Tobacco Control Plan

Bob Blackman Excerpts

Thursday 19th July 2018 Commons Chamber

[Steve Brine]

I already have and NHS England already has: we have already done so. We think that Philip Morris International’s move is totally inappropriate and totally contrary to the protocol. I do not think I could have been clearer either in the press or at the Dispatch Box today, and I thank the hon. Gentleman for giving me the chance to say so again.

All our local activity has the overall goal of helping people to quit smoking and stopping others starting in the first place, so how are we doing? Here is the score card. Publications by the Office for National Statistics and NHS Digital earlier this month show that we are making progress. Since 2011, the number of adult smokers has dropped by a fifth to the lowest level since records began, and we are fully on track to achieve our 2022 ambition for adults. Among 15-year-old smokers, there is good progress, and figures published last year showed that the prevalence of smoking has reduced by a further percentage point from 8% to 7% since the publication of the plan. The number of e-cigarette users in that group is also falling. Latest figures from the ONS annual population survey reveal that smoking rates among 18 to 25-year-olds are falling faster than in any other age group. Considering that that age is when most smokers start smoking, I am particularly pleased with that.

We are also making progress on inequality. Although routine and manual workers continue to have higher smoking rates compared with the rest of the population, the gap has narrowed slightly, from 26.5% at the publication of the plan to 25.7% as reported by the ONS earlier this month. Those are achievements to celebrate. Nevertheless, I must be honest with the House and say that progress on tackling smoking in pregnancy is disappointing, and in truth the figures have barely moved in the past year.

What shall we do in year 2 of the plan? First and foremost, I am determined to redouble our efforts to support pregnant smokers to quit. That will be best for them and for their babies, and we need people to understand that. Secondly, we will use the opportunity of the Government’s investment in the NHS, which the Prime Minister announced last month, to embed prevention and cessation more firmly into the culture of the NHS. Last month, the Royal College of Physicians, which has a proud record of groundbreaking reports on tobacco, published “Hiding in Plain Sight: Treating tobacco dependence in the NHS”. That weighty report calculated that the cost of current smokers needing in-patient care is £890 million a year. It points out that smokers are 36% more likely to be admitted to hospital at some point than non-smokers, and it makes the powerful argument that smoking cessation repays the cost from year 1. I welcome that report, and I will be making that case loud and clear as we engage with NHS England on the content of the 10-year plan that the Prime Minister has asked it to produce.

Thirdly, we will continue to engage with local authorities —they are now top-tier public health authorities up and down the land in England—on promoting smoking cessation as the best evidence-based means of quitting smoking. Encouraging the NHS to do more on cessation is emphatically not about removing responsibilities from local authorities. This is about creating a whole-system approach in which addicted smokers can access the support they need to quit. Public Health England will continue to provide local councils up and down the land with facts and advice on tackling smoking—for example, it will work with sustainability and transformation partnerships, which should be leading that whole-system approach in the constituencies of all English Members.

Fourthly, as I have mentioned, we will continue to raise tobacco duty to make tobacco less affordable, while also taking action to tackle the illicit trade in tobacco. Fifthly, we will maintain a careful watch on so-called novel tobacco products. The Government are keen to use the opportunity of newer products, such as e-cigarettes, to help smokers to quit, without undermining the key message that the best thing someone can do for their health is quit completely. As I said in the Science and Technology Committee’s inquiry into this subject, we will continue to keep the harms of products such as heated tobacco products under review and continue to hold the industry to account. We have been explicit that the promotion of tobacco products is unlawful, as my recent letter to Philip Morris International makes abundantly clear—that letter was written before the one I mentioned in response to the hon. Member for Stockton North (Alex Cunningham).

Last but not least, we will continue to make the case for tobacco control internationally, building on our reputation as a leading tobacco control nation with credibility in that space. We have such credibility because our consistent work in this area goes back to the coalition Government, the previous Labour Government and the Conservative Government before them, and such consistency means that we are highly credible around the world. More than 7 million people a year across the globe die from smoking-related disease, and the UK Government can help make a dent in that toll by sharing knowledge and skills.

[Bob Blackman (Harrow East) (Con)]

I pay tribute to the Minister’s brilliant work both since he became a Health Minister and before then. Will he comment on some of the scientific issues raised about addiction to nicotine, compared with the very harmful by-products that are a part of cigarettes, cigars and other tobacco products? Will he comment on whether it is nicotine or the by-products that are harming people’s health and causing the most damage?

[Steve Brine]

I think cigarettes cause the most damage, because of the tobacco and the nicotine. The carcinogenic properties of the former are lethal. That link was proven with the lung cancer study that started the ball rolling. I pay tribute to my hon. Friend as the chair of the all-party group for the work he has done in this area. There are a lot of things that we know and there are a lot of things that we still do not know. Some people say that I do not go far enough to promote e-cigarettes and novel products, and some people say that maybe we go too far—I mentioned Stoptober. That generally suggests to me that we are in the right place. What I would say—I think that I said it earlier—is that an awful lot of research is still needed on e-cigarettes. One Member once told me that we should make e-cigarettes free on prescription to all pregnant women. The reason I did not say, “Yes, I think that’s a good idea” is that I still think there are risks to that product. I still think that the best thing people can do is to stop chuffing on anything, whether traditional cigarettes or so-called novel products. I thank him for his intervention, and I look forward to hearing what he has to say during the debate.

--- Later in debate ---

[Mrs Hodgson]

That is important, especially when, as the Minister has acknowledged, we are in such straitened times when it comes to local authority budgets. I am sure that Fresh north-east will be very grateful for what he has said.

Sadly, other areas are not as lucky. They do not have a Fresh north-east; if only they did. Stop smoking services are roughly 300% more effective than quitting by going cold turkey, but in some places the specialist services are being decommissioned altogether. For example, in Blackpool, smoking prevalence is 22.5%, while the average for England is 15.5%, yet Blackpool Council recently decommissioned its specialist smoking cessation service, citing a number of factors including public sector budget cuts.

That example leads me to my next point. Between 2012 and 2014, the healthy life expectancy for newborn baby boys in England was the lowest in Blackpool at 55 years. Again, the shortest life expectancy among men was in Blackpool too, at 74.7 years. Interestingly, in 2014, Blackpool had the highest smoking prevalence at 26.9%. Wokingham had the lowest smoking prevalence at 9.8%, but the highest healthy life expectancy of 70.5 years. That is a 15.5 year difference between healthy life expectancies, and while there will be several factors in play in these figures, it is clear that smoking is one of the largest causes of health inequalities in England.

Some 26% of routine and manual workers now smoke, compared with 10% of those in managerial and professional jobs. This has slightly increased rather than decreased the inequality from 2016. Some 28% of adults with no formal qualifications are current smokers compared with only 8% of those with a degree. It is these people—manual workers or those from low socioeconomic backgrounds—who suffer the most when the Government cut spending to public health services. I therefore ask the Minister what steps his Department is taking to ensure that these people are reached by local smoking cessation services. What assessment has the Minister made of the impact that smoking rates have on widening health inequalities, and how does he intend to address them?

Finally, I move on to smoking in pregnancy. The Government’s ambition to reduce smoking in pregnancy to 6% or less by 2022 is laudable. In 2015-16 the rate was 10.6%. However, new data published recently showed that the rate of smoking during pregnancy in 2017-18 had increased slightly, to 10.8%. It is therefore deeply concerning that the Smoking in Pregnancy Challenge Group, which I recently met, has warned that this ambition is unlikely to be met unless urgent action is taken.

In 2010, 19,000 babies were born with a low birth weight because their mothers had smoked during pregnancy. Up to 5,000 miscarriages, 300 perinatal deaths and around 2,200 premature births each year have been attributed to smoking during pregnancy. In addition, many other children will be three times more likely to take up smoking in later life because they live in smoking households. If we are going to have a smoke-free generation in the future, the Government must take urgent action to ensure that rates of smoking in pregnancy fall. We must not forget that it will be those very babies who will become the smoke-free generation that we all hope to see.

The current target is to reduce smoking in pregnancy to 6% or less by 2022. If that is achieved, it could mean around 30,000 fewer women smoking during pregnancy, leading to between 45 and 73 fewer stillborn babies, 11 to 25 fewer neonatal deaths, seven to 11 fewer sudden infant deaths, 482 to 796 fewer pre-term babies, and 1,455 to 2,407 fewer babies born at a low birth weight. That is something to aim for, but it will only happen if the Government take urgent steps to reduce the number of women smoking during pregnancy.

[Bob Blackman]

On behalf of the all-party group on smoking and health, I thank the hon. Lady for speaking at the launch of our recent report. Does she agree that we must encourage not only pregnant women to give up, but their partners, too, so that pregnant women no longer have to face the challenge of not only being deprived of smoking, but of seeing their partner smoke in front of them? This should be a partnership for both parties.

[Mrs Hodgson]

That is a very pertinent point. We all know the damage of passive smoking. It is all well and good if the mother gives up smoking—that will definitely help her and the baby during pregnancy—but if smoking is still going on in the household, the children will still be growing up in an environment of passive smoking. I thank the hon. Gentleman for making that important point and for his excellent work as chair of the all-party group.

I welcomed what the Minister said about tackling smoking in pregnancy, but will he also tell us how he will target work to encourage younger women and women from more disadvantaged backgrounds to give up smoking during pregnancy? Teenage mothers are nearly four times as likely to smoke before or during pregnancy than those aged 35 and over. Young mothers are less likely to quit before or during pregnancy, and only 38% of mothers under the age of 20 did so, compared with 58% of mothers aged 35 or above. It is clear that the Government need to tackle smoking in pregnancy, and smoking in childhood, as a matter of urgency to achieve their ambition of a smoke-free generation.

The Minister and his Department have a huge challenge on their hands if they are to meet the ambitious targets set out in the tobacco control plan. I still welcome the plan as the right thing to do, as I am sure the Minister does. Anything that is worth doing is going to be hard. We have four years to go before the target date, and the Minister must now look at how the Government can properly fund smoking cessation services to drive down smoking rates and support those who need extra help to stop smoking. I look forward to the remainder of the debate and the Minister’s closing remarks.

[Bob Blackman (Harrow East) (Con)]

It is a pleasure to follow the hon. Member for Washington and Sunderland West (Mrs Hodgson), who has done excellent work already in her shadowing role. I know that she was also at the forefront of this debate before shadowing these matters. Equally, I pay tribute once again to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), who set a precedent for future public health Ministers when, at his first outing at the Dispatch Box, he agreed to publish the long-awaited tobacco control plan. We should remember that it had been delayed for a year before it was published last year at the behest of my hon. Friend, probably much to the consternation of his officials.

I also want to pay tribute to the Minister’s predecessors, particularly the former Member for Battersea, Jane Ellison, who did a brilliant job of advancing many of the controls on tobacco that we now have in such a way as to ensure that they were delivered. I remember taking on the first debate on this subject in Westminster Hall, at which many of my colleagues were present. I think it was in September 2013, and it was the first debate after we came back from the summer recess. It took place at 9.30 in the morning, and I feared that I would have an hour and a half to fill by explaining why we should have standardised packaging for tobacco products. I have to say that both major parties were opposed to that idea at the time, but we were able to convince them otherwise and we changed the policy. That measure has now been enacted, which demonstrates the power that we on the Back Benches can have to change policy in a good way.

I must gently chide the Government, however, for taking over our Back-Bench debate. This means that we cannot pass the resolution that we wanted to pass today to encourage the Government not only to adopt smoking cessation policies but to resource them properly, to ensure that the plan is delivered. We understand that we are now having this general debate, however.

I declare my interest as chair of the all-party parliamentary group on smoking and health. We could go through the history of the progress that has been made, and the speeches from the Front Benches have shown us where we are today. I want to take us back to 1974, when I was sitting my A-levels. My late parents were both very heavy smokers. In those days, half the men in this country smoked, as did more than 40% of the women. It is hard to imagine, but in many ways it was considered healthy to smoke; it was somehow considered to be good for our lungs. Sadly, both my parents died five years later of cancer, so for me this is not only a health issue but a personal one. I do not want to see other people going through what my family had to go through as a result of using tobacco products in the way that they are intended to be used.

Smoking rates have dropped remarkably. As has been mentioned, the number of adult smokers has dropped from 7.7 million in 2011 to 6.1 million in 2017. The difficulty with figures, however, is that, as the population increases, we have to go harder and further to reduce the number of people smoking. Smoking-related diseases are the leading cause of preventable death, with 80,000 people a year dying as a result of tobacco products. In Harrow, part of which I have the honour of representing, we still have 14,000 smokers, which is difficult to understand given the encouragement to quit and all the health issues, and the cost to public services is estimated to be £37.9 million a year in just one London borough, out of 32, that has about 250,000 adults. It is clear that we need further action.

The good news is that the UK is one of the leading countries in the implementation of tobacco control policies. We are recognised as a leader in the implementation of the World Health Organisation’s framework convention on tobacco control, and I want to remind the House of article 5.3, which states:

“In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.”

The guidelines on implementing article 5.3 have been agreed by the UK and advise Governments not to enter into any partnerships, whether they be non-binding or non-enforceable, or agreements with the tobacco industry, not to accept voluntary contributions from the tobacco industry, not to accept tobacco-industry-drafted legislation or policy or voluntary codes for legally enforceable measures, not to participate in corporate social responsibility or related schemes funded by the tobacco industry, and not to permit tobacco industry representation on Government tobacco control bodies.

Former MP Paul Burstow, my predecessor as chair of the all-party parliamentary group on smoking and health, is now the chair of the Tavistock and Portman NHS Foundation Trust and co-chair of the Mental Health and Smoking Partnership. He wrote to the Minister about the letter sent by Philip Morris International, and I am pleased that the Minister has taken up the issue straight away. The company, which manufactures Marlboro cigarettes, wrote to say that it is

“keen to work with NHS Trusts and Foundations to see if we can support the NHS in helping its employees to stop smoking”.

I do not usually promote this publication, but an article in The Guardian today quotes me, Paul Burstow and the Minister making it clear that we do not want any interference from Philip Morris and that that company should not avoid its responsibilities under the code. I am delighted that the Minister has completely rejected the position of Philip Morris, which also states that it has

“written to the heads of all the NHS Foundations and Trusts in England, all Clinical Commissioning Groups, Simon Stevens, and the Secretary of State for Health and Social Care”

about the issue.

Most local authorities in England have signed up to the local government declaration on tobacco control, which is a public statement of the councils’ commitment to reduce the harm caused by tobacco. The declaration commits signatories to

“protect our tobacco control work from the commercial and vested interests of the tobacco industry by not accepting any partnerships”

and so on. However, local government officers have reported continuing efforts by the tobacco industry to engage with local authorities over tobacco control issues including, but not limited to, the illicit trade. We must be clear that the industry’s involvement is not required and not welcome.

I am delighted that, on 1 November 2017, the Minister made a clear statement in this House on the Government’s position, and I am delighted that will continue. I welcome his comments, both in his opening speech and in his letter. What else can he do to make sure that local authorities, the NHS and any other interested parties do not get sucked into this offer from Philip Morris?

On the risks we run, as the hon. Member for Washington and Sunderland West said, one of the problems is that the plan and the targets might not be met. We have to encourage everyone to get to that point. The reality is that smoking rates among young people have started to level out. There is a risk that we will not hit those targets. The target to get smoking rates down to 5% or less by 2022 is good, but I would like to see it at 0%—no one smoking. We could then say that we have achieved what we wished to achieve.

We clearly have to encourage young people not to start smoking. As has been said, more than 350 young people a day take up smoking, and 60% of them go on to smoke for the rest of their life. The huge risk is that those people will fuel the tobacco industry for the future.

There is therefore a case for further control measures, including increased funding for the initiatives, and new legislation. Although it is not appropriate to allow the tobacco manufacturers to make voluntary contributions, if they are offering to give money to the NHS and to local authorities as part of so-called corporate social responsibility, the industry clearly has money to pay for the measures we need to control tobacco and to mitigate the harm it causes, so let us make the tobacco manufacturers pay.

At a time when public sector budgets are under pressure both at national and local level, the tobacco manufacturers, if they have money, should pay an increasing share of the cost of control, as an application of the “polluter pays” principle. That is the clear recommendation of the all-party parliamentary group, and I trust my hon. Friend the Minister will therefore advance that recommendation to the Chancellor.

[Steve Brine]

Consider it advanced. Time will be limited for the wind-ups, so I will address the point about young people. Earlier this week, I held a roundtable in the Department of Health with a number of charities working on drug policy and with reformed drug takers. One gentleman said to me, “The trouble was that I really enjoyed taking drugs. What I didn’t enjoy was the outcome of taking drugs.”

I have heard young people say that they really enjoy smoking but that they do not enjoy the outcome. We should welcome today’s statement by the Secretary of State for Education on the new work that will be done in schools on health and relationships education. Specifically, health education can help young people to understand the health consequences of smoking, even if they might enjoy the process of smoking.

[Bob Blackman]

I thank my hon. Friend for his intervention, and I completely agree that health education is an appropriate way to consider the issue.

There is a model in the United States that we could introduce. The Family Smoking Prevention and Tobacco Control Act of 2009 gives the US Food and Drug Administration the power to regulate the tobacco industry, funded through what is called a user fee on manufacturers. The total amount to be raised is set out in legislation and apportioned to manufacturers on the basis of their share of the US tobacco product market. I ask the Minister to look at that US legislation as a way of introducing such a model.

The major recurring costs of tobacco control, and they are important, are mass media campaigns to discourage uptake and to encourage quitting. An approach such as the one in the US would: raise hundreds of millions of pounds a year from the tobacco industry; help to protect the business of legitimate retailers who obey the tobacco control legislation; help to protect Government tax revenues—at the moment, the excise tax raised £9.9 billion in 2016-17, but the loss on illicit tobacco was estimated to be £2.4 billion; pay for the mass media campaigns to discourage smoking, which we desperately need; and provide a source of revenue to local authorities, which could help to fund local tobacco control measures, including enforcement activity and the provision of support to smokers seeking to quit. Funding for trading standards has fallen substantially in recent years, from £213 million in 2010 to only £124 million in 2016, and the National Audit Office estimates that the number of full-time staff has reduced by 56% in seven years. So there are fewer people to enforce the rules that we want to see enforced. Such an approach could also support regional partnerships working to tackle illicit tobacco. The success of that has been shown in the north-east and north-west, which have concerted multi-agency enforcement activity and effective, evidence-based measures to reduce demand. So it is clear that we can deliver on this.

Polling conducted for ASH—Action on Smoking and Health—asked respondents how strongly they would support measures requiring tobacco manufacturers to pay a levy or licence fee to help encourage people to quit and prevent young people from starting to smoke. The net support for that was 71%, with only 9% opposing. So the Minister should impress on the Chancellor the need for this and the benefit of doing it.

One key issue that I wish to emphasise above all else is the need for mass media campaigns to shock people into realising how desperate smoking is and how damaging it is to health. There is nothing like seeing those sorts of mass campaigns for encouraging people to realise that they are responsible for their health. The analysis of these campaigns has shown that they are very effective but that they have declined in recent years. Public spending on such campaigns in the UK peaked in 2008-09 at £23.38 million, but now that has fallen dramatically, to only £1.5 million in 2016-17. Clearly, we need to encourage local authorities and the Department of Health and Social Care to use the opportunity to shock people so that they understand the damage they are doing. I therefore ask the Minister to look at mass media campaigns and ensure that they are used as part of the strategy.

Finally, let me say that my area now has a large number of people from the European Union who have chosen to come here to live in this country. If we go to many eastern European countries, we see people smoking everywhere; these places do not have the tobacco control that we have in this country. Those people need to be reached to encourage them to give up smoking and ensure they look after their own health. It is those people we have to reach out to fully. I look forward to other contributions from right hon. and hon. Members, and I am sure that the Minister will reply in suitable fashion.