Tobacco and Vapes Bill

Andrea Leadsom Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

I want to start by thanking the many lung cancer and asthma charities, particularly ASH, for their advice, research and support. I personally pay tribute to the chief medical officer for England for his commitment to making the strongest possible case for this life-changing legislation, and to Health Ministers across the UK for their collaboration in what will be a UK-wide solution for future generations.

I was very disappointed with the hon. Member for Ilford North (Wes Streeting), who opened for the Opposition. I have said it before and I will say it again: I like the hon. Gentleman. He once said on air that that was death to his career! Why would he have said that, Madam Deputy Speaker? But I am really disappointed today, because he was not listening. My hon. Friends had some very sensible questions about consultation, and they raised very serious points about flavours for vapes and how they might help adults to quit. He was not listening; he was making party political points. In fact, he barely said anything sensible about the legislation. All he did was talk politics. I appreciate the fact that Labour Members have been whipped to support the Bill. On my side, colleagues are trusted to make their own decisions on something that has always been a matter for a free vote. [Interruption.] He sits there shouting from a sedentary position, political point-scoring yet again.

The hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) raised a very serious question about stop smoking services. I can tell her that the Government have allocated £138 million a year to stop smoking, which is more than doubling. The Government’s commitment to helping adults to stop smoking is absolutely unparalleled.

I thank the hon. Member for East Renfrewshire (Kirsten Oswald) for her support for the Bill, and for the collaborative approach of the Government in Scotland in their work bringing forward this collaboration among all parts of the United Kingdom.

I pay particular tribute to my hon. Friend the Member for Winchester (Steve Brine), the Chair of the Health Committee for his excellent speech and his strong case for long-term policies that will prevent ill health and thereby reduce the pressures on the NHS, which is so important. He asked when we will see the regulations and the consultation on vaping flavours, packaging and location in stores. It is our intention to bring forward that consultation during this Parliament if at all practicable.

I thank my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) for his tribute to Dr Javed Khan for his excellent report into the terrible trap of addiction to nicotine. My right hon. Friend made the point that it is simply not a free choice, but the total opposite.

I thank the Liberal Democrats and their spokesman, the hon. Member for St Albans (Daisy Cooper), for saying that they will support the Bill on Second Reading. I am not quite sure where they are going on the smoking legislation, but I am grateful for their support on vaping. I hope to be able to reassure them during the passage of the Bill.

The case for the Bill is totally clear: cigarettes are the product that, when used as the manufacturer intends, will go on to kill two thirds of its long-term users. That makes it different from eating at McDonald’s or even drinking—what was it?—a pint of wine, which one of my colleagues was suggesting. It is very, very different. Smoking causes 70% of lung cancer cases. It causes asthma in young people. It causes stillbirths, it causes dementia, disability and early death. I will give way on that cheery note.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I thank the Minister for giving way. I draw the attention of the House to my entry in the Register of Members’ Financial Interests as a practising NHS consultant addiction psychiatrist. Does my right hon. Friend share my concern that what we have heard from the libertarian right today is a false equivalence between alcohol and bad dietary choices, and smoking, and that moderate alcohol and moderate bad eating are very different from moderate smoking, because moderate smoking kills. It means that people live on average 10 years less and it means less healthy lives. Does she agree that this is not about libertarianism but about doing the right thing, protecting public health and protecting the next generation, and that is why we should all support the Bill?

[Dame Andrea Leadsom]

I am grateful to my hon. Friend, who makes such a powerful point and speaks with such authority. Similar points were made by my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who as a paediatrician spoke with great expertise on this matter. It is absolutely true: it is a false choice. It is not a freedom of choice; it is a choice to become addicted and that then removes your choice.

Every year, more than 100,000 children aged between 11 and 15 light their first cigarette. What they can look forward to is a life of addiction to nicotine, spending thousands of pounds a year, making perhaps 30 attempts to quit, with all the misery that involves, and then experiencing life-limiting, entirely preventable suffering. Two thirds of them will die before their time. Some 83% of people start smoking before the age of 20, which is why we need to have the guts to create the first smoke-free generation across the United Kingdom, making sure that children turning 15 or younger this year will never be legally sold tobacco. That is the single biggest intervention that we can make to improve our nation’s health. Smoking is responsible for about 80,000 deaths every year, but it would still be worth taking action if the real figure were half that, or even a tenth of it.

There is also a strong economic case for the Bill. Every year, smoking costs our country at least £17 billion, far more than the £10 billion of tax revenue that it draws in. It costs our NHS and social care system £3 billion every year, with someone admitted to hospital with a smoking-related illness almost every minute of every day, and 75,000 GP appointments every week for smoking-related problems. That is a massive and totally preventable waste of resources. For those of us on this side of the House who are trying hard to increase access to the NHS and enable more patients to see their GPs, this is a really good target on which to focus. On the positive side, creating a smoke-free generation could deliver productivity gains of nearly £2 billion within a decade, potentially reaching £16 billion by 2056, improving work prospects, boosting efficiency and driving the economic growth that we need in order to pay for the first-class public services that we all want.

I know that hon. Members who oppose the Bill are doing so with the best of intentions. They argue that adults should be free to make their own decisions, and I get that. What we are urging them to do is make their own free decision to choose to be addicted to nicotine, but that is not in fact a choice, and I urge them to look at the facts. Children start smoking because of peer pressure, and because of persistent marketing telling them that it is cool. I know from experience how hard it is, once hooked, to kick the habit. I took up smoking at the age of 14. My little sister was 12 at the time, and we used to buy 10 No. 6 and a little book of matches and —yes—smoke behind the bicycle shed, and at the bus stop on the way home from school. [Interruption.] Yes, I know: I am outing myself here.

Having taken up smoking at the age of 14, I was smoking 40 a day by the age of 20, and as a 21st birthday present to myself I gave up. But today, 40 years later—I am now 60, so do the maths—with all this talk of smoking, I still feel like a fag sometimes. That is how addictive smoking is. This is not about freedom to choose; it is about freedom from addiction.

There is another angle. Those in the tobacco industry are, of course, issuing dire warnings of unintended consequences from the raising of the age of sale. They say that it will cause an explosion in the black market. That is exactly what they said when the age of sale rose from 16 to 18, but the opposite happened: the number of illicit cigarettes consumed fell by a quarter, and at the same time smoking rates among 16 and 17-year-olds in England fell by almost a third. Raising the age of sale is a tried and tested policy, and a policy that is supported not only by a majority of retailers—which, understandably, has been mentioned by a number of Members—but by more than 70% of the British public.

[Tim Loughton (East Worthing and Shoreham) (Con)]

If I had known that my right hon. Friend was such a keen smoker, I would not have recruited her to the Conservative party at the tender age of 18 when we were at university.

I have always taken a free-choice approach to health matters, and as shadow Children’s Minister I had to lead on both the tobacco advertising ban and the public smoking ban. We were wrong to oppose them. Who would now think it remotely normal for people to be able to smoke around us in restaurants and other public places? Does my right hon. Friend not agree that in a few years’ time this measure will seem just the same as banning smoking in public places, and people will ask why we did not do it earlier?

[Dame Andrea Leadsom]

As I have said ever since I met my hon. Friend at the age of 18, he is always right. I can never disagree with him.

I want to say a few even more furious words about vaping. It is just appalling to see vapes being deliberately marketed to children at pocket-money prices and in bright colours, with fun packaging and flavours like bubble gum and berry blast, and with the vape counter right next to the sweet counter.

[Sir Jake Berry]

Before my right hon. Friend gets too furious about vaping, may I ask her to clarify two points on smoking? First, she said that because of the addictive nature of nicotine, it is extremely important that we stop people smoking from the age of 15. I do not support that, but if it is so important, why are we not starting at 17? It is already illegal for 17-year-olds to smoke. What is the magic of 15? If we really believe in the policy, why delay? Secondly, she spoke about her own experience, and I am a former smoker myself. She started smoking at 14, and I started smoking at about 14 as well. It was illegal when I started smoking at 14, but it did not stop me. I am a lawbreaker—how shocking. Why does she think that this ban on people starting smoking when under age will be different?

[Dame Andrea Leadsom]

I am grateful to my right hon. Friend for raising those really important points. As I will come on to, we will be putting £30 million of new money each year into trading standards and our enforcement agencies to clamp down on enforcement, and we are making it illegal to sell cigarettes to anybody turning 15 this year. He asks why. It is precisely because we are trying to bring in the Bill with a decent amount of notice so that people can prepare for it, precisely to protect retailers and allow all the sectors that will be impacted to be able to prepare.

I come back to the area where I am seriously on the warpath: targeting kids who might become addicted to nicotine vapes. I went to Hackney to visit some retail shops, where I saw the vape counters right next to the sweet counters. I saw that it is absolutely not about me—it is not about trying to stop me smoking. It is about trying to get children addicted through cynical, despicable methods. Sadly, for too many kids, vapes are already an incredible marketing success. One in five children aged between 11 and 17 have now used a vape, and the number has trebled in the last three years.

[Kirsten Oswald]

I am grateful to the Minister for giving way as she ploughs through all of this. I wonder whether she can share her views on the advertising of vape products on sports kits and via sports facilities.

[Dame Andrea Leadsom]

The hon. Lady is aware that there is already very restrictive advertising for smoking and vaping. We are very concerned that some advertising is breaching advertising standards regulations, and I will write to retailers specifically about that.

Parents and teachers are incredibly worried about the effect that vapes are having on developing lungs and brains. The truth is that we do not yet know what the long-term impact will be on children who vape. Since I was appointed, I have done everything I can to ensure that this Bill will protect our children. The Government’s position is clear: vaping is less harmful than smoking, but if you don’t smoke, don’t vape—and children should never vape.

We will definitely make sure that people who smoke today continue to have access to vapes as a quit aid, which will absolutely not change, but we cannot replace one generation that is hooked on nicotine in cigarettes with another that is hooked on nicotine in vapes. That is why we are using this Bill to take powers to restrict flavours and packaging, and to change how vapes are displayed in shops. To reassure the Chair of the Health and Social Care Committee and my right hon. Friend the Member for Rossendale and Darwen (Sir Jake Berry), we plan to consult on that before the end of the Parliament, if practicable. The disposable vapes ban will likely take effect in April 2025—those regulations have already been published.

These are common-sense proposals that strike the right balance between helping retailers to prepare, giving sufficient notice and protecting children from getting hooked on nicotine, while at the same time supporting current smokers to quit by switching to vapes as a less harmful quit aid, supported by £138 million a year. Our approach is realistic for those who smoke now and resolute in protecting children. I am convinced that, just like banning smoking in indoor public places and raising the age of sale to 18, these measures will seem commonsensical to all of us in 10 years’ time. In decades to come, our great-grandchildren will look back and think: why on earth did they not do it sooner? I urge all right hon. and hon. Members to vote for this Bill as the biggest public intervention in history. I commend the Bill to the House.

Question put, That the Bill be now read a Second time.

Tobacco and Vapes Bill (First sitting)

Andrea Leadsom Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[The Chair]

Minister—your questions.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Do you want me to ask both questions now?

[The Chair]

Yes.

[Dame Andrea Leadsom]

Could you talk us through ASH’s assessment of the economic cost to the UK economy of smoking? Secondly, what is your view on the importance of restricting vaping for children?

[The Chair]

Can we start with Sheila Duffy, please?

Sheila Duffy: In terms of a complete ban, you are talking about a ban on retail distribution of tobacco. The hope is that we will put it out of sight and out of fashion for the generation growing up. My preference is always to look at the product and the industry, rather than the consumer, so we need to maintain other issues like good fiscal policy, high price and tax.

On packaging and flavours, we know that the tobacco industry sold the sizzle on tobacco—it sold the image, it sold how it made people feel and it sold the very short-term-felt attractions and benefits. In the 1950s, people were recommended smoking to appear glamorous, to appear rugged and confident and to clear their chests in tuberculosis hospitals, and we did not know at that time how devastatingly harmful it was to health and how many years of life it would rob people of.

We must learn the lessons. It is the sizzle. It is the packaging, the marketing, the promotions that we must get on top of with vaping products, because that has driven the interest among young people, and the exponential —the doubling, tripling of regular use among children that were not smoking. There is a link between regular vaping and moving on to smoking, which I can send you the evidence for.

In terms of the economic cost, the World Bank looked at this years ago. Tobacco is not good value for any economy because the long-term costs are huge. What you are talking about is privatising the profit but socialising the costs, and that is a huge burden on the NHS and a huge burden on people’s lives. It undermines their health and the health of their families.

The final question was on the importance of restricting e-cigarettes for children. Well, let us learn the lessons from tobacco and let us take some strong steps to stop the next generation becoming addicted. I note that the devices mainly being used under-age and by children are of the highest permitted nicotine level. They are advertised with bright colours—cartoon characters in some places. They are absolutely all over social media and there is money going into influencing. These are being targeted. We are not talking about medicinal use. We are talking about recreational products, which are addictive and health-harming. We have to get on top of this.

[The Chair]

In view of the pressure on time, I ask the two other witnesses, if they agree with what has already been said, to say so and then make any additional points that need to be made. Obviously, if you do not agree, that changes the nature of it.

Deborah Arnott: I agree with the points being made. On the costs of smoking, the Minister has cited our figures to date—thank you for that. We have done a lot of work on this. New figures will be published next week, so we will give an update on those and on what additional costs we think there are, other than the ones that have been taken into account by the Government so far. That will be available for the Committee, too.

[Dame Andrea Leadsom]

Q Would you state your latest research for the record, though? Obviously, this Committee is here to provide the evidence on the record.

Deborah Arnott: I would rather not summarise it now, but it will come very quickly and we can provide it to the Committee in advance of publication, so the Committee will get the full details.

[The Chair]

Thank you.

Deborah Arnott: I would like to go on to talk about Preet’s question about clauses 61 and 62, and I would also like to talk about clause 63, because they are the ones that are absolutely crucial to prevent vapes from appealing to children.

I do not know whether I am allowed to do this, but I will show the Committee these things. This is a completely reusable vape and this is a completely disposable vape. They look almost identical and they are the same price. The disposable vapes ban being implemented by DEFRA will get rid of disposable vapes—

--- Later in debate ---

[The Chair]

We will also take the Minister, and then we can answer both sets of questions together.

[Dame Andrea Leadsom]

I am also interested in the impact of smoking and vaping on children’s hearts and lungs in particular. I would very much appreciate hearing the professional assessment of you both of the particular vulnerability of children’s lungs and hearts, as compared with adults. I know that the Opposition spokesman and I share that grave concern, as do a number of colleagues. My second question is: do you expect the smoke-free generation policy to stop young people starting smoking?

[The Chair]

I do not know which order you want to take the questions in.

Dr Griffiths: I am happy for us to do a double act between us.

Thank you for such clear questions. In terms of inequality, we know that the burden of smoking falls unevenly. We have a third more smokers in the third most deprived areas, so it affects people’s health unequally. Heart disease is the world’s biggest killer, and there is absolutely no doubt that smoking is one of the major drivers of cardiovascular disease, so the picture is clear and very well established from an inequalities point of view.

In terms of young people, we share your concern at the British Heart Foundation. It scares me to think that, today, 350 young people will start smoking for the first time—and the same tomorrow and the day after, and the day after that. We know that a huge proportion of them go on to become long-term smokers. Tragically, we see the burden and the cost to life and quality of life that that causes, with about 15,000 deaths every year across the UK from heart and circulatory disease associated with tobacco. So, we are deeply worried about people starting, and it is not just us at the British Heart Foundation who are worried. We know that the majority of smokers wish they had never started, but nicotine is an incredibly addictive substance. Once people have started, it is incredibly difficult to stop, so we share your concern.

Just to cover two things on the biology, the way that smoking is so damaging to our hearts and circulatory system is manifold. It damages the lining of our circulatory system, causing our arteries to clog up with fatty deposits, which puts us at an incredibly high risk of heart attacks and strokes. We know that a smoker’s risk of having a heart attack is double that of someone who does not smoke. For stroke, the risk is three times greater, but if someone smokes 20 cigarettes a day, they are six times more likely to have a stroke. So, there is really clear evidence on the biology that smoking is damaging.

We are deeply worried about young people starting, which is where the power of this Bill comes in. What an opportunity to create, for the first time, a smoke-free generation, relieving tens or hundreds of thousands of people from the risk of death and disability from smoking. We, as the BHF, would urge for the Bill to be pushed through in full.

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[Dame Andrea Leadsom]

Q I asked a specific question about children’s asthma and children’s heart damage. Could I urge our witnesses to respond to that question?

Dr Griffiths: Thank you, and apologies if we did not cover that as clearly as we could have. Obviously, there is no such thing as a safe cigarette, there is no safe number of cigarettes to smoke, and there is no safe age to start smoking at all. We would emphasise our concern for children starting to smoke, because the damage starts as soon as you start smoking. There is no safe number of cigarettes to smoke. Combined with that, the fact that nicotine is so addictive that it leads to most people—over two thirds of those who start—becoming long-term smokers, worries us enormously. In terms of both the risk and the damage of starting smoking, the number of people who start and the fact that they go on to adopt a lifelong smoking habit caused by nicotine is of deep concern to us.

Sarah Sleet: It is worth thinking about children’s wider environment. Children who live in households where the adults smoke are four times more likely to smoke themselves, and find it much harder to give up. Children are getting into a cycle of deprivation and damage to their long-term health right from the very beginning. For children, stopping smoking availability is going to be profoundly helpful for their future lives, their ability to contribute to the economy and their overall prospects. This Bill, which tackles the issue from childhood up, will be one of the most profoundly important health interventions that you can make.

[Preet Kaur Gill]

Q I think the Minister was referring to vapes and the evidence based around the impact on growing lungs and hearts. Is there anything you would like to say about that before we move on?

Dr Griffiths: As Deborah from ASH said, vapes are a fairly new product, so the research and evidence base, which we have in abundance for tobacco and smoking, is still forming for vaping. However, there are indications that it is not great for health. We are cautious and worried about the long-term implications. What we do know is that vaping can be an important cessation tool for those trying to quit smoking, and that many do want to quit, so we strongly encourage anything that stops smoking, but the people who are turning to vaping as an alternative to smoking for the first time is of deep concern to us. We do not understand the long-term health implications, but the addiction to nicotine deeply concerns us.

Sarah Sleet: We strongly agree. It is a very delicate balancing act between stopping the harm caused by smoking and looking to the long-term with regard to vaping. Quite clearly, smoking is far more damaging for adults and children. Anything that can steer people away from smoking will be healthier than continuing to smoke in the long run, but we do recognise that more attention and more research need to be put into vaping.

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[The Chair]

I am going to take the Minister at this point, and then Preet Kaur Gill.

[Dame Andrea Leadsom]

Q Some people say that the smoking generation does not need to be raised a year higher every single year. Can you say for the record what your view is of that? Does it need to keep lifting each year?

Dr Griffiths: We support the Bill exactly as it is written at the moment. It is really important to recognise that, as proposed, it does not inhibit anybody who is currently a smoker from purchasing tobacco, but it does take us on a really clear and, I believe, a transformative path to a smoke-free generation.

[Dame Andrea Leadsom]

I understand that, but why?

Dr Griffiths: Because it is a really clear path to make sure that we move to a situation where we have a generation that is prohibited from buying cigarettes, and who are disincentivised from doing so.

Sarah Sleet: We have heard today the evidence about just how harmful and destructive smoking is, particularly for people in more deprived areas. If we really want to tackle that, we need to remove smoking as a normalised, available, legal option going forward. This seems to me a very measured and thoughtful way of introducing a smoking ban that will take hold. It is very important for our children going forward.

[Preet Kaur Gill]

Q I want to ask about the information that is given to parents, especially if their children have never smoked but have taken up vaping. We know that a generation of children is becoming addicted to nicotine because products that have been classified as 0% nicotine do actually contain it. One of the parents that I spoke to asked, “Well, how many puffs are there in one vape? If my child has two or three of those in a day, what does that actually mean?” It is about the information on that sort of risk, and how we share that information with parents who are trying to address this issue with their children. Is there anything you want to say about that, and is there any research being done to look at that?

Dr Griffiths: I would observe that there is so much variation between products and how people are consuming them. I think it is quite difficult to give advice in a standard way, and that it is part of it being an emergent product and market. As we have discussed, there is no doubt that, with nicotine being so deeply addictive, it is an incredible worry that a child has a single puff on a vape, given the potency of nicotine and where we know it leads people, having seen that over generations with smoking.

I should perhaps take a moment to emphasise that we also really support the £70 million investment being allocated to public health campaigning and cessation services, as well as enforcement. You are right that we need to be really clear with the messaging of the Bill to encourage support from parents and others around children in particular. We really applaud the decision to put resourcing behind this as well. We know that effective public campaigning can be an incredibly powerful tool. We were really proud to run the “Give Up Before You Clog Up” fatty cigarette campaign way back 20 years ago, and we know even that campaign led to 14,000 smokers seeking to quit. We know public campaigning works, and it was a great thought to allocate that resource as part of this work—it will be needed.

Sarah Sleet: The variation in nicotine levels and the method of delivery, which affects the uptake of the nicotine, is undoubtedly very concerning in vapes. I am a mother of three adult children who all vape, and I am very concerned about how often they are doing that and what impact that is having. We must also remember that, from what we know at the moment, it would appear that smoking is far and away the most damaging activity, compared with vaping. There is a little bit of concern that we overemphasise the harms of vaping to the extent that people say, “Well, I might as well smoke then. I’ll do that instead.” We need to be very careful about how we have this conversation.

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[Preet Kaur Gill]

Q Thank you, Chair, and I thank the witnesses for giving evidence today. First, is under-age smoking or vaping the bigger issue in schools today, and what is the impact on education, behaviour and so on? Secondly, will the measures in the Bill to restrict sales of vaping products to children under 18 work, in your opinion?

Matthew Shanks: It is an interesting question, whether vaping or smoking is more popular among children in schools. All I can say is that it has increased in the past three or four years. We see evidence of vaping; it is more difficult to catch children vaping, because of the size of the vapes, the fact that the smell is slightly different and does not set off smoke alarms in the same way, and so on. I think it is fair to say that smoking and vaping are still as popular as they were among younger children in certain areas, and vaping is being seen to be a safe alternative.

The marketing of vapes in different flavours and colours makes them akin to a progression from chewing gum for some families—with bubble gum flavours and so on. There is also anecdotal evidence of parents talking about, “If it’s grapefruit, it must be safe.” There is that evidence around it as well out there—because of the way in which vapes are marketed, and if you see them in shops, they seem safe and okay.

With behaviour, the size of vapes makes it very difficult to admonish children, because they can hide them very easily. They can look like mini hard drive sticks—I think that is deliberate targeting in how they are marketed, with the cleverness of it. Certainly in terms of behaviour, it is something else that we are dealing with, when we say to a child, a teenager, “You’ve been vaping”, but they say, “No, I haven’t”—there is nowhere for us then to go, which immediately sets up an issue.

The earlier question about toilets was interesting, because children tend to vape in toilets. It is easier for them to vape in toilets than it was for them to smoke in toilets. You just need to see people on public transport vaping—it is easy for it to dissipate and disappear quickly. So, yes, I would say that vaping is a real issue in schools for children.

Patrick Roach: I support fully what Matthew has just said. I do not think that it is an either/or; the reality is that smoking is a threat to children and young people, in terms of their health and wellbeing and their ability to participate and progress educationally, but so too is vaping.

The NASUWT, at the start of this academic year, published our own research into vaping in schools from the perspective of teachers and school leaders, and it very much reinforces what Matthew has just said, in that vaping is pretty much predominant as an activity taking place among secondary-aged pupils. But we are also seeing teachers reporting pupils vaping from as early as 10 years of age, so the primary phase is also impacted. Three quarters of teachers report a significant increase in the participation in vaping by pupils in their schools, so we are seeing an upward curve in respect of vaping activity within schools.

On the issues that have just been mentioned about the difficulty that schools have in detecting and controlling this kind of behaviour, the way in which vape products are available to pupils is that they are masquerading as hard drives, as highlighter sticks or as other things that it would be legitimate for a pupil to bring into school. This is not like a situation in which you catch a pupil with a packet of cigarettes and you confiscate it; first, you have to identify what on earth it is that that pupil has. At the end of the day, good order in schools is dependent upon there being trust and respectful relationships between teachers and students. You cannot go around every moment of every day asking pupils to turn out their pockets and then inspecting what is in them.

The reality is that we are seeing the impact of vaping not just on pupils’ health, because we are seeing pupils who are presenting as ill as a result of the overuse of vaping products—although, in fact, all of it is overuse—and therefore becoming ill in schools, but on educational participation, progression and achievement. When pupils are diving off into the toilets to vape, that interrupts teaching and learning. When pupils are late arriving at school, perhaps because they have been vaping en route, that impacts on pupils’ learning. We are also seeing bullying behaviours within schools because, quite often, vaping products are being informally circulated, exchanged or acquired. Therefore, it becomes another source of behavioural challenges for teachers and head teachers. So, from a teacher’s perspective, vaping is a serious issue within schools, and one that we are pleased that this Bill is seeking to address.

[Dame Andrea Leadsom]

Q Thank you so much for being here, and also particularly for the work that the NASUWT has done in terms of the impact on schools. Could you expand on that a bit further? I have done a couple of visits ahead of this Bill. I met enforcement officers, for example, who gave me anecdotal evidence that teachers say that pupils will return to the classroom with their eyes spinning and unable to concentrate because of the heady nature of whatever it is they have just been vaping or smoking. There was another anecdote about a school where children decided to drink the vape fluid and the school actually had to have a sort of emergency evacuation as a result of that.

Could you therefore expand on that, in terms of the specific health impacts and, at the one end, the ability of children to concentrate on the class when they are spaced out on vapes, and, at the other end, the very real risk to children from doing something stupid with a vape that was entirely unintended, with disastrous consequences?

Patrick Roach: I very much appreciate your remarks about the research that the NASUWT has undertaken. We come at the problem of vaping from the point of view of our members in classrooms, in schools the length and breadth of the country. What do teachers need in order to be able to teach effectively and what do they believe that pupils need in order to learn effectively? They need good order in the classroom.

My perspective is not that of a medical practitioner or of someone wanting to assume that I have the knowledge about the impact of vaping on a child’s physical development. Our concern is the impact on a child’s educational development, participation and achievement. The reality is that everything you have mentioned there is absolutely right, whether it is about the way in which vaping products might be unintentionally used by pupils; or about how they seek to conceal them about their person; or, indeed, the drinking of vaping fluids, as if somehow that will get the high without necessarily being detected; or about the use of vaping products as a stimulant, which impacts not only on concentration but on behaviour and, indeed, on a child’s wellbeing in the classroom.

Matthew has already referenced the difficulty of detecting vapes sometimes, because they can dissipate very quickly; and they can also trigger fire alarms in schools. We have had plenty of examples of teachers and headteachers reporting that their school has had to evacuate the building not just on one or two occasions in a day but multiple times—five or six occasions. That is a loss of learning not just for one pupil or class of pupils but the entire school. We are really concerned about the impact of all that.

Teachers are not just concerned about a child’s educational development, though; they are also concerned about a child’s wellbeing in the round. Teachers are reporting the very damaging impact that vaping can have on a child’s mental and physical development, just as smoking can. That is one of the reasons we have spoken out—and we are pleased that the Government have responded—to say that we need to be doing more to strengthen the enforcement of rules around vaping, access to it and the availability for school-age pupils. We need to do as much as we possibly can to prevent any school-age pupil from getting access to vaping products, whether in or outside school. We are pleased that the Bill seeks to do just that.

Matthew Shanks: I absolutely echo and reinforce what Patrick has said. Also, as school leaders we are looking after teachers, but we are caring for families as well. The Bill will help families to understand that it is not okay for their children to vape. Anecdotally we have parents saying to us that they let children vape at home, because it is better than them smoking or being out on the streets; parents do not see the harm in it. It is really important that that is recognised. The banning of tobacco sale was interesting in terms of the prescription of it; I would posit that at the moment vaping is seen as safe by the general public.

[Kirsten Oswald]

Q I wonder if you can develop some of the points you have made, which have been very useful. I am hearing anecdotally about issues in schools where the addiction of children to these vapes is itself causing a problem, because the children are unable to sit in the classroom and have to go out to vape, with whatever excuse is made, so that they then feel able to come back to the classroom, such is the level of their addiction to these products. If I may go beyond that slightly, what are your views on the way these things are promoted—for instance, on our particular concern about vape companies advertising on sports strips and in sports stadiums, and the impact on the same young people who are so addicted?

Matthew Shanks: I completely agree. The way in which vapes are marketed—the colours, flavours and so on—and the places where they are marketed suggest to people that they are safe. The fact that they are put forward as a “safe” alternative to cigarettes, the fact that parents use them and the fact that there are lots of colourful vape shops open in high streets: all those aspects promote the idea that vaping is okay.

At the same time, getting into a child’s mindset—we have all been there, as children—we like to break the rules and feel like we are pushing at boundaries. We know that it is not okay, but it is made okay. I would suggest that more children engage in vaping than in cigarette smoking, because they are not sure what the harmful effects are. That is the danger in it. I do think it leads on, because the younger children vape, but by the time they are 16 or 17, vaping might not be cool any more, so they go on to cigarettes or other things.

Anecdotally, we have heard of schools down in the south-west where people are putting cannabis into the vapes, so the addiction grows from that point of view as well. It leads to children coming out of lessons agitated. If I did not have three coffees in the morning, my agitation would be quite high. If children are not getting nicotine, as well as going through all the other things they are going through, they really do present as confrontational to staff, which makes it difficult to deal with them in classrooms and engage them in their learning. At the same time, to repeat a point I made earlier, you have parents at home who are saying, “Well, it’s okay to do.” I absolutely concur about the way it is marketed and so on.

Patrick Roach: To add to that, because those are important points: vape producers and manufacturers, and indeed those supplying vapes, are advertising freely in ways that make their products increasingly attractive to children and young people, with the way vapes are advertised and the marketing descriptors used for them. All the evidence we have, and certainly what our members tell us—our survey was of 4,000 teachers, so this is not anecdotal; it has an impact right across the system— suggests that the way those products are marketed and described deliberately seeks to entice young people to make use of them.

We believe that this is a strong Bill that very clearly sets out the societal expectations in this space, but as with any legislation, there is always scope for loopholes. If there are areas in the Bill where there is potential to further strengthen the legislation, I think the enticing way products are described, before an individual understands what they are getting themselves into, is something that needs to be considered and addressed.

From our point of view, it is about advertising, but it is also about access to these products. With the best will in the world, and no matter how they are advertised, if the products are easily available at the point of sale it makes things incredibly difficult. I remember that when I was bringing up my own children I worried about going to the supermarket with them, because they would be surrounded by candy and sweet products at the checkouts. You could not navigate your way through the checkouts. Thankfully, things have moved on: that has changed, and many parents are benefiting from those changes.

Young people are very much interacting with many of these products at the point of sale. They are in the shops that are in the vicinity of or on the route to and from school. They are being marketed in places that young people will frequent, whether that be a local café, the hairdressers or the barbers. They are in places where young people will be. They are also immediately available. The more we can do to stop the immediacy of marketing of these products and that easy availability, no matter how they are described, the better.

--- Later in debate ---

[Preet Kaur Gill]

Q Welcome, Paul. It is good to have you here. My first question is simple and straightforward: what is Age UK’s view on the Bill?

My second question is this. I know that over-65s are much less likely to smoke. I have a constituent, Eric, who has suffered from a stroke and has suffered with chronic obstructive pulmonary disease and is now a tobacco campaigner in his 80s. Why is this Bill important to the people Age UK works with?

Paul Farmer: Age UK fully supports the proposed legislation, and we have been working alongside the Richmond Group of Charities to highlight the significant health benefits of phasing out smoking, which will help individuals and have a wider impact on society. It will have particular benefits for the NHS, which as we know faces significant challenges at the moment.

Our job at Age UK is to think about not just the health and wellbeing of older people as they are now—I will come to your second question in a moment—but issues affecting future generations of older people. This is quite a rare opportunity for us to have a significant impact on those future generations for reasons we will look at later.

It is worth noting, however, that this Bill is heavily supported by older people. Polling shows that 69% of over-65s support it. Why is that? That goes to your second question. We know from older people and the work we are currently doing that health and wellbeing in later life is pretty much the top priority for older people. Age UK has recently published our blueprint for older people for the next few years, as we enter an election year. It is very clear from the work we have done with older people that health and wellbeing is right at the heart of what is most important for people.

Of course, that is logical: the ability to feel well, remain active and maintain our independence is a major determinant of the quality of life that we aspire to in later life. We also know that there is a huge gulf in life expectancy and life experiences between those who have the opportunity to age well and those who do not. I will not go into the points your earlier witnesses made about the importance of healthy life expectancy in detail, but that is right at the heart of older people’s considerations. It is important that we do something about the fact that healthy life expectancy for those who are most disadvantaged is quite so stark.

How does that affect smoking? As you know, smoking is a leading cause of death and disability. It is responsible for half the difference in healthy life expectancy between the most and the least affluent communities. People living in the areas with the lowest healthy life expectancy are 1.7 times more likely to smoke than those living in the highest healthy life expectancy areas. These are fundamental reasons why the intervention of this legislation will make a difference.

[Dame Andrea Leadsom]

Q I really appreciate your being here—thank you. I would like to tackle the fact that young people tend not to consider either their own mortality or their health and wellbeing. The majority of young people tend to take those for granted, and yet there is a complete correlation: the age at which you take up smoking—or, indeed, vaping—is when you are young and feel pretty immortal, or are at least not concerned about later life.

Could you give us a view, as an Age UK representative, of the sort of advice that older people who have smoked all their lives and are now bearing the brunt of the decisions they took would give to those who argue, “It’s a matter of personal choice. Everyone should be free to smoke if they want”? What would an older person say to that young person?

Paul Farmer: I think a lot of people would say that they wish they had never started. Those are certainly the conversations we have been having with older people in preparation for this session. The reason for that is that, as you enter into your later life, you start to understand the consequences of smoking through your personal experience. The list is frightening.

[Dame Andrea Leadsom]

Q For the record, can you outline some of those experiences? Obviously this is a public evidence session and we are looking to make the strong case for this Bill.

Paul Farmer: Very clearly, there is the relationship between smoking and multiple forms of cancer, COPD, pneumonia, heart disease, aortic aneurysm and stroke, vascular diseases, diabetes, rheumatoid arthritis, hip fracture, cataract and macular degeneration—and dementia. In a society where we are increasingly debating dementia’s impact, I think the relationship between smoking and dementia is a really important context.

These are in and of themselves very challenging physical health conditions, but we can also see the correlation with people who experience multiple long-term conditions. I think many older people who experience those multiple long-term conditions—who have to live with the impact of them often because they smoked in their early life—would say this impacts on the individual being able to do the things they want to do in their later life. There is a severe detriment on pursuing their ambitions of later life as a result of having smoked in earlier years.

[Dame Andrea Leadsom]

My last point: may I just pursue that—

[The Chair]

Very briefly.

[Dame Andrea Leadsom]

Q Thank you. Would that older person suffering those consequences say: “Yes, it was all a matter of free choice”?

Paul Farmer: I think different people will have different opinions about choice, and whether it was as a result of choice. I think what many older people have been telling us is that if they had known about the damaging consequences of smoking, they would not have started in the first place and would certainly have considered it in a greater way.

I want to pay huge tribute to colleagues at British Heart Foundation, who I know you have just heard from, who I think have taken the best way of trying to campaign over a long term on this issue. This is a long-term issue. Sadly today’s generation of older people is seeing the consequences of what has not happened.

[Kirsten Oswald]

Q Could you explain who “older people” are? Sadly, I recently recognised that that might include more of us than we might like to believe. We need to take that on board. What I am really interested in are the different demographic groups, and where you think there might be disproportionate levels of harm from tobacco and vaping within the groups of older people that you support.

Paul Farmer: We work with people over the age of 50, which may be news to some of you here. One of the reasons why we have recently chosen to drop the age group that we increasingly work with is precisely for prevention and early intervention.

This is not the earliest intervention; you can, of course, argue that many health interventions need to take place among children and younger people. However, from an Age UK point of view, we know that there is potential to intervene in people’s lives and support them to live healthier lives—it is not just about health, but in this context it is mainly about health—which means that your healthy life expectancy can improve and, as I mentioned earlier, you can fulfil some of the ambitions of your later life. The burden on the NHS of unhealthy life expectancy is a big issue.

The bulk of our direct work is with people over pensionable age, if you like. In each of those generations, you see the differences in experiences of smoking. Somebody now in their 80s or 90s almost certainly will not be alive if they are a heavier smoker, because they probably will not have benefited from any of the public health information that has taken place under previous Governments, so that is obviously the major difference.

In terms of the different health conditions, we know that certain health conditions will increase with age. Dementia is the greatest example of that, where we know that the older you are, the more likely you are to develop dementia. In a sense, as our population as a whole has gotten healthier and lived longer, it has become increasingly apparent where those health inequalities are at their most acute.

Tobacco and Vapes Bill (Second sitting)

Andrea Leadsom Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[Preet Kaur Gill]

Q In what circumstances do you envision that local enforcement would not be enough and the Secretary of State would need to use the powers to intervene granted to her by the Bill? That is in clause 64.

Cllr Fothergill: We fully support the local penalty notice being issued by the councils. We believe that that is the right way to go and that it will not clog the courts, but there is always the option to refer to the magistrates court if required. Our big concern is the size of the fine, which we believe needs to be reviewed: £100 or, if paid within 14 days, £50 is hardly a penalty. We argue that we need to have greater opportunity to fine those in contravention of the law. Then, we believe, there would be less and less need for the Secretary of State to be involved. The reason he or she would need to be involved is if we cannot contain it—because we cannot issue enough penalty notices to contain it locally.

Greg Fell: A similar issue would be multi-local authority enforcement scenarios. We know that organised crime networks are not linked to an individual area, so it stands to reason that there will be a need for enforcement that cuts across many authority areas, hence there is a need for networked trading standards. That might also include, possibly, the borders—stopping the imports of illegal vapes and tobacco.

Additionally, as Councillor Fothergill said, we are concerned about the size of the fine. Certainly I hear through DPH parochially, who talk to their trading standards and licensing teams, that when there is a much larger fine that may or may not be linked to the removal of an alcohol licence, that will make a retailer really sit up and think.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Q I appreciate you being here. Can you give me an idea of the LGA’s view of a licensing regime? That is not proposed in the Bill, but some people say that licensing would be a better alternative than the measures we are proposing here.

Cllr Fothergill: Certainly. Although we fully support the Bill, we think there could be one or two changes, which I have already referred to—we would like to see amendments—and there is the option of a licensing scheme, which we would support. If it was done on a similar basis to liquor licensing, we would be able to enforce that, because it would be backed by legislation. Of course, we would need to make sure that trading standards were fully funded for that. We would support that, if it was something that the Government brought forward.

Greg Fell: I cannot speak for the LGA’s position; ADPH does not have a formal view on licensing. I would broadly support it, but there is a danger that putting that into the mix delays getting the Bill through Parliament and turned into an Act, and getting the Bill through Parliament is arguably the most important thing.

I would broadly support that, but I come back to the complexity. Vapes are sold in hairdressers and beauty parlours and so on, so we would need to think it through. Arguably, if we are going to get into a licensing scheme, that should be for tobacco and nicotine-containing products, not just vapes; I would personally go to tobacco as well. Critically, the resourcing to make it work properly would need some very careful thought and consideration. All of that would need to be in the mix, but broadly I would support it, with those caveats.

[Dame Andrea Leadsom]

Q You have already said that you do not think the penalties are high enough, but do you think that the enforcement rules as they are, with the proposals to change the packaging, move the location of vapes and so on, will make it easier or harder to enforce? Do you think that enforcement officers will have sufficient time to train and gear up to meet the challenge of the legislation?

Cllr Fothergill: Specifically on vaping, we support the move to plain packaging, moving them away from the counter and restricting flavours—we support all those things. I have to say that we recognise the role of vaping in helping people to give up smoking, but where children and younger people are involved, we want to move the vapes away and make them less accessible. Trading standards will enforce that, as long as there are clear definitions of what can be sold, where it can be sold and who it can be sold to. A lot of the work that they do is evidence-led, so they will work on people who are giving them tip-offs or where they are seeing that there is a trend in an area where those products are being sold. As long as we are resourced and we recognise that a lot of that evidence-led work is required, it is entirely achievable.

Greg Fell: I have a fairly similar view. Largely, trading standards do this work now. The easier and simpler we can make it, and the more we make sure that it is resourced appropriately, the better, but they largely do this job now pretty well.

[Rachael Maskell (York Central) (Lab/Co-op)]

Q My question is for Greg Fell. The clarity and simplicity of knowing where you can smoke has meant that the universal principle of that bar has largely been applied, but it has not applied to vaping to date. Given that vapes contain not just nicotine but cannabis, Spice and other illicit substances, should the same restrictions be applied to vaping?

Greg Fell: Hopefully only illegal vapes contain cannabis or Spice, and not legally produced ones—I sincerely hope that is the case. I have mixed views on vaping in public. I think that Prof McNeill will talk later this afternoon. It is worth reading her evidence review for the Office for Health Improvement and Disparities, which has a whole chapter on the passive inhalation of vapes. The ADPH does not have an official position on the passive inhalation of vapes, but my personal view is that in open spaces I am not too worried about it. In enclosed spaces, I might be, particularly for people who have pre-existing respiratory conditions, but I do not think that the evidence supports it being as big an issue as people think. However, that is definitely a question for Prof McNeill, who is the expert on such matters.

--- Later in debate ---

[Bob Blackman]

I think we should have one.

Cllr Fothergill: I agree.

[Dame Andrea Leadsom]

Q You made a very good case for the age of sale rising each year, but as the LGA, do you think that will be tricky for enforcement purposes? An argument is often made that if you were 40 and I was 41, we would go into a store and I would have to buy your cigarettes for you. What would you say to that as an argument for continuing with the smoke-free generation legislation?

Cllr Fothergill: We have to be very careful that we do not spook ourselves out of doing something that is absolutely right. If people get to the age of 40 and have to show that they are 40 to be able to buy cigarettes, that is what they should do. I am sorry to say that I am 67. I have to show a bus pass every time I get on a bus to show that I am old enough to travel for free.

[The Chair]

You don’t look it.

Cllr Fothergill: Thank you very much—I’ll take that.

At every stage in life, you are asked for verification, and this is just another time. It should not stop us from doing the right thing and moving the age up so that we eventually achieve a smoke-free population.

Greg Fell: It is a long time since I have been asked my age. It may throw up some tricky moments, but as Councillor Fothergill said, let’s not stop ourselves doing the right thing here. I think most people agree that it is broadly the right thing. The Bill itself is massively important for norm-setting. Even if the norm-setting achieves half of the goal, thousands of lives will still be saved.

--- Later in debate ---

[The Chair]

Greg, before I bring Andrea in again, you do not look 67 either. I want to get that on the record.

Greg Fell: Not a day over 25, Chair.

[Dame Andrea Leadsom]

Q I beg people to ask me my age when I am buying a drink, and they just will not.

The additional things—heated tobacco, shisha and so on—that come under this legislation include cigarette papers. We all know that they can be used for rolling joints and other purposes, and that cigarette papers contain carcinogens. However, some have quite a strong desire to exclude them—I do not know why. What is the view of the LGA and ADPH on that point?

Cllr Fothergill: We believe that the scope of the Bill as it is currently written is right, and that is what we would support. We would not want to see anything excluded. Every time there is a change to smoking legislation, we hear the argument that it will increase the amount of illicit trade coming into the country. That is not a reason not to do it. It is our responsibility as trading standards to enforce, and although people always use that argument, we have to do the right thing and enforce by properly funding trading standards.

Greg Fell: If I had £1 for every time I have heard the illicit trade argument, neither of us would be here. The heat-not-burn—the clue is in the title—is a tobacco product, and I would treat it like a tobacco product. It may be safer than burned tobacco—we do not know. I would like to see some independent research. However, I would not delay the Bill until I see independent research. I would personally argue to not allow exclusions. It may seem much harder to enforce, but there will already be some tricky points in enforcement; we already know that we need to resource that properly. I would keep the simplicity and not allow exclusions.

[The Chair]

We have two minutes left. Is anyone burning to ask the last question? We have had very clear evidence and it has been an excellent session, but is anyone sitting on a question they have not yet asked?

--- Later in debate ---

[Preet Kaur Gill]

Q My first question to you is, what is the impact of tobacco smoking on public health? Secondly, do you think the Bill’s measures to prevent vaping products from being sold to children will be successful? That is essentially clauses 61 and 62.

Ailsa Rutter: Tobacco is devastating. It is devastating to every individual who dies way too young, and to the family who lose their loved one. In my region alone, just since the turn of the millennium, 120,000 of our loved ones have died from smoking. It is not an adult choice, but a childhood addiction. The vast majority of those smokers reach a point where they deeply regret having got hooked in childhood, not thinking that first puff on a cigarette would be so addictive. It is really important that we remember the 6.4 million remaining smokers in the UK and the fact that 350 18 to 24-year-olds will get hooked on lethal tobacco smoking today.

I would like the Committee to imagine that cigarettes did not exist. It is 2024, and here we are discussing a product that is designed to hook, kill, maim, and be completely addictive. This discussion today needs to be about the future world we want to strive for. We can talk a lot about how we will enforce it, which is very important, but for me this is about imagining that in 20 years’ time we have created an entire new generation protected from this uniquely lethal product. That is why in the north-east, all 12 local authorities, all 10 NHS trusts, our integrated care board—the biggest in the country—and our Association of Directors of Public Health have given whole-hearted, unanimous support to the “stopping the start” proposal on the age of sale of tobacco.

We absolutely recognise that smoking is much more harmful than vaping, but vaping is not risk-free. Vaping is playing a pivotal role in our region—with our higher levels of deprivation and addiction—to get people off lethal smoking, but that is not to say that we do not absolutely agree that much more needs to be done to reduce the appeal of vaping to young people. We wholeheartedly believe that we must address the inappropriate packaging that is too youth-friendly. Some of the in-store promotions are completely inappropriate, where children are really noticing it. We must ensure that we recognise that children are growing up within a family context; children do not live in isolation. There is also the importance in our region of sending clear, evidenced-based messaging. We can also see the positive impact on children’s health if we can get the parents and carers off lethal tobacco smoking and if we can reduce second-hand smoke harm. Really important as well is more money in people’s pockets, because cigarette smoking has such a negative effect on your income.

[Dame Andrea Leadsom]

Q Thank you so much for being here and for all you do in the north-east. It is fantastic.

As you will know, rates of smoking during pregnancy in the north-east are some of the highest in the country. Do you think this legislation will help to reduce those very high numbers? The rate is somewhere in the region of 14% in the north-east.

Ailsa Rutter: We have made really good progress in the north-east in reducing maternal smoking; that has come through very good collaboration between our local maternity services and our local authorities, as well as the fantastic leadership from key people in the local maternity and neonatal system, the LMNS, and the direction from directors of public health.

As with anything, there is not one magic solution; it is about taking comprehensive measures. The tobacco age of sale increase will undoubtedly have a really positive impact on reducing maternal smoking. It needs to be coupled with important things that we must continue to do as well, so we also welcome the increased investment for stop-smoking services.

We hugely welcome—thank you—the reinvestment in the evidence-based health harms campaigns. We are thrilled that nationally you are using our fantastic “smoking survivors” TV advert featuring Sue Mountain. The role of financial incentives is also really important; we know that they have a very strong evidence base. This will have a positive impact on maternal smoking.

[Nickie Aiken]

Q If there was one thing you could add to this Bill, what would it be?

Ailsa Rutter: Gosh! There are already some fantastic elements in the Bill. The key thing for me is to make sure that we can get the Bill through—particularly the focus on tobacco. It is really good to think that there is going to be subsequent consultation on the important elements around vaping. Factoring in what colleagues said previously, we need a simple mandatory age verification scheme. That is already in place in Scotland, and I would certainly welcome its introduction in England.

--- Later in debate ---

[Dr Johnson]

Q I want to ask you about the licensing regime. You have to have a licence to sell alcohol and tobacco, and some have suggested that you should have to have a licence to sell nicotine full stop because it is an addictive substance. That would mean that you would need to have a licence to sell vapes, partly as a way of making them less accessible to children in the places that they may be sold. Would you support that?

Adrian Simpson: It is not an issue that we have discussed at any length in the British Retail Consortium. We are aware, of course, that there are parts of the UK where licensing is required for certain tobacco products. We are well used to the alcohol licensing that has been going on for many years. Unfortunately, I cannot comment on whether the whole sector would be in support of that. We would perhaps need to see how a potential licensing system would operate before we gave our full support to it.

[Dame Andrea Leadsom]

Q Thank you so much for being here. You will be aware that, in putting together legislation, huge effort is made to be balanced and not excessive and to make it doable and achievable, nowhere more so than for those who are trying to enforce it.

May I press you a bit further on the point that Preet made about whether the fines are sufficient? You have said that it is a bit complicated and will require some lead-in time—which is obviously provided, with the 2027 date—to give appropriate training to shop staff. The quantum of the fine was intended to enable on-the-spot fines, rather than having lengthy litigation because the person who incurs the fine does not have the cash and needs to go away, may or may not pay it, may or may not have to be pursued, may or may not have to go to court, and so on. Understanding that there are different views on all sides, is the balance just about right or, if you could have put your own wish list together, are there things that you would have done differently?

Adrian Simpson: We would have liked to see more education provided to retailers who might have broken the rules. A fine can be life-changing for someone who is given one, so we like to see whether there might be a way around that; perhaps the shop worker could be educated first, rather than going straight to a fine, if at all possible. We would like to see that balance of education before strict enforcement, if possible. That would be our wish.

[Steve Tuckwell]

Q Thank you for coming in this afternoon. It is a pleasure to hear your thoughts. What will be the challenges for retailers in enforcing the ban on sales?

Adrian Simpson: The first challenge is education of all the shop staff. Our members are the very large, household-name retailers, and it will take a long time to get that education out to the hundreds of thousands—in some cases—of shop workers throughout the UK. We also think that there will be issues to do with changing our point of sale systems, things like where we are going to store some of these products if we need to, and even things like the size and nature of the tobacco notices. Retail operates in many different ways—we think of the large supermarkets, but there are very small stores as well—so a lot of thought needs to be given to the technical parts of the legislation, which of course we always work with you on.

--- Later in debate ---

[Dame Andrea Leadsom]

Q You mentioned that your members are used to working with Challenge 25. Do you see the Bill working in the same way? As the age of the smoke-free generation rises from year to year, will your colleagues in the retail sector manage to look at two different customers and ask the one that they are concerned about to verify their age?

Adrian Simpson: I think you made a wise point earlier, Minister, about the difference between a 40 and a 41-year-old. That is absolutely our concern: how will we do that? We hear a lot of things about artificial intelligence and new technology for age verification, but a lot of it is still down to human interaction—whether a human can tell the difference between 40 and 41, which can be difficult. That is certainly one of our biggest concerns. Again, we are keen to avoid situations where there could be a touchpoint for violence against shop workers.

[Dame Andrea Leadsom]

Q You will have heard Mr Fothergill from the LGA saying that he has to show his bus pass every time he wants free transport. Do you feel that that is where the solution lies?

Adrian Simpson: There certainly needs to be a bit more research into what the best methods are to keep this age restriction going. It is a new challenge in the retail sector. We have never had anything like this before, and the UK is a leader in this area. I think that, at the beginning, it will be about us all working together to try to get the age restriction going and to make sure that it is enforced, because—this is one point that I would like to make—our members are obviously very compliant and want to do the right thing. These household names are very protective of their reputations; they want to be good and to do the right thing for society. However, I certainly think that, with this new system that might come in, there could be some teething problems. We hope not, but that can naturally happen with all new systems.

[Dame Andrea Leadsom]

Q May I just clarify, then, that your members support the uplift in age, year on year? As you will no doubt be aware, there are some who challenge that and say, “Well, it shouldn’t keep escalating,” but the British Retail Consortium does support the idea of the increase, year on year, of the smoke-free generation, as so many of our other expert witnesses have done today. Would that be right? I do not want to put words in your mouth.

Adrian Simpson: It was definitely a point that came up quite a lot when we were debating this with members themselves. I would say that we are cautiously welcoming it, just because it will then bring about a level playing field for all retailers—because we know that these measures are not necessarily directed at our members, who are, as I say, in the legitimate, responsible retail sector. It will bring about a level playing field but, as I say, we might still need to see how it would operate in practice, I suppose, before we give it our wholehearted support.

[Mary Glindon]

Q I was just searching for a quote, which I think I cited in a debate last year, about a survey that had been commissioned about buying vapes. Out of the 28 vapes that were bought, 25 were illicit vapes. I presume that those are from places that are not responsible retailers—they clearly are irresponsible if they sell those. Are there a lot of retailers that do not subscribe to your organisation where this sort of thing could be occurring? If that is the case, how can we encourage them to become responsible retailers and join the consortium? What should be done? Do you try to reach out to retailers that you know are perhaps not the best and that you would like to see engage with your organisation to help to prevent this kind of illicit sale?

Adrian Simpson: Exactly. Our membership is predominantly the household-name retailers—the large retailers; the ones that certainly would not be selling illicit vapes. We have comprehensive supply chains, and our members put a lot of effort into making sure that their supply chains are operating with integrity, so that illicit products cannot enter them. I have not seen that report, but my feeling would be that the sellers mentioned in it are highly unlikely to be members of a reputable trade organisation. They might be ones that would not be looking for the same standards that our members would operate to.

--- Later in debate ---

[Preet Kaur Gill]

Q Finally from me, in your response to the Government’s “Creating a smokefree generation” consultation, you called for a fixed penalty notice of £200 and maybe the option of increasing that. Do you think that the fines and the monetary penalties in the Bill are appropriate?

Kate Pike: We really welcome the addition of a fixed penalty notice to our enforcement toolkit, but we absolutely want to have our own range of sanctions, which includes the opportunity to go to prosecution for persistent or egregious offenders. The fixed penalty notice can be a really quick solution, potentially against an individual salesperson, depending on the setting and the nature of the offending. I think that £100 can be quite a lot; £200 would be more. I think that is enough, given the opportunity in the Bill to increase it at a later stage if it is not working or having the impact that we want.

John Herriman: It is all relative at the end of the day. It needs to be tested first. To some illegitimate businesses, that will be seen just as a business cost. Whatever the amount is, we need to ensure that it is not seen as a business cost that can just be absorbed. It has to be a tangible deterrent: that is the key.

[Dame Andrea Leadsom]

Q It is great to see you—thanks for coming today. I think you are saying that at the moment the fine is set at the right level. It is a really important issue: by no means do we want it to appear to be a cost of doing business. Our previous witness was suggesting that for some shop workers it is a very significant sum and is quite problematic for them, so perhaps there should be training in the first instance.

We have sought to get the right balance, with a £100 fine that can be reduced to £50 if it is paid on the spot. For any of us, a day when we have to dish out £50 because we have done something wrong is a significant bad day. On the other hand, there is an escalation process to criminal prosecution. I am really keen that we get the balance right up front, notwithstanding that there will be powers to change it. Can I press you a bit further: is this or is this not the right place to start?

John Herriman: Can I make a broader point, and then maybe Kate can come in on the specifics? This is all about the market surveillance activity that allows you to understand what is happening on your local high streets and your ability to take enforcement action where necessary, whether that is a £100 fine or a prosecution. Fundamentally, that is the challenge at the moment. It is about the ability to have the right level of market surveillance and the right level of enforcement activity. I am sure it is a question that will come up. It is a challenge for trading standards at the moment, because over the past decade or so it has had significant cuts, in the region of 50%.

There are two halves to this question. First, is this the right legislation and are the amounts right? Secondly, legislation is only as good as the ability to enforce it. It feels as though the legislation is right—I will let Kate comment further on that—but the ability to enforce it is critical.

Kate Pike: Absolutely. Whenever we look at a new piece of regulation—as I think somebody mentioned earlier, we enforce more than 300 pieces of legislation across the spectrum—we ask, “Do we have the powers to enforce?” In the Tobacco and Vapes Bill, yes, we do. “Are there criminal penalties in there?” Yes, there are. The key things from our point of view—the building blocks—are there.

Across the spectrum, how many businesses sell tobacco? The impact assessment for the Bill says that there are something like 60,000 or 70,000 across the United Kingdom. On that spectrum, there are big businesses that know what they are doing and do not need a lot of support from us. There is a big chunk in the middle that might need a bit of support and guidance—they may make a mistake, but we can support them, help them and train them. Then there are a small amount at the other end that are the dodgy ones. We need to focus our enforcement efforts on them, because we will never be able to put one trading standards officer outside every business to be watching all the time.

[Dame Andrea Leadsom]

Q It is clear to me, having done a visit with enforcement officers, that some so-called specialist vape shops and some newsagents just have the vapes next to the sweets. It is a free-for-all: you get your bubble gum and your vape there. Is that problematic? Will this legislation mean that enforcement officers shut them down? Will there be enough powers and resources to ensure that this can no longer happen?

Kate Pike: The Bill will have enabling regulations on vapes, with powers and criminal sanctions. That is good, but the specifics around where the vapes are positioned in store will be down to the next stage. We get calls all the time from people saying, “There’s a shop in my area called Toys and Vapes—do something about it!” There is actually no legislation that we can use to tackle that.

If you do not want the vapes next to the sweets, legislate for it. We will enforce what it says in the legislation, but we cannot make it up. People are always saying, “That’s not right,” but we cannot enforce morals. We can only enforce the law, so get it in there. If you do not want the vapes there, for very good reasons, give us legislation and we can enforce it.

[Rachael Maskell]

Q My big concern is the illicit trade around vapes. What further measures would be helpful in the legislation to enable you to do your job? Vapes are clearly a delivery mechanism. We have particularly focused on lung health; I am more concerned about the use of vapes for synthetic drugs, which are available in my community and, I am sure, elsewhere. What more can be done to ensure that we do not see the growth of illicit vapes on our street corners or in our shops?

Kate Pike: Illegal drugs are not a trading standards issue. If drugs are consumed via vape or by injection or rolled up in a roll-up, that is not our issue; that is a police issue. We can only enforce the law around the products where the enforcement is given to trading standards. We have no role whatsoever in illegal drugs in vapes. But there is a huge amount of enforcement around illegal drugs in this country, with the police, and the public health approach, about ensuring that people do not use illegal drugs. However they consume them, it is really important that they are on board—

Tobacco and Vapes Bill (Third sitting)

Andrea Leadsom Excerpts

Committee stage
Wednesday 1st May 2024 Public Bill Committees

[Preet Kaur Gill]

Q Finally from me, and this question is for Frank and Michael, the latest ONS figures in 2022 show smoking prevalence in Wales and Northern Ireland remaining constant rather than continuing to fall in the way that it did in England and Scotland. Do you think Wales and Northern Ireland have specific challenges related to smoking prevalence?

Sir Francis Atherton: It is certainly true that we are not going as fast in Wales as we would like to see. Smoking prevalence has dropped, from about 22% in 2020 down to 13% at present, but our target is to reach 5% by 2030, and we are not currently predicting that we will meet that target unless we go further and faster. We believe that this Bill will enable us to do that.

You asked for the reasons. One of the reasons is that we have deep-seated sociodemographic problems in Wales, which you have been referring to. Given the inequity that we see, meeting the needs of current smokers from those really deprived socioeconomic groups is really quite a challenge. We are doing everything we can in Wales to try to address that through “Help Me Quit” and smoking cessation support, but we really need to prevent the next generation from coming on board with smoking.

Professor Sir Michael McBride: Just following on from Sir Frank’s comments, you are absolutely correct that, while population prevalence of smoking sits at around 14% at the moment—behind the 12% in England and the 13% in Wales—we are doing slightly better than Scotland at the moment, which is sitting at about 15%. The figures for the Republic of Ireland are somewhere in the region of 18%. There is absolutely no doubt that we have the same socioeconomic drivers, in terms of social deprivation and health inequalities, that are fuelling this. Should the Bill succeed and pass into legislation, I see this as a once-in-a-generation opportunity to make a significant change to protect future generations and their children from all the harmful consequences of smoking tobacco and other forms of tobacco use.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Q I thank all you chief medical officers for being here; we appreciate it. You will understand that your witness evidence is crucial to easing the passage of the Bill. I would like to get you on the record talking, first, about the start of life. The shadow Minister has just asked about pregnancy and, only this week, I was talking to a neonatal nursing lead, who said of the pregnancies of women who smoke that the children had a low birth weight and go on to have severe learning difficulties throughout their lives. That is heartbreaking, but also has significant implications for NHS and educational services, and for whole-life costs to the taxpayer. I would be grateful for your comments on that.

At the other end of the age range, elderly people who have smoked all their lives end up with decades of ill health brought on by a lifetime of smoking. I would be grateful, too, if you talked about some of the health outcomes for those who have smoked all their lives—some of the horrors of that. Sir Chris, you told me an anecdote of when you were a young vascular surgeon. For the record, it is important to talk about some of the heartbreak for those who wish they could stop smoking.

Professor Sir Chris Whitty: I completely agree with all the points you made. Starting off with the beginning of life, there are clear and significant increases in stillbirths, premature births, birth abnormalities and long-term effects from smoking just in the pre-birth period. Then, of course, if parents are smoking around babies and small children, that affects lung development and, if children have asthma, that will trigger asthma effects. Young children are significantly affected by passive smoking from their parents. The parents, of course, want the best for their children, but the problem is that they are now addicted to a product that has taken their choice away. We get those problems right from the very beginning, and we have talked about some of the issues in young pregnancies and where that leads.

Moving to the other end of the age spectrum that you were talking about, the full horrors of smoking for most people start to take effect from middle age onwards. At this point, people get a range of things. Everyone knows about lung cancer, I think, and most people know about heart disease, but there are effects on stroke or increases in dementia, which are significant—one of the best ways to delay dementia is not to smoke or to stop smoking at an early stage. That is a huge problem for all of us. Smoking also exacerbates any problems people have with diabetes—it makes that much worse—and people have multiple cardiac events leading to heart failure. In heavy smokers, we see extraordinary effects, like people having to lose their limbs. As you and I discussed, it is a tragedy to be on a ward with people with chronic obstructive airways disease, or on a vascular ward as a vascular surgeon with someone who has just had an amputation, weeping as they light up another cigarette, because they cannot stop, because their choice has been removed. I cannot hammer that point home firmly enough: this is an industry built on removing choice from people and then killing them in a horrible way.

Sir Francis Atherton: Minister, you also pointed out the cost to the NHS. In Wales, we estimate that we have about 5,500 deaths every year from smoking-related diseases. If we look at admissions to hospital, about 28,000 in the over-35 group is about 5% of overall hospital admissions. That is an enormous burden to the NHS. On a more personal basis, in a former life I was a GP, and I remember sitting with an elderly gentleman who at the end of his life was suffering with chronic obstructive pulmonary disease. There is no worse death than not being able to breathe when just sitting there. I remember sitting with him as he was trying to talk to me and trying to express that same level of regret that Sir Chris talked about. If you talk to any smokers towards the end of their life, who are facing such terrible ends to their life, the sense of regret that you hear as a doctor is quite overpowering.

Professor Sir Michael McBride: It is estimated that in Northern Ireland there are more than 2,000 deaths each year directly attributable to smoking cigarettes; over the past five years, smoking makes up 12% of all deaths in Northern Ireland. Sir Frank and Sir Chris have clearly described the horrors of the impact that it has at an individual level, and as doctors we have all experienced that. We have all had those conversations with individuals who look back on a lifetime of regret.

On a more personal level, I also think at this moment about the impact that premature death, and the morbidity and mortality associated with smoking, has on families and children. My own father died at 46 years of age, when I was 16, from acute myocardial infarction as a consequence of a lifetime addiction to smoking cigarettes. So, we need to bear in mind the very human costs, family costs and wider societal costs as well. It is not just the cost to the health service, but the societal cost, the family cost and the cost to the wider economy.

Professor Sir Gregor Ian Smith: We should never forget the societal cost that Sir Michael just spoke about. I am the child of two smokers who died in their mid-60s from smoking-related disease. We see it all too often in Scotland. In fact, in Scotland we still have 9,000 deaths a year attributed to tobacco addiction and smoking. That is one death every 61 minutes that families suffer across Scotland as a consequence of addiction to smoking.

As a clinician, one of the diseases that I had become quite specialised in treating and led a lot of work on is chronic obstructive pulmonary disease. That is a smoking-related disease that people develop, often at too young an age, and begins to really impair their ability to participate fully in life—not only in employment, but in the pastimes that they love. Gradually, over time, it becomes worse.

Sir Frank touched on the sense of regret that people have that they ever started smoking in the first place and find themselves in this position. Beyond that, there is an even sadder element: many of the people who experience these chronic life-limiting illnesses have not only regret that they ever started, but guilt about the burden that they place on the health service and their family because of the illness and disability that they develop. That guilt sometimes reaches to the extent that they do not seek full care. Many people’s attitude is, “I deserve this. I started smoking; I need to pay the consequences.” That is a terrible psychological position for any person to find themselves in. Removing the starting point for that addiction, so that people will not experience that through their life, is the aim of the Bill.

Let me make one last point. We talk about the health impacts of all this. The Scottish burden of disease study projects that over the next 20 years, up until 2043, we will see a 21% increase in the general burden of disease across our population in Scotland, despite having a falling population during that time. Much of that projected burden of disease is smoking related; it relates to cancers, cardiovascular disease and neurological conditions such as dementia, which are all influenced by smoking. It is absolutely necessary for us to address this in a preventive way, and I believe that the Bill is a very good way of doing that.

Professor Sir Chris Whitty: I want to reinforce the point that Sir Gregor just made, with which I am sure the Committee fully agrees, that individual smokers should never be blamed for the situation they are in. An incredibly wealthy, very sophisticated marketing industry deliberately addicted them to something, at the earliest age it could get away with it, and they have had their choice removed. It is important that people do not feel guilt and come forward for care, and that no one blames them for a situation that was deliberately put on them by industry marketing.

[Kirsten Oswald (East Renfrewshire) (SNP)]

Q I will continue on the theme of marketing. Do you have thoughts about the measures relating to the product restriction of vapes in the Bill? Are they robust enough, in your mind, to prevent the harm that is caused by vapes, particularly to young people? I am thinking of the study that came out yesterday that, concerningly, suggested a risk to teenagers who vape of exposure to toxic metals, potentially harming their organ and brain development.

As a follow-on from that, I am concerned about the advertising of vape companies on sports kits, which is profoundly unhelpful. When we look at sporting figures who young people can admire, that has absolutely no place. I wonder what your views are on that.

Professor Sir Gregor Ian Smith: My views are very clear on vaping in young people and on sales to the youth categories. This is an activity that we are still learning much about but that the evidence, as it emerges, appears to suggest is very harmful to them. In my conversations with my paediatricians and with the Royal College of Paediatrics and Child Health, they are very concerned about the impacts on health of young people from beginning vaping. Any attempt to make products such as single-use vapes or flavoured vapes, or the packaging used or the marketing around vapes, more attractive to that age group is something that we need to counter and resist.

I would say that the aims of the Bill will allow us the means by which we can properly consult on the way that we attempt to reduce overall vaping use in this age group. I am very clear in my views on this: while I understand that vaping may be an assistance to people who are already addicted to tobacco and nicotine products as a consequence of use of many years—I see that there may be an argument that it allows them to reduce the level of harm they are exposed to—I am not convinced or led by any of the arguments that starting vaping in a younger age group is a safe activity at all. I do not believe that that is the case; I believe that it is harmful to those groups. We must try to counter that, and to counter the marketing machine that Sir Chris has spoken about, by reducing the flavours and packaging that are attractive to younger people.

--- Later in debate ---

[Preet Kaur Gill]

Q We should all be concerned about the increase in the use of vapes by young children, so it is important that the Bill will ban the sale of vapes to under-18s. It will also close the loopholes for under-16s, because we know that vapes are being marketed and given out for free. That is the issue we must address. My concern with the Office for Health Improvement and Disparities being disbanded is on public health messaging. Parents and families are really concerned that some of their children are going through a number of these vapes per day or per week, and they do not know what is a safe amount.

There is a growing illicit vape market, but how would parents know what is illicit or what the Medicines and Healthcare products Regulatory Agency has notified as being compliant? Where is the public health messaging to support schools? We heard really good evidence yesterday from the union. This is my concern: where can people access support and information? We already have a generation of kids addicted to vapes that are marketed as having 0% nicotine, but we know that there is nicotine contained in them. What would you say to that?

Sir Francis Atherton: There is some messaging going on through the various Governments. In Wales we have a “No Ifs. No Butts.” programme, which tries to work at an individual level, to alert people to the dangers that we have been discussing, and with wider society, about the dangers and links between illicit tobacco and illicit vaping and organised crime. Bringing that awareness to the population is really important for those two reasons.

We work with trading standards to try to tackle the issue of illicit tobacco and vapes. It is important that we continue that. My understanding is that wherever we have been successful in reducing demand, which the Bill intends to do, the illicit supply also decreases. We would expect that to be a consequence of the Bill.

Professor Sir Chris Whitty: One of the many talking points of the cigarette industry is, “Well, any kind of downward pressure on cigarettes would lead to an increase in the illicit market.” All the evidence shows that the reverse happens. When you bring in reduced demand, the illicit market decreases.

[Dame Andrea Leadsom]

Q I think we might be out of time, but I have one more question. In the passage of the Bill, there is a concern that some may wish to fix flavours on the face of the Bill, rather than allow the powers. Sir Chris, can we have a comment on the record on how damaging that would be?

Professor Sir Chris Whitty: That would be very damaging, because we know that this is one of the most innovative marketing industries in the world. That is how they have managed to sell to people something that will addict them and then kill them. If we give them room for manoeuvre by nailing things down, they will find a way around it, because they always have found a way around regulations. I am absolutely supportive of the comment you have just made.

[The Chair]

I am afraid this brings us to the end of the time allotted for the Committee to ask questions. I thank all the witnesses, because you answered a huge number of questions and provided great information.

Examination of Witnesses

Professor Sir Stephen Powis and Kate Brintworth gave evidence.

--- Later in debate ---

[Preet Kaur Gill]

Q Would you like to say anything about admissions of young people in relation to smoking?

Professor Sir Stephen Powis: I will make a few broad comments on smoking, if I can. Seventy-eight years ago, Parliament passed the National Health Service Act 1946, which led to the formation of the NHS on 5 July 1948. In my view, the legislation that you are considering here today is one of the most important—possibly the most important—pieces of legislation since the passage of that Act. Why? Smoking has an extraordinary impact upon the health of the nation, and of course directly upon the NHS.

To put that into a bit more context—you have heard some of this already, but maybe I will provide some more detail—smoking is associated with, or causes, over 100 individual conditions that are managed and treated within the NHS. It impacts the NHS at all levels: almost every minute of every day there is a hospital admission related to smoking; there are over 100 GP appointments every hour for smoking-related disease; and 400,000 admissions a year are related to or associated with smoking. You have heard the chief medical officers briefly talk about the impact on specific diseases. Lung cancer is the one that everyone knows about, and 80% of lung cancers are caused by smoking. This Bill has the opportunity to transform lung cancer from a common disease into a relatively rare disease, and one that clinicians of the future will not see in any way as commonly as clinicians of my generation.

It is not about just lung cancer; you have heard about the impact on cardiovascular disease, and clearly, chronic obstructive pulmonary disease would again become a rare disease for the clinicians and the patients of the future. This Bill can also have an early impact on diseases that affect young people. Asthma is a disease not caused by smoking but a condition exacerbated by it. We see such admissions particularly over the months when asthma is worse and when there are respiratory infections, which are no doubt exacerbated by smoking.

In mental health, smoking doubles the risk of developing depression. More than one in two people with severe mental health conditions smoke, and the life expectancy of those with mental health conditions is reduced because of smoking. Mental health issues in our young people and children are well-known and well-described, and smoking simply exacerbates them. There is great potential, even in the early years, in the passage of this Bill for an impact on conditions that we see and manage in the NHS. Over the long term, that potential impact is extraordinary on those conditions, which number over 100.

You may know that I am a kidney doctor, but you may not know that smoking can impact on kidney disease. The kidney, like any organ, is supplied by blood vessels. When smoking impacts on the health of blood vessels and causes vascular disease, that can reduce the bloody supply to the kidney, which can cause kidney failure and lead to dialysis and transplantation. There is a large range of conditions that are impacted by smoking, and it will be extraordinary for those clinicians of the future not to have to do what we have done—tell patients and their families that people are going to die prematurely. That is an extraordinarily difficult thing for clinicians to do. Those are preventable diseases, and this Bill will prevent them.

[Dame Andrea Leadsom]

Q Thank you so much for being here today. As I said to the chief medical officers, you will appreciate that your words can be very helpful in smoothing the passage of this very important Bill. I would like to talk to Kate, please, about the impact of smoking on mothers who are pregnant. What is the impact on their babies, on the delivery of the baby, and on the baby’s health outcomes? If you could give us an outline, that would be very helpful.

Kate Brintworth: It is important to start with the fact that we know that smoking is the single biggest modifiable risk factor for pregnancy, and we know that every women who gets pregnant wants the best for her baby. As a midwife, I have never sat in front of a woman who does not want the absolute best for her baby. It is important to build on what Chris Whitty said around the removal of choice. Women will go to extraordinary lengths to protect their bodies and babies to ensure that their children have the best start in life, and yet the quit rates that we see in pregnant women are between 30% and 40%, showing how difficult it is for women to extricate themselves from the situation in which they find themselves.

The effects are devastating: stillbirths are increased by 47%; you are twice as likely to have a baby that has not grown properly; and you are 27% more likely to have a baby that is born pre-term. You are more likely to have complications of pregnancy, such as bleeding, the placenta not forming properly or the waters that surround the baby breaking earlier with the risk of infection, so there are immediate effects that we can see. If a baby is small, it goes into labour more vulnerable to the stresses of labour, so we can have more complications there. If a caesarean section is needed, the mother is more vulnerable to recovery and it can be a much harder road to recovery for her, with the risk of infection and blood clots, but also for the baby. If the baby is born early, obviously the risk then is that the baby and mother are separated and you have this unnecessary trauma to a family of a baby having to go into a neonatal unit. The risks that come from prematurity are well-documented for children, for educational attainment and for their lung and health development, but when the children go home, they are more at risk of sudden infant death syndrome—up to three times more—in a smoking household.

There are then the long-term effects. We have already heard about asthma, chest infections and obesity. All those are heightened in children born into smoking households. You have a situation where children are at risk and women are at their most vulnerable when they are pregnant, and it really feels like it is our duty to support this Bill to protect the most vulnerable in our society, because there are the effects of having a child born with possible behavioural problems and malformations, which have been described. Those are really shocking events. I was talking to service users yesterday who have had children in the neonatal unit, and it is incredibly shocking when your pregnancy ends early and you are separated from your baby. There is a mental health impact on the family. There is also the point that this affects those coming from the most socioeconomically deprived backgrounds, for whom having any kind of health challenge makes it a much higher bar to fight.

[Dame Andrea Leadsom]

Q That is very harrowing to hear. Could you further expand on the impact on families of losing a baby due to stillbirth as a result of smoking? How does that impact on their mental health? As you said, parents will do everything they can to protect their baby, but the addiction to cigarettes is so strong that for many it must lead to them blaming themselves for the death of their baby.

Kate Brintworth: The birth of a child is so happily anticipated by every person who gets pregnant. From the moment that you see a thin blue line, you are having a baby. You have hopes and dreams for the expansion of your family, but not just for that individual family: a baby is born, and it is a niece, a nephew, a grandchild, a cousin. It really ripples out across the entire family. When there is then a 35% risk of miscarriage and a higher risk of ectopic pregnancy and, as you said, the absolutely awful, tragic and devastating news that your baby has died when it reaches term, that is something that no parent should ever have to face unnecessarily. It just feels like the worst thing you ever have to do as a clinician to tell someone that their baby has died. Every time I have ever had to do that, it has been the worst point in my career. It is difficult to explain how destroying it can be for families, and we see the long-term sequelae in terms of mental health, to the point where we have put in extra perinatal mental health support for families that have suffered that kind of trauma.

Professor Sir Stephen Powis: Can I pick up on the health inequalities aspect, because I think that is really important and I have the figures in front of me? In 2021-22, 21% of pregnant women in the most deprived areas smoked at the time of delivery, compared with 5.6% in the least deprived areas. That is a really stark difference. Smoking is widely accepted as the most significant driver of health inequalities in the UK. Detailed analysis has concluded that 85% of the observed inequalities between socioeconomic groups could be attributed to smoking. We spend a lot of time in the NHS quite rightly targeting our interventions and support to deprived areas to address health inequalities. At a stroke, this Bill would have the greatest impact that we could possibly see.

[Steve Tuckwell (Uxbridge and South Ruislip) (Con)]

Q Thank you for coming to address us this morning. We heard compelling insight from the chief medical officers earlier. Will you update the Committee on how you see this Bill supporting the NHS in the long term and the short term?

Professor Sir Steven Powis: I have already highlighted some of the short-term impacts, and there will undoubtedly be short-term impacts. Some conditions are exacerbated by smoking, with asthma in children being an obvious one. I have talked about mental health conditions and the way that smoking exacerbates conditions such as depression and chronic mental health illness.

We will start to see immediate effects, but those effects will grow over time. I have given you some of the conditions that are impacted on by smoking—there are well over 100 of them—but I can give some more stats. By stopping children from ever starting to smoke, we estimate that we will prevent about 30,000 new cases of smoking-related lung cancer every year. More than 1.4 million people suffer from chronic obstructive pulmonary disease, which is a chronic disease of the lungs caused by smoking—it causes nine out of every 10 cases. As I said, that is a disease that clinicians commonly see. A common cause of admissions to emergency departments, through the winter particularly, is other respiratory infections on top of COPD—these are diseases that future clinicians will see rarely. They will not see them in the way that clinicians of my generation have had to manage them. The impact will begin immediately, but over time that impact will get greater.

--- Later in debate ---

[Preet Kaur Gill]

Q There seems to be an issue around what is contained in illicit vapes, which we know include things like lead, nickel and high levels of nicotine, versus other vapes that have gone through a notification process. Do you feel that the research on the impacts of illicit vapes is not there, or is it the impact of vapes that have gone through a compliant process?

Professor Hawthorne: There is probably very little research on either.

Professor Turner: If I could just bring a bit of clarity, it is well known that nicotine is bad for us. Sir Walter Raleigh brought it back with some potatoes, and we have known for hundreds of years that nicotine is an addictive drug. As I said previously, it will shorten your life expectancy by between 10 and 15 years. Because we know nicotine is in all nicotine-containing vapes, whether licit or illicit, it is harmful regardless of what the other components might be. It is likely that those other components add to the harm, but there is substantial and well-described harm from nicotine addiction to us as human beings.

[Dame Andrea Leadsom]

Q Thank you both so much for being here. As I said to the other medical professionals, your words today will be incredibly valuable in ensuring the smooth passage of the Bill. Professor Turner, could you explain to us what happens to a baby born addicted to nicotine in terms of the withdrawal symptoms and the impact on its health and development?

Professor Turner: There is not a lot of research on that. Certainly, we know that if you are in utero and your mother is smoking, you will get the harmful effects of nicotine. That is a very good question—I honestly do not know what the effects on the unborn child would be. Certainly, we know that children born to parents who are addicted to morphine or cocaine have learning difficulties. I have to be honest and say that I might have to get back to you on that one, but I can assure you that it is not good to be in utero and exposed to nicotine.

[Dame Andrea Leadsom]

Q Professor Hawthorne, from a GP’s perspective, could you talk us through the impact of second-hand smoking on childhood asthma and how that presents in terms of the innocence of the child and the impact of something being done to them?

Professor Hawthorne: We have known for a long time that passive smoking increases the risk of not just asthma, but upper respiratory tract infections and ear infections. It is very much part of a GP’s role when they are consulting with such patients coming in with these infections to ask about parental smoking. It is interesting that the responses are nearly always the same. If the parent smokes, they will always say, “But I only ever smoke outside.” Of course, one has to take that as it is, but I suspect that they are probably not always smoking outside. It is definitely a well-recognised link, but I am seeing it a bit less than I used to.

Everybody knows about the dangers of smoking. A lot of my patients, when I talk to them about needing to stop smoking, already know what I am saying. Quite often, I will say to them, “Well, you know what I am going to say next, don’t you?”, and they will say, “Yeah, I know. I need to stop smoking.” The conversation then proceeds from there.

We also have evidence that, in general practice consultations, a short intervention can be very effective. We know that people are very pressed for time, and there is only so much we can cover in a 10-minute appointment, especially if the patient is coming with three different problems. But there is good evidence that with even a very short intervention—I think in about 10% of cases—patients will actually stop smoking. It is always worth talking about, and if I get the time, I have a much longer spiel, because you need to think about the behavioural and addictive aspects of smoking. We go through, “When are you most likely to want to smoke? Is it after a meal, when you are on the phone or when you first get up in the morning?” We talk about what else they can do instead. I had one patient who went and dug the garden whenever she wanted to smoke. It is that kind of conversation.

[Dame Andrea Leadsom]

Q We know that it takes up to 30 quit attempts to actually give up smoking. Can both of you give us a clue as to what is it about the 30th attempt that finally gets people over the line? Specifically to Professor Turner, is it being pregnant or having a partner who is pregnant? Is that the thing that makes people finally achieve their goal?

Professor Hawthorne: For adults, it is having that heart attack that maybe you could have avoided if you had stopped smoking before. Again, that is part of the conversation I have with patients. I say, “You are a heavy smoker, and you are at risk. Wouldn’t it be better if you stopped smoking before you have the heart attack, rather than after?” There are things like that, for sure.

We also operate a cycle of change psychological model—the Prochaska and DiClemente model. Essentially, it is a bit like having a clock face. We work out where the patient is on the clock face, and we are trying to get them round the clock to 12. If they are at somewhere like 2 o’clock, that is them saying, “Yeah, I know it is bad for me, but really no way am I going to do anything.” By 4 or 6 o’clock, they are saying, “Yeah, I know it is bad for me. I have tried a few times but it is just hopeless.” By quarter to, they are saying, “I’ve really got to do something”, and by five to, they are coming in and saying, “Doctor, you have to help me stop now.”

[Dame Andrea Leadsom]

Q And is that related to their declining health?

Professor Hawthorne: Not necessarily. It is about pushing people psychologically around that clock face. I try to work out where they are on the clock face and see if I can nudge them a bit further round, until one day they come and say, “I’ve got to stop now. What can you do to help me?”

[Dame Andrea Leadsom]

Thank you.

Professor Turner: As Kamila says, there are myriad drivers—teachable moments. Sometimes, when your child is admitted to hospital with an asthma attack, that might be the thing that makes both parents say, “That’s it.” It might be that the grandmother says to her daughter, “You’ve got to stop for your child.” Legislation might also be one of those teachable moments that make people reflect on their 29 past unsuccessful attempts and think, “I’m going to do it again.” There is no one thing, but there are clearly teachable moments, as we all have when we change our behaviour. As I suggested, I think this legislation will be one of those.

[Dame Andrea Leadsom]

Thank you very much. One last question: do you think the financial incentives for pregnant women and their partners would help?

Professor Turner: I think this is extremely contentious, but the evidence is that it does—sorry, you did ask me about pregnancy before. Pregnancy itself can be one of those opportunities to quit. Those parents who continue smoking—12% in Cumbria—feel terribly guilty. Anything we can do for that person, who has been addicted since she was 15 or 16, can help them to quit. There is no doubt—in Dundee, the trials have shown that, if you give mums incentives, in terms of vouchers rather than money, it helps them to quit, particularly if they are from deprived communities.

[Rachael Maskell]

Q We have already heard how addictive nicotine is, but do we have an understanding of the dosage of nicotine that people inhale through vaping versus through smoking? Secondly, are we missing an opportunity not to introduce a nicotine-free generation?

Professor Hawthorne: I am not a nicotine expert, but my understanding is that there is a risk from vaping, but it is about 5% of the risk from smoking. That is the best I can do in comparing the two. When I talk to patients about stopping smoking, vaping is one of the things we talk about as an alternative, with a view to eventually stopping vaping as well. Of course, there are all the other products: we use patches and chewing gum—all the usual things. It is difficult to quantify exactly how much less dangerous vaping is than smoking.

Professor Turner: Just to supplement that, as a user—if that is the right word—or a customer buying a vape, you can select the dose you want. There are doses that are equivalent to cigarettes and doses that you can wean yourself down on.

You asked whether we would be missing an opportunity if we do not introduce a smoke-free generation. I think we would absolutely be missing an opportunity. If we look back, the legislation on smoke-free public spaces across the UK was landmark. We all remember the days when you went on a plane and there was a smoking bit up front and a non-smoking bit at the back. If we were to go back and say there would be no smoking areas, we would think, “Wow, that would be transformational.” We have come on a journey, and the legislation has been part of it. I see a smoke-free generation as the logical next step, and I really think we have to take it.