

I would like to reassure the hon. Member for Denton and Reddish that I am serious about making England smokefree by 2030, as is the Secretary of State. I thank the hon. Member for the support he and the Labour party have offered in the mission to make England smokefree. It is definitely a cross-party issue, and it is really good that we will all be able to work together.

The point about how we are supporting people with mental health conditions to cease smoking has been made a couple of times. The new universal smoking cessation offer is available through the NHS long-term plan for long-term users of specialist mental health services and people with learning disabilities. It is important that we tackle health inequalities brought about through mental health issues, and help those people to quit smoking as well.

I again thank hon. Members for securing the debate and for all their contributions to it. We have made good progress in reducing smoking rates, but the Government acknowledge that we need to go further to level up society and achieve a smokefree country by 2030. Later this year, we will publish a new tobacco control plan setting out how we will achieve our bold ambition. Working together across all parties, our mission is to make smoking a thing of the past and save future generations from the death and misery we all know it causes.