Oral Answers to Questions

Alex Cunningham Excerpts

Tuesday 24th January 2023 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

8. What assessment he has made of the implications for his policies of the number of excess deaths in 2022.

[Alex Cunningham (Stockton North) (Lab)]

13. What assessment he has made of the implications for his policies of the number of excess deaths in 2022.

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

Excess deaths data are published on the gov.uk website, which was most recently updated on 12 January. They show that causes of death from conditions such as ischemic heart disease contributed to excess deaths in England in the past year.

[Maria Caulfield]

The Government are not recommending that people pay for their GPs. In fact, we are investing more in primary care than ever before, unlike the shadow Secretary of State who wants to dismantle the GP system and privatise the healthcare system as well. I think the hon. Lady needs to have a conversation with those on her own Front Bench. Not only did the shadow Secretary of State insult primary care teams for running up their vaccination programme, calling it “money for old rope”, but we are the ones who are investing in primary care services and making them more accessible to people.

[Alex Cunningham]

According to Cancer Research and Action on Smoking and Health, smoking costs the NHS in Stockton £9 million a year and social care £5 million a year, and it costs some £47 million in lost productivity, unemployment and premature deaths. Assuming that one day soon we will get the Government to back a control plan, will Ministers ensure that it includes the desperately needed funding for local smoking cessation services?

[Maria Caulfield]

Local decisions on public health are taken by local commissioning groups and local authorities, and it is for each local area to decide how it spends the money on public health.

Cancer Outcomes: Tees Valley

Alex Cunningham Excerpts

Monday 16th January 2023 Commons Chamber

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

I would like to open my remarks tonight by paying tribute to the late Professor Stephen Bonner, whose obituary features in The Times today. Professor Bonner delivered marvellous service to the people of Teesside in his various roles delivering critical care at James Cook University Hospital, including the major expansion in the number of our intensive care and high dependency beds and his astonishing success in making James Cook the best place for junior doctors and student nurses to train in intensive care in 2016. It is entirely fitting that in a debate on health services in the Tees Valley we should recognise his enormous contribution to our lives locally. So many of my constituents have reason to be grateful to him. Professor Bonner’s obituary tragically relates:

“With their sons growing up, Bonner and his wife planned for a gradual retirement, but just as he was about to put the plan into action he received a diagnosis of inoperable bowel cancer. Bonner had spent decades improving the system, but the bowel screening test that would have diagnosed the cancer early…had been cancelled during the pandemic.”

That brings me squarely back to the subject of this debate and the particular importance of cancer screening, because ultimately that is at the heart of making sure we improve cancer care nationally as well as locally on Teesside.

A cancer diagnosis is news none of us ever wants to receive, but the reality is that someone in the UK does every 90 seconds. One in two of us will be diagnosed with cancer at some point in our lives. Even those of us not directly affected will undoubtedly have family members and friends who are. Some of the most emotional conversations I have had with constituents have been about the struggles faced by loved ones supporting relatives in their final weeks.

The scale of the challenge posed by cancer is particularly acute in the Tees Valley. The north-east of England has the highest age standardised cancer rate of any English region for both men and women. The incidence rate for female patients is 15% higher than in London, which is the region with the lowest incidence. The difference for male patients who experience higher incidence rates overall is more than 8% higher than the best performing region. The Tees Valley’s industrial heritage is, I am afraid, yielding a grim harvest. There are particular challenges with regard to historic exposure to environmental carcinogens resulting in higher rates of lung cancer and myeloma in particular.

My home area is now at the forefront of progress on much of what is good about the Government’s levelling-up programme under the leadership of Ben Houchen, but the legacy issues persist from our very challenging economic past and the deep deprivation our area continues to suffer from. Smoking and obesity rates are higher than the national average. That context at the very least contributes to Middlesbrough being ranked 140th out of 150 local authorities for premature cancer deaths by Public Health England.

The good news is that thanks to research, many more people are either beating cancer or living much longer with cancer. Macmillan estimates that in 2020, 3 million people across the UK were living with cancer. That is forecast to rise to some 5.3 million by 2040. Median cancer survival has improved hugely as a result of advances in diagnosis and treatment, but there is a lot further to go. We ought to pay tribute at this point to the fantastic effort of those individuals and community groups who are touched by this horrible disease and have decided to make a positive difference to the challenge they have faced. I refer here to Guisborough-raised jockey Bob Champion, who has done a huge amount through the Bob Champion Cancer Trust. He has raised some £12 million over the last 30 years.

On a smaller and more local scale, I pay particular tribute to Claire Starsmore and the amazing East Cleveland Pink Ladies, who have raised £131,000 for Cancer Research UK over the past decade in memory of their much-loved friend Jacqui Hampton. The annual Pink Ball is one of the highlights of the East Cleveland social calendar—I am very much looking forward to attending the 10th version in November, which is firmly in my diary. That kind of event makes the cancer fight very personal and very tangible.

[Alex Cunningham (Stockton North) (Lab)]

I am pleased that another Tees MP is so engaged with the subject. I join the right hon. Gentleman in paying tribute to Professor Bonner for all his work for people in my constituency as well as in his own.

The right hon. Gentleman has already recognised the importance of the early diagnosis of cancer and other diseases to tackling health inequalities in his constituency and mine. Will he join me in congratulating North Tees and Hartlepool NHS Foundation Trust and Stockton-on-Tees Borough Council on their joint campaign over many years to secure a diagnostic centre for our new-look town centre, which was confirmed by the Minister earlier today?

[Mr Clarke]

The hon. Gentleman is absolutely right: this is a subject that crosses party boundaries and constituency boundaries. The contribution of everyone who has fought to ensure that we deliver the best possible cancer care across Teesside is undoubtedly to be applauded. I look forward to hearing the Minister’s remarks about what the Government’s pioneering work to deliver community diagnostic centres will bring to the Tees valley.

I referred a moment ago to the Pink Ball. On the same note, I pay tribute to Councillor Craig Holmes of Skelton West in my constituency, who has raised thousands of pounds for cancer charities through events including the annual Minersfest, an extraordinary music festival in East Cleveland, at which you would always be welcome, Mr Deputy Speaker. Such efforts are incredible tributes—in this case, a tribute to Craig’s mum Alison, who sadly lost her battle with cancer in 2013—and bring huge enjoyment to thousands of local people.

There is much more that we need to do to reduce the average of 460 deaths per day from cancer in the United Kingdom. One of the strongest predictors of cancer outcomes is how early a diagnosis is made and treatment is started. It is estimated that for every week earlier that the treatment of cancer commences, the chance of five-year survival increases by at least 1.5%, so it makes a material difference.

--- Later in debate ---

[The Minister of State, Department of Health and Social Care (Helen Whately)]

Let me begin by thanking my right hon. Friend the Member for Middlesbrough South and East Cleveland (Mr Clarke) for securing this debate. He has been working hard to make sure that his constituents get faster diagnosis and better treatment for cancer. He mentioned working together with his constituents on the clinical side, doing tremendous work to lead efforts to diagnose and care for people in his area, as well as fundraising. I heard him mention the Pink Ball, which sounds tremendous. I pass on many congratulations to all those involved and commend them for their work.

As my right hon. Friend said, many people are affected by cancer, whether due to a diagnosis themselves or somebody they are close to. Many people have therefore lived through that difficult experience of waiting to hear whether they will be diagnosed with cancer, or have the all-clear after being referred for testing. For patients with cancer, it is quite simple: faster diagnosis saves lives. That is why this Government are helping the NHS recover and transform health services in the aftermath of the pandemic, with a particular focus on the earlier diagnosis of cancer.

I will talk a little about what we are doing nationally, but I will focus on my right hon. Friend’s constituency. He mentioned the high prevalence of cancer in his constituency and the wider Tees Valley. To give a sense of the scale, in 2020, there were just under 4,000 cancer diagnoses in the Tees Valley, so that gives a sense of the number of people who could benefit from faster diagnosis, which we know can improve outcomes. There is more that we can and should do to prevent people, both nationally and in the Tees Valley, from developing cancer in the first place, such as policies that help people maintain a healthy weight and lifestyle and stop smoking, and promoting the uptake of the HPV vaccine, particularly in groups where coverage is lower.

[Alex Cunningham]

The Minister mentioned my magic word—smoking. Could she give us some indication of when the Government will bring forward the tobacco control plan? She recognises, as I do, that in the most deprived inner-city communities the incidence of smoking is higher and lung cancer is higher as a result. I would be interested to know what plans she has to bring that forward.

[Helen Whately]

The hon. Gentleman is absolutely right to pick up on what I said about the importance of supporting people to stop smoking, but for the sake of this Adjournment debate I will focus on responding to my right hon. Friend’s speech, particularly looking at cancer diagnostic services.

We want to level up diagnostic services for cancer around the country so that people with symptoms of potential cancer can receive an accurate diagnosis and begin treatment as quickly as possible. That is part of our ambition to reduce health disparities in more deprived areas, such as some areas in my right hon. Friend’s constituency, and to improve early-stage cancer diagnosis rates for all. A key part of improving early diagnoses is ensuring that people come forward when they suspect that they have cancer.

Sadly but understandably, during the pandemic we saw the number of urgent referrals for cancer fall, but it is positive that in the North East and North Cumbria integrated care board over 13,000 patients had their first consultation appointment following an urgent GP referral in November last year. That is an 18% increase from November 2020 during the pandemic, and nearly a 20% increase on the figures for November 2019 prior to the pandemic. That indicates that in the Tees Valley, as we are seeing across the country, people are coming forward to be diagnosed or discover that they have the all-clear from cancer, which is the case for most people.

In a moment I will talk about our innovative new community diagnostic centre programme, but first I want to highlight some of the other things we are doing to improve the early diagnosis of cancer. One important innovation is introducing the serious non-specific cancer pathway, which Tees Valley has successfully implemented. This means that GPs can refer patients into the service when there are possible symptoms of potential cancer, or someone has a gut feeling that something is not right. That is especially important for patients who do not fit specific pathway referral criteria but whose symptoms are more generic.

In addition, Tees Valley has initiated a programme of targeted lung health checks aimed at people aged between 55 and 74. My right hon. Friend referred to that and the impact that it is having. It is anticipated that the programme will result in around 530 diagnoses of lung cancer over the next four years. In deprived areas of Middlesbrough, Hartlepool and Darlington, clinicians are taking part in a trial to assess the benefit of the new GRAIL test that looks for signs of cancer in a sample of blood. This is hugely exciting as it can identify cancer where no symptoms are even present, allowing for earlier diagnosis.

However, the waiting list for diagnostic tests in England currently stands at over 1.59 million patients, with around 26% of those patients waiting more than six weeks. In the North East and Yorkshire region, the waiting list for diagnostic tests has over 200,000 patients, with just over 20% of those waiting more than six weeks. These are figures that we very much want to improve because, as I have said, earlier diagnosis can mean better outcomes. We want to get to the point where 95% of patients needing a diagnostic test receive it within six weeks by March 2025. Equally, early-stage cancer diagnosis is a key ambition of the NHS long-term plan, which aims to ensure that 75% of cancers are identified at stage 1 or stage 2.

--- Later in debate ---

[Helen Whately]

It is good to be able to talk about good news. As my hon. Friend says, his area is not only getting a community diagnostic centre but getting it quicker because the timeframe for doing it has been brought forward. That is tremendous, and I look forward to his area achieving that later this year. It is great that we have been able to announce the date when it will open.

The new Castlegate site for the Tees Valley community diagnostic centre is planned for construction on the Castlegate shopping centre site as part of the local regeneration project. There are excellent transport links, which means that it will be accessible to the whole community. It is important to make these places accessible in order to get people to come forward for testing and screening. This will be the latest addition to the 14 existing community diagnostic centres in the North East and Yorkshire region and the four hub-and-spoke sites in the Tees Valley area, which have so far delivered over 250,000 tests.

[Alex Cunningham]

Will the Minister give way?

[Helen Whately]

I want to respond to the other comments from my right hon. Friend the Member for Middlesbrough South and East Cleveland, who also raised the important role that the independent sector has to play in meeting the needs of patients. Last month, my right hon. Friends the Prime Minister and the Secretary of State for Health and Social Care launched the elective recovery taskforce, bringing together academics and healthcare experts to advise the Government on how best to unlock capacity in the independent sector to reduce waiting times. The independent sector is also helping us directly to tackle the diagnostic backlog, providing additional capacity in underserved communities and forming productive partnerships with the NHS to run community diagnostic centres.

The hon. Member for Westmorland and Lonsdale (Tim Farron) asked about effective treatment, and I am pleased to say that the NHS has treated a record number of people for cancer in the last year, with more than 321,000 people receiving their first cancer treatment between December 2021 and November 2022, which is up by more than 10,000, or 3%, on the same period pre-pandemic. Within the North East and North Cumbria ICB, 1,690 patients started their first treatment for cancer in November 2022. The number has recovered following the pandemic—the equivalent figure for November 2019 is 1,652.

The NHS continues to offer cutting-edge treatments, including newly developed drugs and radiotherapy. Just a week or so ago, my right hon. Friend the Secretary of State signed a memorandum of understanding with BioNTech to bring innovative vaccine research to England, with the potential to transform outcomes for early-stage and late-stage cancer patients.

I thank my right hon. Friend the Member for Middlesbrough South and East Cleveland for raising this important issue and for his continued commitment to improving cancer care in the north-east and Tees valley region. I encourage him to continue his excellent work with his local NHS system, and I look forward to continuing to work with him and the NHS as we meet the challenge of reducing diagnostic waiting times and improving cancer outcomes.

Question put and agreed to.

Smokefree 2030

Alex Cunningham Excerpts

Thursday 3rd November 2022 Commons Chamber

[Alex Cunningham (Stockton North) (Lab)]

I draw the attention of the House to my interests as a vice-chair of the all-party parliamentary group on smoking and health. I, too, welcome the Minister to his place and wish him well. I look forward to working with him. I congratulate the hon. Member for Harrow East (Bob Blackman) on an excellent and measured speech. I could make my shortest speech ever by simply saying, “I agree with Bob.” I won’t. [Laughter.] I will reiterate some of the points he made.

When I wander through parts of my constituency, particularly the areas of greater deprivation, I am struck by the number of people who still smoke, including children on their way home from school in school uniform. I know that in recent times rates of smoking have come down across the borough of Stockton-on-Tees, thanks to initiatives by the council, health staff and Fresh, the north-east charity that helped drive a reduction. Although the incidence of smoking has come down overall, it is still a major issue in areas such as the town centre ward, where it remains high, as does the number of young women smoking in pregnancy.

Sadly, public health is in a dire state after 12 years of Conservative rule and, in recent times, the promise to act on smoking does not align with what is being delivered. Time and again, Members from across the House have asked for the long-overdue tobacco control plan, but despite making commitments to introduce the necessary measures to further reduce tobacco harm in this country, the Government have not done so. We will never meet the Government’s targets if we do not have a plan, so I hope that the Minister will today give us a date for the plan and promise to make available the resources to make it work.

I want to be a little parochial and make it clear again why I have always focused on this health issue, in particular, during my 12 years in Parliament. In my patch of Stockton, 13.2% of adults smoked in 2019 compared with 13.9% in England. That rises to 19.1% among those in routine and manual occupations. When we look at the proportion of women who smoked during pregnancy in 2021, it is worrying that the figure for Stockton was 14.1% compared with 9.6% nationally. The fact that one in 10 expectant mothers smoke across the country is bad enough, but the proportion is 50% higher in my patch and much higher, again, in deprived communities. Smoking can be a family issue. Any expectant mother committed to quitting will struggle if their partner or others in their household smoke. We need a plan to work with whole families to discourage smoking and end the dangers to the unborn child.

There is, of course, an economic argument to invest in smoking cessation. At the local level, smoking costs £62.3 million every year. That includes £47.2 million in lost productivity and costs of £9.2 million to the NHS and £5 million to social care. It is particularly distressing that 7.4% of our Stockton North population suffer from asthma—higher than the 6.5% across England. Furthermore, the level of COPD—chronic obstructive pulmonary disease—in my constituency is 3.1%, which again, is 50% higher than the rate of 1.9% across England. In England, 14.1% of people have high blood pressure, but the proportion is 16.2% in my constituency. It is therefore no surprise that 75% of adults in the north-east support the ambition to reduce smoking prevalence to less than 5%—fewer than one in 20 people—by 2030, with just 9% opposed. Along those lines, 76% of adults in the north-east support activities to limit smoking or think that the Government should do more.

We can all celebrate the fact that, in the past five years, the fastest decline in smoking rates in England has been in the north-east, although that was from a very high starting point. That is due to highly effective regional collaboration between local authorities and the NHS, supported by Fresh, to which I referred earlier, but they cannot do that alone. Government action could have a fast impact if they were to bring in legislation introducing the further regulation of tobacco products, as the hon. Member for Harrow East mentioned.

[Liz Twist]

My hon. Friend is speaking powerfully about the experience in the north-east and nationally. He will be aware that, between 2007 and 2019, when the Government led the way in introducing tough new regulations, our smoking rates declined far faster than in the rest of Europe and most of the world, but that has dropped off, so we need to take further action. Is he aware of this recent research into smoking habits? University College London’s smoking toolkit study has surveyed smokers’ behaviour monthly since 2006. After years of steady decline in adult smoking—the proportion went from 24.1% in 2006, as he said, to 14.8% in 2020—smoking rates have stagnated, standing at 14.9% as we reach the end of 2022. Worse still, although the uptake of smoking among young adults declined year on year from 2007, that started rising again after 2019.

[Alex Cunningham]

I am grateful to my hon. Friend; I was not aware of some of the research to which she referred. However, the reduction in smoking has plateaued in recent times, and that is lamentable. I have a big enough heart to say that the Conservative Government have done much over the years to reduce smoking, building on much of what the Labour Government did between 1997 and 2010, but we cannot allow ourselves to stop there. We need to do so much more.

There are often arguments—many of which are put forward by front organisations funded by the tobacco industry—that further smoking regulation would be the “nail in the coffin” for small businesses, but that is not so. As the hon. Member for Harrow East mentioned, a recent survey commissioned by Action on Smoking and Health found that small tobacco retailers in the UK support further measures to reduce the harm of tobacco, including increasing the age of sale from 18 to 21, mandating a licence to sell tobacco and requiring tobacco companies to pay for services to help smokers to quit. John McClurey, a retired local retailer from Newcastle said, “Tobacco is a burden” to small businesses. The Government could help to lift that burden and charge the tobacco companies to do so.

In my last speech on smoking in Westminster Hall, I again stressed the need for a levy on the tobacco companies, but Ministers were reluctant. The new Minister will want to take action in this space. As we all know, cash will be tight and the Budget in two weeks’ time will be difficult, so he can earn himself brownie points by requiring the industry that makes billions in profits while killing our people to pay up instead. It needs to pay, because more than 4,000 people died prematurely from smoking in the north-east alone last year, with 30 times as many suffering disease and disability caused by smoking.

Going hand in hand with the personal suffering caused by smoking is the economic cost to our already disadvantaged communities. In their election manifesto, the Government claimed:

“We are committed to reducing health inequality.”

Why, then, are there such pronounced inequalities? In the north-east, 42% of smoking households are in poverty and tobacco spending accounts for a higher share of gross disposable household income per head than in any other UK region or nation. Please do not give me the argument that if people are poor, they should give up their fags. Smoking is an addiction and they need help to quit. Ending smoking in such communities would not just benefit the health and wellbeing of individuals but inject money into local economies that was previously going up in smoke.

The Minister will know that, at the current rate of decline, poorer communities risk being left behind as we move towards the hoped-for smokefree 2030. It will not happen in the communities to which I have referred without robust action. Most of the quitting has been done by people from better-off communities, and the benefits have largely accrued to those communities. In 2019, fewer than one in 10 professional and managerial workers smoked—well on the way to the smoke-free target of less than 5%—compared with nearly one in four workers in routine and manual occupations.

Half the difference in life expectancy between rich and poor is due to smoking, which means that the scope for reducing health inequalities related to social position is limited, unless the many smokers in lower social positions can succeed in stopping smoking. Smoking is linked to almost every indicator of disadvantage. Those overlap different communities, so smokers in routine and manual occupations, or who are unemployed, are also more likely to be living in social housing and to be diagnosed with mental health conditions.

There is a clear need for a new tobacco control plan that targets investment and enhanced support at disadvantaged smokers, wherever they are. As long as smoking remains the norm in some communities, not only will it be harder for smokers to quit, but smoking will continue to be transmitted from one generation to the next. The evidence shows that most people who smoke started as children. Prevention is key, so what will the Government do to reduce the appeal of cigarettes?

[Liz Twist]

Does my hon. Friend agree that raising the age of sale, as the APPG proposes, would reduce youth uptake? According to the UCL modelling that I spoke about, it would reduce smoking among 18 to 20-year-olds by a third. It would narrow the inequalities in uptake: as my hon. Friend has powerfully explained, children from more disadvantaged backgrounds are more likely to take up smoking.

[Alex Cunningham]

I have no doubt that everything my hon. Friend says is totally on the money. We can take action, and it need not cost the Government a fortune either. My hon. Friend raises the issue of age. Some parts of the UK have a Check 25 policy—would it not be wonderful if we could introduce such a check on the sales of cigarettes? It might help to put an end to smoking among younger people.

High smoking rates among people with mental health conditions are a leading cause of premature death and disease. Smoking accounts for two thirds of the reduction in life expectancy for people with a serious mental illness. The smoking rate among people with serious mental illnesses is more than three times that of the general population. The rate among people with depression and anxiety is just under twice that of the general population, but they account for 1.6 million smokers. There is now good evidence that smoking exacerbates levels of poor mental health, whereas stopping smoking contributes to improvements in mental health. Tobacco remains the biggest cause of cancer and death in the UK, so Cancer Research would like to see the ambition to make England smoke free by 2030 implemented. I ask the Minister whether we can expect to see that ambition realised.

I would like to say a little about “The Alternative Smoke-Free 2030 Plan” published by the Institute of Economic Affairs, which the hon. Member for Harrow East has also received. After the disastrous free-market policies promoted by the IEA and adopted by the last Prime Minister and Chancellor, I find it hard to believe that any current Minister would give any credence to the IEA’s recommendations on anything. However, the hon. Member makes an important point: as a party to the World Health Organisation framework convention on tobacco control, the Government and all public authorities are required to protect

“their public health policies…from commercial and other vested interests of the tobacco industry”.

If the Minister is in any doubt about the role played by the IEA, he should take note of the leaked documents that show that during the passage of the tobacco products directive, Philip Morris International described the IEA as a “media messenger” on its behalf, able to assist in “policy outreach” to “pro-actively relay our positions”, while British American Tobacco described it as a “vehicle for delivery” of its UK reputation initiatives. I would like the Minister to restate for the record, on the Floor of the House, the Government’s commitment to complying with paragraph 3 of article 5 of the convention and to preventing tobacco industry-funded organisations from influencing tobacco control policy.

The arguments for bringing tobacco regulation forward are multifaceted and can no longer be ignored. As a member of the APPG, I look forward to working with a new Minister who can do the maths to realise the cash value of a tobacco control plan, especially if we make the polluters pay, and—better still—who can help us to ensure that we have healthier people in all our communities.

--- Later in debate ---

[Alex Cunningham]

The Minister knows as well as I do that local authorities have been under tremendous financial constraints in recent times. How can we ensure that local authority public health continues to be funded so that these services can continue? At the moment the services are quite inadequate.

[Neil O’Brien]

The hon. Gentleman is right that these services are hugely important. All authorities saw an increase last year and there is a 2.8% increase this year, with funding heavily weighted towards more deprived areas, but there is much more we need to do, and we keep it under active review.

We are also building investment in anti-smoking marketing campaigns. It was heartening to see the number of people who joined the annual Stoptober campaign last month. This well-known initiative encourages smokers to abstain for 28 days each October, as we know that smokers who manage to quit for 28 days are five times more likely to quit permanently. In England, the Stoptober campaign has now helped more than 2.1 million people quit since its inception in 2012.

Dr Khan also called for the NHS to prioritise further action to stop people smoking. The long-term NHS plan commitments are a huge step towards preventing smoking-related illness, and they are making significant progress towards reducing preventable ill health and reducing the burden of smoking on the NHS. I have talked about using touch points in hospitals to offer people help to stop smoking.

We have discussed vaping as a substitute for smoking. We recognise that vaping is far less harmful than smoking and can be an effective quitting device. We also recognise that there is more the Government can do to tackle the myths and misconceptions that surround vaping. Our recently published “Nicotine vaping in England” report set out the most up-to-date evidence on vaping, providing an even more compelling case for supporting smokers to switch. However, in recognition of the recent increase in vaping rates among children, which my hon. Friend the Member for Erewash mentioned, we are doing more to prevent children from vaping. We have updated our online materials, and we are working closely with the Department for Education to communicate with schools on how best to set policies around vaping.

My hon. Friend asked a specific question about the MHRA and medical licensing. We are working closely with the MHRA to support a future medically licensed vaping product, which would carry many benefits, including tackling scepticism of e-cigarettes among healthcare professionals. We understand that several products are applying for medical licences early next year. I pay tribute to my hon. Friend for all the work she has done on public health.

As a world leader in tobacco control, the Government continue to support lower and middle-income countries to implement effective tobacco control strategies, and through official development assistance funding to the World Health Organisation-led framework convention on tobacco control 2030, we are supporting a further nine countries to protect their populations from the harms of tobacco.

Both my hon. Friend the Member for Harrow East and the hon. Member for Denton and Reddish (Andrew Gwynne) mentioned article 5.3 of the tobacco control treaty, to which I can confirm the Government are absolutely committed. I consider myself forewarned about the report mentioned by my hon. Friend the Member for Harrow East.

The Government are determined to address the challenges raised by the independent review and to meet our bold smokefree 2030 target. I understand the compelling arguments made by the Khan review and the very strong evidence in the recent “Nicotine vaping in England” report. Over the coming weeks, we will be quickly taking stock on whether a refreshed tobacco control plan is the best way to respond, and on how and when to take forward all the suggestions made by that review.

The Government recognise that more action needs to be taken to protect our people from this dangerous addiction. We know that the action we take must be comprehensive, bold and ambitious. The prize of reaching a smokefree 2030 will be huge for this country, particularly for our most disadvantaged citizens. I thank all hon. Members who have taken part in this debate.

Diagnostic Hospital: Stockton

Alex Cunningham Excerpts

Wednesday 26th October 2022 Commons Chamber

[Alex Cunningham (Stockton North) (Lab)]

Thank you, Mr Deputy Speaker, for calling me, especially given that I arrived late.

I congratulate the hon. Member for Stockton South (Matt Vickers), my constituency neighbour, on securing this important Adjournment debate. I apologise to him for missing the opening paragraphs of his speech. We do not agree on very much politically, but we agree about the need for improved health provision in the communities that we both serve. I agree that Stockton desperately needs better health provision so that we can tackle the entrenched health inequalities that blight our communities. We have got fantastic staff—the hon. Member referred to them—but they need the support of proper facilities.

I have cited appalling statistics many times on the Floor of the House. I will do that again tonight and keep doing so until the Government take the necessary action. Men in the town centre of Stockton-on-Tees in both my constituency and that of the hon. Member for Stockton South live 18 years less than their peers just down the road. In Stockton North, 7.4% of our population suffer from asthma—a higher figure than the 6.5% rate across England. The figure for chronic obstructive pulmonary disease in my constituency is 3.1%, again higher than the rate of 1.9% across England. In England, 14.1% of people have high blood pressure. That figure rises to 16.2% in Stockton North. I have been calling for a new hospital to be built in Stockton for the past 12 years after the Conservative-Liberal Democrat coalition Government axed the one we were promised in 2012. In the past 12 years and over the course of the pandemic, the health inequalities in our area have actually grown wider; they have not narrowed.

The hon. Member talked about our town centre in Stockton. We have an innovative local council. The idea of bringing together health and council facilities in the town centre was a tremendous initiative between the council and the North Tees and Hartlepool Hospitals NHS Foundation Trust—a trust that I have had the honour to serve on for some years. I pay tribute to all of its staff for the tremendous work that they have done over the years to get to the point where we just need a final Government decision for this project to go ahead.

There are all manner of reasons why we need the new hospital, but for me it is because we need certainty in our community about the future of structures in the health service. There is now a proposal to merge the chief executive role for North Tees and South Tees hospitals. I am against that, and I want to see a situation where whoever is the chief executive concentrates on delivering for people north of the River Tees—and, of course, part of south of the River Tees served by the hon. Member for Stockton South. It is critical that we achieve that sometime in the near future.

I know that the integrated care board has a tremendous responsibility in all of this, but, again, much of its focus seems to be on structures rather than on getting things done. I hope the Minister will encourage the board to back this tremendous proposal, so that the hon. Member and I can see our constituents get the services that they require, and that we can end these health inequalities that are killing people day in, day out in communities such as ours.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

I congratulate my hon. Friend the Member for Stockton South (Matt Vickers) on securing this debate. He will appreciate that I am standing in for my right hon. Friend the Member for Newark (Robert Jenrick), who has been promoted to the Cabinet and the Home Office, so I ask him to forgive me if I do not have the answers to all of his questions, but I will ask the Department to write to him with those.

I know that this is an important subject for my hon. Friend and that he works tirelessly for the people of Stockton South on healthcare and on other matters. The waiting time for a diagnosis or an all-clear can be a very anxious one. It is something with which all of us who have been on a waiting list, or who have had a family member, a friend or a loved one on a waiting list, will be familiar. It is right that we do all we can to support services to recover from the pressures of the pandemic and to innovate and improve so that patients can have tests and receive diagnoses in a quicker and more convenient way.

Today, I will outline the work being done through the elective recovery programme to improve access to diagnostics and how that will impact patients across the UK, including in Stockton South. The waiting list for diagnostic tests in England currently stands at more than 1.5 million patients. Some 30% of those patients are waiting more than six weeks. That is up from a little under 1 million in 2019, before the pandemic. In the north-east and Yorkshire region, the waiting list for diagnostic tests is more than 213,000 patients, 26% of whom have been waiting more than six weeks. Community diagnostic centres are part of the answer and are a fantastic example of how we are providing more efficient, easier and more convenient access to vital services in the community.

The Government have committed £2.3 billion in capital spend as part of the 2021 spending review to support diagnostic services to recover and improve and to ensure that patients have access to often life-saving diagnostic tests that they need. This includes money to allow the NHS to continue to roll out a community diagnostic centre programme across England. This is a new way of delivering care, and it will ensure that elective diagnostic services are resilient in the face of winter pressures, because they have ring-fenced elective diagnostic activity.

Local healthcare systems, including NHS trusts, integrated commissioning boards, and local authorities, which know their patients and communities best, are being empowered to plan and bid for funding for new CDC sites, ensuring that they are placed where there is the greatest community need and the most clinical value, with successful bids ultimately signed off by the Secretary for Health and Social Care. I am pleased to say that 89 CDCs are currently operational across the country in a variety of sites, including hospitals, football stadiums and shopping centres, ensuring that patients have access to the care they need where they live. Those centres and hard-working NHS staff have so far delivered more than 2 million tests and are well on their way to providing capacity for 9 million tests a year by 2025.

With regard to the provision of a community diagnostic centre in Stockton, I am pleased to be able to inform my hon. Friend that the business case for the centre is currently in development. He will be pleased to learn that a large-model CDC, including capacity for imaging, physiological measurements, pathology and endoscopy, is planned for construction on the Castlegate shopping centre site, with plans for the centre to be fully operational by March 2025.

Castlegate is an ideal site for a CDC because of its accessibility for different population groups experiencing health inequalities, with excellent transport links. It is exactly the sort of area where the new centres can have the biggest impact. The Castlegate CDC will add to the 12 existing CDCs in the north-east and Yorkshire region and the four hub and spoke sites in the Tees Valley area, which have delivered more than 200,000 tests for patients in the north-east and Yorkshire region. Ten further sites across the north-east and Yorkshire are due to be approved in the near future and will all be operational by March 2025 to support our target of up to 160 CDCs.

I heard the comments of my hon. Friend the Member for Old Bexley and Sidcup (Mr French), but I am afraid I do not have the answers for him today. I will ask the Department to write to him with information on his specific bid.

[Alex Cunningham]

This is music to my ears. We have all worked very hard for this—local authority, health authority and politicians—and I am grateful for the positive message the Minister is giving us. Now I am going to be even cheekier and say that we desperately need a new general hospital to serve Stockton and the wider Hartlepool area. We need new facilities there. I hope, 12 or 13 years after the original hospital was cancelled, that this Minister will be the one to deliver it.

[Dr Johnson]

I thank the hon. Gentleman for his comments. The building new hospitals programme is in process and bids are in play, so I am afraid I cannot comment any further, as he will appreciate.

In conclusion, I encourage my hon. Friend the Member for Stockton South to continue his productive conversations with both his local ICB and NHS England to ensure that new developments in Stockton continue to support the local community health needs. I will ensure he is made aware when the proposal for the new centre has progressed further and when he can expect to see it open in his constituency.

I look forward to continuing to work with NHS England, local NHS systems such as the North East and North Cumbria ICS and fellow Members of the House to ensure that as a Government we meet the challenge posed by diagnostic waiting lists and ensure that patients are able to receive the often life-saving diagnostic tests that they need, as quickly and conveniently as possible.

Question put and agreed to.

Access to GP Services and NHS Dentistry

Alex Cunningham Excerpts

Tuesday 21st June 2022 Commons Chamber

[Wes Streeting]

My hon. Friend is absolutely right to highlight that problem. If the front door of the NHS in primary care is jammed, people end up presenting in A&E. As I shall outline in my speech, this is not only a great inconvenience and burden to patients; it comes at an additional cost to the NHS and we all pay the price for that in every respect.

[Alex Cunningham (Stockton North) (Lab)]

At the GP practice in Norton in my constituency, it is almost impossible to get an appointment on the phone. I have dozens of cases of individuals unable to access vital care. One tried 196 times. The Care Quality Commission has not inspected this practice since 2015. Does my hon. Friend agree that it ought to be doing so now?

Health and Social Care Leadership Review

Alex Cunningham Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

I agree very much with my hon. Friend. She will know from her own NHS trust, particularly the maternity problems there and the terrible cases set out in the Donna Ockenden report, just where that kind of culture can lead. Of course there are fantastic examples day in, day out of great culture and great leadership in the NHS, but there are also poor outcomes. She is absolutely right that we need to tackle those. That is exactly what is in this report.

[Alex Cunningham (Stockton North) (Lab)]

I cannot really understand why yet another restructure of the NHS is the answer to the crisis we face. The last one diverted billions of pounds from patient care, and millions of people are suffering as a result. Instead of yet another costly restructure, why does the Secretary of State not just get on with building the new hospitals we need, such as the one at North Tees in Stockton, and tackling the health inequalities that blight our communities?

[Sajid Javid]

This is none of the things the hon. Gentleman claims.

North East Ambulance Service

Alex Cunningham Excerpts

Monday 23rd May 2022 Commons Chamber

[Maria Caulfield]

I hear my right hon. Friend’s concerns. I am happy to look at his concerns for his own particular ambulance service and discuss them further.

[Alex Cunningham (Stockton North) (Lab)]

The Government have again failed the north-east. The failures of the North East Ambulance Service could fill a book and there is no doubt that there cannot be a north-east MP who has not had complaints about poor response times and lack of care. It is also evident that NEAS is now highly reliant on crews from other organisations, something I was told years ago would be phased out of the service as it grew its own paramedics. The latest revelations show the service is far from fit for purpose and we can no longer sit back. Will the Minister order not just an inquiry but a root and branch review of NEAS and get it sorted?

[Maria Caulfield]

In my role as patient safety Minister, I am happy to look at any patient safety concerns. The Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), who is responsible for ambulances, has heard the hon. Member’s request.

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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

Health and Care Bill

Alex Cunningham Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Mrs Miller]

First, I apologise for being late to the debate, Mr Deputy Speaker. I appreciate your calling me to speak, and I will be brief.

Amendment (a) in lieu of Lords amendment 92 is all about increasing women’s choice, not about taking choice away from anyone. The basis on which the amendment can be judged is the evidence we have gathered, not in a short period of time, but during two years in which 150,000 women have used telemedical abortion care. Judge the amendment against that backdrop; it is done not on a whim or a fancy, but after two years of intensive analysis.

While I might want to agree with those of my right hon. and hon. Friends who are calling for a reasoned debate in the House of Commons on the broader issues of abortion, the truth is that we do not have those debates because the Government talk about changes to abortion provision coming from Back Benchers when that provision is now so out of date in our country that we need the Government to look at it more broadly. I will support the amendment because it is the right thing to do. The amendment is backed by a huge range of organisations and a significant body of evidence, and it requires the Government to look more broadly at abortion—to take this as a responsibility and to stop shoving it back on to the Back Benches.

Continuing telemedical abortions will be supported and regulated in exactly the same way as face-to-face abortion care, and to suggest otherwise is to be factually incorrect. Members really need to think about the evidence showing that online sales of abortion pills from unregulated providers have decreased since telemedical abortion was made legally available. Rather than push people back into an unregulated market, let us keep what we have, which has worked for 150,000 women over the past two years. But please, please, Minister, let us have a reasoned look at abortion more broadly. Stop saying that this is an issue for Back Benchers. It is not.

[Alex Cunningham (Stockton North) (Lab)]

I will speak specifically to Lords amendments 85 to 88 on tobacco control. First, I pay tribute to my hon. Friend the Member for City of Durham (Mary Kelly Foy) who put so much work into tobacco control amendments in Committee but is unable to be here. Like her, I am an officer of the all-party parliamentary group on smoking and health, and I strongly support amendments 85 to 88 on the “polluter pays” levy on tobacco manufacturers. I heard what the Minister said about a levy being complicated and how it might take years to implement, but a way must be found to make big tobacco pay for the crisis that it sustains every day that it remains in business.

Like my hon. Friend the Member for City of Durham, I represent a constituency in north-east England, which is the most deprived region of the country and has high rates of smoking. We have reduced smoking significantly in recent years, but, despite that progress, it is still the leading cause of premature death, killing more than 400 of my constituents a year. In my constituency, smoking costs society more than £62 million, which is money that our community can ill afford. I also worry that nearly 15% of local pregnant women are still smoking at the time of delivery, which is 50% higher than the national average. We all know that smoking in pregnancy significantly increases the risks of miscarriage, stillbirth, sudden infant death syndrome and foetal growth retardation. The levy would raise vitally needed money for investment in deprived areas such as ours in the north-east to break the cycle of addiction, disease and premature death. At current rates of decline, Cancer Research UK has calculated that the smokefree 2030 ambition will not be achieved for our most disadvantaged communities until 2047.

[Steve Brine]

This is such an important subject, so it is good that we are discussing it as part of the Bill. I am so puzzled by the Government’s approach because money is clearly short in the Treasury and the levy would be a new source of income that could help with a public health aim and save millions in the long run. The reason for it was summed up beautifully by the chief medical officer when he said that

“a small number of companies make profits from the people who they have addicted in young ages…to something which they know will kill them.”

We have an opportunity to do something about that at no cost to the Exchequer.

[Alex Cunningham]

It is exactly that; I could not agree more. I am sure that Ministers will work hard to try to find ways in which we can make the polluter pay—that is a polluter who pollutes the bodies of our people.

Achieving the smokefree 2030 ambition is the most effective way to achieve the health missions in the Government’s levelling-up White Paper to reduce the gap in healthy life expectancy between top performing and other areas by 2030 and to increase healthy life expectancy by five years by 2035. Becoming smokefree will also improve my constituents’ employability by reducing levels of sickness, disease and disability.

I am pleased that tobacco control is not a party political issue, and I am pleased to work closely on it with the hon. Member for Harrow East (Bob Blackman). We have very different political views on many things—he has heard me say this—but we are as one on this issue. It was a Conservative Government who committed to making England smokefree by 2030, but that ambition is shared by all political parties in Parliament. It is also supported by the public, but, like the all-party parliamentary group, they recognise that this ambition needs substantial funding to be delivered.

A survey of 13,000 people carried out last month for Action on Smoking and Health found that making tobacco manufacturers pay for measures to end smoking was supported by more than three quarters of the public, with little opposition—I think that 6% of people were opposed. Let us remember that, over the last 50 years, smoking has killed an average of 400 people a day year in, year out, which is far more than covid has or will. It is only right that big tobacco, which has lined its pockets from the human misery caused by polluting the bodies of our people, is forced to pay the price of ending this lethal epidemic. I urge the Government to accept the amendments as a step on the track to achieving the smokefree 2030 ambition that we all share.

[Laura Trott (Sevenoaks) (Con)]

It is a pleasure to follow the hon. Member for Stockton North (Alex Cunningham). I will speak briefly to Lords amendment 84 and to the Government amendment in lieu of Lords amendment 92.

On Lords amendment 84, on the licensing of cosmetic procedures, I just want to thank the Government for putting this in. Non-surgical cosmetic interventions such as Botox and fillers are the wild west of the healthcare world. We do not expect something that we can easily and legally get done in the safety of our own home to be able to blind us, but that is the case. It is high time that this was sorted and it is a huge step forward for women’s health, so I thank the Government very much.

Randox Covid Contracts

Alex Cunningham Excerpts

Wednesday 17th November 2021 Commons Chamber

[Angela Rayner]

My hon. Friend makes a good point. He has been a Member for a long time, and he is aware these conventions and procedures are there to ensure that process is followed and recorded, but we do not know what was said in any of the correspondence before or after, including from private email accounts and phones. We do not know why or how these contracts were awarded. I hope the Minister for Care and Mental Health can give us some insight. We do not know what rules might have been broken and what role the lobbying of the former Member for North Shropshire played in the Government’s decision.

[Alex Cunningham (Stockton North) (Lab)]

We all know about the failures of the Government’s dodgy crony contracts, which have wasted taxpayers’ money by the billion. Does my right hon. Friend agree that not only should the Government come clean but they should get the cash back to spend on projects like a new hospital for Stockton to help deal with our huge health inequalities?

[Angela Rayner]

My hon. Friend makes a crucial point, and it is why the public are so frustrated. We know there has been waste in some of these contracts, and that money is needed in many parts of our country and in many areas of our constituencies. We know that money could have been better spent, and we know the cost of not doing it properly.