Smokefree 2030

Bob Blackman Excerpts

Tuesday 26th April 2022 Westminster Hall

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

I beg to move,

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

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

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

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

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

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

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

[Bob Blackman]

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

[Alex Cunningham (Stockton North) (Lab)]

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

[Bob Blackman]

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

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

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

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

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

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

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

[Mary Glindon (North Tyneside) (Lab)]

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

--- Later in debate ---

[Bob Blackman]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Caroline Nokes (in the Chair)]

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

--- Later in debate ---

[Bob Blackman]

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

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

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

Question put and agreed to.

Resolved,

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

Health and Care Bill

Bob Blackman Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

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

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

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

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

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

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

[Bob Blackman]

rose—

[Edward Argar]

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

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

[Bob Blackman]

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

[Edward Argar]

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

--- Later in debate ---

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

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

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

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

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

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

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

[Bob Blackman]

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

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

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

Vaccination Strategy

Bob Blackman Excerpts

Wednesday 12th January 2022 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

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

[Maggie Throup]

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

Health and Care Bill

Bob Blackman Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Dr Whitford]

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

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

[Bob Blackman (Harrow East) (Con)]

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

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

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

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

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

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

[Peter Dowd (Bootle) (Lab)]

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

[Bob Blackman]

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

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

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

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

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

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

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

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

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

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

[Bob Blackman]

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

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

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

[Geraint Davies]

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

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

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

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

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

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

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

Tobacco Control Plan

Bob Blackman Excerpts

Tuesday 16th November 2021 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

I beg to move,

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

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

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

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

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

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

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

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

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

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

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

[Bob Blackman]

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

[Sir Charles Walker (Broxbourne) (Con)]

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

--- Later in debate ---

[Bob Blackman]

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

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

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

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

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

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

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

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

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

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

[Ian Paisley (North Antrim) (DUP)]

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

[Bob Blackman]

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

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

[Sir Charles Walker]

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

[Bob Blackman]

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

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

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

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

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

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

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

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

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

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

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

--- Later in debate ---

[Bob Blackman]

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

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

Question put and agreed to.

Resolved,

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

Smoking Cessation: Prescription of E-cigarettes

Bob Blackman Excerpts

Monday 1st November 2021 Commons Chamber

[Maggie Throup]

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

[Bob Blackman (Harrow East) (Con)]

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

[Maggie Throup]

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

Health and Care Bill

Bob Blackman Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

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

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

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

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

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

Tobacco Control Plan

Bob Blackman Excerpts

Thursday 10th June 2021 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Miller. I am the co-sponsor of the motion, so I crave your indulgence slightly because I have a rather longer speech than five minutes will allow. It is a pleasure to follow my co-sponsor, the hon. Member for City of Durham (Mary Kelly Foy). I chair the all-party parliamentary group on smoking and health, which published the report on the tobacco control plan yesterday.

We were delighted when my hon. Friend the Minister set out the need for a new control plan last December, and we commissioned Action on Smoking and Health and SPECTRUM, a widely acknowledged scientific research consortium, to put together a report for us on what needed to be done and why. The importance of the ambition is very clear: the chief medical officer, Professor Chris Whitty, recently said that smoking is likely to have killed more people in Britain than the covid-19 pandemic, with more than 70,000 people dying from smoking last year in England alone—and for every person killed by smoking, another 30 live with the serious consequences of smoking-related illnesses. Ending smoking is essential if we are to reduce health inequalities between rich and poor, level up the nation and increase healthy life expectancy by five years, in line with the Government’s manifesto commitments.

The smoking rate in my Harrow East constituency is lower than average for England, but there is no room for complacency. More than one in 10 of my constituents smoke, and smoking kills 250 of my constituents every year. In 2018, there were 1,566 smoking-attributable hospital admissions in Harrow alone. Research shows that smokers are likely to need social care a decade earlier than non-smokers because of the impact of smoking-related diseases and disability.

Inequalities in smoking have grown, not shrunk, in recent years. To be smoke free by 2030, we need to reduce smoking by two thirds in only a decade, and by three quarters for smokers in routine and manual occupations. Cancer Research UK has said that, at current rates of decline, we will miss the target by seven years, and by double that for the poorest in society, because there are still 6 million smokers in England. We will achieve a smoke-free 2030 only by motivating more smokers to attempt to quit using the most effective quitting aids, while reducing the number of children and young adults who start smoking.

It is right that the Government brought forward the ambition of the prevention Green Paper, and we need to ensure that bold action is implemented, with appropriate investment. The Health Foundation estimates that a minimum of £1.2 billion is needed to restore public health funding to 2015 levels, and that a further £2.6 billion is needed to level up public health across the country.

The APPG’s view is that when it comes to ending smoking, the industry that makes excess profits from the sale of tobacco should pay, as it does in the US. The US’s user fee legislation raises $711 million annually from the tobacco industry; a similar approach could be introduced in the UK, with a statutory smoke-free 2030 fund imposing a targeted tobacco manufacturer profit cap and utility-style price controls in order to raise funds from the industry through a charge-based mechanism on sales volumes. It would not apply just to tobacco, because obviously this is about incentivising the industry to deliver on making smoking obsolete by 2030. It is quite clear that this is more than demonstrated by the market failure that has happened, and we need to get on with it. Will the Minister commit that the APPG recommendations for a “polluter pays” approach will be considered as a funding mechanism for the forthcoming tobacco control plan?

We also need to look at raising the age at which young people can buy cigarettes. Clearly, young people who start smoking continue to smoke into adulthood, so one of the areas that we have explored is raising the age of sale. It was raised from 16 to 18, which produced a 30% reduction in smokers aged 16 to 17 years old. It would be helpful if we could get to a position whereby 18 to 20-year-olds were prevented from smoking, so will the Minister commit to conducting a consultation on raising the age of sale from 18 to 21 and to coming to a decision about whether to go ahead by the end of 2021?

We have been a leader in the tobacco control plan, but obviously the position is that we have set the record. Now that we are free from the European Union, we can make decisions on our own. Will the Minister investigate extending Official Development Assistance funding for the FCTC 2030 project for a further five years?

Finally, the Minister is the lead for the World Health Organisation’s FCTC in the Department of Health and Social Care, so will she commit to provide the leadership in other Government Departments and public authorities that we need to fulfil their legal obligations to prevent tobacco policy from being influenced by the tobacco industry?

I have been able to touch on only four of the recommendations that we have made, and there are 12 in the report. I urge all Members to read the full report and the recommendations. The recommendations are supported not just by the APPG, but by leading health organisations too numerous for me to mention. There is good evidence that the recommendations will work in synergy to drive down smoking rates, and the forthcoming tobacco control plan offers the perfect opportunity to put them in place. I commend our recommendations to the House, and look forward to the reply of my hon. Friend the Minister.

Covid-19 Update

Bob Blackman Excerpts

Monday 7th June 2021 Commons Chamber

[Matt Hancock]

We are explicit about that. I appreciate what the hon. Lady said about the importance of data and data saving lives, and I agree with her about the importance of trust and bringing people with you. In fact, a large majority of those in the NHS are now actively enthusiastic about using data better. I very much hope we can keep it that way, not least because everybody has now seen the importance of using data to manage a crisis. One of the reasons for the vaccine success—why it has been rolled out so effectively—is that the data architecture that underpins the vaccine roll-out is extremely effective, and I pay tribute to the people who built it.

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

In Harrow, because of the delta variant, we have surge testing in our schools: 13,000 young people have been tested at school and 12,000 relatives at home. This weekend, 3,280 vaccinations took place because we had two new pop-up vaccination centres for 18-year-olds and over. Will my right hon. Friend join me in congratulating the entire team who have made this massive project, so diligently followed, to enable people to be safe in Harrow, but will he also consider having further pop-up clinics for 18-year-olds so that we can get everyone vaccinated as soon as possible?

[Matt Hancock]

I pay tribute to the team at Harrow, and especially for the testing expansion. My hon. Friend said that there were 13,000 pupils and 12,000 of their relatives, and that includes me, because one of my children goes to school in the Harrow area. We got our PCR tests at home, we sat around the kitchen table and we all did them together, and I am glad to say they were all negative. This showed me—I felt like a mystery shopper —how effective this surge testing can be in making sure that we tackle these problems. We have seen that surge testing can work. We saw it in south London, where it worked. We have seen it in Bolton, where the case rate has come down. It has been used in Hounslow. It has been used in other specific areas, and I am glad it is now under way in Harrow to try to keep this under control.

Covid-19 Update

Bob Blackman Excerpts

Monday 17th May 2021 Commons Chamber

[Mr Deputy Speaker (Mr Nigel Evans)]

I do aim to try to take everybody, so can we have concise questions—and concise answers, Secretary of State?

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

My right hon. Friend will be aware that London has a younger cohort and is full of communities from across the world, but many are hesitant because of the activities of pharmaceutical companies in the countries of their origin. Will he look at aspects of control to ensure that those communities can get the vaccine they choose to take, rather than attempting to force them to take vaccines they are extremely reluctant to take?

[Matt Hancock]

We have had a principle of saying that they come forward for the vaccine and get the vaccine that is there on the day, but of course we have nuanced that because of the changes in the clinical advice on the AstraZeneca vaccine. As we reach further and further into those who need encouragement to come forward, so we are willing to look at more and more creative solutions to tackle people’s hesitancy. As it happens, I was in Brent central mosque last week at Eid. It was absolutely wonderful to see the work they have done to make sure that people of all faiths and none can come forward. For many Muslim people it means that in Brent they can go forward to somewhere where they are very comfortable being vaccinated. It was brilliant, frankly, to see teams working in the mosque to vaccinate people of all backgrounds. The imam was vaccinated by someone with the support of a member of the Jewish community with me looking on, all organised by a Hindu administrator. It was modern Britain at its best. They have done thousands of vaccines and they have done great work. I know it is that sort of approach that my hon. Friend is looking for. If we can do more on the specifics of which vaccine, I am very happy to look at that. [Interruption.]