Tobacco and Vapes Bill (Second sitting)

Bob Blackman Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[Nickie Aiken (Cities of London and Westminster) (Con)]

Q I have a question for Mr Fell. Obviously the Bill will cover shisha, so I would welcome your views on shisha smoking and whether there is more we can do within the Bill or in general to tighten up shisha smoking.

Greg Fell: I would say that we need a licensing scheme for shisha smoking, and probably more education about the fact that it is a potent way to consume large amounts of tobacco really quickly and is quite damaging for people’s lungs. I am not sure what more could be achieved in the Bill, but I would like to see a licensing scheme for shisha bars. We enforce the law to its limits, but there are some limits to it.

[Bob Blackman (Harrow East) (Con)]

Q I thank you for covering the issue of age verification; I think it is important to have a similar scheme across the UK. The other issue relating to licensing is that there are potentially two ways of licensing. One is to add to the existing alcohol licensing regime, and the other is to have a separate regime for vaping and tobacco. Which would you prefer to operate if we were to introduce a licensing scheme?

Cllr Fothergill: It is not a topic that we have a policy position on, but my personal view is that it would need to be a separate scheme, because it would have separate enforcement and separate legalities within it. It needs to be very clear for trading standards what they are enforcing against, whereas alcohol is quite different. We should not mix the two just because they both need licensing. I think that they need to be separate.

[Bob Blackman]

Q What is your view on the limitation of the number of premises that would be allowed to sell tobacco or vaping products?

Cllr Fothergill: I could not answer that one, I am afraid, but I would be happy to come back to you with a view on that.

Greg Fell: I have the same view. It is not my area of expertise so I would rather think about that one carefully.

[Mary Kelly Foy (City of Durham) (Lab)]

Q This is a question for Greg. It would be useful for the Committee and for people watching to hear your view on the impact of smoking and tobacco on public health.

Greg Fell: It is the single biggest cause of death. There is no real question about that. It may not be in many years’ time when smoking prevalence has come down, but right here, right now, it is. No other product is available that kills more than half its users when used according to the manufacturer’s instructions. Death is often preceded by a long illness—sometimes a short illness, but often a long one—often in folk of working age. Most people who die from smoking-related illnesses die too early.

Sheffield-wise—I know my numbers locally—it is a bit north of 700 deaths a year out of 5,000 or so, so not insignificant. To give you a reference, covid killed 1,500 people over the period of the pandemic. Smoking kills 700 people every year, year on year, and that is before we get into the illnesses. Aggregated across the country, that is 80,000-odd people—a Wembley stadium-sized group of people, a non-trivial number. It is also very inequitable and led by addiction. People spend enormous amounts of money on smoking, so stopping smoking would free up that money to be spent in other ways. Smoking remains the No. 1 cause of death and it is very inequitable—almost certainly causing the largest gap in healthy life expectancy and life expectancy inequality.

--- Later in debate ---

[Bob Blackman]

Q One issue that was raised on Second Reading but which is not in the Bill at the moment is the practice, particularly by people originating from the Indian subcontinent, of chewing tobacco, particularly paan, and the fact that it can be bought in any place. There are no regulations on it; there is no control over what the product is or what the contents of the product are. What is the view on bringing some regulation in? It is questionable whether it can be within the scope of this Bill, but clearly that causes throat and mouth cancer in large numbers of people.

Greg Fell: I do not have a view, Bob.

[Bob Blackman]

You do not? I am surprised.

Greg Fell: I do not think it is a terribly sensible thing to do. I do not think it would be possible to get it into this Bill. How one would regulate it I do not know. I shall give some consideration to that and get back to the Committee.

[Bob Blackman]

That would be helpful.

Cllr Fothergill: Again, from our perspective, it is not an area that we have looked at in terms of policy. We do have a policy on shisha, but we have not gone as far as the product you have just mentioned. But we will, I am sure.

[Bob Blackman]

I think we should have one.

Cllr Fothergill: I agree.

[Dame Andrea Leadsom]

Q You made a very good case for the age of sale rising each year, but as the LGA, do you think that will be tricky for enforcement purposes? An argument is often made that if you were 40 and I was 41, we would go into a store and I would have to buy your cigarettes for you. What would you say to that as an argument for continuing with the smoke-free generation legislation?

Cllr Fothergill: We have to be very careful that we do not spook ourselves out of doing something that is absolutely right. If people get to the age of 40 and have to show that they are 40 to be able to buy cigarettes, that is what they should do. I am sorry to say that I am 67. I have to show a bus pass every time I get on a bus to show that I am old enough to travel for free.

--- Later in debate ---

[Mary Kelly Foy]

It was about the use of vapes by heavily dependent smokers.

Ailsa Rutter: Yes. In the north-east, vapes have been a “game changer” for some of our heavily addicted smokers. I have permission to share with you the fantastic role that vapes have played in our biggest mental health trust, Cumbria, Northumberland, Tyne and Wear. We are talking about people who have been smoking 40 or 50 cigarettes a day, often for decades, who have really struggled to imagine that they could ever get off lethal smoking. Being able to give them something that still gives them their nicotine, but in a much purer, safer and cleaner form, has been a game changer.

Vapes are being used successfully in our drug and alcohol treatment services—on the point about alcohol, the two often go hand in hand. If we are really intent on ending smoking, we must do more on alcohol. Wearing my Balance hat—Balance is the alcohol bit—it is really important that we do not think of risk-taking behaviour in youth as just vaping. Last week, the World Health Organisation published a report that shows that across 44 countries, the UK sadly has the highest use of alcohol among 11-year-olds. I hope nobody thinks that the amount of alcohol promotion, advertising, marketing and so on is okay. I think it is quite important that we look at risk-taking behaviours in the round.

[Bob Blackman]

Q In answer to my colleague, Nickie Aiken, you raised the primary issue of age verification. We get an opportunity to change the law on tobacco and vaping only once every 10 years or so, so it is quite important that we get as much in as we can. What other improvements would you like to make to the Bill to strengthen the argument you are putting, to get people to quit smoking or not even start in the first place?

Ailsa Rutter: That is a really good point. I think it goes back to not wanting to delay the progress of the Bill. It is not necessarily for legislation, but it is important that we have a very clear communications strategy. Reflecting on previous legislation, much of the high levels of compliance we have seen in this country have come from very proactive communications in advance. We need to be really careful that the narrative does not get overly confused. It worries me enormously that too many people are staying on smoking because they are scared of even trying to switch over to a significantly less harmful product. I worry enormously about scaring people. It is absolutely right that we have evidence-based messaging to children and young people, but they are messengers who go back to their parents, and we know that it is very important that they are sending clear messages back. So, I will defer on your question about additional amendment—sorry.

[Bob Blackman]

Q May I prompt you? We have heard from previous witnesses about licensing. The Minister has talked about warning messages in packs and individual cigarette papers. Would you support those measures?

Ailsa Rutter: I absolutely would. Fresh has been advocating a tobacco licensing scheme for many years. I do not know whether it is in the parameters of the Bill, but it is wrong that anybody can set up their car boot and sell a lethal consumer product. I would also strongly recommend that previous consultations on things such as pack inserts are looked at again: there is a strong rationale for that. Canada is leading the way with a clear message on the cigarette stick itself. Those are called dissuasive cigarettes. There are certainly other things within that realm. I would also be really willing in the future to discuss the role of a “polluter pays” levy; that is something worth considering.

[The Chair]

Thank you. There are four minutes left and three people have already caught my eye, so short questions and short answers please, colleagues.

--- Later in debate ---

[Preet Kaur Gill]

Q You mentioned that trading standards has faced huge amounts of cuts, with many telling us that in some places there is not even a single trading standards officer. The enabling regulation and the powers within that will be really important, especially when making it clear what trading standards officers must look for when they go into a shop, how vapes are being marketed, and so on. The Government have already consulted on that. Do you think the Government should release that information now, so that they can work with you and do the preparatory work? What kind of timescales do you think there should be? We heard today from ASH that there is some evidence—for example, from Canada—around descriptors that we could already put in the Bill, or that we could implement immediately—why should we wait? Would it have been helpful to have some of that consultation around the enabling regulations already there?

John Herriman: The Bill itself is helpful in that it has enabling regulations within it. It is about a phased approach. We cannot turn a switch overnight: we have to build it up gradually. We will need to do a lot of training—and not just training, but recruitment of new apprentices, students and trainees into local authorities, as well as doing the business education part, alongside that—and move in a very structured way. The worst thing that could happen is that we have the regulations, we have the law in place, but cannot enforce it. That would mean that it became ineffective. It is about having a phased approach, and the Bill does that quite nicely. It fits within where trading standards is as a profession. We need to build back that capacity over time. We are still waiting to hear the outcome of the discussions on funding, which are happening at the moment.

[Bob Blackman]

Q You probably heard the previous witnesses giving their views about a licensing scheme. From your members’ perspective, would that make the issue of where tobacco and vaping products can be sold more enforceable? You made a comment in relation to other tobacco products. I have raised the issue of chewing tobacco and paan, in particular, which does not come within the scope here but has no enforcement from Trading Standards at all. Do you see that happening in the future?

Kate Pike: We pushed for tobacco licensing for many years. Since the last time we did that we have had tobacco track-and-trace sanctions come in and the regulation around track and trace, which ensures that every single business selling tobacco in the UK has to have an economic operator identifier, so that, using our scanner, we can see whether a particular product is legal for sale, or whether a business is legally able to sell. Although that is not a licensing system, it does give us many of the advantages of a licensing system that we would look for. Although there are potential benefits in thinking about a licensing system for nicotine products, I am not sure that it is a silver bullet to some of the answers. We have said before that the issues are not just around tackling supply, which licensing does; they are also about tackling demand. We just need to get to grips with a holistic approach to vapes in order to do that. In terms of licensing on the tobacco side, we are probably okay now, as long as we can make use of the track-and-trace sanctions. We might be able to use those for vapes as well, further down the line, given the vape excise duty.

[Bob Blackman]

Q And the attitude to paan and chewing tobacco?

Kate Pike: We do enforce around products. Any tobacco product has to be notified to OHID—it was PHE when it first started. So, there is responsibility for enforcement around products that are legally allowed to be sold in the UK. If they are tobacco products, if they are not notified they cannot be sold. So, there is a role there, although it is more difficult—it is not a day job. Certain local authorities will have more of an issue than others. It is probably not going to be everywhere, but for some local authorities it is a big issue. Perhaps we need to do more enforcement around what we can already do, and see where the gaps are.

John Herriman: To go back to the first point, there is a layered approach, which I think Kate has just articulated. There is a lot in the Bill that should work, so we need to look at that and see how we can enforce it and whether it works. There is a subtlety to this whole issue, particularly with regard to vapes, given that although there are under-age sales and illicit vapes, there is also a positive public health benefit for those that are smokers. So, we do not want to withdraw that access. Trading standards sits right in the middle of that. We can do a really good job when the regulations are clear; so we would like to have that clarity at the outset, which the Bill will give us. We can see whether that works; and there are always opportunities to come back if it does not. We have proved, though, that we can make it work in other areas.

[Bob Blackman]

Thank you.

[Dr Cameron]

Q This question is for John. You stated in the response to the Bill that enforcing the new age restriction will present its own challenges. What challenges do you foresee? Will the sector be penalised if it cannot tell the difference between a 35-year-old and a 40-year-old? How do you manage those intricacies?

John Herriman: I will let Kate answer on this one as well. There was a really good, comprehensive answer earlier from one of the people giving evidence: if this is the right thing to do, the right idea, it is something we will have to get used to doing. I think that is probably the principle that we would apply within the world of trading standards as well. We just have to get used to the new legislation and what it asks us to do, and then make sure that sellers are following that legislation. Probably the problem will be more at the business end rather than at our end, and this is where there is a really important role for business education and the likes of the British Retail Consortium, the Association of Convenience Stores and other organisations.

We must get the balance right: this is about the enforcement activity and the right level of legislation, but we also have to make sure there is an onus of responsibility and accountability on businesses themselves to solve part of the problem. I do not think it is right to put all of the problem on enforcement, for example. Therefore I would definitely be looking towards businesses to make sure that they are embracing this and making sure that they are doing the right business education and training along the way. Have you anything else to say on that, Kate?

Kate Pike: Absolutely. The other point, obviously, is about resources, which John has already highlighted. We are in discussions, but we do need to make it clear that trading standards needs more resources to enable it to deliver the enforcement in this Bill.

Tobacco and Vapes Bill

Bob Blackman Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

I rise to support the Bill and to make two declarations. First, I chair the all-party parliamentary group on smoking and health. The group’s objective is to encourage people who smoke to give up and young people not to take up smoking at all in the first place, which the Bill aims to achieve. My second declaration is personal. I do not want anybody else to go through what I went through, which was seeing my two parents dying of cancer—a smoking-related disease. I well remember my late mother, at the age of 47, gasping for her last breath. She had been smoking since she was 12. At the time, smoking was almost encouraged by doctors and the medical fraternity, as the implication was that it was a good thing to do.

I want to see a smoke-free generation. We have the opportunity to achieve that now. New Zealand was going to be at the forefront of this effort, but has decided not to go ahead, which means that we can now be in the vanguard of creating the first smoke-free generation in the world. However, the stakes could not be higher. Research from University College London says that 350 young people between the ages of 18 and 25 take up smoking every day. That means that 50,000 young people have taken up smoking since the Government first announced their proposals. They will face a lifetime of addiction and early death as a result.

Relatively few people in my constituency smoke—the numbers are way below average rates. None the less, smoking-related diseases accounted for 1,300 hospital admissions in the year before the pandemic. People suffer the same inequalities as a result. Some say that if we implement these measures we will not have the taxation coming into the Treasury, but in 2023, smoking cost the economy £21 billion. That is more than double the revenue that the Government get from tobacco levies. Some say that people who die early are doing us a favour by not being an imposition on the national health service. That is absolutely outrageous. We want people to live longer and healthier lives.

Let me make this clear for all those who believe in freedom of choice. I am a dyed-in-the-wool Conservative and I believe in free choice, but the only free choice that a person makes if they take up smoking is to take that first cigarette, because after that they are addicted for life; the craving is there. Although most adult smokers want to give up, the reality is that it takes 30 attempts to succeed. Only one in 10 smokers achieve that each year. Therefore, if a person smokes, they will die a horrible death, probably as a result of a smoking-related disease.

This Bill has the opportunity of creating a smoke-free generation and of making sure that young people do not get addicted in the first place. If they wish to take up smoking when they are an adult that is their choice—their free choice—but, importantly, this Bill does not criminalise those people who smoke at the moment for either purchasing or using tobacco. The legal obligation will be on the retailers not to sell tobacco to those who are underage.

Like many people, I am concerned about the number of young people taking up vaping. The reality is that we do not yet have the evidence of what that will do to their lungs in the future. We know that it will get them addicted to nicotine, which is the most addictive drug known to man or woman. Once they are addicted to some form of nicotine, the temptation is to go further. We do not know what damage is being done to people’s lungs by the delivery mechanism of vaping, but medical evidence on that will emerge. It is important that we take action now rather than waiting to see what happens.

There is clear public support for these measures. Sixty nine per cent. of the public, including more than half of all smokers, back the Prime Minister’s age of sale proposal. There is support for the Bill across the political parties. The majority of people who vote for each of our parties across the Chamber support this proposal, and that should not come as a great surprise, because no one wants to see their children or grandchildren become addicted.

Sadly, big tobacco is fighting back. Tobacco companies have even attempted to classify themselves as allies of public health. Philip Morris International threatened to take legal action against the Government to delay the legislation. I am not sure what it thinks it is saying with its new corporate slogan, “Delivering a smoke-free future” when its whole aim is to get people addicted in the first place. The other reality is that big tobacco has been trying to get many of its products, such as heat-not-burn and cigars, exempted from the Bill—exemptions that would undermine the Bill before it even takes effect. Those products still contain tobacco and harmful products, and still cause damage to people’s health. We cannot allow those exemptions to happen. Another thing that we should change is the current exemption for cigarillos from standardised packaging laws—maybe we could consider that as the legislating take place.

The other reality that I want to mention is the discrepancies between Scotland, Northern Ireland, Wales and England. Scotland has a clear requirement for retailers to identify people by their age. I welcome that, as it is the right thing to do. As it stands, the Bill does not appear to require that in Wales or in England. I hope that we can amend the Bill as it goes through Committee to allow the provision that exists in Scotland —we should support what they have done there—to apply in England, Wales and Northern Ireland.

I know that you require me to sit down, Madam Deputy Speaker, but this is a subject that I have been passionate about for rather a long time. The reality is that the smoking ban back in 2007 was led from the Back Benches. Indeed, many Labour Ministers voted against the tobacco ban—

[Steve Brine]

Including the Deputy Prime Minister.

[Bob Blackman]

Including the Deputy Prime Minister. From that ban through to the 2015 progress on tobacco control, such measures have consistently come from the Back Benches. In fact, colleagues from across the House have helped to implement many of them. I am delighted that the all-party parliamentary group’s recommendations have been included in the Khan review. I thank the Prime Minister for going even further than what we asked for, which was a rise in the age of sale to create a smoke-free generation by raising the age of sale by one year every year. The reality is that tobacco control measures have consistently passed through this Chamber and the other with overwhelming support from across parties every single time they have been proposed. I am confident that this Bill will be no different.

[Several hon. Members rose—]

Oral Answers to Questions

Bob Blackman Excerpts

Tuesday 5th March 2024 Commons Chamber

[Dame Andrea Leadsom]

I can tell the hon. Gentleman that the Secretary of State met the Northern Ireland Health Minister just yesterday. I absolutely assure him that all parts of the United Kingdom will be included in the once-in-a-generation public health intervention that will save millions of lives.

[Bob Blackman (Harrow East) (Con)]

I urge my right hon. Friend to get on with introducing the Bill, because every single day we delay, more people die of cancer and other smoking-related diseases. Equally, in creating the first generation of people who will not be allowed to buy cigarettes or tobacco products—that is excellent—does she agree that one concern is that young people are now taking up vaping instead of smoking, and that vaping is clearly a path towards nicotine addiction?

[Dame Andrea Leadsom]

Yes. My hon. Friend raises an incredibly important point. There is no doubt that tobacco and vaping companies are now trying to recruit children, putting vapes, including many illegal vapes, next to the sweet counter with extraordinary flavours such as bubble gum and berry blast, which are clearly not designed, as was originally proposed, for adult smokers to be able to quit smoking by moving to vaping. He is absolutely right and we will bring forward this once-in-a-generation legislation shortly.

Smokefree Future

Bob Blackman Excerpts

Thursday 11th January 2024 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

I beg to move,

That this House has considered the matter of a smokefree future.

It is a pleasure to serve under your chairmanship, Mr Sharma, for at least the second time. No doubt you would prefer to be participating in rather than chairing this debate on the evidence and recommendations submitted to the all-party parliamentary group on smoking and health’s manifesto for a smoke-free future.

It is a pleasure to see the new Minister in her place; I thank her for attending a function that we held soon after she was appointed. I welcome the new shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), and look forward to what she has to say. I declare an interest as chair of the APPG, which wants to ensure that Parliament has the chance to debate our recommendations, along with the smoke-free generation proposals set out in the King’s Speech, and consider what more needs to be done to achieve the Government’s Smokefree 2030 target.

I welcome the Government’s historic commitment to create a smoke-free generation by raising the age of sale for tobacco by one year every year from 2027. This measure, along with other commitments set out by the Government, will help to close the door on the tobacco epidemic once and for all. With their Command Paper, the Government have demonstrated their commitment to achieving the smoke-free ambition and to ending the harms caused by tobacco. It was a great pleasure to hear my words in this place echoed almost word for word by the Prime Minister at the Conservative party conference. I congratulate his speechwriter on having observed what we had to say in last year’s debate.

The smoke-free generation policy was due to be implemented first by New Zealand, but it was abandoned by the incoming Government in November under pressure from their coalition partners. That presents us with the opportunity to be the first to implement the policy, thereby cementing the UK’s position as a global leader in tobacco control. In response to New Zealand’s decision, we have seen the tobacco industry going into overdrive on its lobbying machine, arguing that the UK should follow New Zealand in rowing back on our commitments and even promising that it would not vociferously oppose the smoking age rising from 18 to 21. That demonstrates how big a threat it is to have the smoke-free generation policy.

Quite rightly, the Prime Minister has rejected the industry’s arguments and reiterated the importance of creating a smoke-free generation. I commend the Minister for her robust response to the industry when she called out its attempts to undermine and block this measure. As she wrote in the i newspaper:

“The tobacco industry will talk about free adult choice, but we all know there is no freedom of choice once deadly addiction sets in. The industry has a long history of trying to obstruct and delay tobacco reforms. But we have absolutely no intention of going back on our word.”

I welcome those words, and I trust that the Minister will echo them when she responds to the debate.

Government action to end smoking is what the public want. Polling carried out by YouGov for Action on Smoking and Health shows that three quarters of the public, including the majority of smokers, support the Government’s Smokefree 2030 ambition and that two thirds of people in England back the Prime Minister’s age-of-sale proposal, with equivalent levels of political support among voters for all the main political parties at the last general election. This should not be a surprise, because no one wants to see their children smoking.

Just like the public, the majority of independent retailers selling tobacco support the key measures needed to tackle smoking, including raising the age of sale for tobacco to 21, with just over half of retailers in favour and a quarter opposed. Although that happened before the Government announced the smoke-free generation policy, it shows that retailers support the principle of raising the age of sale. That should not be a surprise, either. Tobacco sales now account for a very small fraction of the profits from those shops—less than 10% in 2016—and are dwindling year on year. Most small retailer transactions do not involve the purchase of tobacco at all.

From the 2007 ban on smoking in public places to standardised packaging in 2015, progress on tobacco control has consistently been driven from the Back Benches. Indeed, I am delighted that most of the 2021 recommendations from by the APPG on smoking and health were included in the recent Khan review and are now in the process of being implemented by the Government and the Department of Health and Social Care. They include progress towards much tougher regulation of vaping to protect children, additional funding for stop smoking services and anti-smoking campaigns, the swap to stop campaign, and financial incentives for pregnant women to stop smoking. In particular, I welcome the Minister’s decision to expand the offer of financial incentives so that it includes not only pregnant women but, critically, their partners. Dads and partners have a key role to play in determining whether women smoke or are exposed to second-hand smoke during pregnancy. That announcement is to be commended.

However, the Government need to go further. The Government’s proposals to create a smoke-free generation and curb youth vaping are welcome, but they will not be enough to achieve the Smokefree 2030 ambition. It is imperative that that ambition is realised for everyone, not just for the next generation. According to Cancer Research UK, the Government are nearly a decade behind achieving their target for England to be smoke free by 2030. The most deprived areas are not on track to hit the smoke-free target of 5% smoking prevalence until after 2050. That would leave the most vulnerable people in our society bearing the brunt of the harms from smoking for decades to come.

In our recently published tobacco manifesto, the APPG set out the action needed to accelerate the decline in smoking rates, in order to get us within spitting distance of a smoke-free 2030. The long wait for Government action on smoking means that achieving 5% smoking prevalence by 2030 will be even more challenging than when the ambition was first announced in 2019. However, that target is still within reach. The closer we get, the more lives we can save.

Modelling carried out for the APPG by academics at University College London shows that if our recommendations are implemented in full throughout the next Parliament, smoking prevalence in England, which is currently at 12.7%, will be reduced to 7.3% by 2029. That would deliver immediate benefits to health and wellbeing, as well as saving countless lives in the longer term, and would lead to a 5% rate by 2030.

Smoking remains the largest cause of preventable death, ill health and inequalities in the UK. Some 6.4 million adults in the UK currently smoke, approximately an eighth of the population. Most adult smokers want to stop smoking, but on average it takes 30 attempts to succeed; many never do so. It is one of the resolutions that smokers make, and it is sad when they break them very quickly in the new year.

Two out of three long-term smokers die prematurely, often after years of disability from the cancers and the respiratory and cardiovascular diseases caused directly by smoking. NHS data shows that in 2022-23 there were more than 400,000 smoking-related hospital admissions in England alone, an increase of 5% on the previous year.

Despite Harrow having a below-average smoking rate, tobacco still takes a heavy toll, causing over 1,300 hospital admissions in 2019-20 alone. People in Harrow suffer many of the same health inequalities as the rest of the country, with those from the poorest backgrounds and those with mental health conditions much more likely to smoke than the general population.

Smoking places a major financial burden on individuals, families and the taxpayer. The average smoker spends just over £3,000 a year on cigarettes, which is significantly more than the annual energy cost for a typical household. That is money that could be better spent on products and services to improve people’s quality of life, but instead it literally goes up in smoke to maintain their deadly addiction. In the APPG’s latest report we estimate that the cost of smoking to public services and the wider UK economy is £89.3 billion a year, the equivalent of 3.9% of GDP.

What about the direct costs of smoking to the public finances? One of the arguments made by the tobacco industry and its allies is that higher smoking rates benefit public finances because smokers pay extra tax in the form of tobacco duties and then die younger, meaning they use less of their pensions. Those arguments are callous, cold-blooded and not even true. Detailed analysis of the evidence carried out for the APPG shows that, rather than saving the Government money, smoking had a direct cost to the public finances of £21 billion last year: more than double the excise tax revenues. That cost is made up of extra social security payments, lost taxation from smokers who are too sick to work and, of course, significant costs to the NHS and social care services. Implementing the recommendations in our manifesto would reduce the public finance costs of smoking by an average of £628 million a year, which would total £3.1 billion by 2029. The case is clear: ending smoking once and for all will transform the nation’s health and wealth. The only losers would be the tobacco industry.

Local stop smoking services have a key role to play in delivering a smoke-free future, so I am pleased that the Government have committed to a five-year funding plan for smoking cessation services. That new funding will definitely help to drive down smoking rates, generating a return on investment literally from year one. However, we are significantly behind where we hoped to be when the smoke-free ambition was announced in 2019.

As we all know, the public finances are under significant strain, so why should taxpayers foot the bill for measures to end smoking when the tobacco industry could be made to do so? Tobacco manufacturers make an estimated £900 million profit a year in the UK alone, with an average net operating profit margin of about 50%. That far exceeds the average for UK manufacturing, which stands at less than 10%. In the UK, four companies are responsible for 95% of tobacco sales and are therefore responsible for an overwhelming majority of the tens of thousands of deaths a year caused by smoking. Despite their staggering profitability, the companies pay very little corporation tax in the UK. Through the exploitation of their global footprints and tax loopholes, they have been able to successfully avoid a fair tax bill overall. Imperial Brands, the largest tobacco manufacturer by market share in the UK, lowered its tax bill by an estimated £1.8 billion over the last 10 years.

The “polluter pays” principle has been accepted and successfully implemented in other industries, such as environmental health, the soft drinks industry and, most recently, the gambling industry. It could easily be extended to the tobacco industry. It could be implemented by capping tobacco wholesale prices, and hence profits, to bring the profit margins in line with the 10% average for other manufacturers. A “polluter pays” health promotion levy could ensure that the excess profits were turned into Government revenues, raising an estimated £700 million a year. That could fund the Government’s smoke-free generation commitments several times over, with money left over for other public health measures.

It is hard to think of a policy that has broader public support. The 2023 smoke-free Great Britain survey conducted by YouGov for Action on Smoking and Health revealed that 76% of adults in Great Britain would support a levy on the tobacco industry, while only 6% were opposed. That includes majority support from voters for all the main political parties. I stress that a levy would not mean an increase in the cost price of tobacco bought over the counter. The Department of Health and Social Care already has the expertise and resource needed to administer a levy in the team that oversees the pharmaceutical pricing scheme.

The primary legislation needed for a consultation on our proposals was part of the Health and Care Bill and was passed by the House of Lords. Unfortunately, due to Treasury opposition, it was voted down by the Government in the Commons. Will the Minister commit to discussing the APPG’s proposal of a “polluter pays” levy on tobacco manufacturers with Ministers in the Treasury and with us?

In the short time that I have left, I want to discuss how we can combat youth vaping. For years, we in the APPG have been calling for the Government to toughen legislation on vaping, so I am delighted that the Government have finally committed to taking action. My views on youth vaping are summed up by the chief medical officer:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape; marketing vapes to children is utterly unacceptable.”

In our manifesto, the APPG urges the Government to prevent e-cigarettes from being sold at pocket-money prices and to curtail advertising and promotion of vaping, particularly in shops, where most under-age vapers access e-cigarettes. We know that the rise in youth vaping since 2021 has been driven largely by the availability and marketing of cheap single-use vapes, and anecdotal evidence points to the fact that many young people believe that vaping is perfectly safe because the Government are encouraging people to give up smoking and take up vaping. Of course, that is a false conclusion, because it gets people addicted to nicotine and possibly leads on to cigarette use later in life.

There is clearly a need to address the affordability of vapes for young people while ensuring that they continue to be a cheaper option than smoking for adults who want to quit. Given the effectiveness of vapes as a smoking cessation aid, it is essential that any regulation takes a measured approach and ensures that vapes are still accessible to adult smokers. Can the Minister confirm when the consultation response will be published and when we will see the legislation laid before Parliament?

The case is very strong for a “polluter pays” levy and for all the recommendations that the APPG has put forward. I look forward to the contributions from colleagues around the Chamber, to the response from the Opposition and from our excellent Minister, and to achieving what we all want: a smoke-free England by 2030.

--- Later in debate ---

[Bob Blackman]

The hon. Member is giving a very thoughtful speech about some of the consequences. Does he accept the fact that, when individuals go into a public house, they will now routinely be challenged and asked for proof of identity if they look young? The challenge is often whether they are over 21, although they could, of course, legally buy alcohol at the age of 18. Many public houses will not serve anyone under the age of 21. Does the hon. Member accept the fact that, because this is already in operation, the retailer should have the right to challenge people who look young so that they can make sure that they are only selling to people who are over the legal age to buy?

[Ian Paisley]

That is a very good point when it comes to that threshold between 17 and 21 or 22. The problem is that this generational legislation creates a conveyor belt—from 18 to 19 to 20. Eventually you will be 37 and not be allowed to buy a cigarette under the law. But, if the retailer sells it to you, whether you are a young-looking, handsome 37-year-old or an old-looking boy, you will still end up not having committed a criminal offence, even though you have, but the retailer has committed an offence for selling it to you. At that point, where do the ID checks come in?

Perhaps the intention is that there will be a time in the next five, six, seven or eight years when no one will smoke. I want to turn to that. The one issue that I have pushed hard and heavy on since becoming a Member of Parliament is the criminalisation of illicit sales of tobacco that furnish criminals’ pockets. It is that illegal crime that really worries me.

The hon. Member for Harrow East, who moved the motion today, quite rightly commented on where he thinks the level of public consumption of cigarettes is. I think that the real figure is startlingly higher, because His Majesty’s Revenue and Customs estimates that 11% of cigarette consumption and 35% of hand-rolling tobacco consumption in the UK comes from the illegal trade. People are buying it illicitly, either as stolen products or black market products that have been brought into the United Kingdom. This is happening in a huge number of areas, and it is fuelling criminal gangs.

That is the higher level. There are more people consuming tobacco than some people want to admit but, unfortunately, they are buying it illegally. The Government are not benefiting in terms of tax and legitimate manufacturers are not benefiting. In fact, the companies are disadvantaged because the product is sometimes stolen from their companies, or is a copy—a counterfeit—of their products.

The Government must decide whether they want tobacco to be supplied to UK consumers by a taxed and regulated private sector, as it currently is, or by the public sector as a medicine, which may be one way of doing it, or by the criminal sector, in the same way that cannabis is sold. Those are the choices that the Government ultimately face.

In my view, a generational prohibition will gradually hand even more of the UK tobacco market to organised criminal gangs, who use the money from tobacco smuggling to fund activities including terrorism, people smuggling, prostitution and all sorts of other things. That view is lifted from the US State Department’s 2015 report, “The Global Illicit Trade in Tobacco: A Threat to National Security”. That is why the gangs deploy such resources. When the South African Government banned the sale of tobacco during covid, illegal traders quickly stepped in. Today, 93% of tobacco sold in South Africa is illicit trade and counterfeit trade. We need to get this absolutely right or else we create a bonanza for the criminal. The sooner we do that, the better, and I am sure the Minister will consider those issues.

I do not want to criminalise shopkeepers, and I know the hon. Member for Harrow East does not want that, but that will be an unintended consequence. As people get older, it will be very difficult to judge whether they can be sold a cigarette. Shopkeepers will have to ask for ID, and we do not have ID in Great Britain. In Northern Ireland, we have a form of ID in our electoral cards, but they do not carry a date of birth, although they do show that a person is over the age of 18. That would have to be changed if they were to be used in Northern Ireland.

What are the alternatives? Many retailers and others have suggested that raising the age of sale for tobacco products to 21 would be much simpler to implement and would avoid this potential negative consequence, and the nightmare of regulation. It would be far easier to implement and enforce, and would avoid the complete takeover of the UK tobacco market by criminals. I urge the Government to consider those alternatives in pursuing this incredibly important flagship policy. For the record, I do not promote smoking, but I believe in adults making choices. We have to try to solve the real problem, not create another one.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to speak under your chairmanship today, Mr Sharma. I congratulate my hon. Friend the Member for Harrow East (Bob Blackman) on securing a debate on such an important issue, and pay tribute to his work as chair of the all-party parliamentary group on smoking and health. He really has been tireless in holding not only Health Ministers’ feet, but the Prime Minister’s feet, to the fire and making sure that we keep tobacco control a top priority. I am also grateful to the hon. Members for City of Durham (Mary Kelly Foy), for North Antrim (Ian Paisley), for Strangford (Jim Shannon) and for Blaydon (Liz Twist) for their participation today. I welcome the chance to update the House on our progress towards a smoke-free future. I welcome the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) to her place, and look forward to working constructively with her on the tobacco and vapes Bill and other things. I hope there will be much that we can agree and collaborate on.

I want my legacy as Public Health Minister to be weighed and measured by everything we have done to protect the vulnerable in society. Critical to that, of course, is keeping our children safe. We already know that in the United Kingdom, smoking kills around 80,000 people every year, causing one in four cancer deaths; costing £17 billion a year in ill health, lost productivity and demands on the NHS and social care; and putting a huge burden on our health service. Like many others, I have been appalled in recent years to see the number of children vaping treble. It is estimated that no fewer than one in five children have now used a vape.

That is why, in October, the Prime Minister announced action across four areas: first, creating a smoke-free generation by ensuring that children turning 15 this year, or younger, will never legally be sold tobacco products; secondly, supporting existing smokers to quit through significant new funding and support; thirdly, protecting our children from vaping by reducing the appeal and availability of vapes; and fourthly, introducing new action to enforce these rules.

I will address each priority area in turn. First, let us be crystal clear: the tobacco and vapes Bill will save many lives. Unlike other consumer products, there is no safe level of nicotine consumption; it is a product that kills up to two thirds of its long-term users and causes 70% of lung cancer deaths. We are not doing this blind. We already know that action to increase the age of sale works. When the age of sale was raised from 16 to 18 years old, smoking rates for 16 and 17-year-olds in England fell by almost a third. This is a tried and tested policy, and while we have seen some progress, I know there is a lot more to be done—almost 13% in that age bracket are still smoking.

Our modelling suggests that this measure to increase the age of sale will reduce smoking rates in England among 14 to 30-year-olds to close to zero as early as 2040. I am sure that is not early enough for my hon. Friend the Member for Harrow East, and colleagues across this Chamber, who would like to see that happen sooner—as would I. Nevertheless, that is what the modelling suggests. It is progress in the right direction and will save many lives. I am committed to publishing an impact assessment very soon that will set out for colleagues a more complete picture of the costs and benefits of the Government’s smoke-free generation policy.

No one doubts that smoking massively increases the risk of stillbirth; a number of colleagues have raised that today. Smoking also causes asthma in children, and is strongly linked to dementia, stroke and heart failure in old age, as well as to disability and death throughout the life course. Non-smokers, including children, pregnant mums-to-be and their babies are exposed to second-hand smoke, putting them at serious risk through absolutely no choice of their own. This is not about freedom of choice; it is about protecting the vulnerable. Almost every minute of every day someone is admitted to hospital because of smoking, and up to 75,000 GP appointments can be attributed to smoking each month—that is over 100 GP appointments every hour. Reducing that burden will therefore save the NHS money that we can reinvest into research, frontline care and cutting waiting lists.

This measure is not just the right thing for our children’s health; there is a very strong economic case for it too. Analysis by Action on Smoking and Health has estimated the cost of tobacco to society to be £17 billion a year. That figure is out of date, and I think my hon. Friend the Member for Harrow East has just updated it—the Department is very swiftly trying to verify that—but the last published data showed that the directly attributable cost of smoking to society was around £17 billion a year. That dwarfs the £10 billion a year the Treasury receives from taxes on tobacco products.

That cost of £17 billion includes £14 billion lost to productivity through smoking-related lost earnings, unemployment and early death, as well a direct cost to the NHS and to social care of £1.9 billion and £1.1 billion a year, respectively. The cost of smoking to the economy and wider society is equivalent to the annual salaries of over half a million nurses, almost 400,000 GPs, 400,000 police officers, or 400 million GP appointments.

Reducing smoking rates will bring down those costs and help our economy to become more productive. The smoke-free generation policy could provide cumulative productivity benefits of a staggering £85 billion within the next 50 years. That is why the Government are taking such bold and historic action through the tobacco and vapes Bill.

As well as stopping children starting, our second aim is to do more to help current smokers to quit. Quitting smoking is the best thing a smoker can do for their health: someone who quits before turning 30 could add 10 years to their life. That is very reassuring to me; I started smoking at the age of 14 and gave up as my 21st birthday present to myself, by which time I was smoking 40 a day. I was a student—how did I afford it? I have no idea! I am so glad I stopped. For anyone who doubts how addictive it is, I turned 60 last year and still—

[Bob Blackman]

Surely not!

[Dame Andrea Leadsom]

Yes, I know. You can’t believe that, can you?

Even to this day, talking about smoking all the time, I sometimes think, “Ooh a cigarette.” That is how addictive it is—40 years on and I still think, “Ooh!” It is that addictive, and that is absolutely appalling.

We have announced that we will more than double the funding to local stop smoking services across England to a total of £138 million a year, which will help around 360,000 people to quit every year. We are backing these efforts with substantial new money to support marketing campaigns. These measures are easy, common-sense and cost-effective ways to help people to kick the habit.

As colleagues will know, I am passionate about helping new mums, mums-to-be, new parents, new families and their babies, which is why I have asked officials to redouble our efforts to tackle smoking in pregnancy. Women who smoke during pregnancy are two and a half times more likely to give birth prematurely, and smoking is a significant driver of stillbirth. I want to do everything I can to spare parents the awful and heartbreaking tragedy of losing a baby, which we have heard so much about in this place only recently.

On average, just over one in 10 mums smoke at the time of delivery, but that number is as high as one in five in certain parts of the country, as some colleagues have spoken about already. We know that pregnant women who receive financial incentives are twice as likely to successfully quit throughout pregnancy compared to those who do not, so we are working to roll out a national financial incentive scheme by the end of 2024 to help all pregnant smokers and their partners to quit. This will build on our work over recent years to develop high-quality stop smoking support for pregnant women and their partners, with programmes such as the NHS long-term plan commitments on maternal smoking and the saving babies’ lives care bundle.

Thirdly, as I said at the start of my remarks, youth vaping has tripled in recent years. One in five children have now used a vape. I am especially worried about the damage being done to children’s bodies by illegal vapes, which is a growing concern for mums and dads across the country. The health advice is clear: young people and those who have never smoked should not vape. We have a duty to protect our children from underage vaping while their lungs and brains are still developing. There is not yet enough evidence on the long-term impact of vaping on young brains and lungs. I will not stand by while businesses knowingly and deliberately encourage children to use a product that is designed to help adults quit smoking. Those business do so with full knowledge that our children will become addicted to nicotine—well, not on my watch.

We have announced that we will take tough new action to reduce the appeal and availability of vapes through the tobacco and vapes Bill. In our recent public consultation, we sought views on restricting flavours, point-of-sale displays and packaging. On a visit to retail outlets in Hackney, I saw sweet counters and vape counters side by side, with the vapes in pretty packaging with cartoon characters and in little things that look like Coke cans. These vapes are not designed for 60-year-old smokers; they are designed for children, to get them addicted to nicotine.

The consultation has revealed something we already know: there are serious and justifiable environmental concerns over disposable vapes. It is a simple truth that more than 5 million disposable vapes are either littered or thrown away in general waste every week. That number has quadrupled in just the last year. Being sold at pocket-money prices, easy to use and widely available, disposable vapes are, of course, the product of choice for children. More than two thirds of current youth vapers use disposable products. We must and will take action.

Fourthly, a strong approach to enforcement is vital to ensure that our policy actually takes effect. The underage and illicit sale of tobacco, and more recently vapes, is undermining the work the Government are doing to regulate the industry and protect public health. We are cracking down on this evil and illicit trade by backing enforcement agencies including Border Force, HMRC and trading standards with £30 million extra per year. We will introduce powers in the tobacco and vapes Bill to give on-the-spot fines to tackle underage sales. I am pleased we can count on the strong support of trading standards officers right across the country.

Our public consultation closed on 6 December and we received nearly 28,000 valid responses. I am happy to assure all colleagues that we will publish our response in the coming weeks, ahead of the introduction of the tobacco and vapes Bill. I believe that our actions in this space show that the Government are willing to take tough, long-term decisions to protect our children and safeguard the health of future generations.

I will now answer some of the questions raised by hon. Members today; I thank them again for their contributions. In response to my hon. Friend the Member for Harrow East, our public consultation closed on 6 December and within the next few weeks we will publish the consultation. Of course we will then bring forward the Bill, which is, as everybody knows, a top priority for the Prime Minister.

As for the point about a polluter pays levy, the Treasury has looked at that in detail, but so far it has decided against it. I absolutely assure colleagues that I will take that point away and consider it again.

I thank the hon. Member for City of Durham for her invitation to visit her constituency, which I would be delighted to accept. She highlighted the fact that the discrepancy in life expectancy between different parts of her constituency is 50% attributable to smoking, which is a shocking figure. That is not uncommon around the country, so we need to tackle that issue.

I say gently to the hon. Member for North Antrim that when the legal age for smoking was raised, it reduced illicit tobacco sales by 25%; the evidence suggests that far from increasing criminality, raising the legal age for smoking decreases it.

The hon. Gentleman also asked a question about Northern Ireland specifically. I am pleased to tell him that in the Bill we propose to give Northern Ireland the powers to regulate in the same way as the rest of the United Kingdom. There has been a lot of consultation with the devolved Administrations and once the Stormont Assembly—which I urge him to get back up and running —is back up and running, Northern Ireland will be able to legislate to have exactly the same regime as the rest of the United Kingdom.

--- Later in debate ---

[Bob Blackman]

I thank my right hon. Friend the Minister and the shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), for their responses. I will politely and gently point out that every single measure on smoking has always been led from the Back Benches. I well remember that some 11 years ago I was sitting where I am sitting today, leading a debate on the standardised packaging of tobacco products, and both the Opposition Front Bencher and the Government Front Bencher said, “We have no plans for and do not support standardised packaging of tobacco products.” Two years later, it was introduced. Indeed, the smoking ban, originally put forward under a Labour Government, came from Back-Bench pressure, and the Minister at the time was trying to prevent it. We must be clear that Back Benchers lead the way on tobacco legislation.

I thank all hon. Members for their contributions. It is important that we ramp up and keep the pressure on Government to take action. It is good that we have seen actions over the last few months on introducing the Khan review, but we must remember that the proposed legislation does not introduce every single measure recommended in it. I urge my right hon. Friend the Minister to have another look at the Khan review to see what else can be done, possibly without the need for legislation, and to have discussions again with the Treasury on the “polluter pays” levy. After all, we would all like to see more money invested in the health service: let us get it from the tobacco industry, rather than the hard-pressed taxpayer.

I urge the Government to ensure that we take action on vaping and on youth vaping in particular. I am really concerned, as the Minister quite rightly said in her speech, that there is not yet evidence on the damage done by vaping. It must be safer than smoking, so giving up is a good thing to do, but damage is being done and addiction is being heaped on people. In many ways, what we see in vaping is what used to happen with the packaging of tobacco products: they were made to look sexy and cool for young people. We barred that and, as a result, youth smoking dropped. That is vital.

I also welcome the fact that there is cross-party support for the legislation, so we can ensure that we get it through quickly and on to the statute book. However, let us be clear: we need to go further in order to achieve a smoke-free England. It is for not just the next generation, but every future generation to come. Our all-party parliamentary group’s manifesto sets out the measures that we need to take that will just about get us to a smoke-free England in 2030. However, we need action on those measures soon if we are to achieve that, so I commend the manifesto to the House and look forward to the full implementation.

Question put and agreed to.

Resolved,

That this House has considered the matter of a smokefree future.

Smokefree 2030 Target

Bob Blackman Excerpts

Tuesday 20th June 2023 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

I beg to move,

That this House has considered the Smokefree 2030 target.

It is a pleasure to serve under your chairmanship once again, Mr Evans, and thank you for stepping in to ensure that the debate can take place. We will be considering the 17 April statement to the House on achieving a smokefree England by 2030, cutting smoking and stopping kids vaping.

The debate is co-sponsored by me, in my capacity as chairman of the all-party parliamentary group on smoking and health, and by my friend, the hon. Member for City of Durham (Mary Kelly Foy), who is a vice-chair of the group. The APPG wants to ensure that Parliament has the chance to debate the announcement made by the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), and to consider whether those measures are sufficient to end smoking by 2030 and level up the health and wellbeing of some of the most deprived communities in the country.

At the outset, I commend my hon. Friend the Under-Secretary for announcing the first tobacco control measures since the Government set out their Smokefree 2030 ambition way back in 2019. Since 2021, the APPG has been calling for greater funding to help smokers to swap and to stop, and to provide incentives to help pregnant smokers to quit. We are extremely pleased to see that those measures have been taken forward.

However, while the measures recently introduced by the Government to achieve a Smokefree 2030 are welcome, they are insufficiently ambitious, as they provide only a quarter of the funding called for by the Government’s own independent review last year. Meanwhile, big tobacco continues to make extreme profits selling highly addictive, lethal products that kill if they are used correctly.

The idea of a levy on the industry is popular and feasible, and is supported by voters of all political persuasions, as well as the majority of tobacco retailers. The manufacturers clearly have the money and high profits, so they should be made to pay to end the epidemic. This is more than just a health crisis because delivering a Smokefree 2030 is integral to delivering economic growth, which is a mantra for the Government and for Opposition parties.

Analysis conducted by Landman Economics on behalf of ASH—Action on Smoking and Health—found that, in addition to causing around 75,000 premature deaths a year in the UK, in 2022 smoking cost the economy a staggering £173 billion, including lost productivity and premature death.

Let me break those figures down. The cost to the public finances was £21 billion, which is nearly double the tobacco tax revenues of £11 billion. The cost to the NHS was £2.2 billion, and to social care £1.3 billion. Those figures are substantial, but they pale into insignificance beside the £5 billion of social security payments and the £11.8 billion of lost income tax and national insurance—people who are sick from smoking are unable to work. That is public money, and it will continue literally to go up in smoke for years to come unless we take urgent and bold action.

I welcome the measures announced by the Minister in April, but I recognise that they still fall well short of the recommendations in Dr Javed Khan’s independent review. Of the four “must do” measures recommended by Dr Khan, only one—promoting vaping for adult smokers—has been fully adopted by the Government. The recommendation to improve prevention in the NHS has been partially implemented via the new NHS long-term plan with respect to tobacco treatment services, but those have been constrained by a lack of funding.

Dr Khan’s top two recommendations, which are increased investment in tobacco control and increasing the age of sale, have not been adopted, which has left tobacco control efforts desperately underfunded and put the Smokefree 2030 ambition in critical jeopardy. While I commend the Government’s ambition and commitment to make smoking obsolete by 2030, to date that ambition has not been matched by funding. Dr Khan’s independent review made it clear that a Smokefree 2030 cannot be delivered on the cheap. Speaking recently on improved public sector productivity, the Chancellor stated that

“we count the number of hospital treatments but not the value of preventative care, even though that saves lives and reduces cost.”

I could not agree more.

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 this is where the largest budget cuts have fallen to date, with the public health grant falling by a quarter in real terms since 2015 and funding for tobacco control falling by almost half. Local authorities have done their best to continue delivering vital tobacco control activity despite these funding cuts, but there is much more that we can do. If the Government are serious about the Smokefree 2030 ambition, they cannot keep asking local government to do more with less. More funding must be made available to deliver it.

Last year, Dr Javed Khan called on the Government to urgently invest an additional £125 million per year in a comprehensive Smokefree 2030 programme. One of his options for raising that money was a “polluter pays” levy on tobacco manufacturers, based on the principle that those responsible for the problem should be required to fix it. The principle has been accepted on numerous occasions: the landfill levy; the tax on sugar in soft drinks; requiring developers to pay for the costs of remediating building safety defects; and, most recently, a statutory gambling levy. The “polluter pays” model would enable the Government to limit the ability of manufacturers to profit from smokers while protecting Government excise tax revenues. That will prevent big tobacco gaming the system as it currently does with corporation tax.

Despite paying little corporation tax, the big four tobacco companies make around 50% net operating profits in the UK—far higher than the average of 10% for UK manufacturers overall. Imperial Brands is the most profitable, with 40% market share in the UK and over 70% net operating profits in 2021. Why should an industry whose products diminish the health of users be allowed to make such excessive profits? A levy could raise £700 million a year while capping the profits on sales to ensure that the costs are not passed on to smokers. Some £700 million from tobacco manufacturers would more than cover the £125-million additional funding that Dr Khan estimated was needed for tobacco control, with money left over for other prevention and public health measures.

[Mr Virendra Sharma in the Chair]

Amendments to the Health and Care Act 2022 calling for a consultation on such a levy were tabled by the hon. Member for City of Durham, who is co-sponsor of this debate, and were accepted in the House of Lords last year. Health Ministers were sympathetic, but the Treasury opposed the measure, so it was voted down by the Government, despite overwhelming public support for a levy. Some 75% of the British public think that tobacco manufacturers should be made to pay. My first question to the Minister is: can he tell me, if the Government will not commit to a levy on tobacco manufacturers, how, when and where will they find the additional funding needed to deliver the Smokefree 2030 ambition? Since 2020, public health Ministers have committed to publishing a new tobacco control plan, initially by July 2021 and then by the end of 2022—we are still waiting. The previous tobacco control plan expired last year, leaving us without a strategy or any targets for reducing smoking rates among the most disadvantaged groups.

In the absence of national leadership, local authorities are stepping up to the plate. For example, the London Tobacco Alliance, which I am proud to support, launched last year. It is leading the charge to make the capital smoke-free by 2030. I am sure the Minister will join me in commending the alliance and other regional partnerships across the country that are committed to tackling smoking in their communities. In place of a tobacco control plan, the Minister has said that tackling smoking will be “central” to the major conditions strategy. However, the recent call for evidence for that strategy was not reassuring, and certainly did not place smoking front and centre. My second question is: if the Minister will not commit to a new tobacco control plan—I wish he would—can he at least reaffirm that smoking will be central to the major conditions strategy and that further tobacco control measures will be included in the major conditions strategy when it is finally published? I assure the Minister that he has the full support of the APPG in his efforts to tackle youth vaping, and recent announcements by both the Minister and the Prime Minister are warmly welcomed.

My views on youth vaping were summed up expertly by the chief medical officer:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape; marketing vapes to children is utterly unacceptable.”

The APPG is deeply concerned about recent figures published by ASH showing that there has been a significant rise in youth experimentation with nicotine e-cigarettes, driven by cheap, colourful disposable vapes and child-friendly marketing.

[Dr Neil Hudson (Penrith and The Border) (Con)]

I congratulate my hon. Friend and the hon. Member for City of Durham (Mary Kelly Foy) on securing this debate. Although I acknowledge that vaping has a role in helping adults to quit tobacco smoking, youth vaping has unintended consequences, as my hon. Friend is starting to elaborate. We have seen a surge in such vaping, and there are huge health and environmental concerns. As he said, the products are targeted at young people, with colourful packaging and flavouring. The Government have taken some strong steps. Does my hon. Friend agree that we need to go faster to stop this unintended public-health ticking time bomb?

[Bob Blackman]

I thank my hon. Friend for that intervention. It reminds me that 11 years ago I led a debate in this place on introducing standardised packaging for tobacco products. At the time, both the Government and the Opposition said they had no plans to support such a measure. Of course, we now have standardised packaging of tobacco products. I hope we can get standardised packaging of vaping products as well.

The Government recently issued a call for evidence on the best approaches for tackling youth vaping. I look forward to seeing the response. First and foremost, the Government should make disposable vapes, which are the worst things for the economy, much less affordable, by adding a £5 excise tax. That would also make the distribution of those products subject to much more stringent controls, making it easier to prevent illicit and underage sales. It would in particular ban the issuing of free samples to young people.

Will the Minister tell us when the Government’s response to the call for evidence on youth vaping will be published, and whether it will include specific enhanced regulation to address loopholes in the law? I welcome the Minister’s commitment to adapting the tobacco trace and trace system, to strengthen enforcement and to target the illicit market. I particularly welcome the Minister’s commitment to exploring how to share information with local partners about who is registered on the track and trace system, which is critical.

[Gareth Johnson (Dartford) (Con)]

Does my hon. Friend agree that there is a critical role for trading standards in enforcing measures against illegal vapes, counterfeit tobacco and underage sales? We could greatly secure the environment for the consumer by trading standards enforcing the laws.

[Bob Blackman]

My hon. Friend must have read the next part of my speech. At present, trading standards officers have one arm tied behind their back in the fight against illicit tobacco, due to a lack of options for identifying and cracking down on retailers who repeatedly flout tobacco regulation. We know that retailers who sell illicit tobacco products are much more likely to sell tobacco to children, undermining tobacco-control regulations. They also seek to hook children on the addictive product that kills more than half of long-term users, by giving or selling them vapes in the first place.

Retailers are required to have an economic operator ID before they can trade in tobacco, under the current tobacco tracking and tracing regulations. Through adaptation of that system, local enforcement will easily be able to identify retailers who are breaking the law, and hold them accountable. That is the approach that I recommend in my ten-minute rule Bill, which would introduce a retail licensing system, similar to the one that exists for alcohol. Retail licensing for tobacco was recommended in Dr Khan’s independent review.

The Minister will be pleased to know that that approach has the support of the public and retailers. Survey evidence from ASH, published last autumn, found that more than eight in 10 small tobacco retailers support the introduction of a tobacco licence, backed by mandatory age verification. Will the Minister commit to publishing further detail on his plans to strengthen the track and trace system, before Second Reading of my ten-minute rule Bill on retail licensing in November?

It is undeniable that big tobacco and those representing its interests never cease in their attempts to undermine public policy, not just on tobacco but on vaping. Only last weekend, The Observer revealed that lobbyists connected to big tobacco were funding Facebook campaigns opposing new vaping regulations. Regulations, I think we can all agree, are desperately needed to protect children. It was exceptionally well timed, therefore, that yesterday the Department of Health and Social Care published guidance for all parts of Government on our legal obligations to protect public policy from the commercial and vested interests of the industry—guidance that I very warmly welcome. The Department of Health and Social Care, as custodian of the World Health Organisation framework convention on tobacco control, has been staunch in its support for that treaty and has upheld our legal obligation to strictly limit any engagement with the industry solely to that required for effective regulation of the industry. Will the Minister put it on the record that Government—the Executive, legislature and judiciary—are required to limit interactions not just with tobacco manufacturers but with any organisations or individuals with affiliations to the tobacco industry, including lobbyists or industry trade bodies, such as the UK Vaping Industry Association, which lists big tobacco among its members?

Mr Sharma, it is good to see you in the Chair; thank you for stepping in. When the Government initially announced their Smokefree 2030 ambition, it was described as “extremely challenging”. Four years on, not only has the challenge increased but the need for action has become more urgent. Cancer Research UK estimates that we will miss achieving the ambition by nine years; it will be even longer for the most disadvantaged in society. I am sure that the Minister agrees that that is not acceptable, so I wish to remind him of comments that he made in his previous role as a Minister for levelling up. He said that

“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.”

The proposals brought forward to date have been radical, but are not yet sufficient. There is nothing on key measures recommended by the APPG and by Dr Khan in last year’s review, which included reinstating funding that was cut for behaviour change campaigns, raising the age of sale, retail licensing, and tougher regulations for tobacco as well as vaping. I hope that when the Minister replies to this debate, he can assure the Chamber that the major conditions strategy will be published this year and will contain further measures—and funding—sufficiently radical to achieve our ambition for a smoke-free future, not just in England but throughout the United Kingdom. I look forward to hearing the contributions of other colleagues on this important matter, and thank you, Mr Sharma, for allowing this important debate to take place today.

[Several hon. Members rose—]

--- Later in debate ---

[Bob Blackman]

I thank the Minister for his reply to the debate; the co-sponsor of the debate, the hon. Member for City of Durham (Mary Kelly Foy), for her contribution; the Labour Front-Bench spokesman, the hon. Member for Denton and Reddish (Andrew Gwynne), for his support from across the Chamber; and our SNP colleague, the hon. Member for Linlithgow and East Falkirk (Martyn Day), for his contribution. That we have had contributions from Northern Ireland, Wales, Scotland and England demonstrates the strong cross-party and cross-country support for making the United Kingdom smoke free. It is reassuring to hear people support the campaign with such enthusiasm.

I urge the Minister to consider carefully the questions and points that were put during the debate as we look forward to the action that is required to prevent people from starting to smoke and to encourage those who do smoke to quit. At the end of the day, this is about preventing avoidable deaths, and without that action, we will, unfortunately, see far too many people become ill and die prematurely.

While I have the floor, I will remind colleagues that on 19 July the all-party group will be hosting a reception to mark the fourth anniversary of the Government’s Smokefree 2030 ambition. We hope to hear from both the Minister and the Opposition spokesman, and I invite other colleagues to contribute to the session. I hope that we will be able to celebrate some new announcements from the Government, and that we will move forward to a smoke-free England in 2030 jointly and severally.

Finally, I thank you, Mr Sharma, and Mr Evans earlier, for stepping into the Chair. When we were all sitting here before the start, we were wondering whether the debate would take place at all, and had you not stepped in, it would have been very difficult to continue. I commend the motion to the House.

Question put and agreed to.

Resolved,

That this House has considered the Smokefree 2030 target.

Oral Answers

Bob Blackman Excerpts

Tuesday 25th April 2023 Commons Chamber

[Steve Barclay]

There is consensus in the House on our desire to close the health inequality gap—everyone agrees that is a key aim. The hon. Gentleman seems to have written the question before hearing my answer. I just gave a practical example of how we have transformed the early detection of lung cancer. He raised the public health grant, and I am happy to update the House that we are delivering 2.8% funding growth in the public health grant to help local authorities.

It is also about areas such as obesity and access to employment, which can have a big impact on mental health. The Chancellor announced specific funding—[Interruption.] The shadow Minister chunters away about children; I am conscious that one does not want too long an answer, but let me give the example of mental health. In the Budget we announced extra funding for a whole load of digital apps—[Interruption.] The shadow Minister keeps chuntering about children. Let me talk about the roll-out of our mental health support in schools, which is targeted at getting that early mental health intervention to school children.

[Bob Blackman (Harrow East) (Con)]

3. What steps he is taking to tackle vaping by young people.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

I recently announced new measures to tackle youth vaping, including an extra £3 million for a new enforcement squad to tackle underage sales and illicit vapes. We also launched a call for evidence to identify opportunities to reduce youth vaping, which covers everything from the appearance, marketing and price to the environmental impact of vapes.

[Bob Blackman]

We would all encourage people to vape instead of smoke, but we do not know the long-term health impact of vaping at all. Reports suggest that one in seven young people are taking up vaping directly and therefore becoming addicted to nicotine, the most addictive drug known to humankind. What measures will my hon. Friend take to make sure that young people understand the risks of vaping?

[Neil O’Brien]

I pay tribute to my hon. Friend’s work as chair of the all-party parliamentary group for vaping. He is right; as well as the measures I mentioned, we have updated the guidance on Talk to FRANK, to illustrate for young people the dangers of consuming lots of nicotine.

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.