Smokefree England: Covid-19 and PHE Abolition

Alex Norris Excerpts

Thursday 12th November 2020 Commons Chamber

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to speak in such an important debate. I represent one of the less healthy constituencies in the country, but we could remove half of our health inequalities by being a smokefree community. That is what is at stake here. I therefore commend my hon. Friend the Member for City of Durham (Mary Kelly Foy) for securing the debate, which I understand is her first through the Backbench Business route, and congratulate her on her speech. She set out the challenge very well. The point she made about the current trajectory getting us there only by the mid-2040s was absolutely right. She also did the Minister an extraordinary favour in essentially laying down a tobacco control plan in her speech for you, Minister—sorry, Madam Deputy Speaker; I will never do that again. The Minister could clip my hon. Friend’s speech directly from Hansard and turn it into a tobacco control plan overnight. I think we are almost there, so I hope to hear positive noises from the Minister when it is his turn.

My hon. Friend the Member for Blaydon (Liz Twist) also made a strong case. I was particularly struck by the points made about smoking in pregnancy and with regard to those with mental health issues. We know from Pareto’s law that on any great journey the last 20% takes as much energy as the first 80%, and that is definitely the case with smoking cessation, so we will have to take a granular look at which groups are still disproportionately affected and target resources specifically in a way that works for them.

I was cheered when I saw the name of the hon. Member for Winchester (Steve Brine) on the call list. As he is a former public health Minister, I knew he would have an awful lot of insight to share from his time developing the previous tobacco control plan. His story certainly made me laugh. I agree with him wholeheartedly on a number of issues, particularly when he said that we should get our skates on. I agreed with his points about Public Health England, which I will expand on soon. The case for keeping everything in one place is profound and compelling; I completely agree.

The hon. Member for Strangford (Jim Shannon) seems to have perfected the art of being in multiple places at once, speaking in both Westminster Hall and here very quickly but with characteristic force and insight. I particularly liked the way he characterised this as a social justice issue, which is locked into communities. I relate to that from my home experience. I hope the Minister will address the point on e-cigarettes, which seems like a loophole that none of us would be particularly enthusiastic about.

Earlier this year, the all-party parliamentary group on smoking and health invited me to speak at a roundtable to discuss the next steps to secure the ambition, which I share with the Government, for England to be smokefree by 2030. Both the Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill)—she is responding to the Westminster Hall debate—and I highlighted the importance of cross-party working if we are to deliver that ambition. I want to reiterate that sentiment today. I thank the chair of the all-party group, the hon. Member for Harrow East (Bob Blackman), for inviting me to that event and acknowledge his tireless work in this space. I think it is only the nature of proceedings that has stopped him from contributing; I have no doubt he will be watching.

As the Minister said in our exchanges relating to tobacco last Tuesday, we can all be proud of the shared record of successive Governments over the last two decades in reducing smoking. I say everything in that context. We have a high degree of consensus in wanting to be smokefree by 2030, with that ambition shared by all. That was featured in the Government’s prevention Green Paper last year, which promised to build out a comprehensive approach. It has been more than a year since the consultation on the Green Paper closed, and we are still awaiting the Government’s response and the further proposals they promised, which are expected in January. Given that each day nearly 300 children start smoking, we cannot afford further delay, so the Minister ought to lay out a commitment on the timing of that response when he has his opportunity today.

In my city of Nottingham—colleagues have drawn on their examples from around the country, so I hope they will allow me to do so as well—21% of adults smoke, compared with 14% nationally. The figure is 29% among those in routine and manual occupations. One in six mothers smoked during pregnancy, compared to one in 10 nationwide, and smoking costs the people of our city about 75 million quid, £11.5 million of which comes in the form of NHS spending, which of course is under such pressure due to covid.

This is a social justice issue. It does impact on all communities, but not on all communities equally, and then, within this pandemic, has a compounding and knock-on effect on pandemic outcomes. The prevalence of smoking-related diseases—whether heart disease, respiratory diseases or diabetes—has undoubtedly impacted on the severity of the impact of covid on communities, especially ones like mine. Public Health England has identified these diseases as being very strongly associated with worse outcomes from covid. Of course, as we go into winter, with normal winter pressures and covid-related winter pressures, smoking puts extra pressures on our NHS. Again, there is much at stake for us.

In the covid context, I think we would all be encouraged by the rise in quit attempts and the success rates during the pandemic so far. Again, however, we know that that is not distributed equally. It tends to be older smokers in disadvantaged communities who are quitting in high numbers, not so much younger smokers. It is impossible not to think about the fact that the feeling going into a second lockdown is very different from going into the first. In the first lockdown people talked about ways in which they might improve their lives. I think I was going to re-learn French—I never did—but whether it was banana bread or committing to quit smoking, lots of people used that time very constructively. I worry about the impact of this second one, because there is definitely not the same level of optimism, if optimism is the right word. There will be people who quit six or so months ago who are feeling the pressure at this point, because quitting smoking is really hard. To those people, I think we would all send our solidarity and hope that they can keep going the course, because they are doing a brilliant thing for themselves and for their families.

I am greatly concerned by the Government’s decision to axe Public Health England in the middle of a pandemic. It seems a very odd thing to do. Certainly, without a clear plan for what the future of the health improvement work of PHE is going to be, it risks undermining the progress we have made on smoking and across all other types of health promotion issues. The success on smoking has been driven by a robust national strategy, strong regional delivery and effective, evidence-based local action. I think that is a really good model for smoking cessation and for all other areas of health improvements. I would be very keen to hear the Minister address the issue of when we are going to see an options paper for the future of PHE—I hope he will do so—but I also hope that he will commit to that model and be clear about how public health stakeholders are going to be able to contribute their views and expertise.

I am slightly surprised to have to say this, but, again, it would be good to hear a clear commitment, much in line with what the hon. Member for Winchester said, that the Government believe that this a national-level leadership role and that these functions ought to be together in one place. Whether that is in the Department, as the hon. Gentleman says, or stand alone, as they are currently, they should be in one place, taking a national lead and then providing support for the regional delivery and the effective local action. That has really worked so far, and I do not know why we would not want to do that. I would say to the Minister, as I have said to the Minister for public health—the Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds—that if the Government come to a sensible place on this, we will not run political victory laps. There is no value in that to anybody. I think we just need to get it done.

It is impossible to talk about Public Health England without relating it to public health cuts, which both my hon. Friends the Members for Blaydon and for City of Durham did. I know these very well; prior to this election, I was the custodian of Nottingham’s public health budget for three years. Extraordinary cuts to local government, particularly in the poorest communities, have meant diminished public health services, but particularly smoking cessation services. After we have paid for demand-driven services such as drugs and alcohol or sexual health, there is not an awful lot left. I am not sure that the point the hon. Member for Winchester made about the public health grant ring fence is meaningful. I understood it and I agreed with it, but I think that, as a fence, it has a lot of holes. If we looked up and down the country, we would see a lot of public health spending by name that we would not necessarily consider to be public health by discipline. We need to reflect on the impact of those cuts, because they only create greater financial losses for us later, and I will come to that shortly.

Analysis by the Health Foundation shows that nearly £1 billion a year is required to reverse the real-terms per capita cuts, and that an extra £2 billion a year would be needed for adequate investment in the most deprived communities, and that is before the pandemic struck. I am very concerned that virtually all of our local authorities will have to draw up some sort of in-year budget to deal with covid costs. The promise was made by the Ministry of Housing, Communities and Local Government that those costs would be met. That is clearly now not going to happen, so, again, will those cuts come from public health budgets? That is something that we should all be very concerned about, because, as the King’s Fund characterises them, they are the falsest of false economies. The cuts have damaged not only stop smoking service provision, but all sorts of other provisions, such as health visiting, sexual health clinics and others, and they are storing up problems for our future. I hope the Minister, when he has his opportunity to speak, will confirm whether the upcoming spending review will include an uplift to the public health grant given to local authorities.

Similarly, it would be good to hear a recommitment to national level quitting campaigns, because in their heyday—2008-09—public spending in this area was in the tens of millions. It is not anymore and PHE’s budget for anti-smoking campaigns, including Stoptober, which was estimated in 2012 to have generated an additional 350,000 quit attempts in England—a fantastic figure—has fallen substantially now to £1.8 million, which is a quarter of what it was six years ago. Again, these things work. The Department clearly recognises that, and we should recognise the work that PHE did with Action on Smoking and Health during the pandemic on “Today is the Day” campaign, which was targeted at those communities where rates are the highest, including the City of Nottingham, and we are grateful for it. Therefore, those things work and I hope that we can hear a recommitment in due course.

Just to finish, how do we get to being smokefree by 2030? Following the prevention Green Paper, the Smokefree Action Coalition, which includes ASH, Cancer Research, the British Heart Foundation and the Royal College of Physicians, launched the roadmap to smokefree 2030, which is a really good read and was endorsed by all sorts of leading public health organisations and the all-party group. It also has some great recommendations that the Government should engage with, so will the Minister share his reflections on that important document? We do have to come to a position on the issue of the levy on tobacco companies. We should recognise the work that is being done by tobacco companies to reformulate to safer alternatives, but it is still a very profitable industry.

I was going to pull my punch on what I was going to say on this and leave it quite broad, but as other colleagues have been braver than me, I thought that I had better be a bit braver, too. I do not like hypothecated taxes. If we start opening the door to hypothecated taxation, we will never fund unpopular things ever again, as we will just increasingly create a tax regime that fits around that. Nevertheless, a smokefree fund is attractive and could be a way to try to improve funding for public health grant services. Therefore, again, if the Minister has a preferred way forward on that, I think that we could seek to find a political consensus on it, because we know that it would be a challenging thing to do, but it could also be a very important thing to do.

I am conscious that the sector has told us what it thinks it needs, so now it is time for us to reflect on that and that has to be through, as a matter of urgency, a new tobacco control plan. Again, I hope that we will hear from the Minister on that. There is no room now for flapping and no room for the two-year gap that we saw previously; we must get on with this because, on the current trajectory, we will not make it. I hope the Minister will commit to that as a matter of urgency.

In conclusion, this is a shared goal and it is a significant prize. There are weaknesses in our current approach that we must address now. If we do so and we act decisively, we will make one of the biggest public health breakthroughs that we have made in our nation’s history, so let us grab this moment.