Health and Care Bill

Bob Blackman Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

I strongly support the Bill. However, although it contains strong measures to combat obesity, there is none to tackle smoking, which is the leading cause of preventable premature death, including cancer. I declare an interest as chairman of the all-party group on smoking and health. The report we proposed suggested that we implement the “polluter pays” levy that the Government promised to consider two years ago. The Bill is the ideal opportunity to introduce such a levy. Analysis by Cancer Research UK shows that we will not achieve the Government’s aim of a smoke-free England until 2035—the Government target is 2030, so years later—in our poorest communities, so there is no time to waste. We must get on with the job.

In the Government’s recent paper on public health, they accepted that they have a responsibility not only to help people improve their own health, but to go further when it comes to industries that are based on addictions such as smoking. The Bill is the ideal opportunity, and I urge the Government to consider the recommendations laid out by the all-party group and table them as amendments in Committee, so that we tackle the most deadly addiction in our society.

We need to combat not only smoking rates but the long-standing, unacceptable health inequalities that exist across the country. The plan needs to be comprehensive, but it will not be effective without sufficient additional and sustainable funding. A smoke-free 2030 fund, using the industry to pay for it, but without industry interference, could pay for the comprehensive measures that we need to reach that ambitious target across all socioeconomic groups.

On the plan to combat obesity, there is a measure that will be harmful to many of our media companies, but it will not hit some of the social media and online companies. That runs the risk of having a two-stage process. Perhaps we could consider having limits at weekends to limit the impact of junk food advertising on TV when our young people are watching.

Overall, however, this is a good Bill. We should support it, and we should support our national health service that has brought it before us today.

Health and Care Bill

Bob Blackman Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Dr Whitford]

That is the policy of the Scottish Government, and we would absolutely support the new clause if it is voted on tomorrow.

As Opposition Members have said, key to improving public health would be restoring the non-covid related public health budget in England. We cannot hide behind covid funding, because that is used up by the pandemic and does not help us with smoking, alcohol, or drug addiction. The biggest contribution the Government could make would be to abandon their plans for yet another decade of austerity. We hear the slogan all the time—levelling up—but it rings hollow after taking away £1,000 a year from the poorest families and most vulnerable households. Over the past decade, cuts to social security have caused a rise in poverty among pensioners, disabled people, and particularly children. Sir Michael Marmot was mentioned earlier, and his research was clear: poverty is the biggest single driver of ill health, and the biggest driver of poverty is Tory austerity.

[Bob Blackman (Harrow East) (Con)]

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford), who brings her knowledge of the medical profession to this House on every occasion. I agreed with almost everything she had to say, apart from the last comment.

I declare my interest as chair of the all-party group on smoking and health, and I support all the new clauses tabled in the name of the hon. Member for City of Durham (Mary Kelly Foy). These comprehensive proposals are complementary and can be picked up by the Government. The new clauses were tabled in a different form in Committee. They were discussed and debated, and I think Ministers said they would take them away and have a further look. We have refined the proposals on the basis of the debate in Committee, strengthened them, and brought them back again, and they address the loopholes in current legislation. They strengthen the regulation of tobacco products still further, and they provide funding for the tobacco control measures that are so desperately needed if we are to deliver the Government’s Smokefree 2030 ambition.

We had an excellent debate in Westminster Hall last week, to which the new Under-Secretary of State for Health and Social Care (Maggie Throup) responded. Questions were posed to the Government from across the Chamber about when we will see the long-promised tobacco control plan, which is presumably due to be delivered by 31 December this year. We got no firm commitment on when we will see it, and I would like my hon. Friend the Minister to bring that forward as soon as possible. We can then measure what will happen.

The problem we have with tobacco control right now is that if we do nothing and none of these measures is introduced, the risk is that, as the hon. Member for City of Durham rightly articulated, we will miss the target by seven years. For those on low incomes and in deprived circumstances, it will be 14 years. We must consider how many people will die from smoking-related diseases as a direct result of the Government’s failure to achieve their Smokefree 2030 ambition. It is clear that we need to take further action, and I urge the Minister, who I know is a doughty campaigner for public health, to make sure that we deliver on the proposals.

My main focus is obviously on the new clauses that seek to provide funding for tobacco control. We all accept that not only can we implement measures, but we have somehow to fund them. That is critical. We must also consider raising the age of sale, as that, unfortunately, is a key proponent in encouraging young people to start smoking. The spending review failed to address the 25% real-terms cut to public health funding since 2015. Reductions in spending on tobacco control have bitten even deeper, by a third, since 2015. We need new sources of funding.

The Government promised to consider a polluter pays levy in the 2019 Prevention Green Paper, when they announced the Smokefree 2030 ambition. The all-party group on smoking and health has done the analysis, and we estimate that in the first year alone of a polluter pays levy, £700 million could be raised. That would benefit not only England, but the whole United Kingdom. It is more than twice the estimated cost of the tobacco control measures that we are proposing tonight, and that would then leave the Government with further funding to spend on other health priorities. The proposal is for a user fee, along United States lines, rather than an additional tax. Now that we have exited the European Union and can set our own rules, EU tobacco manufacturers’ profits can be controlled. They cannot pass the cost on to the consumer, but we can control their profits and use those for preventing people from smoking in the first place. It is quite justified that we should tax the manufacturers’ profits. This is the most highly addictive product that is legally available, and it kills those who use it for the purpose for which it was intended.

[Peter Dowd (Bootle) (Lab)]

The hon. Gentleman refers to public health funding since 2015, but is he aware that in 2015, it was identified that the cost to the NHS of smoking was £144.8 million in prescriptions, almost £900 million in out-patient visits, almost £900 million in hospital admissions, and a total of £2.6 billion? Is not investing in smoking cessation money well spent?

[Bob Blackman]

Clearly, if we invest in public health and smoking cessation, we prevent costs in the health service later. It is estimated that most of the cost of people’s healthcare arises in the last two years of their life. Individuals who suffer from cancer or other respiratory diseases caused by smoking will cost the health service dramatic sums of money, so through cessation, we are helping the nation to be healthier and, indeed, saving money for the health service in the long run.

To quote the chief medical officer, the great majority of people who die from lung cancer

“die so that a small number of companies can make profits from the people who they have addicted in young ages, and then keep addicted to something which they know will kill them.”

The time has come to make the tobacco manufacturers pay for the damage that they do, not only to older people but to young people in particular. We need to bring forward the day when smoking is finally obsolete in this country, and I regret to say that if we do not take measures, the time before that day arrives will be lengthened quite considerably.

However, funding alone is not enough; we have to consider tough regulation. The hon. Member for Central Ayrshire mentioned that since lockdown, we have seen the smoking rate among young adults surge by 25%. In the United States, raising the age of sale from 18 to 21 reduced the smoking rate among 18 to 20-year-olds by 30%. We could do the same thing here. We talk about complementary measures; giving tobacco products away is not illegal at the moment. Just imagine—tobacco manufacturers may say, “If we give tobacco products away for free, we can encourage people to become addicted, and then they will buy them, and that will lead them on to a lifetime of smoking.” We have to break that chain of events and make sure that people do not do that.

I have a passion for ensuring that women do not smoke in pregnancy. That is one of the most stubborn measures, and we have to overcome it. Some 11% of women still smoke in pregnancy. We must give them every incentive and introduce every measure to ensure that they give up smoking, and that their partners give up smoking at the same time. That is something that I passionately support.

Our revised amendment, new clause 11, addresses the concerns that the Government raised in Committee about a review of the evidence. I hope that the Government will adopt the new clause at this stage, and then look at the evidence and consult.

People start smoking at certain key points in their life. They may take it up when they are at school and their friends are smokers and they want to be part of the team or the gang. They may take it up when they go to college or university or start a new job, when they are in a new social environment, or at a dreadful time of stress in their life. We have to make sure that they understand that if they take up smoking, they will shorten their life and cause damage to their health—and, indeed, to the health of the people around them.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I am following my hon. Friend’s argument closely. Does he agree that there is an interrelationship between the issues to do with alcohol dependency that the hon. Member for Central Ayrshire (Dr Whitford) mentioned and the issue of smoking? One of the things that comes out from the book “Alcohol Reconsidered” by Lesley Miller and Catheryn Kell-Clarke is that the science shows that alcohol reduces people’s inhibitions, and it is therefore more likely that they will smoke. If we had a culture of moderation in alcohol, we would probably do better on smoking.

[Bob Blackman]

I thank my right hon. and learned Friend for raising that point. Clearly, the fact that people can no longer smoke in public houses or restaurants has dramatically reduced the incidence of smoking. Someone has to make a deliberate decision to go outside and inflict their smoke on the outside world rather than on the people in the public house or restaurant.

We who support these amendments tabled them in Committee—we sought Government support and we debated them in Committee—and now we are debating them on Report. I understand that we may not be successful tonight, but I give fair warning that these amendments, in another form, will be tabled in the other place, and we will see what happens. We know that there is very strong support in the other place for anti-tobacco legislation. In July 2021, the Lords passed by 254 votes to 224 a motion to regret that the Government had failed to make it a requirement that smoke-free pavement licences must be 100% smoke free. That is smoking in the open air; we are talking about measures to combat smoking overall.

Finally, if we look back over the years, the measures on smoking in public places, on smoking in vehicles, on smoking when children are present and on standardised packaging of tobacco products were all led from the Back Benches. Governments of all persuasions resisted them, for various reasons. I suspect that my hon. Friend the Minister, whom I know well, may resist these measures tonight, but we on the Back Benches who are determined to improve the health of this country will continue to press on with them, and we will win eventually. It may not be tonight, but those measures will come soon. I support the measures that are proposed.

[Geraint Davies]

It is a great pleasure to follow the hon. Member for Harrow East (Bob Blackman), who gave an eloquent speech about smoking. What he did not include, and what the Minister is not considering, is the mass passive smoking from air pollution, which causes 64,000 deaths a year. I know that I am in danger of being outside the scope of the Bill, but I will make this point just briefly, because it is about public health.

Indoor and outdoor air pollution is endemic. It costs £20 billion a year. We could simply ban wood-burning stoves, which 2.5 million people have and which contribute 38% of the PM_2.5 emissions in our atmosphere. That is particularly problematic in poorer areas. I make this point partly as I chair the all-party parliamentary group on air pollution, but this is a critical public health issue, so I feel that the Department of Health and Social Care should look at it centrally, rather than leaving it to the Department for Environment, Food and Rural Affairs as an air quality issue.

I turn to the comments by the hon. Member for North East Bedfordshire (Richard Fuller), who sadly is not in his place, about free choice in advertising. Advertising is not about free choice; one would not need to advertise unless one was trying to convince somebody to do something they would not otherwise do. That is not to say that advertising is always bad—good things and bad things can be advertised—but let us be straightforward.

As it happens, I have a background in multinational marketing; I have been involved with PG Tips and Colgate toothpaste—good products. However, the reality is that if someone wanted to make money from a product such as a potato, which is intrinsically good for people, they could impregnate it with salt, sugar and fat, make it into the shape of a dinosaur, get a jingle and call it “Dennis’s Dinosaurs”, and make a lot of money out of that simple potato. That is the way a lot of processed foods work.

Going back to the point about diabetes and added sugar, it is important to remember that diabetes in Britain costs something like £10 billion a year. There is a compelling case for the Government to do more about added sugar, as opposed to natural sugar; obviously, we could discriminate between the two, though a lot of manufacturers will say, “Are you going to tax an apple?”. Clearly, when a child or adult can find a huge bar of chocolate in a shop for £1, we have problems, in terms of the amount of sugar we are supposed to have. Henry Dimbleby put forward a national food strategy, which is worth a read. He makes the key point that reducing the overall amount of money people have—for instance, through universal credit—has a major impact: we find that when universal credit goes down, consumption of alcohol and smoking go up.

It is important for the Department of Health and Social Care to have an idea of how the nutrition of particular natural foods can be increased through better farming. An app will be available next year that will enable people to test a carrot in their local shop. The carrot will have different levels of antioxidant, depending on how it is grown. If it is organic and not impregnated with all sorts of fertiliser and chemicals, it develops a natural resistance to pesticides and is much better for human health. The Government should, in this post-Brexit world, be actively encouraging local high-value, high-nutrition products for export and local consumption.

A whole range of public health measures that need to be moved forward are not in the strategy; but some are, such as those raised by the hon. Member for Harrow East.

Health and Care Bill

Bob Blackman Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

I am grateful to my right hon. Friend. I know him well but I was not sure if would be able to predict exactly what he was going to say, so I am pleased that I have managed, to a degree, to pre-empt him. I recognise the impact, and that is why we believe we have struck the appropriate balance, both in terms of the time for preparation and implementation, but I will of course listen to what my hon. Friend the Member for Buckingham says when he speaks to his amendments.

Finally, amendment 79 relates to the international healthcare arrangements clause, which amends the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019 to enable the Government to implement comprehensive reciprocal healthcare agreements with countries outside the EEA and Switzerland. The clause will give the devolved Governments a power to make regulations giving effect to such agreements in devolved areas of competence. This minor and technical amendment to the definition of devolved competence and the consent requirement in new section 2B(2) reflects the fact that the consent of the Secretary of State under section 8 of the Northern Ireland Act 1998 is given in relation to an Assembly Bill, rather than an Assembly Act. It has no impact on the policy intention of the clause and I hope that hon. Members on both sides of the House will be content to pass the amendment.

On Report in the other place, the Government committed to accept in principle Lords amendment 95 to change the process for regulations that give effect to healthcare agreements, so they are subject to the affirmative resolution procedure. While we continue to support the intention of the amendment, I move that this House disagrees with Lords amendment 95 and moves an amendment in lieu, Government amendment (a). This amendment achieves the same objectives, but amends the international healthcare agreements clause rather than the regulations clause for the Bill to ensure that all regulations made under the soon-to-be-named healthcare international arrangements legislation are subject to the affirmative procedure. This includes any regulations made by the devolved Governments and achieves the objectives of the Lords amendment. This conclusion has been reached following constructive engagement with noble Lords for which the Government are extremely grateful.

In addition, to make parliamentary scrutiny of our healthcare agreements even more robust, we will set out a forward look in annual reports produced under section 6 of the 2019 Act, highlighting any agreements with other countries that are under consideration. We will publish all non-legally binding agreements and their associated impact assessments. I urge the House to accept all those Lords amendments as beneficial to the public and the NHS.

Although I have sought to compromise and reach agreement on many areas, I am afraid that there are a number of Lords amendments that we urge the House to reject. First, let me deal with Lords amendments 85 to 88. I pay tribute to the work of my hon. Friend the Member for Harrow East (Bob Blackman), the chair of the all-party group on smoking and health, for its proposals to help the Government to achieve a smoke-free country by 2030. However, the Government cannot accept these Lords amendments, because the proposals would be very complex to implement, take several years to materialise and risk directing a lot of Government resource into something that we do not see as a sustainable or workable way to fund public health. This would also rightly be a matter for Her Majesty’s Treasury.

The Javed Khan review is under way and I encourage colleagues to wait patiently for that and to be guided by what emerges from it.

[Bob Blackman]

rose—

[Edward Argar]

If I can just finish this point, I will give way to my hon. Friend. Our preference is to continue with a proven and effective model of encouraging tobacco cessation. Ultimately, given the review that is under way and the forthcoming tobacco control plan, which will be published later this year, we do not believe that this Bill is the right place for the proposals.

I will give way to my hon. Friend, but then I wish to turn to the final, important set of Lords amendments on abortion.

[Bob Blackman]

I thank my hon. Friend for giving way and for what he is saying about tobacco control. The recommendations are due to come out next month and most of those—indeed, most of these Lords amendments—refer to carrying out consultations without decisions actually being made. Does he not accept the point about having a consultation, taking people’s views and then deciding what to do?

[Edward Argar]

To a degree, that is why I mentioned the Javed Khan review. We are undertaking a lot of work and let us see what emerges from that, as well as from consultations and other pieces of work, and draw it all together. I can see where my hon. Friend is coming from, but I think that the Government have set out the right approach, so I encourage right hon. and hon. Members to reject their lordships’ amendments.

--- Later in debate ---

[Matt Warman (Boston and Skegness) (Con)]

I rather think that men should enter the debate on abortion with a degree of trepidation and humility. In that spirit, I will make three simple points.

First, it strikes me as absolutely right that parliamentarians in this place and in the other place should seek to use every vehicle before them to enact the improvements in our constituents’ lives that we all want. It is right and fair to say that the measures were temporary and were brought in only for a certain purpose, but it cannot be right to say that now that we have done that extraordinary experiment, seen how many women have benefited from the change in telemedicine and got the data, we cannot let the vehicle of the Bill pass us by without trying to make this improvement.

Secondly, the reason that all the expert bodies—including the Royal College of Obstetricians and Gynaecologists, Women’s Aid and the Academy of Medical Royal Colleges, where I have to declare that my wife works—support this approach is that they have seen the evidence. They look at that evidence as organisations that have the safeguarding of their patients absolutely at the heart of every single thing they do. They have looked at what we have done and the evidence we have gathered, and they say it is right to continue with the measures brought in for the pandemic. That is why Wales and Scotland have continued them.

We have to trust the evidence; we have to trust the science. We have to understand that we are in the position that we are in as a result of the covid vaccine programme because we trusted the science. Today, we have an opportunity to trust the science yet again. That seems to me an incredibly powerful argument.

We are not making telemedicine compulsory; we are making it a choice. Yes, we are putting a huge burden on doctors to say that the person on the other side of the screen is not someone who should have pills by post, so to speak. We are saying that they should make that calculated judgment. We ask the professionals, be they in charities or in hospitals, to make those judgments every day. We do so because they are the experts.

I say simply to hon. Members that there are issues on which we profoundly disagree—of course there are; these are fundamentally ethical issues—but if we are in favour of abortion, we should be in favour of the choice that is provided by the very safest options. We can see today from the evidence of the past couple of years that it is safer for women who are at their most vulnerable to have the option that we are talking about today. It is not compulsory; it is an option. For me, supporting that today is the definition of being pro-choice.

[Bob Blackman]

I have had more correspondence on Lords amendment 92 than on any other in the past 12 years. I shall vote accordingly, against Baroness Sugg’s amendment and against the Government’s amendment in lieu.

As chairman of the all-party parliamentary group on smoking and health, I support Lords amendments 85 to 88, which require the Government to have a consultation on the polluter pays levy on tobacco manufacturers. The levy was the central plank of our recommendations to the Government to deliver their smoke-free 2030 ambition. We had other recommendations, but that was the central one because funding for smoking cessation and tobacco control has been reduced every year since 2015 and has not been reinstated in the spending review or the recent spring statement.

Additional funding is vital to reducing smoking rates among the most disadvantaged in society and particularly among pregnant women. The current target to reduce the national prevalence of smoking in pregnancy to 6% by 2022 will be missed, and I think we should be clear about that. Last year alone more than 50,000 women smoked during pregnancy, which caused damage to them and to their unborn children. If we want to create a smoke-free society for the next generation, we must step up our efforts now.