National No Smoking Day

Bob Blackman Excerpts

Thursday 9th March 2023 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

I beg to move,

That this House has considered national no smoking day.

It is a pleasure to serve under your chairmanship, Mr Efford. Many of us will be well aware that yesterday was No Smoking Day, an annual awareness day in the UK that aims to help people who wish to quit smoking. This year, No Smoking Day is raising awareness of the greatly increased risk of developing dementia that results from tobacco use. Through this debate, I hope that we can raise awareness of the considerable health risks associated with tobacco products.

It shocks me that, despite two out of three smokers dying from smoking-related illness, there are still 6.6 million people in the UK who smoke regularly. I firmly believe that if people were more aware of the self-inflicted harms that they are causing by using tobacco products regularly, that figure would drop considerably, and those people would be less inclined to continue smoking. It is therefore crucial that we reverse the withdrawal of Government funding for the no smoking public awareness campaign, which effectively highlighted the dangers associated with smoking and the support that is available to help people quit.

The wider health implications of smoking are truly frightening. Every single day in England, 150 new cases of cancer are diagnosed as a direct consequence of smoking. Additionally, a person is admitted to hospital with a smoking-related illness every single minute. Tobacco products are the biggest cause of death in the UK, killing on average 78,000 people a year through cancers, respiratory diseases, coronary heart disease, heart attacks and stroke, vascular disease, asthma and chronic obstructive pulmonary disease, or COPD. To be clear, that is 78,000 avoidable deaths caused by self-inflicted harm.

Smoking affects some socioeconomic groups more harshly than others. In areas around the city of Kingston upon Hull, 22% of residents engage in tobacco use, and in Blackpool the figure is as high as 20.6%. That encourages children and other members of the household to take up smoking, because they follow the example of others and have much easier access to such products in the home. When a parent smokes, their offspring are four times more likely to share the habit. I was horrified to learn that 90,000 children between 11 and 15 in this country regularly smoke, despite the fact that it is illegal for premises to supply tobacco to those children. The younger a person starts smoking, the harder it is for them to give up, and the more likely they are to continue the habit into their adult life. Some 80% of regular smokers started smoking before the age of 20.

Smoking in pregnancy is far too common, and it is an area that I have constantly campaigned on. If a mother is happy to smoke, being fully aware of the health implications, she is risking not only her health but the life of her unborn child. As soon as an innocent child, not even born, is subjected to heightened health risks because of smoking, it becomes a far more selfish and cruel act. Smoking during pregnancy is the leading modifiable risk factor in poor birth outcomes, including stillbirth, miscarriage and pre-term birth. Further, it considerably heightens the risk of the child contracting respiratory conditions; attention and hyperactivity difficulties; learning difficulties; problems of the ear, nose and throat; obesity; and diabetes. Unfortunately, there are over 51,000 babies subjected to such experiences each year. I am sure we all agree that that is 51,000 innocent babies too many. 

As I mentioned, the theme of No Smoking Day this year was the increased risk of dementia, so it would be remiss of me not to touch on the strong links between smoking and dementia. A recent study ranked smoking third out of nine modifiable risk factors leading to dementia. The World Health Organisation estimates that 14% of cases of Alzheimer’s disease worldwide are potentially attributable to smoking, and states that smoking increases the risk of vascular dementia and Alzheimer’s. Studies also show that people who smoke heavily—more than two packs a day—in mid-life have more than double the risk of developing Alzheimer’s disease or other forms of dementia two decades later.

It is important to recognise that there is probably an even stronger connection between smoking and dementia than the figures suggest. That is because a higher proportion of smokers die prematurely, so it is possible that the association between smoking and dementia has been obscured through a selection bias. Given that dementia is now the most feared health condition for all adults over the age of 55, I am sure the Minister will help to ensure that the data is shared with smokers whenever possible.

Smoking is not only hugely damaging to the health and wellbeing of individuals; it also puts a gigantic strain on the public purse and wider society. In 2021-22, the tax revenue from sales of tobacco reached £10.3 billion. That may seem a generous return to the Treasury, but it is tiny compared with the £20.6 billion that smoking actually costs the public finances. Let me break those figures down: £2.2 billion fell on the NHS, £1.3 billion fell on the social care system, and a staggering £17 billion was lost as a result of the reduction in taxes and increased benefit payments that arose from losses to productivity, including from tobacco-related lost earnings, unemployment and premature death.

The addictive nature of smoking products pushes many households into significant financial hardship. On average, those who smoke regularly spend more than £2,400 a year on tobacco. In 2022, that figure was enough to cover the average household energy bill—granted, perhaps it does not anymore, thanks to inflationary pressures. Research looking into the income and expenditure of households containing smokers found that 31% fell below the poverty line.

The socioeconomic inequality of smoking is huge. Those from poorer backgrounds and on lower incomes are considerably more likely to smoke, and in turn experience heightened health risks. Consequently, people born today in England’s more affluent areas are expected to live up to a decade longer on average than those in the least affluent areas. In Kingston upon Hull, 22% of households contain smokers, and the average income is £31,000. Comparatively, in west Oxfordshire, where the average salary is £40,000, the smoking rate drastically decreased to only 3.2%. Some £21.4 million in earnings is lost each year to smoking-related causes, and a further £20.2 million is lost due to smoking-related unemployment.

As I said, smokers are far more likely to contract cancer. I was unfortunate enough to witness that at first hand. When I was only 23, both my parents died as a direct result of smoking-related cancers. They died within a month of each other, which was a tragedy for my family and something that I remember every single day. It was a devastating period for my family, and the prospect of suddenly having to raise three younger sisters at a very young age was frightening—an experience I do not wish on any other individual.

Cancer treatments are not cheap. The average cost of treating a patient for lung cancer is more than £9,000 a year. That is a huge burden on already strained NHS budgets, and in many cases it is self-inflicted through smoking. Further, 75,000 GP appointments a year are a result of smoking-related illness. At approximately £30 an appointment, that could save the UK Government £2,250,000 annually and—very importantly in this day and age—would shorten waiting times for patients with other ailments. As I am sure my hon. Friend the Minister will agree, it is clear that we need to take urgent action to tackle this damaging practice.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

It is a pleasure to speak under your chairmanship, Mr Efford. On No Smoking Day, I am delighted to welcome the progress we have made as a country, and I am grateful to the hon. Member for securing the debate. I must declare that I am a non-smoker. In only a few years, smoking policy has worked. It has massively reduced prevalence, and people are healthier, fitter and living longer. Given how few Members are present, Mr Efford, I understand that I can talk a little longer, rather than having to intervene two or three times.

[Mr Sharma]

I accept that. Working-class and black and minority ethnic communities are struggling to quit, and need more complex solutions. Does the hon. Member agree that vaping represents a less harmful alternative?

[Bob Blackman]

I thank the hon. Member for that brief intervention. From my perspective, I would encourage anyone who smokes and who wants to give up to try vaping. If vaping is considered by that individual to be a safer alternative, I would encourage them to try it. However, I am one of those people who say that we have to be very careful about vaping, because we do not know the long-term effects. It is certainly healthier to choose vaping as a way to give up smoking. However, I am concerned about the number of young people who are taking up vaping directly, and who may then go on to smoke, or to other ways of getting nicotine into their system. That is a really serious problem for the long term that the Government have to address.

As I was saying, the Government have set out a vision for England to be smoke-free by 2030, which I strongly welcome—I hope we can do it even more quickly than that —but Cancer Research UK, which has supplied me with information on this issue, has modelled the Government’s plan and suggests that they will not achieve the target until 2039 if recent trends continue. That is not good enough. The delay will cause around 1 million smoking-related cancer cases in the UK alone, so can my hon. Friend the Minister confirm how we will get back on track to reaching a smoke-free 2030?

Nothing would have a bigger impact on the number of preventable deaths in the UK than ending smoking. Smoking rates have thankfully come down, as indicated by the hon. Member for Ealing, Southall (Mr Sharma), and I want further action, so that the downward trend continues. Back in 2021, the Government committed to publishing a tobacco control plan, which we have yet to see. Smoking causes around 150 cases of cancer a day in the UK, meaning that since the last tobacco control plan expired in 2022, around 10,000 people’s lives have been changed forever with a smoking-attributable cancer diagnosis. Can the Minister confirm when the tobacco control plan for England will eventually be published? “Soon” is not good enough.

In June 2022, Javed Khan published his hugely anticipated independent review of tobacco control, which was commissioned by the UK Government. Like many others, I was pleased to contribute to the review, and we welcomed its pronouncements. It set out policy recommendations that would see England become smoke-free by 2030. However, despite being given clear recommendations and a road map of how to achieve the target months ago, the Government have yet to respond. I understand that Ministers have changed over the last year, particularly as a result of the changes in Government, but it is not good enough that we have not had a response to the long-awaited review.

It was stated that a response would be available in the spring. I am not sure if that is spring 2022, spring 2023 or, worse still, spring 2024, but the reality is that in ministerial terms, “spring” can be flexible—hence why we call it spring. Spring is almost upon us, so we await the response to the report. We need to know which recommendations the Government will choose to adopt, and which they will not, and why. Will my hon. Friend the Minister confirm when specifically the response to the Khan review will finally be published?

Next week’s Budget is a critical moment at which the Government must take the urgent action we are calling for. Without additional, sustainable funding, it will not be possible to deliver all the measures we need to make England smoke-free. Severe funding reductions have undermined our ability to deliver such measures. We need to encourage and help people to quit smoking. The reductions have been greatest in the most deprived areas of the country, where smoking is most likely to occur. Sadly, in 2022, only 67% of local authorities in England commissioned a specialist service open to all local people who smoke. That is largely due to financial pressure, following reductions to the public health grant. National spending in England on public education campaigns has dropped from a peak of 23,380,000 in 2008-09 to a mere 2.2 million in 2019-20. That is a 91% reduction. I am disappointed that funding for the No Smoking Day public awareness campaign has been completely scrapped, despite a mass of evidence suggesting that it was a highly effective campaign that had a direct effect on people who continue to smoke.

The four largest tobacco manufacturers make around £900 million of profits in the UK each year. Profit margins on cigarette sales are significantly higher—as much as 71%—than on other typical consumer products. Consequently, the all-party parliamentary group on smoking and health, which I have the privilege of chairing, has called on the Government to introduce a “polluter pays”-style charge on the tobacco industry. That would finally make the tobacco industry pay for the damage its products cause to our nation’s health, and for the strain on the NHS. Remember: this is the only product that people can legally buy that will kill them if they use it properly. It is an outrage that smokers are preyed on by these big tobacco companies. I accept that I may not get the answer I would like, but will the Minister confirm that the Government will introduce a “polluter pays” charge on the tobacco industry in the upcoming Budget?

I have a ten-minute rule Bill going through Parliament that would require people who sell tobacco products to be properly licensed. If the Minister cannot endorse the Bill, I would welcome a commitment from him and his Department to dealing with this issue once and for all, so that we have a proper licensing regime for the sale of tobacco products in this country.

As I come to the end of my speech, I remind colleagues that making Britain smoke-free by 2030 is a well backed public initiative. Recent polling showed that 70% of people supported the Government’s investing more money in helping England to reach the target. Of those people, 74% would prefer the money to come from the tobacco industry, so that it pays for the pollution it causes.

I thank hon. Members for attending the debate. I look forward to hearing the contributions from the Labour and SNP spokespersons, and the Minister’s response, as well as contributions from colleagues from across the House. I commend the debate to the House, and urge the Minister to take urgent action on tobacco today; that would improve the health of the nation, reduce pressure on the NHS, and put money back in the pockets of those who need it most.

[Several hon. Members rose—]

--- Later in debate ---

[Bob Blackman]

I thank my hon. Friend the Minister, the Opposition spokesperson, the hon. Member for Denton and Reddish (Andrew Gwynne), and the SNP spokesman, the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), as well as all Back-Bench colleagues who made this a very powerful debate. As we commemorate national No Smoking Day and seek to reduce dementia in society, it is vital that we look at the causal links between smoking, dementia and many other diseases such as cancer, as hon. Members pointed out.

I look forward to hearing the Government’s response very soon—that is very good news. Very soon is better than soon, and in a few weeks is even better, so we look forward to that. Clearly, the Chancellor has the opportunity in the Budget to introduce the levy that we have long campaigned for, which would directly contribute money to the national health service to treat victims of smoking.

Almost 11 years ago, I led a debate in this Chamber on standardised packaging of tobacco products. The Opposition spokesman at the time said, “Labour has no plans to endorse standardised packaging.” The Minister, who is no longer in the House, said, “The Government have no plans.” A few short years later, we got standardised packaging of tobacco products.

Those who have contributed to this debate should remember this: every single move that Governments of all persuasions have made to restrict smoking and, as a result, improve health have come from Back Benchers. Back-Bench Labour Members introduced the ban on smoking in cars with children present. We should always remember that these great initiatives come from Back Benchers.

I have campaigned on this issue since I was elected in 2010. I am afraid we cannot wait for a Labour Government to introduce the Khan review. Labour Members will have to wait a very long time to have that opportunity, so it is most important that the Government get on with the job. As I said, this has the support of the whole House. Let us get on and deliver it so that fewer people die from smoking.

Question put and agreed to.

Resolved,

That this House has considered national no smoking day.

Oral Answers to Questions

Bob Blackman Excerpts

Tuesday 6th December 2022 Commons Chamber

[Steve Barclay]

First, it is a bit bizarre that, at departmental questions, the best the hon. Gentleman can manage is “a Government source”. Secondly, the revelation from that Government source is that this will affect “a lot of people”. I do not think that comes as any surprise. That is why we regret the action and are very open to having talks. The point is that he himself does not support the 19% pay demand of the trade unions. He stands here saying that we should be talking while he himself does not accept their proposal.

[Bob Blackman (Harrow East) (Con)]

T4. There have been several changes of Ministers, as we know, but officials have carried on working through these changes, so can we know on what day, date and time the long-promised and overdue tobacco control plan will finally be published?

[Neil O’Brien]

Whatever format our next steps forward are set out in, we will be pushing forward very quickly and aggressively on this. This year, we are putting £35 million into the NHS to support our services for everyone who goes in to stop smoking. We have doubled duty on cigarettes and brought in a minimum excise tax. Women who are pregnant now routinely get a carbon monoxide test. National campaigns such as Stoptober have now helped 2.1 million people to quit smoking. We are also supporting a future medically licensed vaping product as a quitting aid. We will be pressing forward at the greatest speed.

Smokefree 2030

Bob Blackman Excerpts

Thursday 3rd November 2022 Commons Chamber

1 pm

[Bob Blackman (Harrow East) (Con)]

[R]: I beg to move,

That this House has considered the recommendations of the Khan review: Making smoking obsolete, the independent review into smokefree 2030 policies, by Dr Javed Khan, published on 9 June 2022; and calls upon His Majesty’s Government to publish a new Tobacco Control Plan by the end of 2022, in order to deliver the smokefree 2030 ambition.

I thank the Backbench Business Committee, on which I have the honour to serve, for enabling us to have the debate this afternoon. On behalf of the all-party parliamentary group on smoking and health, which I chair, I welcome the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien), to his new role as public health and primary care Minister. The all-party group has a long track record of acting as a critical friend to the Government on this agenda and I am confident that that collaborative and constructive approach will continue.

May I take the opportunity to commend the hon. Member for City of Durham (Mary Kelly Foy), who co-sponsored the debate application with me but is not able to be here today? She is currently recuperating from a stay in hospital. I am sure that the whole House wishes her a speedy recovery.

The all-party group originally proposed the debate before the summer recess to ensure that Parliament had the opportunity to scrutinise the independent review by Javed Khan OBE, “Making smoking obsolete”. When the Secretary of State—well, the then Secretary of State, my right hon. Friend the Member for Bromsgrove (Sajid Javid)—announced the Khan review in February, he said that it would

“assess the options to be taken forward in the new Tobacco Control Plan, which will be published later this year.”

We have since had several changes of Health Ministers and Secretaries of State, but it should not be forgotten that a new tobacco control plan was first promised in 2021.

Achieving the Government’s smokefree 2030 ambition and making smoking obsolete is vital to the health and wellbeing of our entire population. It will also help to deliver economic growth, because smoking increases sickness, absenteeism and disability. The total public finance cost of smoking is twice that of the excise taxes that tobacco brings into the Exchequer. Each year, many tens of thousands of people die prematurely from smoking, and 30 times as many as those who die are suffering from serious illnesses caused by smoking, which cost the NHS and our social care system billions of pounds every single year.

Javed Khan’s review, which was published in June, concluded that, to achieve the smokefree 2030 ambition, the Government would need to go further and faster. He made four recommendations that he said were critical must-dos for the Government, underpinned by a number of more detailed interventions. I will concentrate on the four main recommendations, given time.

The four must-dos were: increasing investment by £125 million a year to fund the measures needed to deliver smokefree 2030; raising the age of sale to stop young people from starting to smoke; promoting vaping as an effective tool to help people to quit smoking tobacco, while strengthening regulation to prevent children and young people from taking up vaping; and prevention to become part of the NHS’s DNA and the NHS committing to invest to save. Since then, we have had conflicting reports about whether the Government intend to publish a new plan at all. That has been deeply concerning to me and others who support the ambition and want to see it realised. To abandon, delay or water down our tobacco strategy would be hugely counterproductive when the Government are trying to reduce NHS waiting lists, grow the economy and level up society.

As well as increasing funding, Khan recommended enhanced regulation. Both of those are supported by the majority of voters for all political parties, and the results of a survey published just this week show that tobacco retailers share that view as well. I therefore commend the “Regulation is not a dirty word” report by ASH—Action on Smoking and Health—to the Minister. It shows that most shopkeepers support existing tobacco laws and want the Government to go further in protecting people’s health. Retailers want tougher regulations—that is what they think will be good for business—and not deregulation.

There is no time to be lost. When the ambition was announced, we had 11 years to deliver it. Now, we have less than eight years, and we are nowhere near achieving our ambition, particularly for our more disadvantaged communities with the highest rates of smoking. Research cited in the Khan review estimates that it will take until 2047 for the smoking rates in disadvantaged communities to reach the smokefree ambition of 5% or less. Will the Minister put on record his commitment that the Government, having considered the Khan review recommendations, will publish a new tobacco control plan by the end of 2022 to deliver the smokefree 2030 ambition?

As Javed Khan made clear with his leading recommendation, smokefree 2030 cannot be delivered on the cheap. However, public health interventions such as smoking cessation cost three to four times less than NHS treatment for each additional year of good health achieved in the population. Yet that is where the cuts have fallen to date. The public health grant fell by a quarter in real terms between 2015 and 2021, and funding for tobacco control fell by a third, while NHS spending continues to grow in real terms.

Last week, London launched its tobacco alliance with a vision to deliver the smokefree 2030 ambition across London. Cabinet members for health and wellbeing from across London are writing to the new Secretary of State to make clear their commitment to achieve the ambition and pleading for the funding they need to deliver it. Before I became the MP for Harrow East, I was a councillor in the London Borough of Brent for 24 years, so I am well aware of what local authorities want to do on tobacco, but they lack the resources they need so to do.

Javed Khan called on the Government to urgently invest an additional £125 million a year in a comprehensive programme, including funding for regional activity such as that proposed in the capital. His recommendation was that, if the Government could not find the funding from existing resources, they should look at alternatives such as a corporation tax surcharge—a windfall tax—and a “polluter pays” tax. Banks and energy companies have been made subject to windfall taxes, so why not the tobacco manufacturers, who make eye-wateringly high profits from products that kill many tens of thousands of people every year? Four manufacturers, who are collectively known as “big tobacco”—British American Tobacco, Imperial Brands, Japan Tobacco International and Philip Morris International—are responsible for 95% of UK tobacco sales and the same proportion of deaths. For every person their products kill, it is estimated that 30 times as many suffer from serious smoking-related diseases, cancers, and cardiovascular and lung diseases caused directly by smoking.

A windfall tax could be implemented immediately through the Finance Bill. Experts on tobacco industry finances from the University of Bath have estimated that that could raise about £74 million annually from big tobacco. However, that is much less than the hundreds of millions in profits that big tobacco makes annually, because it would be a surcharge on corporation tax paid in the UK and tobacco manufacturers, just like the oil companies, are very good at minimising corporation taxes paid in the UK. For example, Imperial Tobacco, which is responsible for a third of the UK tobacco market, received £35 million more in corporation tax refunds than it actually paid in tax between 2009 and 2016. In contrast, a polluter pays levy would take a bit longer to implement, but it could be designed to prevent big tobacco from gaming the system as it currently does with corporation tax.

The polluter pays model we propose enables the Government to limit the ability of manufacturers to profit from smokers while protecting Government excise tax revenues, so it is a win-win for the Government and for smokers. Unlike corporation taxes, which are based on reported profits and can be—and indeed are—evaded, the levy would be based on sales volumes, as is the case in America, where a similar scheme already operates. Sales volumes are much easier for the Government to monitor and much harder for companies to misrepresent.

The scheme is modelled on the pharmaceutical price regulation scheme—the PPRS—which has been in operation for over 40 years and is overseen by the Department of Health and Social Care. The Department already has teams of analysts with the skills to administer a scheme for cigarettes, which would be a much simpler product to administer than pharmaceutical medicines. Implementing a levy would not require a new quango to be set up, as the Department has all the expertise needed to both supervise the scheme and allocate the funds.

Despite paying little corporation tax, the big four tobacco companies make around 50% operating profit margins in the UK, far more than any other consumer industry. Imperial Tobacco is the most profitable, with around a 40% market share in the UK. It made an operating profit margin of over 70% in 2021. Why should an industry, whose products kill when used as intended, be allowed to make such excessive profits, when 10% is the average return for business? The polluter pays model caps manufacturers’ profits on sales and could raise £700 million per year, which is nearly 10 times as much as a windfall tax.

Amendments to the Health and Social Care Bill calling for a consultation on such a levy were passed in the other place. Health Ministers were sympathetic, but the Treasury was opposed so they were reversed when the Bill came back to this place to be considered. However, that was before the Government knew they had a fiscal hole of around £40 billion that had to be filled. The £700 million from tobacco manufacturers would more than provide the £125 million additional funding that Khan estimated was needed for tobacco control. That would leave £575 million a year that could be used for other purposes, perhaps even for other prevention and public health measures which otherwise in the present economic climate are unlikely to secure funding.

The polluter pays principle has been accepted by Conservative Governments in areas such as the landfill levy, the tax on sugar in soft drinks and requiring developers to pay for the costs of remediating building safety defects. The Government promised to consider a polluter pays approach to funding tobacco control in the prevention Green Paper in 2019. Surely, we can now put it into practice.

[Liz Twist (Blaydon) (Lab)]

The hon. Gentleman will know that in the north-east smoking remains the leading cause of death, as well as of inequalities in healthy life expectancy. The all-party group has come forward with the polluter pays model, which is really important, and I ask the Government to consider it again as a means of funding the essential work on stopping smoking.

[Bob Blackman]

I thank the hon. Lady for her intervention. Clearly, there is a difference in smoking rates across the country, and we need to ensure that that is addressed. I will come on to that in my speech in a few moments.

We need the levy to be introduced, so will the Minister commit to investigating the feasibility of a windfall tax, backed up by a polluter pays levy, to provide the funding needed to deliver smokefree 2030?

I want to talk about the need to protect generations to come. The Government are set to miss the ambition, set in the 2017 tobacco control plan, to reduce SATOD— smoking status at time of delivery—rates to 6% by 2022. Currently, 9.1% of women, or about 50,000 women a year, smoke during pregnancy. Smoking during pregnancy is the leading modifiable risk factor for poor birth outcomes, including stillbirth, miscarriage and pre-term birth. Children born to parents who smoke are more likely to develop health problems, including respiratory conditions, learning difficulties and diabetes, and they are more likely to grow up to be smokers. Reducing rates of maternal smoking would contribute directly to the national ambition to halve stillbirth and neonatal mortality by 2025.

Younger women from the most deprived backgrounds are the most likely to smoke and be exposed to second-hand smoke during pregnancy. Rates of smoking in early pregnancy are five times higher among the most deprived areas than the least deprived. That contributes to this group having very significantly higher rates of infant mortality than the general population. As such, if we can drive down rates of smoking in younger, more deprived groups we will then have a rapid impact on rates of smoking in pregnancy. Two thirds of those who try smoking go on to become regular smokers, only a third of whom succeed in quitting during their lifetime. Experimentation is very rare after the age of 21, so the more we can do to prevent exposure and access to tobacco before this age, the more young people we can stop from being locked into a deadly addiction.

If England is to be smoke free by 2030 we need to stop people from starting smoking at the most susceptible ages, when they are adolescents and young adults, and not just help them quit once they are addicted. The all-party group, which I chair, has called on the Government to consult on raising the age of sale for tobacco to 21, which, when implemented in the US, reduced smoking in young adults by 30%. This is a radical measure, but one that is supported by the evidence and by the majority of voters for all political parties, retailers and young people themselves. It would have a huge impact on reducing smoking rates among young mothers, who are more likely than older women to smoke. It would also reduce rates among young men, so reducing the exposure of young pregnant women to second-hand smoke throughout their pregnancy. If men smoke it makes it harder for pregnant women and new mums to quit smoking, and makes it more likely that mother and baby will be exposed to harmful second-hand smoke. Will the Minister consider committing to a consultation on raising the age of sale for tobacco, as supported by both the public and tobacco retailers?

Finally, I want to warn the Minister about the Institute of Economic Affairs’ alternative smokefree 2030 plan, which popped into my inbox yesterday. The IEA’s plan is an alternative that is entirely in the interests of the industry, which is hardly surprising given the funding the IEA has received from big tobacco. The IEA itself refuses to be transparent about its funding, but through leaked documents it has been exposed as being funded by the tobacco industry for many years. I am sure the Minister is aware that the UK Government are required, under article 5.3 of the international tobacco treaty, the World Health Organisation framework convention on tobacco control, to protect public health from the

“commercial and other vested interests of the tobacco industry”.

The guidelines to article 5.3, which the UK has adopted, spell out that that includes organisations and individuals that work to further the interests of the tobacco industry, which includes industry funded organisations such as the IEA and the UK Vaping Industry Association.

I look forward to hearing contributions from across the House. I hope my hon. Friend the Minister will echo the words of his predecessors in his new role and restate for the record on the Floor of the House the Government’s commitment to complying with article 5.3. I hope he will state that on his watch the Government will continue to prevent the tobacco industry-funded organisations from influencing tobacco control policy.

--- Later in debate ---

[Bob Blackman]

With the leave of the House, I thank my hon. Friend the Minister, who is new in post, for answering this debate. I am grateful for the extremely welcome support from the shadow Minister, which demonstrates the will on both sides of the House to deliver a smokefree 2030.

I thank all colleagues who have contributed, including the hon. Members for Stockton North (Alex Cunningham) and for Blaydon (Liz Twist), and my hon. Friend the Member for Erewash (Maggie Throup).

Achieving a smoke-free England is key, and it is a major part of the levelling-up White Paper’s mission to increase life expectancy by five years by 2035. I know this is close to the Minister’s heart, because he was previously the Minister for Levelling Up. I remind him that in that role he said:

“ultimately on public health and on prevention, we need to think extremely radically and really floor it, because otherwise the NHS will just be under humongous pressure for the rest of our lifetimes because of an ageing population.”

I think we all agree with those statements. He needs to act radically and immediately on the Khan review and bring forward those proposals. I think he has the commitment of the whole House to deliver them, if legislation is required, but he could do much of what is in the Khan review just by regulation.

We need a tobacco control plan that will end smoking, increasing healthy life expectancy and narrowing inequalities, but without funding, a plan will not deliver. That is why we are proposing the polluter pays levy, which is popular, feasible and supported by voters of all political persuasions and by tobacco retailers. The idea has come to pass and we must now implement it.

Question put and agreed to.

Resolved,

That this House has considered the recommendations of the Khan review: Making smoking obsolete, the independent review into smokefree 2030 policies, by Dr Javed Khan, published on 9 June 2022; and calls upon His Majesty’s Government to publish a new Tobacco Control Plan by the end of 2022, in order to deliver the smokefree 2030 ambition.

Heart and Circulatory Diseases (Covid-19)

Bob Blackman Excerpts

Thursday 23rd June 2022 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the impact of the covid-19 pandemic on people with heart and circulatory diseases.

May I say how pleased I am to have this debate in the main Chamber? It was originally earmarked for Westminster Hall, where most of my debates are—indeed, probably all of them—but on this occasion I have kindly been elevated to the main Chamber, and I am greatly humbled to have this opportunity. I spoke to Mr Speaker’s Office this morning to thank the staff for that. I understand the reasons for it, but the reasons do not matter: we are here, and that is the important thing. I am very pleased to be able to participate in this debate.

[Bob Blackman (Harrow East) (Con)]

I thank the hon. Gentleman for taking on the opportunity to have a debate in this Chamber; as he well knows, had he not been so flexible the House would be rising now. He has enabled the House to continue, and on behalf of the Backbench Business Committee I thank him. Of course, his season ticket is honourably renewed.

[Jim Shannon]

I thank the hon. Gentleman for his kindness. The Backbench Business Committee is kind to everyone who applies for a debate, so I am always very pleased to do so, and on a regular basis. It will not be too long before I am back looking for more debates.

On this debate, I put on the record my thanks to the Committee. I am pleased to see that Members from across the House are involved, although I am mindful that today right hon. and hon. Members have many other engagements that mean they are unable to be here, even though the debate is in the main Chamber.

It is just over two years since the start of the lockdowns, and a little more since the pandemic first arrived. Life changed for everyone—I do not think there is anyone in the United Kingdom of Great Britain and Northern Ireland who did not have a life-changing moment—and for some of us it may never be the same as it was. It will never be the same for those who have lost loved ones; that is very real for every one of us. Some of the changes that took place due to the pandemic and covid-19 were cosmetic, but others have been life changing, and it is those changes that we need to address.

I want to say a massive thank you to all the doctors, nurses, auxiliary staff and cleaning staff—there are so many to name—who have been outstanding. There is nobody in this House who does not know some of them, has not spoken to them and does not also want to put that on the record as well. I thank them at the beginning of this debate.

During lockdown, barriers and obstacles to providing care for heart patients and all patients rocketed. I know that happened across all health departments, but in particular I thank the British Heart Foundation and the Stroke Association for all the information, detail and evidence they sent to me and others for the debate. We are very pleased to have that.

Some of those efforts by doctors were heroic; I do not use that word often, but on this occasion it is a word that aptly describes their efforts. Despite those heroic efforts of doctors, nurses and other key workers in our health systems, however, we have seen cardiovascular services disrupted so greatly that people are still feeling the effects today.

I am beyond thankful for every NHS staff member who went ahead with emergency surgeries. The reality of life for elected representatives is that we do not get many people coming and saying, “Thank you very much for that.” We get the complaints, but that is what we do. We are a conduit for their complaints and concerns. Some of the people were waiting for emergency surgery were not sure whether they would pay a price for that, so again for that I sincerely say a big thank you.

We are all aware of the waiting lists, reduced access to primary care and the pressures on urgent and emergency care. They all have real consequences for people’s health. That is why hon. Members pushed for this debate and why we are so pleased to have the opportunity to hold it today in the main Chamber. I feel incredibly privileged, honoured and humbled to be able to present this case—not for me, because I am not important, but on behalf of our constituents who have experienced hardship because of those things.

Those problems have also had real consequences for families’ lives, their relationships and the happiness of their families. Very often, the issues for those who were ill reflected back on the families, who were under incredible pressure to deal with circumstances that would be difficult to deal with normally but that, with covid-19 and the pandemic, escalated even more. There are 11,000 people living with heart or circulatory diseases in my constituency. I know the Minister does not have responsibility for Northern Ireland, but I will provide examples from Northern Ireland that are relevant across the whole of the United Kingdom of Great Britain and Northern Ireland. There are 2,000 stroke survivors and 13,000 people who have been diagnosed with high blood pressure.

Long waits, difficulty accessing routine medical services and long ambulance response times make life more difficult for the 7.6 million people living with heart and circulatory diseases in the UK. I mention those issues not as a criticism, but to highlight them and raise awareness. Ambulance response times in many parts of the United Kingdom, including in my own constituency, have been difficult, as have been the waiting times outside accident and emergency departments, with ambulances in place. That is happening not just in Northern Ireland but elsewhere, as I am sure other hon. Members will confirm.

Someone in the UK dies from a heart or circulatory disease every three minutes. This debate has been going for six minutes, so that means two people will have died from heart disease since it began. By the time the debate is over—it is a stark headline, unfortunately—as many as 20 people will have passed away. That statistic reminds us of the fickleness of life. It also reminds us of what this debate is about and why we are here. Someone is admitted to hospital due to a stroke every five minutes. Indeed, someone will have been admitted to hospital since this debate began. Two thirds of patients leave hospital with a disability. Stroke as a standalone condition costs the UK economy £26 billion annually, yet it is largely preventable and recoverable.

I look forward very much to hearing the response to the debate from the Under-Secretary of State for Health and Social Care, the hon. Member for Erewash (Maggie Throup). I know she is very committed to her job and has a deep interest in it, so I look forward to what she has to say in response to the questions we will ask her today. I also look forward to hearing from the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), who is a good friend and with whom I seem to be in debates all the time. If we were not in the Chamber today, we would be in Westminster Hall.

Northern Ireland Chest, Heart and Stroke highlights that there were 15,758 recorded deaths in 2019. That is some figure and it is worrying. The top three causes were cancer, circulatory diseases and respiratory diseases; together, those accounted for 64.3% of all deaths in Northern Ireland. That figure reminds us of just how fickle life is and that we are just a breath away from passing from this world to the next. They have been the three leading causes of deaths since 2012. Deaths due to chest, heart and stroke conditions, when combined, are the No. 1 cause of death, at 36%. As I said earlier, that reminds us why this debate is so vital and why we look to the Minister for a response that can help us, encourage us and give us some hope for the future.

These are some of the most prevalent, serious and life-altering conditions that anyone could have the misfortune to suffer from. They touch everyone’s lives, be they in Northern Ireland, where my Strangford constituency is, Scotland or Wales—or England, with whose health matters this House is primarily concerned. I also very much look forward to hearing from—I apologise; I should have said it earlier—the hon. Member for Motherwell and Wishaw (Marion Fellows) on behalf of the SNP. She has a deep interest in health, too, and I look forward very much to her contribution.

Every one of us has a neighbour, a friend or a loved one who has problems with their heart. Those problems do not halt at any border. They do not even, dare I say it—rather mischievously, perhaps—stop at the Irish sea border, which is able to prevent most things from crossing over. What prevents them from getting the care they need? The most obvious issue is undoubtedly waiting lists, which are at record levels. One of the questions I would like to ask the Minister—I always ask such questions constructively; that is my way of doing things—is: what is being done to reduce waiting lists and to provide some hope? According to NHS England, only this month the queue for NHS care stood at 6.5 million, the highest number on record ever. The number of patients waiting more than a year to be seen has increased to 323,000, which is a massive number. These are record levels as the health sector recovers from the impact of the pandemic.

Although the pandemic has hugely affected waiting lists, the issue predates the pandemic. At the start of 2020, around 30,000 people were waiting more than 18 weeks for cardiac care. This problem was not caused by covid, but it was exacerbated and worsened by covid. If it was bad before, it is much worse now.

The pandemic has had a seismic effect. In April 2022, two months ago, 170 times more people in England were waiting more than a year for heart procedures than in February 2020. I look for an indication of how we can reduce that number, and I know there is a strategy. I am putting this constructively, because I believe there are ways to do it, and the hon. Members for Denton and Reddish and for Motherwell and Wishaw, other Members and I are keen to hear what they are. Waiting lists for cardiac care have also hit record levels, rising to 319,000 people. In Northern Ireland there are 31 times as many people waiting more than six months for cardiac surgery compared with the end of 2019.

And it is not only life-saving surgery, as some of this surgery is about people’s quality of life. Waiting times for echocardiograms, a kind of heart ultrasound used to diagnose a range of conditions, have risen, too. More than 170,000 patients were waiting for an echocardiogram at the end of April 2022, with 44.6% of them—almost half—waiting more than six weeks. That is a 32% increase on the year before. The covid-19 pandemic has increased those numbers, and I am not blaming anyone for that, but we need to address these issues, both as a Government and collectively, in a way that gives succour and support to our constituents.

In Northern Ireland, the number of people waiting more than six months for a cardiac investigation or treatment reached a new record in March 2022. That is the responsibility of Robin Swann, the Health Minister in the Northern Ireland Assembly, and I know he has taken steps to try to address it, but this is a general debate about how we address heart and circulatory diseases across the whole United Kingdom of Great Britain and Northern Ireland following covid-19.

Nearly three quarters of people in Northern Ireland waiting for an echocardiogram have waited longer than the recommended clinical maximum. A number of worried, heartbroken family members have come to my office to say that covid is killing their loved ones, even though they did not have covid themselves. The delays were and continue to be a threat to life. Covid-19 does not seem to result in the number of hospital cases that it once did, which is good news.

Although an echocardiogram is not open-heart surgery, delays still cause increased anxiety for patients and delay the treatment they need. Taken as a whole, cancelled operations risk a rise in avoidable deaths and disability, and they cause anxiety and put physical pressure on people with heart problems.

What can we do about this? The British Heart Foundation is watching this debate, and I thank it for giving me most of my information. I also have a staff member who is qualified in this, and she has given me some information, too. I am proud to work with the British Heart Foundation, which has welcomed the additional funding for the NHS and the announcement that 95% of patients who need diagnostic tests will receive them within six weeks by 2025. It is good news that we have a target but, with respect, that target is a few years away. We need to consider how we address the situation over the intervening three years. The foundation has also pushed for an accompanying Government strategy for cardiovascular disease to take us beyond recovery and address the problems that existed before the pandemic.

With all that in mind, we need to think about how we can do better and support those who need help today. The NHS long-term plan identifies cardiovascular disease as

“the single biggest area where the NHS can save lives over the next 10 years.”

If there is one issue I would love us to tackle, it is how we can save lives. I am ever mindful of the statistic I cited earlier that every three minutes someone dies as a result of heart problems. If we can save lives, that is what we want to be doing. We know that the NHS is doing all it can to deliver cardiovascular services, but without a properly funded cardiovascular disease strategy, it cannot meet its targets and deliver adequate care. When will a strategy be put in place to address the issues in the short term?

What else would such a strategy address? Cardiovascular diseases have many and varied impacts on patients, who need different forms of care as a result. Access to primary care is integral to the identification and management of heart conditions. When people cannot access primary care, opportunities to prevent heart attacks and strokes are lost, and more problems are caused for those who are already under pressure. How do we address that issue?

A 2021 survey of 3,000 heart patients found that 12% had a routine medication or condition review cancelled or rescheduled in the first year of the pandemic. I understand that the pandemic was not the Government’s fault; the Government are to be complimented and thanked for how they responded to it, because we are all beneficiaries of the vaccination programme and it is probably why some of us are alive today. However, the cancellation or rescheduling of routine medication or condition reviews explains the longer waiting lists. Four patients in 10 have had appointments cancelled or rescheduled more than once. I know people back home who have actually fasted for an operation and then been told that it would not go ahead, which has caused anxiety and worry.

Health Foundation analysis shows that 31 million fewer primary care appointments were booked between April 2020 and March 2021 than in the previous 12 months. The pandemic has also had an impact on how patients with heart and circulatory disease interact with primary care. Some people say that there are lies, damned lies and statistics, but statistics prove a point: there were 5 million fewer face-to-face GP appointments in 2020 and in 2021 than in 2019. We understand the reasons why, but we have had a lot of debates in this Chamber and in Westminster Hall about GP appointments, and there is not one of us who would not wish for the number of appointments that we once had. My constituents tell me that, and I am anxious and keen for appointments to return.

Many people welcome the flexibility and safety that remote appointments bring, but they can mean that healthcare professionals lose the opportunity to collect information that they usually gain through physical examination. Constituents have told me that their ailments and problems would be better assessed physically. The quicker we move back to physical assessments, the better. Someone cannot really be diagnosed at the other end of a Zoom call; they can say what their issues are, and by and large the doctor may get a fair idea, but in many cases it takes a physical examination. The situation is no one’s fault, but it may lead to a delayed or even missed diagnosis of a condition such as high blood pressure. I take a Losartan tablet for my blood pressure every day; I was told by my doctor not to worry about it, but after he told me I would have to take it every day, he said, “By the way, you can’t stop it.” At that stage, I realised that it is necessary to keep me on the straight and narrow and keep me breathing, so perhaps in a small way I understand the need to control blood pressure.

We do not know for sure how many missed diagnoses there have been but we do know that the NHS issued 470,000 fewer prescriptions for preventive cardiovascular drugs between March and October 2020 than in the same period of the previous year. The Institute for Public Policy Research forecasts that if those missing people with high-risk cardiovascular conditions do not commence treatment there will be an additional 12,000 heart attacks and strokes in the next five years. I ask the Minister what is being done to find those who have not been prescribed these preventive drugs over the last period of time, mindful that the unfortunate end result of that is more heart attacks.

This is a ticking time bomb, and we need to defuse it if we are to meet NHS long-term plan aspirations to prevent 150,000 heart attacks, strokes and dementia cases by 2028-29 and, more importantly, if we are to be able to look those families in the face. Behind every person who dies of a heart attack there is a grieving family; we know that probably personally and certainly from constituent cases. As the Good Book says, we have threescore years and 10; we might get less than that or we might get more, but one thing we do know is that our time will pass. We must address the issue of preventing heart attacks, strokes and dementia.

At least half of the 15 million adults in the UK who have high blood pressure are undiagnosed. We all need a bit of stress; it is part of life, and I thrive on a bit of stress, but we can only take so much and it is important to find the right balance. Many of those with high blood pressure are not receiving effective treatment. It is vital to find people early and support them to manage cardiovascular risk factors such as atrial fibrillation. The Automated External Defibrillators (Public Access) Bill was introduced in the House not long ago, with support from all parties; I hope the Government will support its progress so its measures can be introduced in health and education settings. Finding the people with conditions early is vital; we must try to help people manage conditions such as raised cholesterol and hypertension so they can longer and healthier lives.

However, we cannot do that if we do not know who they are, which shows that data is important; it comes up in almost every health debate I participate in. To be fair, the Government and the Minister understand this, as data helps to focus on the right strategy and develop it in a constructive way based on evidence. I ask the Minister to put on the record where we currently are in relation to the collection of data, as it will point the way forward.

Some patients do not need to be found, however, as they or a loved one call 999 because of a medical emergency. For cardiovascular conditions, that normally means they have had a heart attack or stroke. A fast response that gets the right person to the right hospital department at the right time in an ambulance can be the difference between life and death. The newspapers often present examples of ambulances not arriving in time for whatever reason and people passing away. Unfortunately, in England the average response time in May for a category 2 emergency such as a heart attack or stroke was almost 40 minutes; we must do better. The target is 18 minutes; it is not being met.

I did not manage to source the corresponding data for Northern Ireland, but I know personally of one 70-year-old lady who had called believing her husband was having a stroke. She was told to give him an aspirin to chew and that the ambulance was delayed. She was then told in another phone call, which was fairly frantic, that if possible she should bring him herself to hospital, so she dragged him to the car—he is a fairly big man—and arrived at the hospital crying and begging passers-by to help. This man was diagnosed with some form of hernia which presented like a heart attack, and I thank God for that because he could have died waiting on the ambulance and then waiting on his elderly wife to trail him to a car and on to a hospital; that is simply not good enough.

Owing to the scale of current ambulance and A&E delays, we will see more disability and deaths from heart and circulatory disease that could otherwise have been avoided, but if we can avoid them—if we can do things better—the debate will have achieved its goal. This is happening despite NHS workers and paramedics going above and beyond the call of duty to help those in need. I used the word “heroic” earlier, and I use it again now. It is not a word that is taken out of context when I apply it to those workers. Ambulance delays are the symptom of a system that is under immense pressure at every level. Problems in one part of the NHS affect other parts. Problems with accessing primary care lead to more emergencies, which means that, again, there is a greater demand for ambulances.

Smokefree 2030

Bob Blackman Excerpts

Tuesday 26th April 2022 Westminster Hall

[Bob Blackman (Harrow East) (Con) [R]]

I beg to move,

That this House has considered progress towards the Government’s smokefree 2030 ambition.

It is a pleasure to serve under your chairmanship, Ms Nokes. For those who do not know, today is my birthday. What better way to celebrate my birthday than to speak in Westminster Hall? On a personal level, it is tinged with sadness, because tomorrow is the anniversary of my mother’s death. She died from smoking—officially, it was lung and throat cancer, but I am clear that smoking killed my mother. That is one of the reasons I am so passionate about ensuring that young people do not start smoking and that those who smoke give up as quickly as they can, because the medical reality is that the lungs can recover. In fact, if smokers quit at an early enough stage, even seasoned smokers who have smoked for many years will see their lungs recover.

I thank the Chairman of Ways and Means and the Backbench Business Committee, on which I sit, for granting this debate. Originally, our intention was to focus on Javed Khan’s long-awaited review. The officers of the all-party parliamentary group on smoking and health and I believed that the review’s recommendation would be published last Friday. Javed has had to delay his publication, but I hope that when we see it, it will be as radical as we believe it to be. Given the delay in publication—until the middle of May, I believe—we were left having to decide whether to proceed with this debate or wait. My view is that, given that we have the opportunity to debate this issue, and possibly even shape Javed Khan’s views and recommendations, it is better to proceed and get the answers from the Minister about where we stand on the review. I hope the Government will commit to introduce all the recommendations of Javed Khan’s review, whatever they may be, to achieve what I am sure we all in this room wish to achieve: a smokefree 2030.

The hon. Member for City of Durham (Mary Kelly Foy)—I will call her my hon. Friend—and I have co-sponsored this debate, and I am sure she will speak on many of aspects, particularly levelling up. The Government have a bold ambition, which I strongly support—I am sure we all do—to bring the end of smoking within touching distance. But it is deeply disappointing that, three years on from that being announced in the Green Paper, we do not seem to have made much progress. There is no road map to put us on the route to success. The purpose of this debate is to remind the Minister of the urgent need to deliver the bold action that was promised in the 2019 Green Paper.

The 2030 ambition was acknowledged by everyone to be extremely challenging only three years ago. We have lost three years, so it is even more challenging now. We should be clear that if we do nothing, we will not achieve that target, so there is no time to be lost. When the ambition was announced, we had 11 years; now, there is only eight. We are nowhere near achieving our ambition, particularly for our more disadvantaged communities in society, which have the highest rates of smoking.

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

I congratulate the hon. Member not just on jointly securing the debate but on his birthday. He talks about the harder-to-reach, socially disadvantaged communities. Does he agree that if we do not get the younger elements in particular to a smoke-free society, we will not get future generations, and the 2030 target will not be met?

[Bob Blackman]

I thank the hon. Member for that intervention. Clearly, people start smoking when they are young. They continue to smoke well into their later life, and it is very hard for people to give up if they have already committed to smoking cigarettes, because nicotine is the most addictive drug that we know of. Therefore, it is very hard for people to get off it once they have started, so it is far better that we prevent people from starting to smoke in the first place. At the moment, I believe that around 200 to 300 young people start smoking every day, which is why it is imperative to stop them doing so right now. Indeed, Cancer Research UK has estimated that we will have to wait until 2047 for the smoking rate in disadvantaged communities to reach 5% or less, which is the smokefree ambition.

[Alex Cunningham (Stockton North) (Lab)]

I wish the hon. Member a happy birthday and congratulate him on securing the debate. One of the problems that we have is that some deprived communities are in larger areas where the smoking rate has actually come down, but it has remained high within those communities. We also have a high incidence of smoking in pregnancy, which causes other tremendous problems. Does the hon. Member agree that we need specific action to help people who are pregnant to quit smoking, and that we also need to tackle the whole community at the same time?

[Bob Blackman]

I thank the hon. Member for his intervention and for the work that he has done on combatting smoking over many years. He raises the issue of smoking in pregnancy, which is the one target that the Government came closest to missing at the time of the last review. The target was 11%, and the Government just about achieved it. I am very clear that, for young women who are pregnant, we need to ensure that, if they smoke, they should be referred immediately to quitting services at the first meeting to discuss their pregnancy through the health service, and not just them but their partner as well. If both give up smoking, there is a strong chance that they will continue to not smoke. They need to understand the damage that they will do to their unborn child and the damage that they are doing to themselves. If we get to that point, it will improve the position no end. That is in the NHS plan, but for future years. I see no reason at all why that could not be introduced now. That is a management decision by the NHS, and I would ask my hon. Friend the Minister to encourage the NHS to do precisely that.

The all-party parliamentary group had an excellent meeting with the chairman of the independent review, Javed Khan. It was a very encouraging meeting, and we expect his recommendations to match the scale of the challenge, but unless his review is turned into a meaningful plan of action that is backed up by funding, it will not be worth the paper it is written on. We need new sources of funding, and the 2019 Green Paper recognised that we would need funding to end smoking, that there was pressure on budgets and that existing sources of funding were not sufficient. Three years and one pandemic later, the pressure on budgets in even greater. In its submission to me, the Local Government Association said that local authorities are paying some £75 million for quitting services overall. Clearly, they need additional funding to achieve what is required.

We are talking about disadvantaged communities, and levelling up is quite rightly a flagship policy for the Government, but there is no new funding to deliver on the bold ambitions set out in the levelling-up White Paper. The Institute of Fiscal Studies says that

“instead, departments will be expected to deliver on these missions from within the cash budgets set out in last autumn’s Spending Review. Departments and public service leaders might reasonably ask whether those plans match up to the scale of the government’s newfound ambition—particularly in the face of higher inflation.”

The levelling-up White Paper missions include narrowing the gap in healthy life expectancy between the local areas where it is highest and lowest by 2030, and increasing healthy life expectancy by five years by 2035. Smoking is responsible for half of the 10-year difference in life expectancy between the most and least disadvantaged in our society, so achieving the Government’s levelling-up mission on life expectancy will depend on delivering the smokefree 2030 ambition.

The Under-Secretary of State for Levelling Up, Housing and Communities, my hon. Friend the Member for Harborough (Neil O'Brien), has said that the Government must “floor it” when it comes to prevention and public health, but we cannot floor it unless there is gas in the tank. Gas in the tank is what we are lacking right now. Funding for public health is in a parlous state. We must face up to the fact that funding for smoking prevention has been particularly hard hit.

After the spending review was published, the Health Foundation estimated that funding for smoking cessation and tobacco control had been cut by one third since 2015. The cuts in budgets for tobacco control are the falsest of false economies. Unlike most pharmaceutical drugs, smoking cessation saves money, and with no negative side effects. The National Institute for Health and Care Excellence has estimated that, for every pound invested in smoking cessation services, £2.37 will be saved on treating smoking and smoking-related diseases, as well as increasing productivity.

[Mary Glindon (North Tyneside) (Lab)]

I am so pleased that the hon. Gentleman’s birthday is in this month of VApril, and I congratulate him on this debate. Does he agree that the vaping industry, which is supporting harm reduction by encouraging people to turn to vaping, should get more support, and that vaping should be part of the Government’s harm-reduction strategy? Vaping is also more economical. Encouraging people away from cigarettes to vaping would be a good step in the direction of better health.

--- Later in debate ---

[Bob Blackman]

I thank the hon. Lady for that intervention. Vaping has its purpose, which is to encourage people to quit smoking and take up vaping. I am concerned that people may take up vaping and then escalate to smoking. We do not yet have medical evidence on the long-term effects of vaping on health, so I am cautious. Clearly, it is better to vape than smoke, but let us not encourage people to take up vaping as an alternative to stopping smoking completely.

The all-party group has encouraged the “polluter pays” approach. The situation is very frustrating. The Government recognised in the Green Paper three years ago that budgets are tight and new sources of funding are needed. As recommended by the all-party parliamentary group, which I chair, the Government agreed to consider the “polluter pays” approach to funding. They also acknowledged that there were precedents, and that the approach had been taken by other countries, such as France and the USA.

Only months after the consultation closed in October 2019, the pandemic struck and put the prevention strategy on the back burner. It soon became clear that an effective prevention strategy was essential to build back better from the pandemic. It is also essential to deliver on the Conservative manifesto commitments to level up, reduce inequality and increase healthy life expectancy by five years. Those commitments are baked into the levelling-up White Paper and, the Government have said, will be enshrined in statute.

On the anniversary of the Green Paper’s publication, on 22 July 2020, the all-party group held a roundtable to examine the actions needed to deliver the smokefree ambition. The then Public Health Minister, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), and her opposite number, the hon. Member for Nottingham North (Alex Norris), were the keynote speakers. The Minister gave her commitment that the Department would continue to explore further funding mechanisms with the Treasury, as had been promised in the Green Paper.

On 30 March, the former Public Health Minister, my hon. Friend the Member for Winchester (Steve Brine), challenged why the commitment to consider a “polluter pays” approach had not been fulfilled. The response at the Dispatch Box from the Health Minister, my hon. Friend the Member for Charnwood (Edward Argar), was:

“My understanding—although my recollection may fail me, so I caveat my comment with that—is that this was initially looked at that stage, but was not proceeded with.”—[Official Report, 30 March 2022; Vol. 711, c. 867.]

My hon. Friend the Member for Charnwood might like to check his recollection. The all-party group on smoking and health, following its initial recommendations, put forward detailed proposals to Government in its June 2021 report about how a “polluter pays” levy could operate. I shared a copy of the report with Health Ministers at that time and wrote to the Secretary of State in July 2021, and again in December, asking for a meeting to discuss the levy. In September, I wrote to the Chancellor about the proposals. However, to date I have not had the courtesy of a reply to any of those letters.

If the “polluter pays” levy has been seriously looked at and a decision has been taken not to proceed, that was certainly not communicated to MPs or the all-party parliamentary group. That is precisely why officers of the APPG tabled amendments to the Health and Care Bill calling for a consultation on the levy. The amendments would not have committed the Government to going ahead, but would have ensured that they fulfilled their commitment to consider a “polluter pays” approach and that our proposals get the consideration they deserve. Our amendments were carefully considered by the other place and passed by a majority of 59—the greatest defeat the Government suffered on the Health and Care Bill. However, to the great disappointment of the APPG, the Government opted to oppose our amendments when they returned to the Commons for consideration. That leaves us without a mechanism for funding the smokefree 2030 ambition, with only eight years to go.

It appears that when the noble Lords met Ministers and Treasury officials to discuss the amendments, it was the Treasury, not the Department of Health and Social Care, that objected to the proposal to consult on a levy—not to introduce one, but to consult on the principle. The Treasury has a philosophical aversion to anything that smacks of hypothecation—raising funds to be put to specific purposes. Its preference is for funds raised to go into one big pot—the Consolidated Fund, from which all Government spending flows—that it controls and allocates, thereby giving it ultimate control. However, there are already numerous exceptions where hypothecation has been justified. One is the health and social care levy, which has just come into force. Another is the pharmaceutical pricing scheme, which the Department of Health and Social Care uses to raise funds for the NHS and provides a model for how our proposals could be implemented.

The noble Lord Stevens, formerly chief executive of the NHS, pointed out that the pharmaceutical pricing scheme was put in place by a Conservative Government in 1957 and has been sustained ever since with the support of Conservative, Labour and coalition Governments. He also said—and who could disagree?—that if it is deemed appropriate to have a form of price and profit regulation for the medicines industry, which delivers products that are essential for life saving, it is not much of a stretch to think that an equivalent mechanism might be used for an industry whose products are discretionary and life-destroying. I completely agree with him on that approach.

The Government already accept the principle that the polluter should pay to fix the damage they do. The extended producer responsibility scheme, which comes into force in 2024, is another good example. It requires producers of packaging waste to pay for its collection and recycling. Lord Greenhalgh, the Housing Minister, said:

“The reality is that we cannot keep looking to the Treasury to keep bailing everybody out—we have to get the polluter to pay.”—[Official Report, House of Lords, 5 January 2022; Vol. 817, c. 566.]

I could not agree more, and that principle applies even more strongly to smoking, which, as the chief medical officer pointed out, is a deadly addiction created and marketed by companies for profit.

There were objections because we were part of the European Union, but when speaking for the Government on Report in the House of Lords, the noble Lord Howe stated:

“the tobacco industry is already required to make a significant contribution to public finances through tobacco duty, VAT and corporation tax.”—[Official Report, House of Lords, 16 March 2022; Vol. 820, c. 297.]

However—this is the key point—tobacco companies pass on the cost of tax increases to smokers, which means that it is not the tobacco industry that contributes to the public finances but ordinary smokers, who have little choice but to buy cigarettes to maintain their deadly addiction. Indeed, when HM Treasury consulted on and rejected a levy in 2015, it was on the grounds that it would add an extra tax burden to smokers. That may have been true in 2015, but it is not the case today.

In 2015, we could not prevent tobacco manufacturers from passing the costs on to consumers because we were in the European Union. We are no longer part of the European Union, and therefore by capping tobacco prices and controlling profits, the Government can ensure that tobacco manufacturers bear the full cost of the levy, helping incentivise the industry to move out of combustible products and make smoking obsolete by 2030. I can think of few better Brexit dividends than making tobacco companies pay for the damage they do.

To quote my noble Friend and fellow APPG officer Lord Young of Cookham, speaking in the other place, our proposed levy will allow the Government to

“put the financial burden firmly where it belongs, on the polluter—the tobacco manufacturer—and not the polluted—the smoker.”—[Official Report, House of Lords, 16 March 2022; Vol. 820, c. 290.]

The reality is that this levy could raise £700 million a year from the profits of the tobacco companies—money that could be applied to smoking cessation services.

There is public support for this measure. It has been endorsed by more than 70 health organisations, including Cancer Research UK, Asthma + Lung UK, the British Heart Foundation, the Royal College of Physicians and the Health Foundation. It is also supported by three quarters of the public, including those who voted Conservative in the 2019 election, with fewer than one in 10 being opposed to the levy. What could be better than introducing a tax that the public support?

If we want to achieve a smokefree 2030, it is vital that we tackle high rates of smoking among our most deprived communities, pregnant women and people with mental health conditions. As the Government have said, this will be “extremely challenging” and cannot be achieved on the cheap. Health Ministers in both Houses have said that they do not want to prejudge the review, and therefore could not accept amendments calling for a consultation on a levy. However, as I have said, that review will report very shortly—in the middle of next month—and the discussions I have had with the chairman of the review make it very clear that the measures he will be recommending will need investment, and will be radical.

Once Javed Khan has reported back to the Government, there will need to be serious consideration of how the funding to deliver the smokefree 2030 ambition can be found. That will need to be done in parallel with decisions about what interventions are needed, as interventions cost money and can be delivered only if the funding is found. Pressure on budgets has only worsened since 2019, with the covid-19 pandemic wreaking havoc on our nation’s health and on Government finances. The Government made it very clear in the spending review that there is no new money for public health, so an alternative source of funding is urgently needed. With only eight years to go before we reach 2030, the Government need to decide where that money is coming from.

The existing funds are not sufficient, and our proposals provide a new source of funding in addition to tobacco taxes. If the Government are unwilling to accept our proposals, they must come up with an alternative solution that will match the scale of their ambition. As such, my question to my hon. Friend the Minister is this: if the Javed Khan review recommends a levy, will she commit to meet with us as APPG officers and with independent experts to discuss our proposals for a “polluter pays” levy to provide the investment that is needed to deliver the Government’s smokefree ambition?

My final point is that this review also needs to look at shisha tobacco, chewing tobacco and snus. Unfortunately, those areas are completely unregulated at the moment, but are extremely damaging to people’s health. I look forward to hearing the contributions of other Members and of the Front Benchers.

[Caroline Nokes (in the Chair)]

I will call the Front Benchers at 10.40, so perhaps Back Benchers could try to limit their contributions to about six minutes.

--- Later in debate ---

[Bob Blackman]

I thank everyone who has contributed to the debate, including the Front Benchers, and I thank my hon. Friend the Minister for her commitment, which we all share. We have to remember, however, that Professor Sir Richard Peto has pointed out that smoking has killed nearly 8 million people over the past 50 years in the UK alone. That is 400 a day, every day—far more than have died under covid. It is obviously something that can be prevented, but more importantly even than that, 2 million more people are expected to die over the next 20 years unless we get smoking rates down.

We all support the Javed Khan review, and we are looking forward to it. I understand that it is going to be published on 17 May. I can inform my hon. Friend the Minister that we will be calling for another debate on its recommendations and looking forward to a commitment from the Government that they will be implemented. However, the most important thing is that all those recommendations, whether they are on raising the age of sale, more tobacco control or licensing—we could go through all the options—will cost money to implement, which is why today we have concentrated on the levy.

I return to the central point that I made at the beginning of the debate: the difference between a levy and taxation that is imposed on the tobacco companies is that the companies just pass the costs of taxation on to the consumer, so they suffer no consequences whatsoever from it. Those companies would not be allowed to pass a levy on to the consumer; they would have to pay it out of their profits, making their product that kills people less profitable. Until we get to that stage, we are not going to have the money in the health service that is required to stop smoking—to encourage people to quit, and to encourage young people not to start. That is why we have concentrated on the levy today. I look forward to helping my hon. Friend the Minister in her arguments with the Treasury, if that is what we need to do to achieve that goal.

Question put and agreed to.

Resolved,

That this House has considered progress towards the Government’s smokefree 2030 ambition.

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.

Vaccination Strategy

Bob Blackman Excerpts

Wednesday 12th January 2022 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

I have been a big advocate of the vaccination programme, and I got my jabs as soon as I could. Will my hon. Friend address a key issue of concern? The time gap between the different vaccines has been adjusted at various times and, as the hon. Member for Rhondda (Chris Bryant) mentioned, those who are extremely clinically vulnerable had their booster a long time ago and its effectiveness is waning. We know that Israel is already administering a fourth dose to the extremely clinically vulnerable. Will the Minister take that point to the JCVI, so that it can look specifically at the extremely clinically vulnerable and see whether they need a fourth dose?

[Maggie Throup]

Those who are clinically extremely vulnerable or immunosuppressed have already been offered a booster, so they have already received four doses. As I said earlier, at the end of last week the JCVI determined that at this stage it was not appropriate for others to have a booster or a fourth dose.

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.

Tobacco Control Plan

Bob Blackman Excerpts

Tuesday 16th November 2021 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

I beg to move,

That this House has considered the delivery of a new Tobacco Control Plan.

It is a pleasure to serve under your chairmanship, Mr Bone—I believe for the first time in this place. I speak as, and declare an interest as, the chairman of the all-party parliamentary group on smoking and health. We welcomed the Government’s announcement of the new tobacco control plan, and we welcomed that it would be published this year, to deliver the Government’s smoke-free by 2030 ambition. I do not want to put any pressure on my hon. Friend the Minister, but she does not have long to achieve the first ambition. The Government’s ambition to reduce smoking rates to 5% or below, making smoking obsolete, is one that all of us in the all-party parliamentary group share. I believe that will be endorsed on an all-party basis this morning, because it is clearly a great way to ensure the health of the nation.

For me, this is deeply personal. Both of my parents died of cancer caused by smoking. My late mother was only 47 when she died of lung and throat cancer, as she was a very heavy smoker for most of her life. I do not want to see families go through what my family had to go through during those terrible days. For me, it is a lifetime ambition to ensure that people understand the risks of smoking, the damage to their health and the damage to their families.

The all-party parliamentary group is keen to support the delivery of the ambition of a smoke-free Britain, which is why, in June this year, we published a report setting out our recommendations for the tobacco control plan for England. Those recommendations were endorsed by more than 50 organisations, including the Royal College of Physicians, Cancer Research UK and the British Heart Foundation. On behalf of the APPG, I am pleased to welcome my hon. Friend the Public Health Minister to her new post, and indeed to welcome her opposite number; to put our recommendations on the record; and to give the Minister the chance to respond to those views.

The APPG has a long-term track record of acting as a critical friend to the Government on the tobacco control agenda. I am confident that this collaborative and constructive relationship will continue. Although smoking rates in my constituency are lower than the English average, there is no room for complacency. In Harrow, more than one in 10 people still smoke and smoking kills around 250 people a year. That is obviously far too many. In 2018-19, there were 1,566 smoking-attributable hospital admissions and 370 emergency admissions for chronic respiratory disease, which is caused almost entirely by smoking. That is in one constituency, so imagine what smoking does to the national health service up and down the country.

Research presented to the all-party parliamentary group shows that, on average, smokers are likely to need social care a decade earlier than non-smokers, and particularly never-smokers. Smoking-related disease and disability make it hard to carry out normal daily activities such as getting dressed, walking across a room and making a meal. Most of us take these things for granted, but we should not.

The importance of the smoke-free 2030 ambition is clear. As the Minister herself stated recently,

“tobacco continues to account for the biggest share of avoidable premature death in this country. It contributes half the difference in life expectancy between richest and poorest.”—[Official Report, 1 November 2021; Vol. 702, c. 621.]

More than 70,000 people died from smoking last year in England alone. For every person killed by smoking, at least another 30 are living with serious smoking-related illnesses.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I warmly congratulate my hon. Friend on bringing forward this debate. On the point about the 70,000 deaths, is it not important to understand that that is year after year after year? Would he set that in contrast with the awful toll we have had from covid and the terrible restrictions that we have necessarily placed upon the population of this country, and agree with me that getting rid of this horrible substance would be far less of an intrusion on people’s liberties than the sort of things we have seen over the past 18 months? Over time, that would have a far greater impact on health, wellbeing and people’s ability to go about their daily lives. It would reduce the burden on the national health service very substantially indeed, and address the health inequalities that sadly mean the life expectancy of the richest and poorest in this country are currently separated by upwards of 10 years.

[Bob Blackman]

I could not have put it better myself. My right hon. Friend quite clearly makes the comparison between covid-19 and smoking. People cannot help catching covid, but when they smoke they make the choice as to whether they inflict life-changing circumstances on themselves.

[Sir Charles Walker (Broxbourne) (Con)]

Like my hon. Friend, I had a parent who died in their 40s from throat cancer. As we try to migrate 7 million people away from burnt tobacco, the challenge is to move them to less harmful forms of nicotine. Their addiction is to the nicotine; they crave nicotine, not the burning of tobacco. If we can make these transitions, we can reduce harm at a much quicker rate.

--- Later in debate ---

[Bob Blackman]

My hon. Friend is quite right. Nicotine is one of the most addictive drugs on the market, if not the most addictive, and perfectly legal to consume. The issue is whether someone, once addicted to nicotine, can quit. The damage is done not necessary by the nicotine, but by the delivery mechanism by which someone gets the nicotine.

Anything that reduces the risk of cancer or other related diseases has got to be good news. We can migrate people and encourage them to quit. Ideally, they give up completely. However, because it is so addictive they may need help and assistance to do that. Vaping and non-heated tobacco are ways of migrating people to safer means of delivering the nicotine they desire.

Taking up the point made by my right hon. Friend the Member for South West Wiltshire (Dr Murrison), ending smoking is essential if we are to level up the nation’s health after the pandemic. We need to reduce health inequalities between rich and poor, and increase healthy life expectancy by five years by 2035, in line with the Government’s manifesto commitments.

As well as being necessary, tobacco control measures are popular with voters for every main party, including the Conservative party, which both my hon. Friend the Minister and I represent. Results from the annual YouGov survey of over 10,000 adults in England, funded by Action on Smoking and Health, show that more than three quarters of the public support the Government’s smoke-free 2030 ambition, and eight out of 10 members of the public support Government intervention to limit smoking.

The Government have the full support of the APPG in delivering the smoke-free 2030 ambition. However, as the Government stated in the 2019 prevention Green Paper, achieving that ambition will require “bold action.” Inequalities in smoking rates have grown in recent years, not shrunk. In order to be smoke-free by 2030, we need to reduce smoking by two thirds in just a decade—we have only nine years left to achieve that—and by three quarters for smokers in routine and manual occupations. At current rates of decline, Cancer Research UK has estimated we will miss the target by seven years, and double that for the poorest in society.

There are still nearly 6 million smokers in England. We will only achieve a smoke-free 2030 by motivating more smokers to make quit attempts, using the most effective quitting aids, while also reducing the number of children and young adults who start smoking each year. With 1,500 people dying from smoking-related diseases every week and less than a decade to achieve a smoke-free 2030, there is no time to waste.

Disappointingly, with the end of the year in sight, there is still no sign of the tobacco control plan that was promised this year. My first question to my hon. Friend the Minister, therefore, is whether she can she set out a timeline for the publication of the next tobacco control plan. But the tobacco control plan is only as strong as the measures it includes. That is why the APPG was disappointed that the Government rejected the amendments to the Health and Care Bill tabled by my friend the hon. Member for City of Durham (Mary Kelly Foy), and supported by myself and other officers of the APPG, in Committee.

Those amendments would have closed the loopholes in the regulations that expose children to the insidious marketing tactics of the tobacco industry, provided funding for tobacco control and strengthened the regulation of tobacco. As it stands, the Bill fails to include a single mention of smoking or tobacco and represents a major missed opportunity to introduce key policies for achieving a smoke-free 2030. That is why we have retabled the amendments on Report. I hope the Government will look at them sympathetically, because the Bill is the ideal opportunity for them to deliver their 2019 commitment to finish the job and introduce the legislation that is needed if we are to achieve a smoke-free 2030. My second question is whether the Minister will commit to considering the adoption of tobacco amendments to the Health and Care Bill on Report.

My next area is the “polluter pays” levy. The bold action that the Government acknowledge is needed cannot be taken without investment. The Health Foundation estimates that a minimum £1 billion is needed to restore public health funding to its 2015 levels, with more needed to level up public health across the country. While there was some positive news on tobacco taxation in the recent spending review, which we welcomed, unfortunately the Government opted not to increase the public health grant to local authorities. As a consequence, we need to establish new sources of funding.

The Government promised to consider a US-style “polluter pays” levy on tobacco manufacturers in the 2019 prevention Green Paper. This scheme would mirror the approach taken in the United States, where user fee legislation raises $711 million annually from the tobacco manufacturers, with the funds then used to cover the cost of stop smoking campaigns, tobacco control policy development, implementation and enforcement.

[Ian Paisley (North Antrim) (DUP)]

I must say that I am opposed to punitive taxation policies, because I do not think they work. Does the hon. Member accept that tobacco companies already pay the Government £13 billion? An additional levy could lead—and most likely would lead, as the evidence shows—to a significant increase in criminality, because instead of paying for taxable product, people will buy smuggled product. Is that not a huge worry that he has about introducing a levy?

[Bob Blackman]

I will come to some of these issues in a few moments, if the hon. Gentleman will be patient and let me build the case. Obviously, it has been estimated by ASH that the funding needed for a comprehensive tobacco control plan to deliver a smoke-free 2030 would cost around £266 million for England and £315 million in total for the UK. A levy could raise around £700 million from the tobacco manufacturers, to be spent on tobacco control and other public health initiatives. The devolved Governments would also have the ability to opt into the scheme, should they so wish.

Such a scheme is more than justified in response to market failure that allows an industry, whose products kill consumers when used as intended, to make exorbitant profits. While net operating profits for most consumer staples, such as food, beverages and household goods, stands at 12% to 20%, Imperial Brands in the UK enjoyed net operating profits of 71% in 2019. That is £71 in profit for every £100 in sales. In 2018, it is estimated that tobacco manufacturers made over £900 million in profits in the UK alone.

[Sir Charles Walker]

The hon. Member for North Antrim (Ian Paisley) makes an interesting point about taxation. Would it be possible for politicians, with all their imagination, to use the taxation system to encourage cigarette and tobacco companies to transition their products away from combustible tobacco to less dangerous nicotine-delivery mechanisms?

[Bob Blackman]

My hon. Friend makes a good point; clearly, research could be undertaken to establish how we could use the taxation system to transition people in that way. I personally welcome the escalators that have been put on tobacco products and continued by the Chancellor.

Despite the enormous profitability for those companies, major tobacco manufacturers pay very little profit tax in the UK. That probably reflects their global engagement in diverse and elaborate tax avoidance strategies, which allowed Imperial Brands to lower its UK corporate tax bill by an estimated £1.8 billion over the past 10 years, and British American Tobacco to reduce its bill by an estimated £760 million over the same period. Public support is strong for such a measure, with 77% of the public supporting making tobacco manufacturers pay a levy or licence fee to the Government for measures to help smokers quit and to prevent young people from taking up smoking, and just 6% opposing it.

The covid-19 pandemic has put huge pressure on public finances, and there is a desperate need for bold, properly funded policies to level up public health after the pandemic. Our recommendations on the “polluter pays” approach are backed up by a much more detailed policy paper on how this would work, which we commend to the Minister and her officials. Will the Minister commit that the recommendations for a “polluter pays” mechanism will be included in any consideration of how the tobacco control plan should be funded?

My last major point is about raising the age of sale. If England is to be smoke-free by 2030, we need to prevent people from starting smoking at the most susceptible ages—when they are adolescents and young adults. Two thirds of those who try smoking go on to become regular smokers, only a third of whom succeed in quitting during their lifetime. Experimentation is rare after the age of 21. Therefore, the more we can do to prevent exposure and access to tobacco before that age, the more young people we can stop from becoming hooked into this deadly addiction.

Raising the age of sale from 16 to 18 was associated with a 30% reduction in smokers aged 16 and 17 in England, as was increasing the age of sale to 21 in the United States among 18 to 20-year-olds. University College London estimates that increasing the legal age of sale from 18 to 21 would immediately result in 95,000 fewer smokers aged 18 to 20 in 2022, and an additional 77,000 fewer smokers over the long term, to 2030. That would reduce smoking prevalence among 18 to 20-year-olds to 2%, compared to 9.6% without the intervention. It would be simple and inexpensive to introduce, as ongoing enforcement costs are already factored into the existing age regulations. This is the regulatory measure that would have the biggest impact on reducing smoking prevalence among young adults.

Compared to non-smokers aged 18 to 20, smokers in this age group are more likely to be from lower socioeconomic backgrounds. As such, the effect in increasing the age of sale would be particularly beneficial in poorer and more disadvantaged communities. It could also have knock-on benefits. Smoking during pregnancy, for example, is concentrated among young, disadvantaged mothers, and whether a woman smokes during pregnancy is significantly affected by her wider environment. Discouraging experimentation and the uptake of smoking among young, disadvantaged people would prevent smoking in young women who may go on to become pregnant, as well as their male partners, friends and family members. That then reduces the likelihood that young women and their children will be exposed to toxic second-hand smoke during, or indeed after, pregnancy.

In keeping with the current age of sale legislation, raising the age to 21 is not about criminalising those under that age, but about making it much more difficult for them to get hold of tobacco. Increasing the age of sale is supported by a majority of the adult population, with 63% in favour and just 15% opposed. The support is consistent among Conservative, Labour and Liberal Democrat voters—I do not have figures for the Democratic Unionist party. That is also true for those aged 18 to 24, among whom 54% support the measure and just 24% oppose, and for 11 to 18-year-olds, of whom 59% support and 14% oppose.

Given the strength of the evidence and the public consensus that this is the right thing to do, I and other members of the all-party parliamentary group urge the Government to launch a public consultation on raising the age of sale. It is particularly important to encourage children and young adults, who will be most affected by the policy, to participate.

Experience of smoke-free law implementation in England in 2007 showed that a public consultation can help raise awareness and bolster compliance with legislation. For example, 98% of all premises and vehicles inspected in the first nine months after the law was implemented complied fully with the legislation, and 81% of business decision makers thought the law was a good idea.

When the Government rejected the amendment to the Health and Care Bill that would have provided the power to raise the age of sale to 21 by regulation, they said that they would like to review the evidence base for increasing the age of sale to 21 in more detail. That seems to me and others a very good idea. The best way to do that would be by carrying out a consultation, which is what we are calling for in the revised amendment on Report. I urge the Minister not to wait for the debate but to give her support to the consultation now.

My final question for the Minister is this: will she give a commitment to conducting a consultation on raising the age of sale from 18 to 21 within three months of Royal Assent of the Health and Care Bill? That brings me to my conclusion, Mr Bone. I welcome the opportunity to have this debate and look forward to contributions from right hon. and hon Members and the replies from the Front Benchers.

--- Later in debate ---

[Bob Blackman]

I thank my hon. Friend the Minister for her reply. I also thank the Opposition Front-Bench spokesperson for his strong support. I thank every colleague who has participated in the debate. We all share the same view: smoking must be eliminated and we must get to a smoke-free 2030. All the advancements in legislation on this subject have come from the Back Benches, and they will continue to come from the Back Benches. If the Government refuse to act, we will continue to press further.

In answer to the hon. Member for North Antrim (Ian Paisley), the “polluter pays” principle is key. When we raise tobacco tax at the point of delivery, the individual who smokes pays, but if we continue to tax the profits, we can pass the benefits on in terms of prevention. I thank colleagues for their contributions today. We have had a very good debate. No doubt the debate will continue, on both the Health and Care Bill and other measures.

Question put and agreed to.

Resolved,

That this House has considered the delivery of the Tobacco Control Plan.

Smoking Cessation: Prescription of E-cigarettes

Bob Blackman Excerpts

Monday 1st November 2021 Commons Chamber

[Maggie Throup]

There will be officials at COP9. It is a very important meeting. The UK’s approach to e-cigarettes has been and always will be pragmatic and evidence-based. I am sure that will be the message they put forward at COP9.

[Bob Blackman (Harrow East) (Con)]

I declare an interest as chair of the all-party parliamentary group on smoking and health. Clearly the best way of ceasing smoking is to stop altogether. I welcome the fact that this proposal was originally contained in the last tobacco control plan in 2017, so I congratulate my hon. Friend on her prompt action on assuming the job. We will get an opportunity to debate the tobacco control plan on 16 November in Westminster Hall, and I trust she will reply to that debate. Will this particular proposal be targeted at the extreme smokers—the people who are hardened smokers and smoke a lot—and pregnant women to encourage them to give up?

[Maggie Throup]

I thank my hon. Friend for his question. I am looking forward to our debate in a couple of weeks’ time. As I mentioned earlier, the NHS already has measures in place through the long-term plan to help those who are pregnant to stop smoking. That is important. Should e-cigarettes be licensed as a medicinal product, it will be a gateway for those smokers to stop smoking through that method and hopefully stop smoking completely.