Tobacco Control Plan

Baroness Blackwood of North Oxford Excerpts

Thursday 13th October 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate the hon. Member for Stockton North (Alex Cunningham), my hon. Friend the Member for Portsmouth South (Mrs Drummond) and the right hon. Member for North Norfolk (Norman Lamb) on securing the debate, and the Backbench Business Committee on allowing it. The importance of the debate is shown by the fact that we have the Chair and former Chair of the Health Committee and a former Health Minister present, as well as our newly appointed shadow Minister, whom I welcome here today; there was not much chance to do so in Health Question Time.

As hon. Members have made clear, despite the continuing decline in prevalence, smoking remains the largest single cause of preventable and premature death in this country, with approximately 17% of deaths annually caused by smoking. I want to be clear from the outset that the Government remain committed to reducing the number of people who smoke by stopping them before they start. We have a clear track record in reducing the harms caused by tobacco, which has already been mentioned.

We have made good progress through a comprehensive package of measures, many of which were brought about by my predecessor, my hon. Friend the Member for Battersea (Jane Ellison), with a lot of support from the all-party group on smoking and health; I thank its many members who are here today. We have introduced standardised packaging and the ban on displaying tobacco in small shops. We have maintained a high duty rate on cigarettes and hand-rolled tobacco, and we have ended smoking in cars with children in them. Such measures have played a part in ensuring that the public are protected from the harms of tobacco. We now see that 80% of people support the smoke-free places legislation, which shows a change in culture and attitude.

We have also continued to support people to quit smoking, with Public Health England running media campaigns such as Stoptober. As the Minister responsible for public health and innovation, I am pleased to see the innovative use of digital tools such as the Stoptober app and social media messaging, which have allowed campaigns to reach out to groups in which smoking rates remain high and target them more effectively. That approach has proved extremely successful and was responsible for 130,000 people successfully quitting for 28 days in Stoptober in 2015.

I have heard the concerns about the lack of use of mass media, and I will look at the evaluation of Stoptober and see whether there has been any impact. That strategy has been used so that we can have a more focused targeting of high prevalence areas and groups by using the most efficient social media channels, but we will examine the evidence to see how effective that has been. As today is so close to the halfway mark for those attempting to quit during the campaign, I take this opportunity to wish them all the best in reaching 28 days smoke-free. I want to tell them not to give up.

As the former Chair of the Health Committee, the right hon. Member for Rother Valley (Kevin Barron), said, it is notable that one of the most significant disruptions to smoking in recent years has had nothing to do with Government intervention. We have seen considerable take-up of e-cigarettes in the UK, and we know that almost half of the 2.8 million current users are no longer smoking tobacco. We need to continue to embrace developments that have the potential to reduce the burden of disease caused by tobacco use. However, we need to recognise that the use of such products is not risk-free. We need a regulatory framework that minimises risks to users and targets the promotion of products at existing smokers and not at children. I have heard the comments made today about e-cigarettes.

[Kevin Barron]

Will e-cigarettes, or vaping, be in the new tobacco strategy?

[Nicola Blackwood]

I am looking closely at PHE’s expert independent review. I have asked officials to examine that closely, and they are updating the review of the evidence each year. I do not have a date for this year—I know the right hon. Gentleman asked for it—but I will write to him when I find out exactly when that will come forward.

Our approach has been comprehensive and has seen smoking prevalence fall in all age groups for both men and women. As various Members have said, adult smoking prevalence in England is now just under 17%, the lowest rate since records began, and we should take a moment to be proud of that. However, as others have said, we cannot be complacent. Smoking continues to be one of the largest causes of social and health inequalities in this country. It accounts for approximately half of the difference in life expectancy whereby, as the Prime Minister said, those on the lowest incomes die an average of nine years earlier than others. The Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), said it so well: it has an even greater impact on healthy life expectancy, which we also need to focus on.

At national level, smoking prevalence is declining year on year. There remain significant regional and demographic variations—an issue raised by the hon. Member for Stockton North, the shadow Minister and others—with the prevalence in some population groups, such as those with mental health conditions, at more than twice the national average. That point was particularly raised by my hon. Friend the Member for Harrow East (Bob Blackman) and the former Health Minister, the right hon. Member for North Norfolk. I shall certainly look at the report that was mentioned, “The Stolen Years”.

Regional variation means that rates of smoking during pregnancy can range from anywhere between 2% in some areas to 27% in others. That is another issue that we must focus on. Given the wide variation in smoking rates across the UK, it remains crucial that local councils have the flexibility to consider how best to respond to the unique needs of their local population and tackle groups in which prevalence remains high.

[Alex Cunningham]

The Minister talked about local authorities having flexibility. Will she support ring-fenced funding in this area, which we discussed earlier?

[Nicola Blackwood]

Ring-fencing is a highly political question, but I recognise that some difficult decisions have been made right across Government to reduce the deficit and ensure sustainability. Councils have been given £16 billion of public health funding across this Parliament, on top of further NHS prevention funding. The big question is whether that is being targeted at the right public health priorities.

We have been looking at that issue closely in my office. Local PHE centres are working with local commissioners to try to ensure that evidence-based service provision remains a priority. Nationally, PHE has been putting together a range of tools to support local commissioning decisions and has convened a round-table of experts to review the situation and propose a range of actions. However, I recognise that ensuring that the right services are prioritised will require more than just providing data about cost-effectiveness and smoking prevalence. The sustainability and transformation plans are supposed to be part of the answer.

[Norman Lamb]

On the adequacy of public health budgets, does the Minister think it is rational in any way to increase in real terms the budget for the NHS while reducing in real terms the budget for public health?

[Nicola Blackwood]

Prevention is a core part of the NHS five year forward view and should be embedded in NHS funding, public health funding and social care funding, as the right hon. Gentleman has stated. We are looking for the STPs to show a joined-up plan for how prevention, acute delivery services and social care will work together. PHE can and does advise and support local councils to tailor their services effectively, but we need to see how we can improve that. The local tobacco control profiles are one way in which we are doing that, but we must ensure that we see some of that work implemented.

At national level, to help drive a reduction in variation, the Government are committed to publishing the new tobacco control plan that all Members have mentioned, which has tackling inequalities at its heart. The plan will build on our success so far and will include renewed national ambitions. We have to maintain the proactive, comprehensive and non-partisan approach we have seen so far. The UK is recognised as a world leader in tobacco control strategy, and we intend to maintain that. However, I am afraid that on this occasion I will not be able to match my predecessor by announcing the date of publication. [Hon. Members: “Oh!”] I know; I feel inadequate.

My hon. Friend the Member for Harrow East is right in identifying my desire to ensure that the plan is evidence-led. It is reasonable for a new Government to want to check that the plan offers the best possible strategy, based on evidence. On something as important as a tobacco control plan, which is a golden moment, we have to ensure that we do not publish the plan until we get it right. It has been valuable to have the opportunity to listen to and engage with this debate, so that I can hear from colleagues as expert and engaged as those present before going forward. I assure all Members that the Government see the issue as a matter of urgency and are pressing forward with the plan as quickly as possible. I will certainly take away the suggestion from the hon. Member for Stockton North about incorporating respiratory health monitoring into the NHS health check.

I would like to go through a few of the points that we have discussed before I finish. As I have highlighted, it is right to turn our focus to population groups in which smoking prevalence remains higher than elsewhere. In particular, we must turn our attention to reducing health inequalities in populations who already suffer from poorer health and social outcomes, such as those in routine or manual occupations or those who suffer from mental health conditions.

As my hon. Friend the Member for Totnes said, improving maternity outcomes and giving children the best start in life is an important priority for this Government, and supporting pregnant women to quit smoking will be an important factor in working towards that. We all know that smoking during pregnancy increases the risk of stillbirth, as the shadow Minister said, and of problems for a child after birth. We also know that babies born to mothers who smoke are more likely to be born underdeveloped and in poor health. Tackling that was a priority under the previous tobacco control plan, during the period of which smoking prevalence among that group fell by three percentage points, but more can be done to reduce it further and, most importantly, to tackle the variation I mentioned. We will look at that.

Alongside limiting babies’ exposure to smoke during and after pregnancy, we must continue to work to end the cycle of children taking up smoking in the first place. As the percentage of 15-year-olds who regularly smoke has fallen to 8% and continues to fall, we must press our advantage and work towards our first smokeless generation. That would be something that we could genuinely be proud of. Restricting access to tobacco remains key, and we will want to maintain the enforcement of measures mentioned today, such as age of sale laws. Evidence shows that children who have a parent who smokes are two to three times more likely to be smokers themselves. Continuing to support adults to quit is therefore vital to ending the cycle of children taking up smoking and must remain a key part of tobacco control in the future.

In order to achieve our ambitions for the population groups I have mentioned, and to reduce smoking prevalence across all populations to even lower rates, we have to continue to draw on the things that we know work. This is an area in which we have a strong evidence base, and that work will include continuing a programme of evidence-based marketing campaigns such as Stoptober and monitoring the evidence base for e-cigarettes.

Finally, the right hon. Member for North Norfolk is right to say that tobacco use is a global issue and an international priority. Our new tobacco control plan will need to reflect that. As a world leader on tobacco control, the UK will continue to work closely with others to reduce the burden that smoking places on individuals, families and economies across the globe. As he said, we are investing official development assistance funds over five years to strengthen the implementation of the WHO’s framework convention on tobacco control. The project will be delivered by the WHO, and through it, we will share the UK’s experience in tobacco control to support low and middle-income countries to put effective measures in place to stop people using tobacco. That will happen through capacity sharing. We will carefully monitor the progress of that initiative to ensure that it delivers results, using very effective evaluation measures. I am happy to have further discussions about that with the right hon. Gentleman, if he would find that helpful.

We can be proud of the progress that successive Governments have made on helping people to quit smoking, preventing them from starting in the first place and creating an environment that de-normalises smoking. With prevalence rates at an all-time low, there is no question that good work has been done, but as the issues raised in this debate clearly show, there is more work to be done. The Government are committed to doing that work as a matter of urgency. I will take away the comments made today, which are incredibly helpful to me as a new Minister, and I will ensure that as we finalise the new tobacco control plan—

[Mrs Hodgson]

Will the Minister give way?

[Nicola Blackwood]

This is literally my last sentence, but I will.

[Mrs Hodgson]

I am very grateful; I thought I could just catch the Minister before she finishes. Can we expect the tobacco control plan this year or next year?

[Nicola Blackwood]

The hon. Lady will have to wait and see.

In conclusion, the Government recognise this area as a top priority and will continue to work on it as such.