Tobacco and Vapes Bill (Second sitting)
Andrew Gwynne ExcerptsTuesday 7th January 2025
(1 year, 7 months ago)
Public Bill CommitteesRead Full debate Tobacco and Vapes Act 2026 View all Tobacco and Vapes Act 2026 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 7 January 2025 - (7 Jan 2025)
The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
I beg to move a manuscript amendment: Tuesday 7 January Until no later than 3.10 pm Professor Linda Bauld OBE, Bruce and John Usher Chair in Public Health, University of Edinburgh Tuesday 7 January Until no later than 3.30 pm National Trading Standards Tuesday 7 January Until no later than 3.50 pm British Retail Consortium Tuesday 7 January Until no later than 4.10 pm Department for Education’s Secondary Headteacher Reference Group Tuesday 7 January Until no later than 4.30 pm Medicines and Healthcare products Regulatory Agency Tuesday 7 January Until no later than 5.00 pm Royal College of Paediatrics and Child Health; Royal College of General Practitioners Tuesday 7 January Until no later than 5.20 pm Department of Health and Social Care
That the Order of the Committee of 7 January 2023 be varied by leaving out from “Aneurin Bevan University Health Board” to end of table and insert—
This amendment is in order to accommodate witness availability. It would take Professor Linda Bauld at 2.40 pm and move the witnesses representing the royal colleges to start at 4.30 pm. This will add an extra 10 minutes to the last two panels, concluding oral evidence at 5.20 pm.
Manuscript amendment agreed to.
The Chair
I welcome the panel again, although I was not here for this morning’s sitting. We will now resume by hearing oral evidence from David Fothergill, chairman of the Local Government Association’s Community Wellbeing Board, Professor Tracy Daszkiewicz, executive director of public health and strategic partnerships and vice president of the faculty of public health at Aneurin Bevan University Health Board, and Alison Challenger, tobacco and vapes lead at the Association of Directors of Public Health.
For this panel, we have until 2.40 pm. The floor is now open to any members of the Committee who wish to ask questions, but we would traditionally ask the Opposition spokesperson to ask the first question, so, Dr Caroline Johnson, the floor is yours.
Dr Beccy Cooper (Worthing West) (Lab)
Q
Professor Tracy Daszkiewicz: From the public health community, it is widely accepted and supported. It gives us a great opportunity not only to increase the conversation, but to broaden it. How we embed the legislation into practice will be key: making sure that we are getting it to the point of delivery where we can effect change in terms of protecting our populations in the most effective way, making sure that we have a focus on smoking cessation, that we have a consistent and unified approach, and that we have the agility and adaptability to target different cohorts and different populations effectively. From the public health perspective, though, the Bill is hugely supported.
Alison Challenger: Similarly, from the Association of Directors of Public Health, the Bill is very much welcomed. It will represent a sea change in reducing harm caused by tobacco, which is still our biggest killer. Significant numbers of people continue to smoke and are still addicted to smoking. The product itself is not only extremely dangerous but extremely addictive at the same time. We welcome these measures to address that.
The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
Q
David Fothergill: The engagement has been really positive and constructive. We have faith in the Bill and that it has the right intention, the right measures and the right provisions. Our concern is around the funding, the timing and the pipeline of trading standards. The key thing for us is that it is an empowering Bill; it empowers local authorities. If you tried to legislate for every single local authority to implement it in the same way, we would run into some quite difficult conversations and difficult times; it would make enforcement more difficult. Allowing local councils to do what is right for them is the route to go.
People who sit on licensing committees have local understanding. I can give you an example. Should we ban the sale of tobacco within 100 metres of a school? That would be quite easy to do in an urban area, but I look after villages. If you do that, they have lost their only shop. People would not be able to go to that shop to buy legally. So you have got to have local knowledge. It is the right Bill, but we need to make sure that it is an empowering Bill for local authorities to implement in their local communities.
Andrew Gwynne
Q
David Fothergill: It is very much about keeping our feet on the ground. Let us be honest: trading standards are under a lot of pressure and have been cut over the last 10 years. Trading standards have responsibility for enforcing over 300 pieces of legislation, so there is a lot of pressure on trading standards; but I think that by working with retailers and building the relationship locally and ensuring that we use enforcement as the final tool, we can work very well in our local areas.
Andrew Gwynne
Q
Professor Tracy Daszkiewicz: It is a really useful question. It is about looking at it through multiple lenses. So there is the enforcement element of it, but there are also the elements that go behind that. If you take hospitals as an example in terms of having NHS smoke-free sites, enforcement is part of that, but it is also about having cessation services in place. If you have people going in for elective surgery, for example, you have got a period of time where you can put in a smoking cessation intervention. It is a “waiting well” method, if you like, so that people go in for surgery in a way that makes for the best possible outcomes, and have an opportunity to either get towards a quit or at least not go in smoking. That enables patients not to be going outside and using cigarettes and so on, which enables that smoke-free site and also creates better outcomes for our patients. So, we do need to think about that.
There has to be a common-sense approach. We know that vaping is a tool towards quitting smoking; we recognise that is part of the process. Where we can get people off tobacco smoking, that is crucial, particularly around health and wellbeing. The open spaces element and the public spaces element is a part that we have really focused on in Wales. The learning from that is still going on; it is not the end of the road. We are learning all the time, adapting to new evidence and making the changes that we need to make to enforce that more consistently, but in a fair way for our population.
Andrew Gwynne
Q
David Fothergill: We would like to see a licensing scheme that is very aligned with the alcohol licensing scheme, although there clearly cannot be a single scheme. The four provisions within the alcohol licensing scheme brought in by the Licensing Act 2003 were preventing crime and disorder, ensuring public safety, preventing public nuisance and protecting children from harm. If we can build those provisions into this legislation for the licensing of the sale of tobacco and vapes, that will give us enough to work on. I would also say that the flexibility we need at a local level remains critical.
Tristan Osborne (Chatham and Aylesford) (Lab)
Q
David Fothergill: I will take the fines element first and then talk about the cost of licensing for those retailers. A fine of £200 is quite a low figure. I think it was £100 previously, so it has been increased. If you pay within 10 days, it goes from £200 to £100. If you sell 40 vapes in one day, you have paid your fine. Some retailers—very few, because the vast majority are scrupulous—will take the view that they could sell more vapes to under-age people and those they should not be selling to, and pay that £100 fine within 10 days. So yes, we view it as too low. We would like to see a review brought in within a year to see whether it should be increased.
If we can align the cost of licensing fees with alcohol licensing, that would enable us to find a way to reduce the burden, because the vast majority of people who are selling alcohol are also selling tobacco. We need to work with our businesses to reduce the cost of applying for those licences, which is why we need the consultation period over the next few months, before we bring in legislation, to ensure that we have worked with our retailers, the public and our communities in order to deliver a scheme that actually works.
Dr Johnson
Q
Professor Linda Bauld: I think we also heard this from previous witnesses, but as the legislation comes into place, it is really not about 34-year-olds versus 35-year-olds; it is about acting on the age of sale gradually, so that we are de-normalising tobacco use and stopping the start at an earlier stage.
By the time we get to the difference between the 34-year-old and the 35-year-old, you will have far lower smoking rates than we do at the moment. The modelling for the legislation that was carried out by the University of Sheffield for the Department of Health and Social Care suggests, as I think Hazel Cheeseman said earlier, that by 2040 we will have reduced the smoking rate among those aged 14 to 30 to 0.4%—down from 0.6% by 2030—so I think you are going to see very low rates. To go back to Challenge 25, age verification is something that we can build in, and, irrespective of how old you are, actually seeing proof of age will support this.
Andrew Gwynne
Q
Professor Linda Bauld: Thank you for that question, Minister. I have been working in tobacco control for almost 30 years, and the impact has been phenomenal. If you look back to the late 1940s and 1950s, 80% of men smoked in the UK. We have driven that down gradually over the years. We started to measure it in about 1974, and the level of smoking in the UK is now about 12% or 13%—the second lowest in Europe. The reason that we have achieved that is in line with what is being proposed in this legislation. It is about using comprehensive measures and implementing them over the years to regulate what I often call the four p’s: the product, the place, the price and the promotion. You are taking action on potentially all of those—including price, with the levy that is coming in, or the tax on vapes.
We have made a lot of progress, but we are not there yet. I think what you will hear from my clinical colleagues later is that in line with keeping that firm focus on prevention, as you are doing in this Bill, we also need to keep the focus on cessation and particularly on marginalised groups, deprivation, mental health and so on. The key is comprehensive tobacco control. Keep doing it, and that is what the Bill is adding to.
Andrew Gwynne
Q
Professor Linda Bauld: If I can start with the second part of your question, in terms of not deterring adult smokers, we need to continue making the products available for smoking cessation. We are not banning vapes—that has happened in a number of other countries, as the CMO for England was saying—but we are recognising the things that make them appealing, attractive and affordable to young people, and taking action on those. It is fine for the adult smoker not to be able to see a wide array of advertised products on the shop front, on the billboard or at the point of sale, but to know they are there behind the counter and ask for them. I also do not think that the adult smoker who is trying to quit cares about gummy bears or Coca-Cola flavours—maybe they want some flavours, but not all of them. It is about striking a balance.
Finally, although we are not here to talk about the funding of smoking cessation services today—certainly in England, you have made previous announcements about that—it is important that in clinical settings and through stop smoking services we can give good information about vaping and other cessation aids, and support people to quit that way.
Liz Jarvis (Eastleigh) (LD)
Q
Professor Linda Bauld: It is very ambitious on tobacco. We will be the first in the world—after unfortunate events in New Zealand, from my personal perspective—to introduce the smoke-free generation policy, and the world is looking at us. That is good. In terms of protecting people from vaping, the Bill has a proportionate set of measures, but if I come back to the answer that I gave to the shadow Minister, we really need to keep our eye on the regulations and—going back to the Minister’s questions—make sure that we are striking a balance. Given the evidence that we have for much stronger regulations on vaping, I think this strikes the right balance, but we need to make sure that we do that in a proportionate way. Finally, to go back to the comments from the previous set of witnesses, we also need to make sure that local areas have the flexibility around some of the measures to adapt them for their local circumstances.
Dr Johnson
Thank you, that is a really helpful answer. We know that vapes are very difficult to dispose of and to recycle.
Andrew Gwynne
Q
Lord Michael Bichard: I think we do feel we will have the right powers, based on the fact that we are already doing some of this quite successfully. We seized something like 2 million vapes last year; we carried out 400,000 test purchases—which is how we check whether or not the legislation is being enforced—and we seized, I think, 19 million illegal cigarettes. So in a way, this is not new stuff for us; it is just bigger. We have the powers and we use them quite effectively. We know that HMRC thinks we are pretty effective in relation to tobacco. We like to think we are a good delivery agency.
Wendy Martin: There has been a lot of work in the development of the Bill and the associated Department for Environment Food and Rural Affairs legislation around the ban on single-use vaping products with officials, so we have worked together with them to try to get this to a good place in terms of enforcement powers.
Andrew Gwynne
Q
Lord Michael Bichard: No. Our experience of the illicit tobacco market is that it has reduced rather than increased, despite the additional regulation, the price rise and all the rest of it, so we do not think that is a serious issue. We think that there are a number of myths around illicit tobacco and illicit vapes that do not stand up to close scrutiny. So no, we do not think that is a serious problem.
Andrew Gwynne
Q
Lord Michael Bichard: Yes, I think we feel that. You might also consider an increase for second offenders before you move to prosecution. I do not think anyone wants to move to prosecution, because it is such a time-intensive process. I know we have limited time, but one thing we have not talked about is retailers. We also ought to be concerned about the online market—or rather, you should be concerned, as we are. It is a difficulty for us and for local authorities, because no single local authority thinks it should be responsible for enforcing legislation in an online marketplace.
We have a solution to that, which is that we have a lead authority that we think could deal with this and avoid the problem with individual local authorities. I think that will become an increasingly important element of the vape marketplace.
Sarah Bool (South Northamptonshire) (Con)
Q
Lord Michael Bichard: It seems to me that it is now such a part of life that it is not as big a problem as it was; I think it is a problem that will diminish.
Wendy Martin: Certainly the retail violence is of concern and has been well publicised. It is clearly a policing issue rather than a trading standards issue. I guess it needs activity to make sure that everyone understands what is being done and why it is being done, and to make sure that there is a policing response, if possible, where there are issues. I know that local authorities work through community safety partnerships and things like that in local areas if there are particular incidents. Again, it is not specifically a trading standards response, but local authorities and local police forces will work together to do their best to address these things, because nobody wants anyone to be threatened with violence.
Andrew Gwynne
Q
Inga Becker-Hansen: Retailers are quite comfortable with the licensing scheme for tobacco at this point. That is something we are used to as a whole. One aspect of it is the fact that your larger retailers, for example, who have multiple premises do not have to worry about individual licenses for those individual premises. That is something we are quite concerned about with the licensing scheme, and what that could mean. If individual licenses had to be applied for, that could lead to divergence across a retail brand, and that affects your overall public retail image for customers.
We would also like to highlight that if the licensing scheme were to follow something such as the tobacco licensing scheme—the idea that licensing authorities could approve or deny certain applications—that could affect long-standing, established, compliant retailers, and that could lead to a loss of revenue for them. We appreciate the need for the legislation. We appreciate the need for a level playing field, and that is what we would encourage through the Bill.
Andrew Gwynne
Q
Inga Becker-Hansen: Currently, retailers are used to the idea of over the age of 18, simply because of tobacco and alcohol sales. The identification of January 2009 is more difficult, in terms of the rolling age and how that will look in the future. Currently, it is quite identifiable. I would say that January 2009 is more difficult for retailers to handle in the future per se.
Andrew Gwynne
Q
Inga Becker-Hansen: Yes, currently that is true. However, in the future, if somebody walks into a store and they are 45 or 43, I would not be able to tell that at face value.
Andrew Gwynne
Q
Inga Becker-Hansen: From their ID, you would. What I am trying to say is that it raises the thing of eventually becoming “no ID, no sale”, which is a concept that retailers would have to follow. But it would also mean that consumer-wise, you would require a consumer-facing public awareness campaign to identify and illustrate to the general public that it is “no ID, no sale”, if that is the angle that the Government are focusing on.
Andrew Gwynne
Q
Inga Becker-Hansen: Ideally, with a cohesive guideline illustrating to retailers how to implement the legislation. We would also encourage alignment across the regulations in terms of new regulations coming through, such as secondary legislation on the licensing scheme, and consultations on any secondary legislation so that both larger and smaller retailers may contribute their ideas. Ideally, there would be constant communication with industry to understand how these changes are made, as well as a public awareness campaign so that the public is aware of the changes, which would hopefully reduce any potential violence against or abuse of retail workers.
Andrew Gwynne
Q
Inga Becker-Hansen: We would like to see a licensing scheme as a level playing field where small, independent and larger retailers are viewed on the same level. Again, we would encourage the multi-stores to require only one licence rather than looking at individual premises licences, because that will make things more difficult.
In terms of the tobacco scheme, ideally things would be grouped together so that there is less administrative burden and therefore less cost for retailers, so that, if the aim for the Government is to transfer from the idea of selling tobacco to people to selling vapes because of the health benefits, that transition is made easier for retailers. Adding on an additional licensing scheme with additional costs and a separate administrative system makes it more difficult for retailers to handle those things at the same time, particularly smaller retailers and independents.
Sadik Al-Hassan
Q
Inga Becker-Hansen: It is a bit difficult for me to give you specific details, but in initial response my thinking would be that it would be a discussion between retailers and their primary authority and how that is handled, bearing in mind smaller retailers versus larger retailers. I am happy to follow up in writing and give evidence that way, but I cannot give specific details currently.
Dr Johnson
Q
Matthew Shanks: Yes—very much so.
Andrew Gwynne
Q
Matthew Shanks: I think it will, but for some it will not unless it has the education behind it as well. I also think it is too easy for children to purchase vapes. It is all very nice to think of shopkeepers not allowing children to buy vapes or tobacco if they are under age. I am not denigrating them, but we have instances, for example, of a year 9 child who had a loyalty card for a vape shop. She is 13 years of age—she did not look 18—yet she is being sold that at the local shop. You go in and talk to the local shop and they say that no, of course they have not sold it to her, and then there is conflict there. We need to look at the legality of it and sterner punishment, for want of a better word, for people who are found to be selling.
The drop box online purchasing industry also needs to be looked at. I do not know how, but again, we know that people purchase vapes from those places. The education side is for parents, because parents and older brothers and sisters think it is safe and will therefore give them a vape. The Bill will help, but there are other things that could help as well.
Andrew Gwynne
Q
Matthew Shanks: Packaging and flavouring is really important. As I said before, it is set out as if it were sweets and bubblegum. Why would you need these different flavours? Why are they making something more attractive that is meant to help you stop doing something, so that if you do not like one flavour, you can try lots of them, and collect the different coloured vapes, or build them up into towers? Addressing all those things would help. Linking vaping with smoking, in terms of not being able to purchase it as you go up the age range, would also help.
Vape-free zones are really important. People are vaping indoors. I have seen it today in London on the tube, in pubs and other places—I have not been in a pub today, by the way; that was over the Christmas period, but people are vaping in pubs in the way they used to with cigarette smoke. Again, it is not seen as something dangerous.
If you put all that out there and then put children into the mix and they are looking up and seeing the colourful packaging, the flavouring and so on, why would they not do this?
Andrew Gwynne
Q
Matthew Shanks: Yes. My question would be: why would we not?
The Chair
Looking at the number of Members who wish to ask questions and the amount of time that we have left, I ask Members to be short in their questions and the panellist to be short in his answers.
Dr Johnson
Q
Dr Laura Squire: I do not have any evidence of that, but it does worry me. We are an organisation that is about healthcare products, medicines, medical devices and blood products—that is our business—and it concerns me that people might think that vapes are safe. When I talk about risk-benefit, what I mean is that vapes are safer than tobacco; I do not think that anyone disagrees with that. However, vapes are not safer than nothing—and we do not actually know how unsafe vapes are, because there is a need for much longer-term study and understanding of the damage that they could cause.
My feeling is that, yes, there is potentially a misleading position with an organisation like ours, which is basically about healthcare products, running this scheme.
Andrew Gwynne
Q
Dr Laura Squire: I think we heard earlier about the different elements you need to make something work—licensing, regulations and registration—and I agree with that. I think it was also mentioned that registration is important to allow compliant businesses to check that the product that they have is compliant.
The significant problem with the notification scheme at the moment is that there is not an easy way to take something off the register once it is already on it. That is a problem, because if people are checking the current register, there might be something on it that we would quite like to take off but cannot.
There are powers to take things off the shelves, so if there was a recall issue, that could be dealt with. However, the main problem, or the primary thing in the Bill that I think needs to change, is having powers to take things off the register. Obviously, we must consult on the regulations themselves, but we welcome that change.
Andrew Gwynne
Q
Dr Laura Squire: I think somebody talked earlier about the package; the Bill is more than the notification scheme, and I think the whole thing works together to make a much safer environment. I was particularly pleased to see that there is a requirement to carry out studies and a requirement to carry out testing. We are sometimes asked about testing. Testing at the point of registration is one thing, but you need to know that the product remains compliant.
Obviously, there must be consultation about exactly what will go into the regulations, but I would expect that there would be an awful lot more linked to the other requirements of the Bill, and that will make it tighter. I think that would be an improvement, because at the moment the Bill is very light-touch.
Taiwo Owatemi
Q
Dr Laura Squire: For a medicines licence?
Dr Johnson
Q
Professor Sanjay Agrawal: No.
Andrew Gwynne
Q
Professor Steve Turner: Smoking is bad whether you are an active smoker or a passive smoker. Sadly, there are lots of children who still actively smoke, but there are many hundreds of thousands of children who are exposed to second-hand smoke in the home. There is undeniable evidence that that exposure is harmful. I do respiratory paediatrics. Asthma admissions are very common and are clearly associated with exposures.
We can look at natural experiments. For example, in Scotland we had the “Take it right outside” campaign, which was a smoke-free homes initiative. After that, there was a reduction in the number of children coming into hospital. When we brought in the ban on smoking in cars in Scotland, there was another reduction. On that whole-population basis, there is a lot of evidence of benefit to the population, particularly children, from smoking interventions. There are also benefits to the birth weight of children.
There is no doubt that there is a huge amount of harm from second-hand smoke, and anything that reduces the population’s exposure to second-hand smoke will benefit the whole population. As we heard earlier from Matthew, the headteacher, it is part of a package, and it is part of education as well. Smoking continues to be something that children should not do. Children should never vape. Children should never smoke. They continue to do so, and anything that we as a responsible society can do to stop that is to everybody’s benefit.
Andrew Gwynne
Q
Professor Steve Turner: Children are very susceptible and can be easily influenced, and they are learning all the time. If they see that it is okay to watch your child’s football match and smoke, or to smoke outside a pub, they will very quickly adapt and think that that is a social norm. There is a powerful social norm exercise there about what we as a society expect is normal, and approving smoking outside hospitals seems to be such a bad, conflicting message. To me, that argument in itself is very powerful.
There were a number of people back in the early noughties who felt that the smoke-free legislation might not have much benefit on pregnancy—why on earth would that reduce low birth weight and premature delivery? Well, it did. That was probably the snowballing effect of stopping smoking in pubs, for example—I think the whole of society changed its attitude and behaviour around smoking. So, going back to the original question, I think that putting restrictions in public spaces will change that social norm to everybody’s benefit.
Andrew Gwynne
Q
Professor Steve Turner: That is a really good question. I think that the balance in this Bill—between supporting the 6 million smokers to quit and not engaging children in nicotine addiction—is the right balance. Going back to what I was saying earlier, getting the message across to young people is a multifaceted intervention that requires education as well as legislation. It is a really difficult balance, but I do believe that the Bill, as it is, has that balance just right.
Dr Chambers
Q
Professor Steve Turner: The impact on the whole of society of second-hand smoking in children is complex, but there are various pieces of the jigsaw. First of all, children come to the clinic, are admitted to hospital, come to the emergency department, or go and see the GP, so there is that healthcare side. If any of you have children, however, when your child is off school, that has implications for you as a family; there are some difficult discussions over breakfast about who is going to work and who is not. Therefore, there are a number of different impacts on us as a society, economically and to the NHS from second-hand smoking.
I am not clever enough to put a number on it, but it is a lot bigger than I think people know. I do know that £46 billion is the number cited as the direct health cost to the NHS of smoking—it is almost too big to consider—but I suspect that the wider societal cost will probably be a magnitude greater than that.
Tobacco and Vapes Bill (First sitting)
Andrew Gwynne ExcerptsTuesday 7th January 2025
(1 year, 7 months ago)
Public Bill CommitteesRead Full debate Tobacco and Vapes Act 2026 View all Tobacco and Vapes Act 2026 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 7 January 2025 - (7 Jan 2025)
The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
Q
Professor Sir Chris Whitty: May I take one impact that extends my previous points about outdoor smoking, and then maybe pass on to Sir Gregor and Sir Frank? For outdoor smoking, the previous Bill—the very good Bill put forward by the previous Government—did not have anything that addressed the needs of current smokers. It also did not address the needs of people exposed to smoke, despite the fact that, like over 88% of the population, they are not smokers and many of them are medically vulnerable.
The Bill allows the Government to take powers to prevent outdoor smoking, first with additional public consultation and then additional measures in Parliament. Ministers—you, Minister, have demonstrated this in the House of Commons—have indicated the areas where they intend to use these powers to reduce the risks of passive smoking. These are the areas of the greatest vulnerability: around hospitals, where some of the most medically vulnerable are highly concentrated; and around children’s playgrounds, where children are—I think everybody who does not have shares in cigarette companies would agree that exposing children to second-hand smoke is an unacceptable thing to do. That is one area where the Bill has gone further than the previous one. Maybe Sir Frank might want to add to that.
Sir Francis Atherton: In Wales, we have had smoke-free hospitals, schools and play areas since 2021, under our earlier public health legislation, and it is completely non-controversial. There are clearly issues around implementation and enforcement, particularly around hospitals, but if you go now to schools and hospitals there is no controversy whatever. So that will not make a huge amount of difference in Wales.
The one thing that will make a difference, I think, is aligning the vaping legislation with the smoking legislation. I say that because, going back to the earliest question, vape use among young people in Wales has shot up over recent years—8% of 11 to 16-year-olds regularly vape, up from 5% and a bit in 2021. It has absolutely shot up. Bringing together vaping and tobacco legislation in terms of vape-free and smoke-free places is a really important thing and one for which I have been arguing for quite some time.
Andrew Gwynne
Q
Professor Sir Gregor Ian Smith: Perhaps I can begin this answer; my colleagues may then want to come in. Alignment in this respect is really important, partly because of the clarity of message that exists to the public around about what is legally acceptable in relation to smoking and to vaping. Alignment across tobacco smoking and vape use is similarly important across the four nations.
Public health messaging is incredibly important. Having a consistent message across our four nations helps to ensure that the message is much more clearly understood and adhered to by the public. I welcome the attempts by Ministers to ensure that alignment exists within the Bill, so that as we go forward we give protection to those who do not smoke in the way that we are planning on doing with the Bill as it proceeds.
One of the most important aspects is to make sure that, although in Scotland, for instance, legislation prevents smoking within 15 metres of the likes of public places such as outside a hospital, we bring that much more closely in line with where the Welsh position is—so to the whole of the hospital grounds. Extending it to protect, as Sir Chris has said, more vulnerable places such as play parks is something I would certainly welcome in Scotland. We should do that in step across the four nations. I again emphasise that public messaging is incredibly important in making sure that we get the adherence we seek.
Andrew Gwynne
Q
Professor Sir Chris Whitty: I have already given my view that, although I have a lot of sympathy for choice and freedom arguments in many situations, tobacco addiction and second-hand smoking are not among those.
Sir Francis Atherton: If anything, choice is undermined by the addictive nature of nicotine. It is incredibly addictive. We know that now; we have known it for many years, actually. The tobacco industry has known it for many years, which is why the industry, through vaping and other means, is quite keen to have the next generation of people in our countries addicted to nicotine. Choice is completely undermined and taken away by the addictive nature of the product being marketed.
Professor Sir Gregor Ian Smith: Nicotine addiction is horrific. Nearly 9,000 people a year still die in Scotland as a result of tobacco-related health issues. Two thirds of people who begin smoking are potentially at risk of dying as a consequence of their addiction. We know that the industry targets both the younger age spectrum and vulnerable groups to sustain their industry.
If you have ever spoken to a patient with a serious tobacco-related illness such as chronic obstructive pulmonary disease, who is now suffering from the consequences of that—the limited ability to live their life—and the addictive nature of the disease, you soon begin to learn that they are filled with nothing but regret and guilt for the part that their addiction has played in the development of the disease. The stigma associated with tobacco-related disease is quite terrible for those who experience it. The basis of that is this lack of choice that they have developed as a consequence of the addictive nature of the nicotine products.
Professor Sir Chris Whitty: If I could just add a specific example from—
The Chair
Sorry, Sir Chris, but before we go further, I am trying to establish whether Sir Michael McBride has contact with us yet. If you can speak, Sir Michael, then we will know whether we have connection. It is as simple as that, really.
Professor Sir Michael McBride: Yes. The problem is not on my side, so I asked that you unlock me. I think I have now been unlocked, so perhaps I can speak.
The Chair
We will now hear evidence from Hazel Cheeseman, chief executive of Action on Smoking and Health; Sheila Duffy, chief executive of ASH Scotland; Suzanne Cass, chief executive of ASH Wales; and Naomi Thompson, health improvement manager at Cancer Focus Northern Ireland. We have until 10.55 am for this panel. I call the first Member to ask a question—the Minister.
Andrew Gwynne
Q
Hazel Cheeseman: We are all delighted to see this Bill return, and in such a strong form. There is complete consensus across the ASHs of the four nations that this is a Bill that is needed, wanted and workable.
As the chief medical officer said in the previous session, the improvements in this Bill are that there are more provisions that will assist in reducing smoking among people who are already smoking and in protecting those exposed to second-hand smoke. It also creates a comprehensive set of regulations around all tobacco and nicotine products and provides us with that future-proof—the flexibility to respond to evidence as it emerges and changes and to the market as it emerges and changes over time.
The Bill is enormously welcome for its comprehensiveness and robustness, and therefore for the opportunity to significantly reduce the uptake of smoking among the next generation and to aid people in quitting. The Minister will not mind me saying that I think there is more that the Government will need to do to accelerate that progress, in terms of investing in support for those who are already smoking and ensuring that we have the right strategy in place for that, but the Bill is a really good step in the right direction.
Andrew Gwynne
Q
Sheila Duffy: We have seen that tobacco control measures work. We have seen that they have reduced adult smoking rates over time. The points made by the chief medical officers were well made: we are looking to the generation growing up now in the UK; we are looking to protect them from addictions that so many now regret and that are claiming lives unnecessarily.
Suzanne Cass: I would add that tobacco control policies that are put in place are popular, and are really welcomed among members of the public; they are also welcomed among people who smoke. There is a huge surge of public support for tobacco control policies, and that grows—it does not diminish—as we introduce new policies; it grows, and that public support increases.
Naomi Thompson: In Northern Ireland, we are working towards a smoke-free Northern Ireland by 2035, and the reality is that tobacco control over the past 10 years has managed to bring things down to a stage where 2035 has potential. That is why tobacco control needs to continue. A Bill like this is just brilliant to keep that focus. If we can prevent people from starting, that will be absolutely key to making Northern Ireland, certainly, smoke-free by then.
Andrew Gwynne
Q
Suzanne Cass: As you know, ASH Wales and the Welsh Government have been at the forefront of implementing smoke-free spaces. We campaigned for smoke-free playgrounds and smoke-free school gates, both on a voluntary basis. Luckily, the foresight of the Welsh Government has made that provision legislation when it comes to hospital grounds, playgrounds, sports grounds, mental health units and a raft of other smoke- free spaces. We are obviously delighted that the Welsh Government has implemented that legislation.
The legislation has made a huge difference, in that it has allowed a platform for communication—communicating the message that it is not okay to smoke around children. There is a massive amount of public support for that messaging, and we have had the opportunity to communicate it. When it comes to smoke-free hospital grounds, a lot of us are looking at that legislation and the possibility of implementing it.
We have obviously had the legislation in place in Wales since 2021, and what we would say on the lessons learned is that there has to be a package when it comes to implementation. We cannot just legislate; we need to be looking at the support that is in hospitals for smokers to quit, we need to have trained staff and we need to have enforcement on the ground. There needs to be a whole package that comes with that legislation. That is the enormous lesson that we learned.
We implemented that legislation in 2021—in the midst of covid, which was tricky—but we have had problems around enforcement and problems around compliance. It is a very different kind of tobacco policy from that in the other smoke-free spaces. When it comes to the other smoke-free places—playgrounds, sports grounds and other areas like that—there is a lot of compliance, but when it comes to hospital grounds, you have to do a bit more of the legwork. But it is well worth it, because what comes with that is on-site hospital support for stopping smoking, and the message to everybody coming on to that site that smoking is not okay and that there is support available if you want to quit. So it comes with a whole raft of measures that support that smoke-free message.
The Chair
I call Caroline Johnson—apologies; I should have called you before the Minister.
Dr Johnson
Q
Dr Ian Walker: First, thank you very much for the opportunity to be here. I start by thanking Parliament for boldly introducing this Bill; it is genuinely world leading. I have spoken to organisations across the world that are envious of the position we find ourselves in. That is a very important question, and the answer is absolutely yes—I think this Bill will be very important in reducing the number of cancers caused by smoking tobacco. We know that there is no bigger thing we could do to actually influence that going forward for the next generation and generations thereafter.
As you have heard this morning, we know that we still have 6 million people smoking across the UK, and we know that we can expect hundreds of thousands of cases of cancer caused by smoking over the term of the next Parliament. As we move towards a truly smoke-free generation over the next 20, 30 or 40 years, we will absolutely expect to see the number of cancers caused by smoking—and, alongside that, the number of other illnesses associated with smoking—reduce.
Andrew Gwynne
Q
Dr Ian Walker: To start with smoking and cancer, the links between passive smoking and cancer, particularly lung cancer, are very clear. It is fair to say that there is less evidence around different scenarios that you might predict through this Bill, such as different outdoor environments and so on, but that is more because those studies have not necessarily been done. It is an important point to make that there is an absence of evidence, rather than evidence of absence.
You heard from the CMO of England this morning that if you can smell cigarette smoke, you are exposed to it. The direct risk, then, is linked to how long you are exposed to it, how concentrated the environment is, how close you are to it and so on. Nevertheless, passive smoking is harmful—not just for cancer, but for vulnerable people with many other conditions as well—so we are very much supportive of the introduction of smoke-free places and the ability to restrict people smoking in particular outdoor spaces.
Sarah Sleet: When it comes to people with lung conditions, second-hand smoke is incredibly important; it is a well-known, severe risk factor for people with lung conditions. About one in five of us in the UK will experience a lung condition—there are around 7 million people with asthma and about 1.6 million people living with chronic obstructive pulmonary disease. Those are two major conditions that are profoundly affected by second-hand smoking, and are clear risk factors in terms of deaths from asthma and people being hospitalised with exacerbations, so it is incredibly important that we deal with the issue of second-hand smoking. People said earlier that there is no choice about second-hand smoking, and yet it profoundly affects those with lung conditions. It is incredibly important that we ensure that we protect those vulnerable people as far as possible.
When it comes to the discussion about how far we should go in terms of smoke-free and vape-free places, we would consider going further than what has been suggested already and looking at other areas to make smoke-free. I know there has been discussion about hospitality and trying to balance the potential economic impact that has been talked about if we make the outside of hospitality places smoke-free. However, we think, given the balance between the public health impact and what we have seen with smoke-free indoor spaces and its impact on business, we could go further and should go further, there.
Andrew Gwynne
Q
Sarah Sleet: People with asthma and lung conditions are in the middle, where they are affected by both smoking and vaping. It is really important to get the balance right. Smoking is terrible—it is terrible for people with lung conditions—and we need to make sure we can drive down smoking rates as much as possible.
Vaping can play a part in helping with smoking cessation, but it should only be used for smoking cessation. People who have never smoked, and definitely children, should not be taking up vaping. We see vaping as a staging post to being completely nicotine-free. It is important to get the balance right between making vaping available for those who need smoking cessation and not encouraging people to try vaping or to keep vaping longer than they need to.
The legislation is good in allowing that flexibility for adjusting over time, as we get more evidence in. It is really important to put evaluation in place and make sure that robust evaluation does flow through over time, so we can adjust and respond to it. Traditionally—certainly in respiratory diseases—there has generally not been enough research and evaluation, so we need to correct that now.
Dr Ian Walker: First, I want to confirm that we are very much supportive of taking those powers. I think one of the real strengths of the Bill is the ability to adjust, moderate and titrate those powers and the actions that we take over time, not just as new evidence emerges, but as the tobacco industry and new products may emerge to try to circumvent the regulation that is in place. That is a really important part of the Bill.
I think the crux of the question was about what is important to consider through the consultation. From our perspective, it is important to get a balanced view on what the right actions are in this area. Of course we all agree that we want to limit, reduce and stop access for children and young people and to limit the appeal to never-smokers, while balancing that carefully against making cessation tools available to people who are trying to quit. It is important not to forget the 6 million people who are currently smokers and the long-term health implications ahead of them. We need a balance so that it is as easy as possible for those people to quit when they have chosen to do so. There will be many balancing features and balancing points of evidence that will be really important through the consultation in coming to the right outcome.
Andrew Gwynne
Q
Dr Ian Walker: Critical. Without a doubt, there is no single bigger action that you could take to reduce the cancer burden on the country. The cancer burden sits at a very personal, individual level for people getting their own diagnosis; it sits at a family level and at a friend level. It also sits at an economic level for the country and at an NHS level, in terms of the burden that smoking-related illnesses cause for the NHS.
From my perspective, this is a world-leading piece of legislation. It is absolutely an opportunity for generational change and a long-term legacy that will see our children and grandchildren never able to legally buy tobacco in the UK and never exposed to the harms that that would cause them.
Sadik Al-Hassan
Q
Sarah Sleet: As I said earlier, the research evidence around vaping harms is currently very poor. There has not been enough. It takes a long time to build up evidence of things that are generally very progressive rather than having an immediate impact, so we will have to wait. We need to put that in place, and we are going to have to wait to get that evidence back.
We have had anecdotal reports from our beneficiaries and those who contact the organisation about places—particularly in closed spaces, but sometimes outside—where there is a concentration of vaping. It is that classic thing where you go through a door and suddenly everybody around you is vaping immediately outside it. We get reports that that exacerbates people’s asthma and sometimes their COPD, but they are anecdotal. We really need the evidence base to support what is happening.
Dr Ian Walker: The only thing that I would add specifically from a cancer perspective is that although there is very little long-term evidence, because the products have not been around long enough and the cumulative effects have not been seen yet, what we do know, based on the current evidence, is that vapes are far less harmful than cigarettes. You heard the advice earlier that if you smoke it is better to vape or take other nicotine products, but if you do not smoke you should not vape, because we do not know yet what the long-term effects will be. In particular, we are very light on evidence on what the impact of vaping will be on bystanders.
Health and Social Care
Andrew Gwynne Excerpts(1 year, 8 months ago)
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Andrew Gwynne
For MSK conditions such as rheumatoid arthritis, early diagnosis is the key to preventing joint damage and improving quality of life. The Government are investing £1.5 billion in capital funding in 2025-26 for new surgical hubs and diagnostic scanners, to build capacity for over 30,000 additional procedures and over 1.25 million diagnostic tests as they come online.
[Official Report, 17 December 2024; Vol. 759, c. 68WH.]
Written correction submitted by the Under-Secretary of State for Health and Social Care, the hon. Member for Gorton and Denton (Andrew Gwynne):
Andrew Gwynne
The Government are investing £1.5 billion in capital funding in 2025-26, including for new surgical hubs and diagnostic scanners, to build capacity for over 30,000 additional procedures and over 1.25 million diagnostic tests as they come online.
Musculoskeletal Conditions
Andrew Gwynne Excerpts(1 year, 8 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
It is a pleasure to serve under your chairmanship, Mr Efford. I thank my hon. Friend the Member for Dudley (Sonia Kumar) for securing this really important debate, and for bringing her professional expertise to the House. I also thank my hon. Friend the Member for Morecambe and Lunesdale (Lizzi Collinge), who showed that she can think on the spot and turn an intervention into a short speech.
It is important that we acknowledge just how significant the impact of musculoskeletal conditions can be on both individuals and their loved ones. Poor MSK health can severely impact every aspect of a person’s life. It also has a significant impact on the NHS and the wider economy. Pain, stiffness and limited movement all affect quality of life and independence, including the ability to work. MSK conditions are the leading cause of years lived with disability in England. They are responsible for up to 30% of GP consultations, and MSK community services have the longest waiting lists of all community services in England, as of September this year. MSK conditions are also one of the leading causes of sickness absence, with approximately 23.4 million working days lost due to MSK conditions in 2022 in the UK.
That is why the Government are committed to improving care for the 17 million people living with MSK conditions in England, and ensuring that they receive support and access to the latest treatments. Improving health and work outcomes for people living with MSK conditions also forms a key part of the Government’s missions to build an NHS fit for the future, and to kickstart economic growth.
Turning first to the health mission, my Department recently announced plans to develop a 10-year NHS plan. It will consider what actions are needed to improve patient access and reduce waiting times. It will set out a bold agenda to deliver the three big shifts needed. Those are moving healthcare from the hospital to the community, from analogue to digital, and from treatment to prevention. We recognise that there is much more we can do to support earlier diagnosis and management for people with MSK conditions, and the need for timely and comprehensive care that starts at home. We know that many people with MSK conditions can be diagnosed and well managed in the community, which is why we are making a start by exploring how best to support MSK primary and community service improvement, helping to give MSK conditions greater parity with other conditions.
I will certainly take away the suggestions made by my hon. Friend the Member for Dudley on physiotherapists, AHPs more generally, and other issues. They could play a vital and important role in getting the better outcomes we want to see. She spoke rightly about how we deal with children. The Government want to create the healthiest generation of children ever. We must ensure that we have the services to diagnose bone conditions at an earlier stage and get children the appropriate treatment.
My hon. Friend also talked about communities that are difficult to reach. I have a row with my officials because I do not accept that any community is difficult to reach—we have just not tried hard enough. It is precisely the kind of suggestions that she set out that will ensure, on a whole range of health conditions including MSK, that we do better at identifying where those people and health inequalities are, and get access to services into the places where those people are so we can get them on to the treatment pathways.
With NHS England, we are considering a range of options to identify the most effective ways of improving the quality of and access to the fracture liaison service model, and the interventions that that model provides. For MSK conditions such as rheumatoid arthritis, early diagnosis is the key to preventing joint damage and improving quality of life. The Government are investing £1.5 billion in capital funding in 2025-26 for new surgical hubs and diagnostic scanners, to build capacity for over 30,000 additional procedures and over 1.25 million diagnostic tests as they come online.
I turn now to the growth mission. The “Get Britain Working” White Paper highlighted the issue of spiralling economic inactivity, with 2.8 million people, which is equivalent to the population of Greater Manchester, being locked out of work because of long-term sickness. Tackling economic inactivity caused by ill health will play an important part in realising our ambition of having an 80% employment rate.
To support that ambition, the Further Faster 20 scheme will be delivered by NHS England’s Getting It Right First Time programme. Further Faster 20 will operate in 20 areas of the country that have high levels of economic inactivity, with the aim of reducing waiting times and enabling people to return to work. Actions will include improving secondary care interfaces with primary and community services.
We will also launch a set of place-based trailblazers in eight areas in England and Wales to run during 2025-26. These trailblazers will be at the forefront of developing joined-up approaches to support people with work, health and skills. Three trailblazer areas will be funded to become health and growth accelerator sites, in order to build evidence of the impact of targeted action on the main health conditions driving economic inactivity, and I assure the House that those conditions include MSK conditions.
I also say to my hon. Friend the Member for Dudley that I am more than happy to meet her to discuss these issues further. If we can squeeze it in somewhere in my diary, I am also more than happy to visit the fracture liaison services in her area.
I want to reassure my hon. Friend the Member for Morecambe and Lunesdale that we take very seriously the impact of MSK conditions on the NHS workforce itself. As part of our workforce planning, we need to get better at identifying NHS employees who have MSK conditions and ensure that we provide them with the appropriate support, so that they can carry on working in our health and care systems.
To conclude, once again I thank my hon. Friend the Member for Dudley for securing this important debate. I hope that she is reassured by some of the measures I have outlined today. In addition, I will take on board the very important points she made about how we can do better on those issues and ensure that they are fed back through my team to those working up our policies on fracture liaison and MSK more generally.
I hope that my hon. Friend recognises that MSK is a priority for this Government. I absolutely recognise that we must go further, but today I will close by reaffirming this Government’s commitment to supporting the millions of people in the UK living with an MSK condition, to ensure that they receive the support they need, including improved diagnosis and management, and to ensure that we drive down waiting times and waiting lists, identify conditions earlier, get people into treatment as quickly as possible, and have the happier, healthier and more prosperous country that we have all been elected to this place to help deliver, which would be the consequence of having a healthier, happier workforce and a healthier and happier population.
Question put and agreed to.
Commercial Research Delivery Centres
Andrew Gwynne Excerpts(1 year, 8 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
My noble Friend the Under-Secretary of State for Health and Social Care, Baroness Merron, has made the following written statement:
Today, I am pleased to announce an ambitious expansion of commercial clinical research capabilities across the four nations of the UK through the establishment of 20 new commercial research delivery centres.
The CRDC programme will be funded across the UK by the voluntary scheme for branded medicines pricing, access and growth investment programme and, in part, by the Department of Health and Social Care through the National Institute for Health and Care Research in England. The VPAG Investment programme, a unique joint public-private partnership between the UK Government and the pharmaceutical industry agreed as part of the 2024 VPAG Scheme, aims to boost economic growth and the global competitiveness of the UK’s life sciences sector. This network of CRDCs is the first clinical trial infrastructure to receive funding from the VPAG investment programme to accelerate access to new medicines and vaccines to patients, through research.
Funding is being allocated to NHS organisations across all four UK nations, reinforcing the pan-UK commitment to research. The CRDCs cover the length and breadth of the UK from the Sussex coast to Aberdeen, including coverage across Wales and Northern Ireland, ensuring a truly UK presence. They will act as hubs for pioneering approaches in commercial clinical research delivery with a dedicated workforce and facilities and streamlined and efficient trial set-up to support industry trials. The CRDCs will enhance the UK’s competitiveness on the global health research stage and make it a destination of choice for life sciences innovation, supporting both the health and growth missions set by Government.
In a significant step forward, the CRDCs will bring clinical trials beyond large hospital trusts and into smaller hospital community settings and primary care. This will make research participation easier for people across our communities, including those currently underserved by research, ensuring that everyone can have access to new treatment through cutting-edge medical research.
Aligned with the UK Government’s missions to build a healthcare system fit for the future and kickstart economic growth, the CRDCs bring enhanced resource and infrastructure across the NHS, by growing research capacity and creating opportunities for collaboration with industry partners to trial new treatments. They will contribute to the strength and vitality of our life sciences sector, creating opportunities for growth and collaboration across the UK. This significant investment in commercial research delivery is a powerful signal of the UK’s commitment to the life sciences and it contributes to advancements in patient care to improve health outcomes for people across the UK.
[HCWS309]
Clinical Trials Regulations
Andrew Gwynne Excerpts(1 year, 8 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
My noble friend the Under-Secretary of State for Health and Social Care, Baroness Merron, has made the following written statement:
I am pleased to announce that the Medicines for Human Use (Clinical Trials) (Amendment) Regulations 2024 have been laid before Parliament today. When approved by Parliament, this legislation will represent the most significant reform of UK clinical trials regulation in over 20 years, addressing the sector's need for a more efficient and adaptable regulatory framework, while safeguarding the wellbeing of trial participants. It will establish a proportionate, streamlined, flexible and effective clinical research environment, placing patients at the heart of the process and strengthening the UK’s position as a global leader for innovative clinical trials.
Clinical trials are essential for the safe development of medicinal products, allowing innovators to rigorously evaluate their products in healthy volunteers and patients. Through this, clinical trials provide a route for bringing pioneering new treatments directly to patients, serving as a crucial step in healthcare innovation. This legislation will play a vital role in transforming the environment for running clinical trials in the UK.
Modernising the regulatory framework will strengthen the UK’s standing as a prime destination for conducting groundbreaking, safe clinical trials. This supports the recommendations of the Lord O’Shaughnessy review, making the UK more attractive for commercial clinical trials and increasing opportunities for UK patients to have early access to innovative treatments that could improve or even save lives. These reforms will also help the NHS conduct trials more efficiently, fostering research that improves methods for preventing, diagnosing, and treating a wide range of conditions. Ultimately, this will expand patient access to new therapies and reinforce the NHS’s reputation as a world-leading platform for health and life sciences research.
The revised legislation aims to reduce unnecessary administrative burdens on trial sponsors while keeping participant safety at the forefront. By removing overly prescriptive elements, the legislation will introduce greater flexibility and risk-proportionality, reflecting the evolving nature of clinical trial design and the innovative treatments they investigate.
These reforms will:
Create a proportionate and flexible regulatory environment—the new legislation will empower researchers to take more risk appropriate approaches to trials, meaning the regulatory requirements will be more flexible to match the risk that a trial presents.
Cement the UK as a leading destination for international trials—the new legislation will introduce more streamlined and efficient application processes, making it easier to apply for trials in the UK but without compromising on safety standards. A combined regulatory and research ethics review will be brought into legislation and approval timelines will be internationally competitive.
Move away from a one-size-fits-all approach, to be responsive to innovation—the new legislation has been drafted to ensure it is as future-proof as possible and is responsive to different types of trials and innovative ways of carrying out trials. Guidance will be used for specific details, rather than granular and duplicative requirements in legislation.
Ensure patients and their safety are at the focus of all clinical trials and supported by greater transparency bring the benefits of clinical trials to everyone—the new legislation will ensure increased public transparency about trials, including a requirement for registration on a public database and sharing of trials results with participants.
The reforms were developed by the Medicines and Healthcare products Regulatory Agency and the Health Research Authority through a series of stakeholder workshops, seeking the views of a wide range of organisations and individuals from across the clinical research sector, including patient representatives. A public consultation took place in January to March 2022, to which over 2,000 responses were received, and the Government response was published in March 2023.
The regulations, along with the associated explanatory memorandum and de minimis assessment, an analysis of the impact of the reforms on business, will be published on gov.uk today.
[HCWS310]
Rare Autoimmune Rheumatic Diseases
Andrew Gwynne Excerpts(1 year, 8 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Strangford (Jim Shannon)—I want to call him an hon. Friend because he is a friend, but convention dictates that I must call him an hon. Member—and I welcome the fact that he cares so much about health-related issues. I now see him more than I see my wife, because he is always in debates about a whole range of health conditions, and he brings so much passion to those debates. Importantly, he highlights rare diseases. I thank him for the way he made his case this morning, and for speaking about Zoi’s experience. When we humanise these things, we make them all the more impactful.
I thank my hon. Friend the Member for Bootle (Peter Dowd) for his contributions, and I thank the Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett), for humanising the issue through Carrie’s story; that is crucial. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), brings his professional experience to this debate, and that cannot be underestimated. I confess that I am not a medical professional, but in health debates it is important to listen to the expertise of those who work in the sector and on the frontline. I thank him genuinely for the way he has approached the debate. This is not a party political, knockabout debate; it is something on which we all want to see progress. The beauty of Westminster Hall is that we can leave the knockabout to the main Chamber, and in this room we can get into the detail of important subjects that are often overlooked. I pay tribute to those who are affected by rare disease, including rare autoimmune rheumatic diseases, and to their families.
The work of patient organisations such as RAIRDA is vital in raising awareness and campaigning to improve the lives of people who are living with rare diseases, and I thank those who dedicate their lives to this community. It is important to make the point that although rare diseases are individually rare, they are collectively common. One in 17 people will be affected by a rare condition over their lifetime. People living with rare diseases may face additional challenges in accessing health and social care. As the hon. Member for Mid Sussex said, this applies to a whole range of health services, including dentistry, and I hope that the Minister responsible for dentistry will pick that up. I will ensure that he receives her comments, because dentistry is often overlooked when it comes to people with rare conditions.
We are committed to improving the lives of people who are living with rare conditions. As the hon. Member for Strangford mentions, the UK rare diseases framework outlines four priorities to achieve this aim: helping patients to get a final diagnosis faster; increasing awareness of rare diseases among healthcare professionals; bettering co-ordination of care; and improving access to specialist care, treatments and drugs. Rare diseases are a priority for the Government. In England, we publish a rare diseases action plan annually, which details the specific steps we are taking to meet the shared priorities of the framework. Each action has an owner, desired outcomes and detail about how we will measure and report on progress. This Government are committed to delivering on the priorities framework, and we are working to publish the next England action plan in early 2025.
The UK rare diseases framework comes to an end in 2026, and I know that the rare disease community would like the policy to continue, to maintain the momentum and progress made over the lifetime of the previous framework. It is UK-wide and agreed across the devolved nations, and I am more than happy to discuss it further with colleagues in Wales and Scotland and, for the hon. Member for Strangford, with Mike Nesbitt, the Health Minister in Northern Ireland. I am the UK Health Minister with responsibility for engagement with the devolved Administrations when it comes to health and social care; indeed, we have a meeting with them and with the Secretary of State tomorrow to discuss a whole range of subjects. I am more than happy to discuss this issue further with colleagues to see if we can maintain four-nation co-ordination in this area. I believe that if we can do so, we should. I give the hon. Member for Strangford my commitment that I will take the matter up with the devolved Health Ministers to see if we can continue the four-nation approach.
In England, I am committed to working towards the four priorities of the framework, which were identified through the 2019 national conversation on rare diseases. Alongside the evaluation of England’s rare disease action plans commissioned through NIHR, the Department will undertake engagement next year to inform future policy decisions. The Government are committed to providing the best diagnosis and care for rare diseases, as set out in the UK rare diseases framework. Good diagnosis should be timely and accurate, and I know that people living with rare diseases often face journeys that are years long—diagnostic odysseys—before they receive an answer.
As the shadow Minister set out, many health professionals are involved in a patient’s journey, from those in specialist testing and genetic screening to GPs and primary care professionals. Raising awareness of rare conditions among those professionals is one way in which we can help to speed up diagnosis. I know that every experience of living with a rare disease is unique, and, with more than 7,000 identified rare diseases, we focus on addressing shared challenges across all rare diseases.
Although the increasing use of genetic testing is an groundbreaking tool in diagnosis, many conditions, including rare rheumatic autoimmune diseases, do not have an identified genetic component, so it is important that overall awareness, diagnostics and quality of care continue to serve all people living with rare conditions. NHS England is working to improve awareness of rare diseases among healthcare professionals, including those in primary care, through the NHS England genomics education programme, which includes non-genetic rare diseases. The GEP provides education and training to support the specialist and wider workforce to diagnose rare conditions early and to know how to deliver the best possible care for patients and families—the shadow Minister mentioned that. Working with partners such as Medics 4 Rare Diseases, the GEP has created genomic notes for clinicians, GeNotes, an innovative digital educational resource for healthcare professionals. The GEP works to provide information to GPs where and when they need it—for example, by presenting at primary care educational events, producing blended learning modules for GP trainees or ensuring regular reviews of the curriculum of the Royal College of General Practitioners.
The shadow Minister rightly mentioned research. I reassure him that the Department of Health and Social Care—this started on the previous Government’s watch, and we rightly are continuing the progress—supports research into rare diseases through the NIHR. The NIHR is the nation’s largest funder of health and care research, and it welcomes funding applications for research into any aspect of human health, including rare diseases. The usual practice of the NIHR and other research funders is not to ringfence funds for expenditure on particular topics. The “Rare Diseases Research Landscape Project Report” described investment of almost £630 million from MRC and NIHR programmes in rare disease research over five years. We are now working with the rare diseases community to further understand the gaps and the priorities, and to get them into those research pathways so that we can, we hope, fill the gaps.
As many rare diseases are chronic and affect multiple body systems, those living with rare disease face complex condition management, and interact with many specialists and providers of health and social care. That can include travelling across the country to access highly specialised care from experts. All of that can add up to a significant emotional and physical burden, and deepens existing inequalities. Co-ordination of care is essential to ensure that care is effectively managed, that the burden on patients and their carers is minimised and that healthcare professionals are working together to provide the best possible joined-up and high-quality care.
Last year, we hosted a workshop with RAIRDA to explore how best to support people living with “non-genetic” rare diseases. That highlighted the importance of specialised networks of care in delivering high-quality care at value for money. As we heard from the hon. Member for Strangford, networks, such as the Eastern Network for Rare Autoimmune Disease, are an example of best practice. I encourage integrated care boards to consider similar models across the whole country for types of rare diseases. I am more than happy to look closely at how we can seek to spread that best practice across the country, across different rare disease types and across ICBs, because patients with rare conditions deserve the same quality, safety and efficacy in medicines as other patients with more common conditions.
NICE, the MHRA and NHS England are working to understand and to address challenges preventing treatments for rare conditions from reaching patients who need them. I take on board precisely the points that the shadow Minister raises about the new drugs, how we ensure faster access and how we create the environment whereby clinical trials are more readily available in the United Kingdom. I want to assure Members that that is a central part not just of our health mission but of the Government’s economic mission, because we want the United Kingdom to be a base for investment in life sciences, in medtech and in access to clinical trials, so that our patients win as well as our economy. We have to ensure that safety is foremost in our deliberations. Safety is paramount, and we must ensure, in whatever regulatory regime that we have to encourage the life sciences, medtech and data industries into the UK, that safety is never compromised. I take on board fully the comments made by the shadow Minister.
NICE has also been working with RAIRDA to create a quality standard for rare diseases. That will find commonalities across the more than 7,000 identified rare diseases to develop standards that will drive quality improvement across multiple rare disease groups. Although the majority of rare diseases are genetic, others, such as rare autoimmune rheumatic diseases, do not yet have an identified genetic cause, as I said. A study by Genetic Alliance UK suggests that such conditions often have higher prevalence, impacting on a significant number of people, so it is important that both genetic and non-genetic conditions are considered.
Approximately 3.5 million people in the UK live with a rare condition, and addressing shared challenges across all conditions will be central to this Government’s approach. In addition, shared challenges across the health and social care system are often exacerbated for people living with rare diseases, such as access to mental health support—something else that the hon. Member for Mid Sussex mentioned. A central mission of this Government is to build a health and care system fit for the future.
The hon. Member for Strangford referred to our 10-year health plan. I reassure the House that that is intended to focus on the three shifts needed to deliver a modern NHS—not just fixing our NHS, but making it fit for the future, for the next 10, 20 or 30 years, putting it on a modernised footing as well as fixing the fundamentals. The three shifts are moving from hospital to community, from analogue to digital and from sickness to prevention. Those shifts offer opportunities to improve time to diagnosis and care for people living with rare diseases. Many highly specialised services for rare diseases must be delivered in hospitals to ensure the high standards of expert care that we want to see, but we can improve co-ordination of care to deliver better treatments closer to where people live, where possible. While many rare diseases are not preventable, early diagnosis can lead to interventions that improve health outcomes.
On the point made by the shadow Minister about community diagnostic centres, the Government’s commitment is to continue that programme. Indeed, I have seen the benefits of it myself—I got to open the new CDC at Crownpoint in Denton in my constituency in July. It is already having a game-changing impact on the local community, giving faster diagnosis and getting people into treatment more quickly, with better outcomes and better patient experiences for those who access the facilities.
The 10-year plan will ensure a better health service for everyone, regardless of condition or service area. On 21 October, we launched a national conversation on the future of the NHS, inviting views from across the country on how to deliver a health service fit for the future. Patients, staff and organisations can make themselves heard by logging on to the online portal, change.nhs.uk. I encourage hon. Members to do the same and to encourage their constituents to do likewise, if they have not done so already.
Unmet need remains, however, for people living with rare diseases, including rare autoimmune rheumatic conditions. I reaffirm that I am deeply committed, as is this Government, to working across the health and care system and with the rare disease community to address that need.
Finally, on workforce, the hon. Member for Strangford and other Members asked if the goal of the Government is to ensure that a patient gets the treatment, and that we get that treatment with the workforce we have. Getting that right workforce will be key. I reassure Members that the goal of the Government is to ensure that the patient, as they deserve, gets all the help that the NHS can offer in treatment, care and support.
The 10-year health plan will deliver those three big shifts on hospitals to community, analogue to digital, and sickness to prevention. To support delivery of the plan, the Secretary of State has confirmed that next summer we will refresh the NHS long-term workforce plan. That will help to ensure that the NHS has the right people in the right places with the right skills to deliver the care that patients need when they need it, not just today but in the future. The shifts we want to see in the delivery of healthcare will require us to rethink the kind of workforce we need in 10 years’ time.
Dr Luke Evans
I am grateful to the Minister for acknowledging the workforce, and for looking at the workforce plan. I was aware of the Health Secretary’s plan to revisit this, and the Minister talks about it being done next year. Does he have a timescale for how long the review will take? The danger, especially in healthcare, is that modernisation happens so quickly that, by the time we review something, it is already out of date and needs another review. This is always a chicken-and-egg situation. I would be grateful for a timescale.
Andrew Gwynne
We will refresh it next summer, and the Department is already beginning to think about whether this is what the shifts are intended to bring about, and whether these are the outcomes we want to see as a result of those shifts. If we are to have a neighbourhood health service that delivers much more in a community setting, how do we ensure we have the right skills and the right workforce to deliver that?
Particularly with the shift from analogue to digital, we will need a lot more tech-savvy clinicians, too. How do we build in some of the massive advances in artificial intelligence into medical devices and medical technology? We will be doing that concurrently with the 10-year plan to make sure that the workforce plan refresh is ready to go. This will allow us to embed the future, not just today’s practices, into the training and recruitment processes for the immediate future. The refresh will begin next summer, but it is a chicken-and-egg situation. We need to work out what the future of the NHS will look like, and then we have to ensure that we have the skills to meet that ambition—not just for today, but for the future.
In closing, I again thank my friend, the hon. Member for Strangford, for raising such an important matter, and I thank the rare diseases community for their continued and constructive engagement with the Government to help bring about meaningful change. I hope I have reassured the hon. Gentleman both on cross-UK working—and I take up his challenge to try to get colleagues across the devolved Administrations to agree to continue a UK-wide approach—and on my specific responsibility here in England. We will take forward the four areas identified in the UK plan. We will have a new plan for England, and we will seek to make the significant progress that I believe all Members of this House want to see happen.
I am more than happy to work collegiately with Members across the House, whose role is to scrutinise the Government, to hold our feet to the coals and to make sure we do what is in the plan at the best speed and pace for people living with these conditions. I also accept that I am not the sole fount of all wisdom in this area.
Andrew Gwynne
I know the shadow Minister is surprised by that. Genuinely, whatever people bring to the table, whether it is personal experience, professional expertise or their constituents’ stories, we need to share that knowledge so that we can improve how we deliver the outcomes we want to see for people living with rare diseases. I stand willing and ready to work with hon. Members across the House, and indeed with organisations that champion this area, so we can get the best outcomes that people deserve.
Cumberlege Review: Pelvic Mesh
Andrew Gwynne Excerpts(1 year, 9 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for Harlow (Chris Vince) on securing such an important debate on pelvic mesh and the independent medicines and medical devices safety review, also referred to as the Cumberlege review. We are all privileged to see the noble Lady Baroness Cumberlege in the Public Gallery. We thank her sincerely for the work that she has done over a number of years on women’s health, and on this issue in particular. I also thank my hon. Friend for the opportunity to contribute to this vital debate.
I am responding today on behalf of Baroness Merron, who leads on women’s health and patient safety in the Department of Health and Social Care. I will try to address as many as I can of the issues that right hon. and hon. Members have raised in this debate. If for any reason I do not get round to addressing something, I will ensure that Baroness Merron, as the Minister responsible, writes to Members.
This debate came about because of a meeting between my hon. Friend the Member for Harlow and one of his constituents, Debbie. As we have heard, Debbie described undergoing a failed procedure to remove vaginal mesh, which has caused her severe pain. She has remained in constant pain since the operation, and I express my deepest sympathy to her for her ongoing experience. It should never have happened.
My predecessor as a Minister, Nadine Dorries, placed on the record in 2020 the previous Government’s apology. We are a new Government, so I take this opportunity to make the same apology today on behalf of His Majesty’s Government elected on 4 July. This should not have happened, and I say to every single person it has happened to that we are sorry and we have a duty to put things right. That is what this Government will seek to do, and at pace.
This Government will build a system that listens, hears and acts with speed, compassion and proportionality. Complications from vaginal mesh can be devastating and have included severe and chronic pain, recurrent infections, reduced mobility, sexual difficulties and psychological impacts. It can be hard to imagine the avoidable suffering that many women have endured and the damage that has been inflicted on their lives. It is unacceptable that concerns raised by women were not listened to and that women were left to suffer alone. It is vital that we acknowledge those failures and ensure that the mistakes of the past are not repeated.
I assure the right hon. Member for Wetherby and Easingwold (Sir Alec Shelbrooke) that the 10-year health plan that the Government are consulting on will ensure a better health service for everyone, regardless of their condition or service area. A core part of the development of the 10-year plan, including its approach to women’s health, will be an extensive engagement exercise with the public, NHS staff and stakeholders.
We have heard about the nine specialist mesh centres that NHS England has established across England. The intention behind them is that every woman, in every region, who experiences mesh-related complications receives the appropriate support.
I hear the message of my hon. Friend the Member for Shipley (Anna Dixon) that more needs to be done on accessibility, outcomes and listening to women. I agree, and I will take that message back to Baroness Merron.
I share the concerns of the right hon. Member for Wetherby and Easingwold—I thank him for his support on this—about the battles and challenges that lie ahead to get the system right. The Government will consider how we build on existing provision in a sensitive way that meets the needs of the women. At the heart of all we do to try to put things right is addressing the needs of the women involved, and their families, who have been so dramatically affected by what went so tragically wrong.
Each mesh centre is led by a multidisciplinary team that comprises urology, gynaecology and colorectal consultants, in addition to nurses who specialise in a range of things that I am unable to pronounce, and in urology and incontinence, which I can pronounce. Patients also have access to other healthcare professionals, including psychologists, occupational therapists and pelvic floor specialists, to help with pain management.
I recognise the trauma that women have experienced and the vital need to exercise patient choice. That is especially true for women who are rightly concerned about being treated by a surgeon who previously operated on them. I hope that things have moved on since the answer that the right hon. Member for New Forest East (Sir Julian Lewis) received, but I will ensure that what Members have said, with the sincerity and the strength of feeling, is communicated back to Baroness Merron. I agree with the right hon. Gentleman that the process set out in that written ministerial answer is not acceptable. Yes, women have the right to choose treatment from another surgeon, but I actually agree with the shadow Minister that there should be an automatic assumption that their treatment should be done by somebody who did not operate on them previously, unless that woman does not mind. That is a stress and a trauma for many women, and we have to think about their rights.
I also recognise that there is a need to support GPs’ knowledge and understanding of pelvic mesh so that they can identify the symptoms of mesh complications and refer patients on to the appropriate services. I do not want any woman to be in the position of my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), or any other woman who has had her body tampered with in the most inappropriate way, when the procedure was not even necessary, and has suffered lifelong complications as a result. We have to move on at pace.
Following Baroness Cumberlege’s recommendations in 2018, the national pause on mesh remains in place for the use of vaginally inserted mesh to treat prolapse and the use of retropubic suburethral mesh sling to treat stress urinary incontinence. That means that mesh can be used only in exceptional cases where clinicians are of the opinion that there is a clinical urgency and no suitable alternative exists. NHS England continues to monitor progress on the conditions associated with the national pause and will only make changes to it linked to clinical advice and following consultation with a wide range of stakeholders, including patients, professional bodies and NHS organisations.
The Cumberlege review made nine recommendations, and the then Government accepted seven. Of those seven, four have been delivered, including the appointment of Dr Henrietta Hughes as the first Patient Safety Commissioner in England, the establishment of nine specialist mesh centres across England and the establishment of a patient reference group. Through our ongoing work, the Government are committed to delivering on the remaining three recommendations.
On redress, I will mention briefly the recommendation set out in the Hughes report, which was published in February. I first thank the Patient Safety Commissioner, Dr Henrietta Hughes, for her commitment to improving patient safety. Although the Government are not yet in a position to comment on the recommendations, I assure Members that we are considering the wide range of work set out in the report. I agree with the hon. Member for Eastleigh (Liz Jarvis) that the previous Government were too slow on that. It is a priority for this Government. We are working at pace, and we remain focused on making meaningful progress. This is a complex area of work, involving several Departments, but we are committed to providing an update at the earliest opportunity. I have heard the desire for urgency today, and I hope that we can make the progress that Members want to see.
I am afraid that I have left my hon. Friend the Member for Harlow 30 seconds to sum up, but I hope we have made some progress.
Food and Drink Advertising Restrictions
Andrew Gwynne Excerpts(1 year, 9 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
This Government are committed to creating the healthiest generation of children ever, and today we are taking another step towards achieving that goal.
Further to my statement on 12 September 2024, I wish to inform the House that today the Government will lay before Parliament the Advertising (Less Healthy Food Definitions and Exemptions) Regulations 2024 and an explanatory memorandum. This legislation enacts the provisions set out in the Health and Care Act 2022, which amended the Communications Act 2003, for a 9 pm watershed on the advertising of less healthy food or drink on television and a 24-hour restriction on paid-for advertising of these products online. Alongside laying the regulations, the Government are publishing a response to the technical consultation held between September and October 2024 on how the advertising restrictions apply to internet protocol television (IPTV) services, which deliver TV and advertising live over the internet. The consultation response confirms that IPTV services regulated by Ofcom will be subject to the broadcast restrictions (9 pm watershed), in the same way as other Ofcom-regulated TV and on-demand programme services, and we have clarified this in the final regulations. The Government are also publishing guidance for industry on the food or drink categories in scope of the advertising restrictions to support their preparation for implementation.
Following previous policy consultations and the Government’s response on 12 September 2024 to the consultation on the draft secondary legislation, the legislation and guidance published today provide businesses with further certainty in terms of the products, businesses and services in scope of the restrictions as well as practical guidance on their application, so that they can continue to prepare ahead of the restrictions coming into force on 1 October 2025. We will continue to engage with stakeholders during this period.
This delivers on our manifesto commitment to implement the junk food advertising restrictions without further delay, and in doing so we expect to remove 7.2 billion calories from UK children’s diets per year and reduce the number of children living with obesity by 20,000.
Obesity is the second biggest preventable cause of cancer and costs the UK health service more than £11 billion each year. By taking preventative action now, the Government will begin fixing the foundations of good health and protecting the next generation so that it can become the healthiest ever.
The Government’s response to the IPTV consultation and guidance on food or drink products in scope of the restrictions will be published on gov.uk shortly.
[HCWS278]
Health and Social Care
Andrew Gwynne Excerpts(1 year, 9 months ago)
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Andrew Gwynne
…We will still encourage adult smokers to switch to vaping through Swap to Stop in England, and I am delighted that localities have asked for over half a million starter kits so far. On advertising regulations, of course the consultation will take place after Royal Assent, but I hope that I can assure the hon. Member for Harrow East that we will take away his point about ensuring that the NHS can still advertise Swap to Stop under those regulations.
[Official Report, 26 November 2024; Vol. 757, c. 736.]
Written correction submitted by the Under-Secretary of State for Health and Social Care, the hon. Member for Gorton and Denton (Andrew Gwynne):
Andrew Gwynne
…We will still encourage adult smokers to switch to vaping through Swap to Stop in England, and I am delighted that localities have asked for over half a million starter kits so far. On vape regulations, of course the consultation will take place after Royal Assent, but I hope that I can assure the hon. Member for Harrow East that we will take away his point about ensuring that the NHS can still promote Swap to Stop under those regulations.