(8 years, 7 months ago)
Commons ChamberIf by “ideology”, the hon. Lady means a commitment to make the NHS the safest, highest quality health care system in the world, I plead guilty to ideology. That is the NHS that I want, and that means a seven-day NHS in which we do not have higher mortality rates for people admitted at weekends. There was a time when the Labour party would have been prepared to take tough and difficult decisions to make things better for patients, but that day has passed.
Many professions and occupations require seven-day working in the public and private sectors. Given that all but one of the points of difference between the BMA and the Government have been resolved, does my right hon. Friend agree that this drastic strike action on the remaining issue of Saturday pay is wholly unjustified?
(8 years, 9 months ago)
Commons ChamberThe hon. Gentleman has made an important point. I think that there are some things that we just need to do differently. For instance, we should allow managers to remain in their posts for longer. If the average tenure of NHS chief executives is only about two years, their horizons will inevitably be very short-term, so we need to give them enough time to turn their organisations around. The chief executive of the latest trust to be given an “outstanding” measure, Frimley Park Hospital NHS Foundation Trust, has been there for 26 years, and I think there is a connection. We can ensure that managers have the necessary resources. I think we can also make sure that we identify their problems quickly, and give them support before those problems turn into a crisis.
Barking, Havering and Redbridge University Hospitals NHS Trust is working extremely hard to improve its services and has already achieved considerable success, but although there are 250 spare home beds in the London borough of Havering, there are still a great many frail elderly patients in hospital who are no longer clinically ill. Has any research been done on the reasons for delayed discharge, and to what extent does patient choice play a part in it?
Unfortunately, it sometimes plays a part, but the main way to tackle the problem is to establish better co-ordination between what local authorities do, what the CCGs do and what the trusts do. That applies not just to my hon. Friend’s local trust, but to trusts throughout the NHS. I do, however, commend her local trust. At its last inspection, the CQC found that it had made significant progress. It has more doctors, more nurses and, in my view, an excellent chief executive, and I am very confident about its future.
(9 years ago)
Commons ChamberI have had conversations with my opposite numbers in Scotland about this issue and, as the hon. Gentleman knows, Shona Robison wrote to me about it. We are looking at her proposals in the context of wider scheme reform. I have also ensured that my officials are talking to the other devolved Administrations as we move forward to a better solution to this tragedy.
14. What progress has been made on integrating and improving care provided outside of hospitals.
The Government are committed to transforming out-of-hospital care for everyone, in every community, by 2020. We have seen excellent progress in areas led by integration pioneers, such as South Devon and Torbay. My hon. Friend’s own area also has in place a number of initiatives, such as the community treatment team and intensive rehabilitation service, which is rated very highly in her local community.
My right hon. Friend will be aware that elderly people deteriorate rapidly and lose their independence skills when they are admitted to hospital. What discussions have been held with local authorities to ensure that there is an adequate supply of carers to enable older people to remain in their homes whenever possible?
(9 years, 10 months ago)
Commons ChamberI draw Members’ attention to my entry in the Register of Members’ Financial Interests. I thank the hon. Member for Glasgow North (Ann McKechin) for allowing me to make a brief contribution during her debate—doubly so, because she did not withdraw her permission when I told her that I was going to disagree with her. Similarly, I thank the Minister.
I speak as a lifelong non-smoker. That is my choice, and it is a choice open to everybody. Nobody is forced to smoke. The Government have already invested heavily in existing strategies: television adverts, which were extremely effective—particularly the one about not smoking in front of children in one’s car—street hoardings, newspapers and magazines, smoking cessation treatment free of charge in GP surgeries and pharmacies, and anti-smoking advice in schools. My own schools are very effective in giving citizenship classes warning about the health risks of smoking. There cannot be anyone in this country, young or old, who does not know about the health risks of tobacco. Nobody smokes in ignorance.
Plain packaging has the laudable purpose of deterring children from starting smoking and helping smokers who wish to quit, but there is no reliable evidence that plain packaging will influence smokers in general or children in particular. In Australia, where plain packaging was introduced in 2012, both youth smoking and sales of illicit tobacco increased in the following year. There are many complex social reasons that lead to youth smoking, but packaging is not one of those factors. Currently 3% of under-15s smoke in the United Kingdom—the lowest percentage in a generation. I have asked people who were buying cigarettes in my local newsagent whether plain packaging would influence their tobacco purchasing habits, and they find the idea laughable.
Standardised packaging would be bad for exports, bad for retailers, particularly small shops, bad for jobs in warehousing, distribution, marketing, design and packaging, and bad for the Treasury, but very good for criminals, making the illicit trade much easier. What would follow—bottles of wine with plain labels, or bars of chocolate in plain packages as we are controlled and someone else makes our decisions for us?
Let us try to be positive and sensible. Let us clamp down on illicit sales of smuggled cigarettes in our neighbourhoods, and enforce a new ban on purchasing tobacco for under-18s, as with alcohol. Let us support shopkeepers in their role as gatekeepers to age-restricted products, encourage “No ID, no sale” signs in shop windows, and enforce stiff penalties against retailers—
Order. I hesitate to interrupt the hon. Lady, but time is very short. I hope she will draw her remarks to a close because the Minister has a speech to make.
I am very aware of that, Madam Deputy Speaker.
Let us enforce stiff penalties against retailers caught selling cigarettes knowingly to children and let us not forget the responsibility of parents to know how much pocket money their children have to spend and what they spend it on. In short, the policy of plain packaging is well intentioned but misguided. It will do more harm than good. It will not work and I oppose it.
(9 years, 10 months ago)
Commons ChamberNo, and I can tell the hon. Lady that her constituents would be receiving far worse care had we not tackled the long-standing issues with the South London Healthcare NHS Trust, which the last Government ducked but which we have confronted and dealt with. If she looks at the performance of A and E in her area, she will see that 48,000 more people are being seen within four hours than when Labour was in power.
T2. The Secretary of State will be aware that the London borough of Havering has the highest proportion of elderly people of all the London boroughs, but he may not know that the average age of an in-patient at Queen’s hospital is 86. Will he agree to look at the balance of future funding between acute care and community health care, so that elderly people can be supported at home and beds freed up for people waiting for acute operations?
My hon. Friend makes an important point. It is one of the underlying causes of pressure in A and Es that for an over-75 attending an A and E in winter, there is an 80% chance that, rather than going home, they will be admitted to hospital and probably stay there a long time. That is why improving community care, as she says, is at the heart of this Government’s strategy to reduce pressure on hospitals.
(10 years, 4 months ago)
Commons ChamberWe have recommended levels of staffing, but in the NHS we have decided not to have minimum levels of staffing. We were worried that that would be seen as a hurdle where, once achieved, nothing more would need to be done about staffing levels. The real issue about staffing levels and mandating numbers from the centre is that care needs change on a daily basis depending on how complex the needs are of the patients in a particular ward or home. That is why it is difficult to do it from the centre. We want to make sure that everywhere has the right numbers of staff. That is why I hope the hon. Gentleman welcomes the fact that we have so many more nurses.
Barking, Havering and Redbridge University Hospitals Trust is working really hard to get out of special measures. We have a new chief executive and a new chairman who are paying particular attention to the recruitment of nurses and improving the efficiency of the appointment system. Will my right hon. Friend join me in congratulating Barking, Havering and Redbridge Trust on improving the level of patient satisfaction by four points?
I am very happy to do that, and I pay tribute to the leadership of the trust. There is a new chief executive and, as I have said, I have met the chief nurse. It is a very large trust with two big hospital sites. There are some very big challenges to tackle, but they are making important progress, and, like my hon. Friend, I am keen to get them out of special measures as soon as we can.
(10 years, 7 months ago)
Commons ChamberI welcome the hon. Lady’s response. I know that she, as a former shadow Public Health Minister, takes a great interest in this area. I want to publish the draft regulations this month, alongside the short final consultation. The timetable that the Government are contemplating once a final decision is made should allow us to introduce the measure during this Parliament.
I support my hon. Friend’s measures to reduce the number of young people smoking, but she will not be surprised to hear that I do not support this measure. Only 5% of under-15s smoke, which is the lowest level for a generation. The Government’s anti-smoking measures that are already in place are clearly working. There are smoking cessation classes and posters in the streets and in every publication we pick up; there are television adverts warning people constantly about the health risks of smoking. Nobody in this country smokes in ignorance. The people who smoke make a deliberate choice to do so—they deliberately ignore all the warnings that are made available to them. We also must not forget parental responsibility in this, because parents are responsible for their children’s habits and for how much money they have to spend unsupervised—
(10 years, 9 months ago)
Commons ChamberMy hon. Friend makes an interesting point, but that is probably a debate for another time.
The Government would not necessarily use all the powers I have just described, and if we proceed, we will need to decide which aspects would be included in any regulations. However, it is prudent to take a comprehensive approach now, so that we are prepared for the future.
My hon. Friend will know that every packet of cigarettes carries the bold message “Smoking kills”. However, that does not influence the purchasing habits of smokers. There is also no evidence yet that the appearance of a cigarette packet will deter anyone from smoking.
This is a matter for the Chantler review; it is one of the things we have asked Sir Cyril to look at. I am not going to second guess the outcome of his review.
My hon. Friend anticipates some of my next remarks, and I agree wholeheartedly with what he says.
The amendment would amend existing smoke-free legislation in the Health Act 2006 to make it clear that the Secretary of State and Welsh Ministers have the powers to make regulations to provide for a private vehicle to be smoke-free when a person under the age of 18 is present. During the passage of the 2006 Act, Ministers at the time said they did not want to use the powers in that legislation to make private vehicles smoke-free. This amendment, if enacted by Parliament, would make it clear that regulations could be made, if the Government so decided, to prohibit smoking in private vehicles carrying children.
My hon. Friend described this measure as “workable”, but I wonder how she envisages it being enforced. Are we going to have smoking police weaving in and out of the traffic, looking in car windows? There must be a serious answer—how could this be enforced?
Enforcement has been the subject of much of the debate in both Houses over a number of years, and clearly the detail of that would be looked at in regulation, if the House is minded to give the Government a steer on the principle of this. So that is not a matter for today’s debate, but I am sure it will be—[Interruption.] It is not for me to comment on the detail of it, but I am sure it will be explored during the debate that follows my speech.
(10 years, 11 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
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We have asked Sir Cyril to conduct an independent review and to weigh all the different evidence. I do not wish to seem to pre-empt the review, because it is important that it is independent, but I will say that I am not aware of any health organisations that are not in favour of plain packaging. Indeed, as the hon. Lady can imagine, such organisations have expressed the opposite view to me with considerable strength.
Will the Minister remind the House of all the investment that the Government have already made in anti-smoking strategies so that no one smokes out of ignorance? Does she agree that the main responsibility for children’s smoking habits lies with their parents?
Of course we want parents to set a good example to their children and to try to prevent them from starting to smoke. The important public health measures to which my hon. Friend has referred are proceeding but, sadly, a great many children start smoking at a very young age.
(11 years ago)
Commons ChamberMay I begin by drawing the House’s attention to my entry in the Register of Members’ Financial Interests? I speak as a lifelong non-smoker. I have never smoked and I do not intend ever to smoke. That is my choice, and such a choice is open to anyone, but there has been a huge change in the culture surrounding smoking since I was a child. I do not know whether anyone in the Chamber is as ancient as me, but if they are, they will remember a television advert saying, “You’re never alone with a Strand”. It had a picture of a glamorous, enigmatic man with the collar of his raincoat turned up. He was smoking, and every man wanted to be like him because he was glamorous and mysterious. Hollywood stars, who appeared to spend their entire lives in evening dress, had long cigarette holders and the practice was presented as glamorous, attractive and sophisticated. People of my age at that time could not wait to grow up and reach 16 so that they could smoke—everybody did—because it was a sign that someone had grown up. I suppose that it was a blessing that I was brought up poor and working class. I could not afford to buy cigarettes and I should probably be grateful for that fact now, as it meant that I never took up the habit.
A couple of hon. Members have referred to the harrowing experience of losing a parent to cancer. I share that experience, although it was not smoking-related in my case. It is important that the education on smoking that I never received as a child, nor for several years afterwards, is now available to our younger generation. It was normal for me to see every adult around me smoking, but that is not normal now. If one goes past a place of work, however, there will be a group of people outside smoking, leaving a carpet of cigarette ends on the ground. That is a cause for complaint for all the non-smokers in that organisation, who know that smokers get smoking breaks from time to time during the day that they do not.
In a previous life, when I worked in local government, the one recreation room for staff had to be surrendered to the smokers because the council was obliged to provide a smoking room. It had glass walls, and as one walked around, all one could see was a great fug of smoke. Again, people in there were spending time on breaks that non-smokers were not allowed to take.
I pay tribute to the schools in Hornchurch and Upminster for the important work they are doing to educate our children from the youngest age. They have citizenship classes and school councils, and they take anti-smoking education extremely seriously.
The purpose of plain packaging is mainly to deter young people from taking up smoking and, hopefully, to deter established smokers. As has become obvious, there is consensus on both sides of the House that we should do everything we can to deter young people from taking up smoking and to enable them to understand the health implications of which people were not aware years ago. When I was a child, the health implications of smoking were never mentioned.
The first question we need to ask ourselves is: would plain packaging work? Secondly, what would be the effect on illicit tobacco sales and products? Finally, what would be the effect on small retailers and the design and packaging industry? Several speakers have referred to the fact that plain packaging has been introduced in Australia, but that was only about a year ago. I think that it is far too soon for us to make a credible evaluation of how effective the measure has been on young new smokers and existing smokers.
In 2008, the Department of Health identified the predictors of smoking initiation as age, gender, home environment, drug use and alcohol. Truancy and exclusion from school were also factors, but not packaging or the appearance of tobacco products—and, strangely, not price. When I was young, price was the one thing that stopped me smoking. Had I been able to afford it, I probably would have tried it. The NHS study “Smoking, drinking and drug use among young people in England in 2011” reported that 5% of 11 to 15-year-olds smoked regularly—that is, at least one cigarette a week. That sounds to me as though one child who could afford a packet of cigarettes was handing them around to their friends. That was half the number reported in 2001 and it compared favourably with the 6% who said that they had taken drugs in the past month.
There are better solutions to reduce the number of young people who take up smoking. Such smoking is at an all-time low of 5%, but we need to do more. We must not underestimate the influence of fashion and trends on young people, and if smoking becomes the in thing again, that percentage could rise.
On the question of smoking becoming fashionable again, what is my hon. Friend’s view on recent concerns about electronic cigarettes? Of course, they are not covered by the 2007 legislation and they can be smoked indoors in bars, clubs, pubs and restaurants. Recently, e-cigarette fluid has been marketed in champagne, vodka and bubblegum flavours. Is she concerned about that?
I must confess that I have tried e-cigarettes. I tried an apple-flavoured one, and it was quite an attractive, comforting thing to do.
I was a co-signatory to the open letter from my hon. Friend the Member for North Antrim (Ian Paisley) that highlighted the dangers posed by plain packaging to jobs, businesses, tax revenue and the legal trade due to increased smuggling and counterfeiting. Plain packaging would make smuggling easier and cheaper, and such products could be manufactured without regulation or quality control—I am told that some contain quite noxious additives. That situation could only exacerbate the associated criminality and revenue loss.
Her Majesty’s Revenue and Customs estimates that in my constituency of Hornchurch and Upminster, and those of other hon. Members, up to one in six cigarettes and 48% of hand-rolling tobacco is already illegal, costing the Exchequer up to £3 billion a year. If plain packaging were introduced, those figures would undoubtedly rise.
Plain packaging would also have a negative impact on small convenience stores. The display ban that is already in place in large stores will cover small shops in 2015. Most customers make additional purchases when buying their cigarettes and that custom is essential to the viability of small shops. I was in my local newsagent recently, standing behind somebody who was buying a packet of cigarettes. There was a warning on it in big, bold letters to the effect that smoking can kill. One could not possibly miss it, so that person had made a conscious choice to disregard the warning on the packet.
Plain packaging would also have a devastating effect on the supply chain for the tobacco sector, particularly as regards the design and production of branded packaging. That would stifle innovation, development and competition. It would be likely that lobby groups would continue to campaign for other product groups, such as alcohol or certain foods, to be subject to similar measures. That would be the thin end of the wedge, and it would pose a further threat to the design and packaging sectors and to the freedom of customers to make informed choices.
The Government are already investing significantly in anti-smoking measures. Anyone who wants to stop can get smoking cessation courses free of charge. We have television adverts and hoardings on the street, and there cannot be anybody in the country who does not know the health risks of smoking. People make a choice about whether to do it. As far as children are concerned, the principal responsibility lies with their parents, who should know how much money their children have to spend—a packet of cigarettes is very expensive—and how they spend it unsupervised.
And another 207,000 nationally will start this habit a year.
One might ask why people buy a packet of cigarettes when it has a warning on it, but this is an addiction. All sorts of addictions sadly roll over common sense, and tobacco is no different. Stopping young people starting is crucial, and that is working. Smoking rates for young children are diminishing now, as are rates for adults, partly as a result of taxation and partly because we are stopping tobacco companies promoting cigarettes.
There are no figures to show that counterfeiting is more likely with plain packaging. Earlier this year, the Japanese company came to the House and told us that there would be more counterfeiting, but there is no evidence of that. It showed us—I have one in my pocket —a counterfeit packet. It looks like any other Benson & Hedges packet, so counterfeiting happens now. Standard packaging could include features to protect against counterfeiting, and it is for the House to regulate to introduce them. Hon. Members should not use the arguments that have been sold by the tobacco companies year after year. When it was found that tobacco related to massive numbers of deaths, the companies were still questioning that decades after the event—they still do now. They use this House to do it on occasions and, I have to say, it is wrong. When there are 100,000 premature deaths a year, we as legislators have some responsibility to alleviate the problem. I know that smoking is addictive and it is difficult for people to stop.
Does the right hon. Gentleman agree that no young child can become addicted to cigarettes unless their parents provide them with the money to buy them?
My father used to provide me with cigarettes; the only thing was that he did not know about it. I used to go in his packet of Woodbines and take one out, and he did not count them very often. That was how I started smoking on the street at a very early age. If we put the price up, of course it will reduce the consumption of cigarettes, but we need to stop young people starting.
This is the first time I have had the privilege of speaking with you in the Chair, Madam Deputy Speaker, and I look forward to it.
I thank the hon. Member for Harrow East (Bob Blackman) for seeking this debate, the co-sponsors from all parties and the Backbench Business Committee for making it possible. It has been a very good debate, with many thoughtful and powerful contributions and, I think, a large degree of consensus. There is a clear reason for that consensus. In the final analysis, this is a debate about children. Adults do not take up smoking; children do. Despite hon. Members having referred to a drop in the take-up of smoking, more than 200,000 children still take up smoking every year. Eight out of 10 smokers start by the age of 19. As my right hon. Friend the Member for Rother Valley (Mr Barron) said, there are few new smokers over the age of 21. In my patch, there are 460 regular smokers across Liverpool who have not yet turned 15. As the right hon. Member for Sutton and Cheam (Paul Burstow) said, we are talking about a childhood addiction, not an adult choice.
We know that about half of those children—half of all regular smokers—will eventually be killed by their addiction. Contrary to the presentation by the hon. Member for Ribble Valley (Mr Evans), who I am sorry to see is not in his place, tobacco is different from other products, because if it is used properly, as instructed, it kills one in two of its users. It is the only product for which there is an international treaty, the World Health Organisation’s framework convention on tobacco control, precisely because it is not like any other product and has to be treated differently.
Smoking remains by far the largest preventable cause of cancer. As my hon. Friend the Member for Barnsley Central (Dan Jarvis) said, more than 100,000 people die across the UK from smoking-related diseases every year. In Liverpool, 346 deaths per 100,000 are attributable to smoking, whereas the national average is 201 deaths per 100,000. The hon. Member for Rossendale and Darwen (Jake Berry) spoke about NHS spending on the cancer drugs fund.
The question that we should be asking ourselves is whether we are doing everything we can to discourage children from starting to smoke in the first place. Contrary to what the hon. Member for Aberconwy (Guto Bebb) said, I make no apology for asking the emotive questions. Are we doing all that we can to protect our young people? Have we exhausted every measure at our disposal? With that in mind, I want to cover three broad themes: first, why packaging matters so greatly; secondly, why the arguments against standardised packaging do not stand up to close scrutiny; and thirdly, why we cannot afford to wait.
I echo what was said by the hon. Member for Harrow East, my hon. Friends the Members for Stockton North (Alex Cunningham) and for Barnsley Central and my right hon. Friend the Member for Rother Valley about the part that packaging plays in encouraging young people to smoke. It is widely accepted that in the years since the last Labour Government banned tobacco advertising in 2002, the tobacco industry has developed far more sophisticated ways of using packaging to entice people to smoke.
We have all seen what cigarette and tobacco packaging looks like in Britain today, with its bright colours, shiny veneers and slimmed-down packets. We have heard about the boxes shaped like perfume bottles and lipsticks, with the glamorous slogans to match. One slogan that struck me was:
“Indulgence—change the taste to suit your mood”.
Such novelty packets appeal to young people, because that is exactly what they are designed to do. Academics at the university of Stirling tested that by surveying more than 1,000 children for a study that was published in the British Medical Journal a few weeks ago. They found that the children were overwhelmingly more attracted to the packets with such designs.
The hon. Lady has spoken about children starting to smoke. Does she agree that the main responsibility lies with their parents, because the money has to come from somewhere? If it does not come from their parents, where does it come from?
That point has been made by other hon. Members in this debate. I remember from when I was a young person that children do not get their money only from their parents and that they do not necessarily buy the cigarettes themselves. Often, they see other people getting out their packs of cigarettes.
The children in the university of Stirling study who were shown a packet of Silk Cut cigarettes were found to be more than four times more likely to be susceptible to smoking. Those children had never smoked.
It is the packaging that entices children. If we want to discourage children from ever starting to smoke, we need to question whether that is an acceptable way to market a product that is highly addictive, seriously harmful and clinically proven to kill. Smokers advertise tobacco brands to other people every time they take out their pack to smoke. The packets should not be glitzy adverts, but should carry strong and unambiguous health warnings about the dangers of smoking. We should not allow those warnings to be subverted by the design of the rest of the packet.
I will move on to my second theme. We have heard a few arguments against standardised packaging in this debate. We have also heard those arguments from the tobacco industry. I will deal with each of the arguments in turn. Much of the discussion has centred around evidence. Hon. Members have said that there is no evidence that standardised packaging will work. That is not true.
Last year, the systematic review by the Public Health Research Consortium, which was commissioned by the Department of Health, looked at all the evidence on standardised packaging. The findings are clear for everyone to see. It found that standardised packaging is less attractive, especially to young people. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) rightly pointed out that it takes away the cool factor. The review also found that standardised packaging makes health warnings more effective and combats the utter falsehood that some brands are safer than others. Those findings have been backed up by 17 studies that have been published since the systematic review. Government Members, including the hon. Member for Ribble Valley, have asked for evidence. We have the evidence.
A separate study that was published in the British Medical Journal in July looked at research from Australia soon after the introduction of standardised packaging. It found that smokers who used standardised packs were 66% more likely to think that their cigarettes were of a poorer quality, 70% more likely to say that they found them less satisfying, 81% more likely to have thought about quitting at least once a day in the previous week and much more likely to rate quitting as a higher priority in their lives than smokers who used branded packs. Not only are people less likely to take up smoking when presented with standardised packs; people who already smoke are more likely to think about quitting if the cigarettes that they buy come in standardised packaging.
When looking at future policy development, will the Minister pay greater attention to how parents can be encouraged to take responsibility for the behaviour of their young children and how much money they have to spend unsupervised? Such money obviously gives children access to tobacco, but it is in parents’ hands to control it.
I thank my hon. Friend for that important point. We know that many children who start smoking are within a family who smoke and that they are sometimes given cigarettes by parents or other family members and friends. I will of course consider her very relevant point.
I reiterate that there are many things we can do, but we are actively considering whether standardised packaging could make an important contribution to our overall policy on tobacco control. I have noted the strength of feeling on both sides of the House. This has been a good debate, and an informative one for me as a new Minister. As I have said, I am actively considering the matter, and today’s powerful contributions have spurred me to give further and urgent consideration to this important public health issue.