Obesity and Fatty Liver Disease

Beccy Cooper Excerpts

Tuesday 28th October 2025 Westminster Hall

[Dr Beccy Cooper (Worthing West) (Lab)]

I beg to move,

That this House has considered obesity and fatty liver disease.

It is a pleasure to serve under your chairship, Mr Efford, alongside my parliamentary colleagues who have kindly come along this morning to debate and highlight the public health emergency that is obesity and fatty liver disease.

The vast majority of us do not often think about the health of our livers. If we do, our biggest concern is how many units of alcohol we drink every week and whether our livers can keep up. But we do talk about our weight a fair amount, either in terms of how we look and how our clothes fit, or, if we are linking it to disease, whether we are blocking up our arteries and risking a heart attack. Today I want to make the case for linking our concerns about being overweight and sedentary with the very real risk of developing fatty liver disease. Before I give the alarming statistics about the huge increase in liver disease in the UK, I want us all to hold on to the fact that a weight loss of 10% can halt and even reverse fatty liver disease progression, and the way to help us all to do that is not to point fingers and tell individuals to try harder. There are much more effective public health solutions than that.

Now for the alarming statistics that should give us all pause for thought: after heart disease, liver disease is the biggest cause of premature mortality and lost working years of life in the UK. In stark contrast with other killer diseases where the mortality rate has gone down, deaths from liver disease have increased by 400%—yes, 400%—over the past two decades. Every year we are seeing 18,000 deaths from liver disease. It is now the biggest killer of 35 to 49-year-olds in the UK. In two to three years it is set to surpass heart disease as the leading cause of premature death in the UK.

Today’s debate matters because fatty liver disease is becoming one of the defining public health challenges of our generation—a disease that already affects as many as one in five adults in the UK, equating to about 1 million people, but one that hardly anyone knows about. When I asked my parliamentary colleagues to speak in today’s debate, they said, “Fatty liver disease? What’s that?” So hopefully this debate will highlight this alarming disease.

Closely linked to our ongoing struggles with obesity, fatty liver disease—for the record, its clinical name is metabolic dysfunction-associated steatotic liver disease; that is the last time I am going to say that today—is deeply rooted in our broken food systems and the stark health inequalities that our communities face.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Lady on securing the debate. She is outlining very clearly the importance of the issue. It is vital that people are aware of it. Does she agree that if we do not deal with the issue, the NHS waiting lists over the coming years will be compounded even further than they have been already?

[Dr Cooper]

I thank the hon. Member for making that excellent point. He is absolutely right. The issues of the NHS waiting lists are pertinent and stark. Reducing them will mean that we have to get the left shift right as well as invest in acute services.

Our policies have failed the population for decades. This debate is an opportunity to make the urgent case for a national liver strategy, joined-up public health work and profound reform of the conditions that stop us all living well. Because we have failed to build an environment where healthy food is affordable and accessible, two thirds of UK adults are now overweight or obese, and one in three children in England are above a healthy weight when they leave primary school.

Fatty liver disease is a silent killer, often asymptomatic until at a very advanced stage, meaning many patients are diagnosed too late for effective intervention. Left untreated, as too many are, fatty liver disease can progress to liver inflammation, fibrosis, cirrhosis, liver failure or liver cancer. Fatty liver disease also increases significantly the risk of heart attacks, stroke and heart failure. It is projected to overtake alcohol as the leading cause of liver transplants within a decade.

How do we treat fatty liver disease? Despite high and rising mortality rates, there are limited treatment options for patients with this disease. As I have said, weight loss and lifestyle change are essential.

[Clive Jones (Wokingham) (LD)]

I thank the hon. Member for bringing this very important subject to Westminster Hall. She is absolutely right. Fatty liver disease is the fastest rising cause of liver cancer death in the UK and highlights the risk of developing a less survivable cancer for people living with obesity. Does the hon. Member agree that improvements to diagnosis of and treatment for fatty liver disease should be covered in the national cancer plan, which I called for a year ago and the Government are to announce early next year?

[Dr Cooper]

I thank the hon. Member for his excellent intervention. I absolutely agree that the national cancer strategy is essential. We must make sure that liver cancer is integrated into it, and that diagnosis and treatment are a key part of it and are funded across the country, to make sure that the inequalities that I am going to talk about are addressed sufficiently.

Before we get to the issue of diagnosis and treatment, weight loss and lifestyle change are essential. We know that a Mediterranean diet plus exercise improves liver function and that reducing ultra-processed foods reduces intrahepatic fat. However, for those whose disease has progressed to scarring of the liver, or liver fibrosis, there is an urgent need for therapies that directly target the liver.

Currently, no drugs are licensed to treat fatty liver disease in the UK. We have fallen behind the United States and Europe, as our market is too small for prioritisation. If I might get a bit more political, that is driven in part by our decision to leave the European single market. But this is a rapidly advancing field and we are approaching a potential breakthrough in treatment. With adequate planning, co-ordinated action, investment and leadership, we can ensure that our national health system is patient-ready to deliver the next generation of medications, and that all patients, regardless of postcode, can benefit.

Early diagnosis offers significantly better outcomes and a wider range of treatment options, but despite fatty liver disease being medically recognised in the 1980s, clinical and public awareness of it remains far too low. We urgently need to increase public understanding and encourage early liver checks, particularly for those at higher risk because of obesity or type 2 diabetes. What is more, we have seen primary care systemic failures to improve early detection, such that three quarters of people are diagnosed with cirrhosis at hospital in an emergency, when it is too late for effective treatment or intervention.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I, too, congratulate my hon. Friend on an excellent and really important debate. May I take her back to what she was saying about the food industry, wider population prevention measures and what this means for school meals and for our poorer communities, who are reliant on food supporters, such as the Trussell Trust and others, in terms of the type of food made available to them?

[Dr Cooper]

I thank my hon. Friend for that excellent intervention. She is absolutely right. With her public health expertise, she highlights the very real problems that lead to fatty liver disease: our broken food system, the issue with access to good, nutritious food for children in school, and the need to ensure that our stark health inequalities are addressed. I will come to that later in my speech.

To go back to the issue of diagnosis and treatment, we should note that a staggering 80% of England currently has no effective detection and treatment pathway—yes, a staggering 80%. The British Liver Trust, whose representatives are here today, is rightly calling for an end to this postcode lottery, so a key ask raised in this debate is that every integrated care board, every regional and national health area that we have, should have a full pathway for early detection of liver disease.

There is some excellent, innovative work out there that can help us to get to a much better place in tackling this disease. I recently met the team at Predictive Health Intelligence—whose representatives I think are also here today—who have developed hepatoSIGHT, which is a great name; well done. That is an inspiring example of how technology can transform early detection. The system uses existing NHS data to identify people at risk of liver disease before symptoms develop, allowing GPs proactively to invite patients for screening and support. I am delighted to say it is now being implemented across NHS South West. It is proof that, with genuine support from senior NHS management, clinical and digital teams at all levels can come together for the good of patients. That system is exactly the kind of innovation we need in order to make early diagnosis and prevention the norm and not the exception.

I now come to prevention. Screening and early diagnosis are vital but, as for all population health issues, as my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) rightly highlighted, we must have a laser focus on preventing the root causes of fatty liver disease.

[Steve Yemm (Mansfield) (Lab)]

I thank my hon. Friend for raising this debate. We are calling obesity the enemy, but the liver does not count in pounds or kilograms. The real culprit is not body weight; it is metabolic dysfunction, as she points out—insulin resistance, poor diet, genetic risk and so forth. Lean people also get fatty liver disease, not always people who are overweight. Does my hon. Friend agree that we should talk less about obesity and more about screening early, taxing junk food and treating metabolic disorders and disease rather than strictly BMI? If we chase the scales, we might miss the science.

[Dr Cooper]

I thank my hon. Friend for that excellent point and agree absolutely. In our society, we focus on how people look for many reasons, cultural and commercial, but this is purely about health. This is about keeping people healthy on the inside and allowing them to live good quality lives. My hon. Friend is absolutely right in that sense.

Poor diet is now the leading risk factor for death and disability. It is responsible for millions of preventable deaths each year. In the UK, almost two thirds of adults are overweight or are living with obesity, increasing the risk of fatty liver disease, cardiovascular disease and a multitude of cancers. In my job as a public health consultant, I see a lot of data and read many papers, but this statistic shocked me: four in 10 children with obesity may already have fatty liver disease. That demonstrates the urgent need to act now to prevent an even greater epidemic of disease in future.

That has not happened by accident; it is the result of a broken food system, which has made the UK Europe’s third most obese country and one of the world’s biggest consumers of ultra-processed food. We have a system that makes the unhealthy choice the cheapest, easiest and most available choice. Healthier food now costs more than twice as much per calorie as unhealthy food. That is £10.24 per 1,000 kilocalories compared with £4.50. For fruit and vegetables, the cost is even more at £11.90 per 1,000 kilocalories.

For the lowest income households, following a recommended healthy diet would swallow half or more of their disposable income. It is no surprise that obesity and fatty liver disease hit hardest in poorer communities. As I said at the beginning, this is not about personal failure. As hon. Members have said, sometimes people feel that that they are failing to lose weight and failing to keep themselves healthy. This is not about personal failure; it is a political failure. It is our collective failure to create a food environment that protects rather than undermines public health. If we are serious about prevention, we must be serious about reform—the right type—with stronger fiscal and regulatory measures to reduce the availability and marketing of foods that are high in fat, salt and sugar, and to rebuild a food system that serves public health and not profit.

Why have we not addressed this yet? Weighted against the commercial gain of the food and drink industry, our obesogenic environment is killing our population and costing the taxpayer billions. Economic analysis last year suggests that excess weight costs the economy £126 billion a year. A Budget is coming up next month; I am fairly sure that our Chancellor would like £126 billion a year. That figure takes in wider factors, such as lost productivity, care costs and lost years of healthy life. The direct NHS cost of obesity is projected to rise from £6.5 billion to £9.7 billion by 2050. We cannot separate our health and our wealth, and we cannot hope to achieve economic growth without tackling issues such as obesity and fatty liver disease.

Since 1990, there have been nearly 700 policies proposed by Government to reduce obesity. Imagine having 700 policies about your life! Past strategies fell short because they targeted behaviour change—individual choice—rather than the structural and commercial drivers of diet. Many lacked delivery plans, timelines or evaluation frameworks, leading to fragmented progress and limited long-term impact.

What can we do now to ensure that this public health emergency is addressed? My key asks for our Health Minister, who is kindly listening here today, are as follows. First, there is a clear need for a national liver strategy, ensuring increased public awareness, early liver checks and primary care pathways. As stated earlier, every integrated care board should have a pathway for the early detection of liver disease.

Secondly, we need strong planning and co-ordination to be ready to deliver the next generation of medication for liver disease. Thirdly, if we truly mean to deliver the left shift to prevention, promised in the 10-year health plan for England, then we have to change the environment that is driving poor health. There is strong consensus about the necessity of upstream interventions to regulate the unhealthy food and drink environment. We can build on that strong consensus to extend the levy model to high-sugar and high-salt foods; to enforce the 9 pm watershed for high fat, salt and sugar advertising, closing brand mark loopholes; to provide stable funding for local food partnerships, so that councils can act on local needs; to reinstate the full childhood obesity plan; and to address food affordability via fiscal reform.

None of this is easy or it would have been done already, but right now our environment is draining our health service of billions each year and weighing heavily on the nation’s health—no pun intended. Let us not keep repeating our mistakes, but rather embed food policy as a national health priority. Through our work on preventing obesity and fatty liver disease, let us support and finally see the long-discussed and essential shift towards prevention and a healthier, wealthier country.

[Clive Efford (in the Chair)]

I remind Members to bob in their places if they intend to speak.

--- Later in debate ---

[Dr Cooper]

Thank you, Mr Efford, for chairing the debate this morning. I thank the Minister for her excellent remarks, and all the parliamentary colleagues who have taken the time to be here. I thank the British Liver Trust and everybody who came to hear the debate. I hope they found it edifying and useful.

I have no particular further remarks; I think most points have been covered. There is a lot of work to do. As has been said, 90% of liver disease is preventable. That is a serious amount of disease that we do not need to face in this country, which is incredibly important to remember.

Our obesogenic environment—my hon. Friend the Member for Chelsea and Fulham (Ben Coleman) told me to say that slowly; it basically means it is hard for us to do healthy things and keep well—encourages us, consciously and subconsciously, to do things that are not great for our bodies. The Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), said that we have agency. Of course we do, but we are humans in an environment that is telling us all sorts of things all the time. Our job as parliamentarians, as representatives of our residents, as members of the party that is governing the country, is to make sure that the messages and signals that we send, and the legislation that we pass, encourage a healthy environment for our residents to live in. Within that healthy environment, people can make their own choices.

To those who accuse me and other public health consultants of being part of a nanny state, I say, frankly, the nanny we have in this state right now is not a great nanny. It is one that allows us to eat things that make us ill, that encourages us to not exercise, that makes our children sick and that means we die earlier than we need to. I do not want to live in a nanny state, but I do want to live in a healthy environment that allows our children to live well and allows all of us to live the lives that we want to lead—one that makes the healthy choice the easy choice, the affordable choice and the normal choice, and one where, if we want to do things that make us ill, we really have to try hard. I thank everybody for their time today.

Question put and agreed to.

Resolved,

That this House has considered obesity and fatty liver disease.

Dementia Care

Beccy Cooper Excerpts

Tuesday 3rd June 2025 Commons Chamber

[Dr Beccy Cooper (Worthing West) (Lab)]

I thank the hon. Member for South Devon (Caroline Voaden) for bringing this important debate to the House this afternoon. I also thank other Members for sharing such personal testimonies; as well as bringing broader context, it really adds value to what this House brings to our national conversation.

As a public health consultant, it would be remiss of me not to spend a couple of minutes talking about how to reduce the risk of dementia before getting on to dementia care, as only about a third of UK adults think it is actually possible to reduce their risk of dementia. I am sure these recommendations will all be familiar to everybody listening. As healthcare professionals and as politicians, we should encourage people of all ages and stages of life, and in particular middle-aged adults, to be more physically active, eat healthily and maintain a healthy weight, drink less alcohol, stop smoking—very apt at the moment—and be socially active.

Many Members have spoken today about being socially active, and socially isolated older adults are nearly twice as likely to develop dementia within 15 years. Further recommendations include controlling diabetes and high blood pressure. If that sounds familiar, it is because we talk about that in the cardiovascular realm, too. We should be communicating loudly that what is good for the heart is good for reducing the risk of dementia.

Let me move on to dementia care. I want to talk a little bit about what we are doing in Worthing West, which relates to a lot of what has been said already, and then I shall conclude with the national picture. In Worthing West we have 2,361 people currently living with the condition. The charity Guild Care is a not-for-profit care service for older people, people with dementia, and children and adults with learning difficulties. It provides care for 120 people with dementia in their own homes and for a further 100 in its respite service. It is great that we have heard so much about respite services in this debate today. It is so important to help people with dementia access support, care and activities that provide a healthy way of living. People visiting dementia day services experience stronger social ties, have better mental health, require fewer GP visits, use less medication, sleep better—something that we all need to do—and have more active engaged minds.

We also know that respite is vital because behind each diagnosis, as we have heard today, often stands an unpaid carer whose career and life are put on hold while their own health quietly deteriorates, as stress, sleep loss and isolation take their toll. Inevitably, in that situation, we see dementia rates rising. Recognising and investing in the value of respite has huge benefits.

We have also heard about some innovative community care hubs across the country. Guild Care in Worthing West is developing its own community hub to combat social isolation. It provides integrated dementia care, diagnosis, support and a rich programme of activities that keep people healthy and living at home. That is an aspiration that we want for all of us—to live well and to stay at home for as long as possible. Our role in Government is to ensure a more co-ordinated system, building on best practice models, such as those that we have heard about today, including that of Guild Care in Worthing West.

We have also touched on training. Guild Care delivers in-house specialist dementia training to its staff in a bespoke programme that it developed with colleagues in the Bromley dementia hub—so I give a shout-out for Bromley there. Good research-based staff training is essential to help care professionals to deliver compassionate, person-centred support, as so many hon. Members have said today. It is the bedrock of quality care.

[Martin Rhodes (Glasgow North) (Lab)]

My hon. Friend mentioned person-centred care in dementia. Does she agree that initiatives such as Playlist for Life in my constituency, which uses meaningful music to reconnect people with dementia to their memories and their identity, should be more widely supported across the NHS?

[Dr Cooper]

What an outstanding service that sounds. I know there is a creative mental health all-party parliamentary group taking place today. We underestimate the benefits of exposure to the creative arts for all of us, specifically for those with dementia. My hon. Friend is absolutely right and I thank him for raising that. Clearly, training is essential, as are the creative arts.

To conclude, I wish to talk about what this all means nationally, and specifically about the implementation of a national social care service, which I know the Minister is very well aware of. I acknowledge that the Casey Commission is a vital step towards implementing that service. The Darzi report and our recent work in the Health and Social Care Committee, some members of whom are here this afternoon, underline what we all know, which is that we cannot fix the NHS without fixing the broken social care system. The two are fundamentally interconnected; we must not look at health and social care issues in isolation, and that includes dementia. We must ensure that strategic plans build better integration and recognise that investment in social care is essential. It is essential to improve people’s lives. Moving from treatment to prevention of illness is pivotal to the NHS 10-year strategy and to reducing the spiralling costs to the NHS of an ageing population.

Let me conclude now with this idea of changing the narrative. This has been touched on this afternoon. Sometimes we think about dementia as an illness that has no hope. One Member has already said that 50% of us may well develop dementia in our lifetimes. One way or another, the illness has touched pretty much everyone in this Chamber. Care Talk recently published a comprehensive report on dementia, which is well worth reading. I would like to urge everyone to take up this new narrative on dementia. The traditional narrative surrounding dementia focuses on decline and inevitability, but, as I have already mentioned, around 40% of dementia cases might be attributable to risk factors that can be modified. A 20% reduction in the risk factors per decade could reduce UK prevalence by 16%—even by this year.

I am advocating for policies that help people live well and protect them from illnesses including dementia, and for services that help people to live well with dementia, by emphasising their strengths, which many personal testimonies have already touched on. We must also be supporting people and their families to better navigate the condition and contribute to their communities and our society.

Tobacco and Vapes Bill

Beccy Cooper Excerpts

Report stage
Wednesday 26th March 2025 Commons Chamber

[Nigel Farage]

It is quite possible that sugar should be banned, so yes, I agree. It is possible, but I do not think that is what the Government are here to do. The Government can educate; individuals should make up their own mind.

Some of the nonsense I have heard this afternoon has been quite extraordinary. A smokefree generation! We even had the hon. Member for Harrow East (Bob Blackman) suggesting we would be smokefree by 2030. To begin with, the idea that nobody born after 2009 could buy the tobacco products that those born before then could is just another aspect of two-tier Britain. And not a single Member—not one, despite the fact that we are discussing nicotine and tobacco products—so far has mentioned drugs. Oh, no! Let’s forget about that, because drugs are illegal already and we cannot do anything about them. I have been hearing for decades that there will be a war on drugs. Where is it getting us? Drug use is rocketing, and class A drugs in particular, with all the associated crime, are proliferating everywhere.

Here is the danger: believe it or not, an ounce of tobacco is now more expensive, if purchased legally in a shop, than an ounce of silver, so already we have a rocketing trade in illegal cigarettes and loose tobacco. If we carry on down this route, with age bands and so on, we will find ourselves in the position that Australia has stupidly put itself in by over-taxing tobacco and making it very difficult to smoke. There have been 40 fire-bombings of premises in Melbourne alone in the last two years. Do not drive tobacco into the hands of the criminals. Do not create a new black market. I totally agree with the Minister: this is not an activity that we should encourage. We are not keen for our kids to smoke, but please treat us as grown-ups. Educate us. Let us make our choices. Do not let the criminals win.

[Dr Beccy Cooper (Worthing West) (Lab)]

First, I should say thank you to the Minister for presenting this afternoon, and for allowing me to be on the Tobacco and Vapes Bill Committee, which was incredibly interesting. There were differing views and there was robust conversation. It is always good to listen to different views, but overall the Bill generally had cross-party support. As Conservative Members have pointed out, many Members of their party have been campaigning for this Bill for a long time.

I am a public health consultant—I trained for 10 to 15 years to be one—and the precondition for public health policy is data and evidence. Opinions are interesting—they can add great colour and character to a conversation—but data and evidence will ultimately deliver better population health outcomes. This public health Bill will stop people dying and will take away addiction to a substance—an addiction that is not a choice.

For many years, there have been public health conversations about whether we should impose measures. This conversation is not new. I wonder how many of us in the House feel strongly these days about wearing seatbelts, but we do not have to go too far back to find a time when people really objected to being told to wear a seatbelt. Tobacco is undoubtedly still the leading cause of premature death and disability in the United Kingdom, as has been mentioned by my hon. Friends. Every day, around 160 people are diagnosed with cancer caused by smoking, and smoking causes at least 16 different types of cancer.

I will talk primarily about new clause 13, proposed by my hon. Friend the Member for City of Durham (Mary Kelly Foy). The Bill will do outstanding work to enable a smokefree generation, but we also need to continue to tackle health inequalities for existing smokers. Smoking is harmful, and differences in smoking prevalence across the population translate into major differences in death rates and illness. We in this place come together from across the country and represent different constituencies. We want the best health outcomes, among many other things, for our residents. It is therefore incumbent on us to look at inequalities and where they reside, and to legislate against them where possible.

Smoking is the single largest driver of health inequalities in England. It is far more common among people with lower incomes, and I am happy to discuss with any Members why that is. The more disadvantaged someone is, the more likely they are to smoke, to suffer from smoking-related disease, and to suffer a premature death. Smoking-related health inequalities are not related solely to socioeconomic status. We represent different parts of the United Kingdom. The poorer health of people in the north of England is in part due to higher rates of smoking there. Smoking rates are also higher among people with a mental health condition, people in contact with the criminal justice system, looked-after children and LGBT people. We all have different types of people in our constituencies, and we should be mindful of those inequalities and the need to address them.

Health inequalities will be reduced through measures that have a greater effect on smokers in higher prevalence groups. In practice, that means prioritising population-level interventions that disadvantaged smokers are more sensitive to, and targeting interventions on those smokers. Having run smoking cessation services during my time as a public health consultant, I can absolutely say that it is incredibly difficult for anybody to give up smoking. We have Members who have succeeded, and who are perhaps still trying to give up. To give up smoking, a person needs to be in a place where they have the mental resilience and can put time and energy into quitting. If they are fighting all the other issues that come with the burdens of being poorer—if they are fighting for employment or trying to feed their children—it is so much harder.

My hon. Friend has proposed a road map to a smokefree country, and a report to this place every five years. I am not particularly wedded to that, but we should be laser-focused on reducing health inequalities across all populations. I therefore hope that our Government will consider having a reporting process similar to the one in new clause 13 among the changes to the national health service. In the Health and Social Care Committee this morning, we were talking about where the Office for Health Improvement and Disparities will go following the dissolution of NHS England. This is an ongoing conversation that we need to be mindful of.

We need to ensure that the ongoing importance of addressing health disparities is not lost, and I think that is front and centre of the Secretary of State’s agenda in the 10-year plan. On behalf of public health consultants and professionals, I commend the Bill to the House, and I am proud to be part of a Government and a Parliament that will bring this life-changing piece of legislation to the country.

[Sammy Wilson (East Antrim) (DUP)]

I want to speak to amendment 4 and the subsequent amendments in my name, and to new clause 3. It is right that where a public health issue is identified, this body should look at whether anything can be done about it through law, fiscal policy, or the other levers available to us, but we should ask ourselves, when we introduce laws, what the consequences are. Are there any unintended consequences, and how practical and enforceable are the measures? If they are unenforceable, all we do is bring the law and this place into disrepute. While some have described this Bill as well-meaning, essential, a flagship Bill, and a show of leadership, I am concerned that we have given little thought to, and had little debate about, the consequences, which are hitting us in the face. Let us be honest with ourselves: it would be good to walk away at the end of today’s sitting and say, “We have done a wonderful thing for future generations; we have introduced laws that will do away with smoking and will improve the health of the nation,” but we are ignoring the fact that we have introduced legislation that is unworkable, and to which I believe, through my amendments, there is an alternative.

--- Later in debate ---

[Sir John Hayes]

In our post-spiritual or at least post-religious age, two phenomena are evident. When God is forgotten and faith declines, people do not believe in nothing but, as G.K. Chesterton said, they believe in anything. They find new causes and crusades, and I know the advocates of this Bill believe that they are crusading in a noble cause.

The second thing that occurs is that, as demons are regarded as purely mythical entities, things that were once regarded as normal and regular become demonised. The curious paradox is that while cocaine is widely available—and, I am told, de rigueur among certain elements of the urban liberal elite—pipe smokers are now seen as heretics. Were that not so alarming, it would be the subject of a comic satire. That is the kind of world we live in: we are simultaneously becoming more prurient and more puritanical.

The amendments that stand in my name and those of other hon. and right hon. Gentlemen are designed to improve the Bill to avoid unintended consequences. The hon. Member for Worthing West (Dr Cooper) said— I think I am quoting her accurately—that we need data and evidence. What is clear from the data and evidence is that previous attempts to deal with the issue of smoking have resulted in a huge surge in illegal tobacco. Some 83% of smokers report purchasing tobacco not subject to UK tax in 2024. That number has increased hugely since that earlier legislation. Three quarters of smokers claim to buy tobacco not subject to UK tax from under-the-counter suppliers, who have become legion in constituencies such as mine and, I am sure, in small towns across the whole of the country.

Those are the unintended consequences of well-meaning crusaders who thought they were doing noble things when they passed legislation in this House. That is the data. Those are the facts.

[Dr Beccy Cooper]

Will the right hon. Member give way?

[Sir John Hayes]

I will give way. As I have cited the hon. Lady, how could I do anything other?

[Dr Beccy Cooper]

I thank the right hon. Gentleman for giving way. Is he making the argument that we should not address population health issues—population health interventions have seen a reduction in smoking and a reduction in health-related damage from smoking—because of the consequences of illegal tobacco? Those issues do need to be addressed, but is he saying that we should keep it legal and therefore not see a reduction?

[Sir John Hayes]

What I am saying to the hon. Lady is that the Government—and the previous Government should have done the same—need to take concerted and decisive action to deal with the unintended consequence of well-meaning legislation that led to a huge growth in the illegal sale of tobacco and cigarettes. Rather than introducing a rolling age of consent, which, by the way, is entirely unenforceable, they ought to target their efforts, draw on their resources and seek the almost limitless expertise that is available to Government to deal with an issue that, frankly, is going largely unrestricted.

Good work is being done by trading standards in my constituency in Lincolnshire and by local police, but they struggle, because the legislation is inadequate. I would have supported a Bill, had it come to the House— I will not digress too much, Madam Deputy Speaker, because you will not allow me to do so—that licensed the sale of tobacco. Most tobacconists and most newsagents, I suspect, would welcome that measure. I know that police would like to see that kind of measure, which is rather like what we do with alcohol. There is a precedent there, but that is not what is before us today.

On the rolling age of consent, the right hon. Member for East Antrim (Sammy Wilson), who has tabled amendment 4, is right that it cannot be enforced. I am in favour, by the way, of raising the age of consent. To be honest, I am in favour of raising the age of consent to 21 for virtually everything. That could be enforced, although it would not be straightforward. But the idea that someone will go into a tobacconist or a newsagent and say, “I am 29” and the tobacconist will say, “Actually, I think you could be 28” or in years to come, “I am 57” and the tobacconist or newsagent will say, “No, no, I think you could be 55” is nonsense. It is never going to happen. No retailer is going to do that. Either the Bill will fail—I think the law would be broken daily—or we will devote undue resources to policing something that frankly does not warrant such attention. Let us recognise that this is a preposterous proposal. As the right hon. Member for East Antrim said, by and large we should not do things in this House that are preposterous.

Maternity Services

Beccy Cooper Excerpts

Tuesday 25th February 2025 Westminster Hall

[Dr Beccy Cooper (Worthing West) (Lab)]

I thank the hon. Member for Chichester (Jess Brown-Fuller) for calling this debate. As neighbouring parliamentarians on the south coast, we are both passionate champions of the health of our residents and want the best healthcare provision for all, and that includes maternity services.

Unfortunately, despite numerous reviews, plans and strategies, too many maternity services remain shockingly, stubbornly poor, as the hon. Member pointed out. Successive investigations into high-profile failures have described a pattern of dysfunctional and even dangerous cultures, with a failure to listen to families and missed opportunities to address known issues. As a result, too many mothers and babies have experienced substandard care and unacceptably poor outcomes.

In the past year, the number of maternity services in England receiving ratings of inadequate or requires improvement from the CQC increased from 54% to 67%. Of the 131 maternity services inspected from August 2022 to December 2023, only 4% were rated outstanding, and not one was rated outstanding for safety. In that context, we see stagnating progress on improving stillbirth and maternal mortality rates not seen in the UK for over 20 years.

As we have heard, black women are almost three times as likely, and Asian women almost twice as likely, as white women to die during birth or post-natally. Maternal mortality rates for women from the most socioeconomically deprived areas are twice those for women from the least deprived areas. Closing the black and Asian maternal mortality gap and tackling profound health inequalities such as those is rightly a priority for this Labour Government, and it is the reason I went into politics.

Poor outcomes exist, too, for the most vulnerable and marginalised women, such as refugees, LGBTQ+ women, prisoners, those who have been through the care system and those who have experienced domestic violence or sexual abuse. All of them are more likely to experience poorer maternity care and the resultant trauma. Poor standards in maternity services are part of a wider picture of a healthcare system that has not prioritised women’s reproductive health.

The Women and Equalities Committee highlights that gynaecological care waiting lists have grown faster than lists in any other specialty in recent years. As a public health professional, it saddens me to say this, but the NHS Confederation reports that the UK stands out as the country with the largest female health gap in the G20 and the 12th largest globally, with women spending three more years in ill health and disability compared with men. Those systemic failings underpin the poor outcomes and health inequalities that we see in maternity care.

As a public health doctor, I have worked in and led health teams, and as the proud MP for Worthing West, I have heard from dedicated staff across our local services. I understand that systemic issues fail staff as well as patients. In our hospital in Worthing, the maternity services are staffed by hard-working, capable healthcare professionals who want to get on with the job they have trained for. They are as frustrated and saddened as the rest of us when processes, equipment, staffing levels and governance are simply inadequate for the provision of excellent healthcare.

Our Government have pledged to recruit and train thousands more midwives, which is to be warmly welcomed. The forthcoming 10-year plan for the NHS is an opportunity to address the underlying problems of a deskilled and demoralised workforce, which impact maternity services. We must take action to improve midwife training and retention, address the numbers of qualified medical staff on maternity wards, improve patient voice and bring a relentless focus to safety and compassion.

There is an urgent need to transform the health and social care system. In doing so, we have a superb opportunity to look at innovative models of integrated and accessible “neighbourhood health” maternity services, delivered alongside hospital care. Finally, I welcome the recommendations of the APPG on birth trauma for a national maternity improvement strategy and a maternity commissioner to drive improved outcomes and rebuild our services.

Tobacco and Vapes Bill (Thirteenth sitting)

Beccy Cooper Excerpts

Committee stage
Tuesday 28th January 2025 Public Bill Committees

[Gregory Stafford]

I agree with my hon. Friend the shadow Minister. It seems strange that the Government want to have such wide-ranging powers in this area. Unlike other parts of the Bill, where technologies and such may move on and where I appreciate the need to future-proof, here it is very clear. I do not think that at some point in the future we will believe that smoking in playgrounds, or smoking in a field with nobody else around, are better or worse than they are now.

I have a lot of sympathy for the Liberal Democrats’ amendment 4 and our amendment 95. As my hon. Friend pointed out, the amendments are relatively similar, if not word for word the same. It almost takes us back to coalition days in 2010—let us hope that does not happen too often—and shows that His Majesty’s Official Opposition and the Liberal Democrats have significant concerns. While the Minister and his colleagues have said that they will not extend a smoking and vapes ban to hospitality venues, there is a lack of trust on our part, because even if it is not in the current Minister or Secretary of State’s mind, a future Secretary of State may be minded to put such a ban in place. That is why the amendments tightly define exactly where the smoke-free areas could be.

It is obvious that we do not want people smoking in children’s playgrounds, nurseries, schools or higher education premises. We have had some debate about this on other clauses, but I personally believe that we should not be smoking in NHS properties either. None the less, to return to a point I made previously, if we are going to permit people to do something within the law—people born before 1 January 2009 if we are talking about smoking and everybody over the age of 18 if we are talking about vaping—they must have somewhere safe to be able to do it.

The point of the clause is to address the impact of smoking and vaping on others. I take the shadow Minister’s point that clearly, if someone is smoking in a playground, it will have a greater impact on other people than if they are standing in the middle of a park or field with nobody else around. There needs to be an element of proportionality. As the shadow Minister and the hon. Member for Winchester said, we do not want to do anything that could harm our already stretched hospitality industry, which is under extreme pressure. If the Minister or Secretary of State were minded to start imposing bans in hospitality, that would have a significant impact on the hospitality business. I support the two amendments.

[Dr Beccy Cooper (Worthing West) (Lab)]

This is an interesting debate, and I want to add some thoughts from a public health point of view. There is a balance to be struck in Government between supporting the hospitality industry and making sure that we are being fair and proportionate and encouraging businesses. We should also be mindful of public health evidence about passive smoking in an area—for instance, outside a pub where there are multiple people and some are passive smoking. It is clear that the Government, the current Secretary of State and our Minister have taken the proportionate response that the law will not extend to public spaces with hospitality. We should be mindful, however, that history does play out in public health and that people’s attitudes about what is acceptable does change. Therefore, leaving this issue open to allow that debate to continue within our political sphere is absolutely fair and proportionate.

[Gregory Stafford]

The hon. Lady makes a very good point, but it is almost one that supports mine—although she said she believed that the current statements from the Government are proportionate, I can already hear in her voice that actually, she would like to see this provision extended to those areas.

[Dr Cooper]

The hon. Gentleman raises a fair point. I am perhaps a public health consultant first and foremost and a politician second, but I do appreciate that in politics, we have to find fairness and balance and support people in their businesses, as well as being mindful of their health. As a public health consultant, I am looking at people’s health first and foremost, but I think this is the right place in Government to have this sort of legislation and this debate, so I am supportive of what is in the Bill. It is for people like me to make the argument that passive smoking outside hospitality, for example, is not the way forward, but as a politician, I absolutely appreciate that I have to be mindful of businesses. I therefore maintain that the proposals are balanced, but I take the hon. Gentleman’s point that I am a public health consultant, and I declare that as an interest.

[Gregory Stafford]

I thank the hon. Lady for her clarification. I have great respect for her public health abilities and knowledge. I accept the points that she made, but Opposition Members feel that including in the Bill areas that will potentially be consulted on being smoke-free is proportionate to ensure that there is not overreach. I know that if the amendments are accepted and, at a future point, attitudes and science change, she will be a doughty campaigner to have the law changed, and I am sure that she will achieve it, if that is the way she wants to go.

Tobacco and Vapes Bill (Twelfth sitting)

Beccy Cooper Excerpts

Committee stage
Thursday 23rd January 2025 Public Bill Committees

[Dr Beccy Cooper (Worthing West) (Lab)]

From a public health point of view, I just point out to the hon. Member that we are basing this Bill on evidence and therefore we are looking at the evidence of tobacco harm, which I think we agree on. There is incontrovertible evidence; tobacco is undoubtedly harmful. People should not start smoking tobacco, and we should assist those who come forward to stop.

In relation to vaping, I go back to a previous comment I made, about the precautionary principle. There is evidence on vaping; there do appear to be some harms associated with vaping. There is not sufficient evidence right now for it to be incontrovertible, but it would be irresponsible not to adopt the precautionary principle that we use in public health.

In relation to gambling, I just urge caution—again, on the evidence. There may not be incontrovertible evidence about gambling, but there are undoubtedly health harms from gambling that we need to look at as we move forward.

[Jack Rankin]

I thank the hon. Member for her intervention.

Tobacco and Vapes Bill (Eleventh sitting)

Beccy Cooper Excerpts

Committee stage
Thursday 23rd January 2025 Public Bill Committees

[Gregory Stafford]

I do not intend to opine for very long on these clauses, because they have been covered amply by my hon. Friends. I caveat everything I am about to say with an absolute commitment: I continue to believe that this is the right Bill, that the clauses that we are discussing are the right clauses, that we should be trying to stop people smoking tobacco products and that people under 18 should not have any access to vapes.

However, I have mentioned on a number of occasions that vapes could be and are used as a smoking cessation tool. This is why I perhaps go further in my desire than the shadow Minister does in relation to the amendments that she has put forward. I do not know whether she will press them, but I do ask the Minister to think about the issue of smoking cessation. The shadow Minister talks about how someone who is promoting smoking cessation might fall foul of these rules as they are written—the Minister shakes his head, and I am sure that he will be able to give us reasons for that in a minute.

I would go one step further. For example, we allow the promotion and advertisement of gums and nicotine patches, because they are classed as a medical product, being effective smoking cessation tools. Of course we do not want anybody who does not smoke, either an adult or a child, to be chewing nicotine gum or wearing nicotine patches—to be frank, I am not clear whether there is any evidence that they do, but I suspect they are not seen as, to use the word I think the Minister used last week, “sexy”. I do not think anyone thinks that chewing gum is particularly sexy, and certainly a patch on the arm is not sexy, so I accept that those are not in the same bracket as a vape with colourful packaging and so on. However, gums and nicotine patches are monitored by the MHRA.

I know that the Minister has indicated that a new home is being sought for vapes, but as it stands in the law, they would be monitored by the MHRA. If we are going to say that they are in a similar vein to a patch or a gum in terms of smoking cessation, it is possible that we might want to be able to promote and publicise them, maybe through something in a doctor’s surgery or in a maternity ward, as my hon. Friend the shadow Minister said, that says, “Don’t smoke. Instead, use a vape, a patch or a gum.” If that advert in a doctor’s surgery said “gum” or “patch”, there would be no problem, but if it said “vape”, my understanding is that it would fall foul of these clauses. As my hon. Friend said, they may not want to fall foul of the law, but we might want to be able to advertise vapes as a smoking cessation tool in that very limited circumstance and in an appropriate place—that is, in a pharmacy or a doctor’s surgery.

[Dr Beccy Cooper (Worthing West) (Lab)]

I want to add something to what the hon. Gentleman is saying, which is interesting and relevant, about smoking cessation services and how they currently work. I have run and managed smoking cessation services. As it stands, when a smoking cessation adviser is talking to a person who wants to stop smoking, they discuss nicotine patches, gum and whatever other options may be available. They do not promote vapes or actively say that they are an option.

The reason for that is the public health evidence. In public health, we apply the precautionary principle, by and large, where we think that there may well be harms ensuing from using a particular product, but the evidence is not yet sufficient. The hon. Gentleman is absolutely right that, in the case of smoking, using vapes is much more preferable for a person’s health, but in terms of smoking cessation, as clinicians and advisers, we need to be careful in how we apply clinical norms, and that is relevant here.

[Gregory Stafford]

The hon. Lady makes an interesting point. I will not labour my point any further, because I think I have made it; I am sure that the Minister can respond to it when we get there.

The only other thing I will mention is the online advertisements mentioned in a number of the clauses. Is the intention to do with the website displaying the advert, the person who has put forward the advert or the intermediary companies? Online, a lot of adverts are now tailored via cookies. When the Minister goes on to a website, the adverts that he sees are tailored to the things that he has been looking at. I could go on to exactly the same website at exactly the same time and receive a different set of advertisements based on my internet viewing preferences—[Laughter.] I do not know why my hon. Friend the Member for Windsor is laughing. I get a lot of weird stuff, mostly for hoof trimming videos—I am not sure what I typed in to get those. Maybe it is my rural seat. I do not know.

My point is that those advertisements are totally unconnected to the website that I am looking at, which essentially has no control over what adverts are being displayed, as far as I understand it. Because the internet is so complicated, what thoughts does the Minister have about the fact that essentially, the internet provider and the website may not have any knowledge of what adverts are being put on?

Tobacco and Vapes Bill (Ninth sitting)

Beccy Cooper Excerpts

Committee stage
Tuesday 21st January 2025 Public Bill Committees

[Gregory Stafford]

I agree entirely with my hon. Friend. He has two Windsor castles in his constituency: the big one where the royal family lives and a Lego model of it at Legoland. The enforcement of this clause should apply equally to Legoland and the real Windsor castle. But I agree that there is a power imbalance: it is unlikely that trading standards enforcement officers from the royal borough of Windsor and Maidenhead will go into Windsor castle.

[Dr Beccy Cooper (Worthing West) (Lab)]

What does the hon. Member think happens currently? On various issues, there is obviously enforcement across the board, including tobacco control, and the Crown Estate has to comply. How would this extension of that enforcement differ from what happens now at Windsor or any other Crown Estate?

Obesity: Food and Diet

Beccy Cooper Excerpts

Monday 20th January 2025 Commons Chamber

[Dr Beccy Cooper (Worthing West) (Lab)]

I echo earlier comments by thanking all Members who have contributed to this debate. As a new Member, it has been heartening to hear so much agreement across the House and so many colleagues putting their evidence, enthusiasm and opinions into finding a solution to this epidemic.

I thank my hon. Friend the Member for Stroud (Dr Opher) for introducing this debate. Unlike my hon. Friend, who has a medical degree and has become a GP, I took my medical degree and went into public health. I am a public health consultant and that is why I am here. It has been fantastic to hear everybody in this House talk in such resoundingly positive public health terms. It is past time for us to address this issue.

Many great points have been made and I do not intend to repeat them, but I would like to stress a couple of things, starting with an interesting observation about the term “obesity”. It carries with it a certain load and stigma, which as a female I very much recognise. I want to put on record that this is not about fat-shaming; this is not about how people look or how society tells us we should look. This is about our health; this is about being well and feeling well and being able to live well and thrive.

I also want to put on record something about body mass index. This is a slightly controversial subject in my area at the moment. It is a useful tool, as people have said, but as my hon. Friend the Member for Ilford South (Jas Athwal) mentioned, there are different levels of BMI for different ethnicities, and also it can be a limited metric. The House might be aware of the case of a female Olympic bodybuilder being classed as obese. We need to be careful about BMI and what we are saying to people— children or adults—when we see their BMI. This is about taking health in the round, and looking at what we eat, not what we look like.

There is no debate about the evidence of obesity’s cost to our population’s health and our health system. We have heard the figures from multiple Members across the House, and £6.5 billion annually to the national health service is no small figure. We are literally eating ourselves into our sick beds, from diabetes to heart attacks, from liver disease to cancer; as we have heard, this is the second most preventable cause, after tobacco, of cancer.

I have spoken before in the House, and will continue to do so, about creating conditions for people to thrive and to make healthy choices. Today, as so many hon. Members have highlighted, we live in an obesogenic environment—an environment that promotes unhealthy eating and does not make it easy to undertake regular exercise. A less familiar term is the opposite of that, and perhaps Hansard has never heard it: a leptogenic environment promotes healthy food choices and encourages physical activity. The comments on housing and on fair pay for good work were about a leptogenic environment. We might reflect on our own environment, Madam Deputy Speaker—whether it is an obesogenic or leptogenic environment. I wonder how many of us have managed to have dinner yet this evening, and how we are feeling. That is something for the Modernisation Committee to reflect on.

To achieve a leptogenic environment we need to look at measures that create a functioning food system. As we have heard, we need to work with our farmers and food producers to produce a skilled food sector and a vibrant food economy. For our food system to allow us all to enjoy healthy food—again, we have heard this before—we need to ensure that it is accessible, affordable and attractive. We are visual creatures: what we see really influences us and our choices, and, boy, do the food organisations and the food companies know that.

On accessibility, how easy is it to buy nutritious food? We have heard Members across the House talking about their constituencies, their residents, food deserts and how for some people, when they go into a shop, the choice is not from an array of vegetables, fruits, decent carbohydrates and decent proteins, but from processed, often cheap, quite filling, nutritionally poor food. That is not making healthy food accessible.

On affordability, we have heard several times from different Members that healthy food—this is worth repeating—on average is more than twice as expensive per calorie as less healthy options. If people feeding their children across the country this week on a budget are faced with two different options, and one is cheaper and will fill their children’s stomachs, the odds are that they are likely to take that option, and there is no judgment in that at all. It is on us to make healthy food much more accessible and affordable for people.

On attractiveness, how attractive is healthy food? We have heard this evening about the marketing and branding of ultra-processed, high-fat, high-sugar, high-salt food. It is fantastic that our Labour Government and our Minister for Public Health and Prevention, my hon. Friend the Member for Gorton and Denton (Andrew Gwynne) have taken the step to ban junk food advertisements before the watershed. That is a great step forward, but we need to be mindful of how much investment the major brands of high-fat, high-sugar and high-salt foods put into advertising. In digital advertising alone, that figure was £87.5 million. Food organisations do not put money into things if they do not make profit from them. Profit essentially remains their bottom line, not our waistlines.

These are systemic issues, but we do not need to reinvent the wheel. We need to implement the wide-ranging recommendations of the national food strategy. The last Government missed that opportunity, but as we move forward with this Government, let us look at those recommendations, many of which have been mentioned in the House this evening. They include introducing a sugar and salt reformulation tax and expanding the Healthy Start scheme.

In conclusion, we need to ensure that we in this place are legislating to make good nutrition an easy choice for all and that we are curating a healthy leptogenic environment. In that way, we will ensure that we are enabling healthy choices for all our residents and reducing obesity to a slim, historical footnote as we move forward into a healthier future for everyone.

Tobacco and Vapes Bill (Sixth sitting)

Beccy Cooper Excerpts

Committee stage
Tuesday 14th January 2025 Public Bill Committees

[Andrew Gwynne]

Clauses 12 and 78 prohibit vape and nicotine product vending machines in England, Wales and Northern Ireland, and similar provisions are made elsewhere for Scotland. However, it is really important that the Committee understands that Scotland already specifically prohibits vape vending machines.

Clause 12 makes it an offence for any person managing or controlling a premises to have a vaping or nicotine product vending machine available for use, which effectively prohibits the sale of vapes and nicotine products from vending machines. I will try to clarify this point for the shadow Minister. She asks, “Who is responsible? Who is that person?” The offence is linked to the person with management control of the premises, as that is the most appropriate mechanism; they have control over whether the vending machine is present. That is the answer to her question.

This Government will stop the next generation from becoming hooked on nicotine. To do that, it is essential that we stop children from accessing harmful and age-restricted products. Prior to the prohibition of tobacco vending machines, we know that children who smoked regularly used those machines as their source of cigarettes. We cannot allow the same thing to happen with vapes.

Vending machines do not require any human oversight, so it is much easier for determined individuals to bypass age-of-sale restrictions and, crucially, to undertake proxy purchases on behalf of individuals under 18 because there is a much lower chance of their being challenged about such a purchase. Additionally, by their very presence vending machines advertise their contents and the Bill will ban the advertising of vapes. We need to ensure that children are protected from harmful and addictive products. Ensuring that we remove the ability of children to access age-restricted products is an essential part of that approach.

I turn to amendment 96, regarding the exempting of mental health units from the vending machine prohibition. I am grateful to the hon. Member for South Northamptonshire for bringing this important issue before the Committee today for discussion. Her amendment would allow vape and nicotine product vending machines to be available for use in specialised mental health units in England and Wales.

I am very sympathetic to the needs of adult smokers and vapers in mental health facilities, and I know that this topic came up during the evidence session. However, we do not currently believe that there is a need to exempt mental health settings or other healthcare settings from these requirements. Scotland did not exempt mental health units from its vape vending machine ban, and it has had no issues. I want to be clear, because it is really important that I make this point: we are not banning the sale of vapes and nicotine products in mental health settings. We are only prohibiting their sale from automatic machines that provide no means to prevent proxy purchasing. Facilities that contain shops will still be able to sell vapes to patients and staff. Additionally, patients in mental health settings may be able to benefit from stop smoking services and the swap to stop scheme.

The majority of in-patient trusts, both acute and mental health, successfully deliver stop smoking support to smokers. As part of the swap to stop scheme, localities can request free vaping starter kits to provide to adults engaging with their local stop smoking services. Awards have now been made to individual services in a range of settings, including NHS and mental health settings, and to specific populations. It will still be legal and possible for vending machines to dispense medicinally licensed nicotine replacement therapies such as gums, patches and inhalers. These important medicines will still be available to patients who are looking to quit smoking or who are struggling with their nicotine addiction.

[Dr Beccy Cooper (Worthing West) (Lab)]

I thank my hon. Friend for making the arguments on vending machines. From a public health consultant point of view, I have listened and think there is a reasonable debate to be had. I am convinced by the arguments that my hon. Friend the Minister has given, but I would ask that following the debate the conversation continues as the Bill progresses and that the Department of Health and Social Care continues to have these conversations.