Smokefree 2030

Debate between Alex Cunningham and Bob Blackman

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.

Tobacco Control Plan

Debate between Alex Cunningham and Bob Blackman

Thursday 13th October 2016 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That injustice is a clear issue for tobacco.

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

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

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

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

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

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

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

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

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

[Alex Cunningham]

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

[Bob Blackman]

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

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

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

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

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

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

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

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

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

Local Government Funding

Debate between Alex Cunningham and Bob Blackman

Monday 6th December 2010 Commons Chamber

[Alex Cunningham]

We accepted that there would be the cuts outlined by my right hon. Friend the Member for Don Valley (Caroline Flint). However, we believe that cuts must be fair, and that cuts as deep and as fast as those proposed by the Conservatives and Liberal Democrats must be questioned.

I hope to secure a Westminster Hall debate in the new year about the impact of cuts on the voluntary sector, 32% of which relies on local authority funding. I know that many excellent third-sector organisations fear that the cuts will severely limit their work. Stockton is trying hard to protect our third sector, but will face real challenges. I should be interested to know how cutting funds for those organisations will do anything to further the big society programme on which the Prime Minister is so keen. The third sector is the big society in action, and exposing those groups to possible cuts seems incoherent given the emphasis on big society and localism.

Of course, we must not consider local authority cuts in isolation. PricewaterhouseCoopers forecasts that for every job lost in the public sector, another will be lost in the private sector. That means 1 million lost jobs. One industry that we know relies heavily on the public sector is the building industry, which has already lost out in Teesside as a result of the cancellation of the Building Schools for the Future programme, as well as the scrapping of the new hospital to serve the North Tees and Hartlepool area. Spending by local authorities boosts the economy, and there is no doubt that the cuts will indirectly make life difficult for many local businesses.

[Bob Blackman (Harrow East) (Con)]

Will the hon. Gentleman give way?

[Alex Cunningham]

No, I will not.

Let me finally say something about the Cleveland fire service, which is critical to the safety of people in the area that I represent. I am told by the Fire Brigades Union that 68% of Cleveland’s funding comes from a central Government grant. Given that that grant is set to fall by 25%, the chief fire officer is seriously concerned about the possibility that lives will be put at risk by the cuts. The seriousness of the situation is exacerbated by the fact that our local area has large numbers of high-risk COMAH— control of major accident hazards—sites owing to chemical and other manufacturing in the area. The Minister responsible for the fire service has already refused my request for him to visit Teesside and see the problem for himself. I have written asking him to meet local MPs across the political spectrum, as well as representatives from Cleveland fire authority, to discuss the issue here in Westminster, and I hope that I shall receive a positive response.

These cuts place our communities at real risk, and I hope that the Government will think again.