King’s College Hospital Foundation Trust

Bob Blackman Excerpts

Tuesday 12th December 2017 Commons Chamber

[Mr Dunne]

I am afraid that the hon. Gentleman was not referring to the urgent question. We are talking about what has happened at King’s over the past few days, rather than what is happening in Scotland.

[Bob Blackman (Harrow East) (Con)]

My local hospital trust, based on Northwick Park Hospital, has had to make some very difficult decisions to make itself more efficient and to reduce its deficit, and it has done so under excellent leadership. Does my hon. Friend know whether decisions were taken at King’s to keep to the deficit target? Were efficiencies made, and how effective were they?

[Mr Dunne]

What is particularly disappointing about King’s is that it does have a cost improvement programme, but regrettably, it has not been able to keep to it. It is particularly surprising that, as recently as October, the senior leadership team indicated that they were on track to meet their deficit, which palpably, as we now realise, was not the case.

Hormone Pregnancy Tests

Bob Blackman Excerpts

Thursday 16th November 2017 Commons Chamber

[Steve Brine]

First, may I correct myself? I might have said that the expert working group met “companies”, not “families”. If I said “companies”, I wish to correct the record.

I agree with the hon. Lady that the notice the families were given was not good enough. I and my colleague in the other place have made that crystal clear. Some notice was given to Mrs Lyon on Friday last week that there was likely to be an event on Wednesday, but that was not confirmed until Monday, so that was the notice the family got, and I do not think that is good enough; I have made that very clear.

On the hon. Lady and the hon. Member for Bolton South East (Yasmin Qureshi), who chairs the all-party group, being locked out of the press conference, I cannot imagine how that happened, and again I have sympathy on that. I expect the MHRA to look into that and explain that to me, because, while we may disagree, I can see how that merely feeds the conspiracy theory that some have around this subject.

[Bob Blackman (Harrow East) (Con)]

My hon. Friend is clearly struggling to defend this position. I urge him to look at the scope of this review and all the evidence that was presented to it, as all the evidence that was available should be looked at and looked at again. Without that, many people across this country will not be satisfied that justice has been done.

[Steve Brine]

With respect, I do not think I am struggling at all; I am just setting out a very clear position. Ministers are confident in the report and the review process. I say again that this was a comprehensive independent scientific review of all available evidence by experts across the expert working group who have a broad range of specialisms.

Oral Answers to Questions

Bob Blackman Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Dunne]

As the hon. Lady will be aware, we are looking for a relationship with the EU to ensure that we have tariff-free access to the single market, including for drugs and medicines, because the life sciences industry is such a critical element of our economy. Contingency plans are being put in place for a no deal. She will have to wait, as will the rest of us, to see whether or not that eventuality happens. Of course we do not want it to occur—it is not our intent.

[Bob Blackman (Harrow East) (Con)]

8. What steps he is taking to reduce smoking rates.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Adult smoking prevalence is now 15.5%, the lowest ever. As the House will be aware, in July we published a tobacco control plan for England, which sets out stretching ambitions to reduce smoking prevalence still further and commits us to a series of actions to deliver those ambitions. Our end goal, as we have made clear, is a smoke-free generation.

[Bob Blackman]

I thank my hon. Friend for that answer. Does he agree that one of the most effective ways of helping people to give up smoking is the provision of smoking cessation services? In Harrow, the local unit managed to help 4,000 people attempt to give up smoking, with more than 50% doing so, but the answer from the local council has been to close the unit—that is very ineffective. Will he take action to make sure that this does not happen across the country?

[Steve Brine]

My hon. Friend is right to raise the issue. Local authorities, not Ministers in Whitehall, are best placed to take local spending decisions, but they must be accountable for their decisions. That is why we publish information at local authority level on smoking prevalence and quit numbers, so that local decision makers can be held to account. We also offer them expert support from Public Health England. I have a strong feeling that he will continue to hold those in Harrow to account.

Tobacco Control Plan

Bob Blackman Excerpts

Thursday 19th October 2017 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

It is a pleasure to follow that contribution by the new hon. Member for Ipswich (Sandy Martin). I agreed with almost all of what he had to say—except perhaps about pension funds investing in pornography, which I think stretched the point. I also congratulate the right hon. Member for Rother Valley (Sir Kevin Barron), who I have known since I was elected as a great champion of anti-tobacco and anti-smoking measures.

I should declare an interest as the chairman of the all-party group on smoking and health. For me, this is a personal issue: both my parents died of cancer, directly as a result of smoking, and I do not want anyone to go through what my family had to go through.

My hon. Friend the new Minister for public health is the third Minister I have berated about getting the tobacco control plan published, and I congratulate him on the fact that it was duly published almost in his first few days in his role. I thank him for that, and I look forward to many such measures, which we will be calling for, being given equal standing and impetus.

We should, of course, review the outcome of the previous plan, which expired at the end of 2015. The three ambitions of the old plan, which included reducing smoking rates among adults and children, were more than achieved, and I congratulate Governments of both political persuasions on that. We just about made the target of reducing the level of smoking among pregnant women to below 11%, although that happened somewhat later than envisaged in the plan. We now have the lowest prevalence of smoking ever recorded among adults and children.

We are still in the position where 80,000 people a year die from preventable smoking-related diseases, and the single cause of that is tobacco. It is the only product available legally that, if people use it as the manufacturer intends, will kill them. My hon. Friend the Member for Chippenham (Michelle Donelan) made the point that were tobacco to be discovered now, there is no chance that it would ever get to the stage it has.

Tobacco kills half of lifetime smokers. On average, smokers lose 10 years of their life expectancy. For every death that is caused, about 20 smokers suffer from a smoking-related disease, so the problem is not only death but smoking-related diseases and the cost to the health service.

Every year in Harrow, my local borough, about 1,500 hospital admissions and 200 premature deaths are caused by smoking-related diseases. If we extend the picture across the country, we see that there is a huge problem.

Tobacco control policy should have as its objective the end of smoking, which I absolutely support. The Minister states in the plan that the aim is

“to create a smokefree generation”,

which is a wonderful idea, but if we go further into the plan, we see that the aim is to cut smoking rates to no more than 12% by 2022. That is too weak a target—we should be looking to go much lower than 12% by 2022.

I particularly welcome the targets to cut the number of 15-year-olds who smoke regularly to lower than 3%, and to cut the number of pregnant women who smoke to less than 6%. Those key targets will have long-term effects. The reality is that most people who smoke—two thirds—acquire the habit before the age of 18, so one of the key issues is to prevent young people from starting to smoke. If we can achieve that, we can make sure that we cut off the supply of smokers. We know that once people are addicted, it is much harder for them to give up smoking.

Funding for tobacco control is essential. We need to be clear that the headline figure for public health spending has increased since 2013, rising 25% each year, but that does not take into account the extra responsibilities that local authorities have. Analysis by the King’s Fund has shown that once we take those responsibilities into account, local authority spending on public health has fallen in real terms since 2013-14 by 5%. At the same time, the population has grown by 3%, so the reality is that we are seeing a reduction in spending.

In Harrow, spending on tobacco control has fallen from £364,000 a year in 2013-14 to £9,000 in the current year—a decline of 98%. If we analyse Department for Communities and Local Government returns, we see that spending on tobacco control across the country has fallen by 33%. That cannot be acceptable.

It is clear that one of the issues we have to address is stop smoking services, which are key to helping people to get off smoking in the first place. They are highly cost-effective and they would make sure that we reduced the number of deaths. Every smoker who goes to a GP or any doctor should be relayed to a stop smoking service immediately to help them to give up smoking. Clearly, that will cost money, and I share the view of my hon. Friend the Member for Chippenham that the tobacco industry should pay for the damage it does to our national health service and our health. Imperial and Japan Tobacco International make joint profits of about £1 billion a year, and they should be charged for cleaning up the damage that these products cause on the basis that the polluter pays. In the United States, the tobacco industry is required to pay an annual user fee, which means that the Food and Drug Administration collects more than $2 billion a year.

The Government introduced the annual tax escalator of 2% above inflation, but that is due to end in 2020. We should increase it and make sure that the money raised is ring-fenced so that it can be used to implement smoking-cessation measures. That would not only encourage the tobacco industry to look at what it does to prevent people from smoking, but discourage it from manipulating prices to subsidise cheaper brands and encourage people on low incomes, or young people, to start smoking—we know that the industry does precisely that. As we move in that direction, we should see an increase in tobacco tax.

A licensing system for tobacco should be introduced to make sure that we have complete control, from manufacturer to retailer. That would ensure that we could have proper enforcement all the way through the process and take action against the illicit trade.

One issue that is very prevalent, but is not mentioned in the tobacco control plan, is oral cancers. The British Dental Association estimates that between 91% and 93% of oral cancers are preventable and that two thirds are caused directly by smoking or by chewing tobacco. Large numbers of people who originate from the Indian subcontinent—between 40% and 50%—chew tobacco that is unregulated. There are no warnings on any of this tobacco and nor is there any estimate of how much damage it is doing, but large numbers of people from the Indian subcontinent who chew tobacco routinely present with oral cancer as a result. We should make sure that there are health warnings on these products, and that people are warned about the consequences of taking them. Tobacco does not have to be included within these products, but frequently it is included. If tobacco is involved, clearly there should be warnings and proper regulation should be in place. My hon. Friend the Minister has suggested that there are no plans to do anything about this, but I urge him to review the situation very closely, examine the evidence, and then act in the same way that he has done on the tobacco control plan.

--- Later in debate ---

[Stephen Kerr]

I note in the plan the £16 billion commitment to funding public health programmes, in conjunction with local authorities in England, which is surely welcome news.

[Bob Blackman]

Just to reiterate, although it is local authorities that spend the money to help people give up smoking, which is warmly welcome, the savings go directly to the health service, and so the money is not recycled back to those helping people to stop smoking to meet the considerable expense incurred.

[Stephen Kerr]

I thank my hon. Friend for his intervention and his moving and impactful contribution earlier.

Behind the numbers on lives and costs, there is above all else the human suffering and the suffering of the families who lose family members to this terrible disease. I welcome any and all efforts to help people across the UK stop smoking.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful to the right hon. Member for Rother Valley (Sir Kevin Barron) for securing this important debate on the tobacco control plan for England. I congratulate him on his work over the years and, as a testament to that, on the general consensus today.

Scotland has its own strong tobacco control strategy. The Scottish Government have implemented and overseen a number of progressive actions on smoking, and I am grateful to the hon. Member for Stirling (Stephen Kerr) for listing many of them, which shows the strength of the consensus in the Chamber to which I referred. Record investment in NHS Scotland on smoking cessation services has helped hundreds of thousands of people to quit smoking, and our aim is to create a tobacco-free generation by 2034. Last year, the Scottish Parliament celebrated the 10-year anniversary of the smoking ban and welcomed comments from the World Health Organisation praising our excellent example of global public health leadership.

Not everything that we want to achieve can be done in isolation, however. A good example of something that required UK-wide co-operation was the introduction of standardised packaging for tobacco products. However, I want to focus on another area that requires co-ordination across the jurisdictions of the UK, and indeed of Europe and the world: the illicit tobacco trade. I press the Minister to report on progress to secure a Europe-wide traceability system, which is still being discussed at the European Commission, and to confirm that the UK Government will rapidly ratify the illicit trade protocol, the first subsidiary treaty under the WHO framework convention on tobacco control.

Illicit tobacco undermines public health policy because it makes tobacco products available at a low price and often in branded packaging. It damages public revenue because it reduces the take from tobacco taxation. Figures from Her Majesty’s Revenue and Customs for 2015-16 estimated that the illicit market share in the UK for cigarettes was 13%, with the figure for hand-rolling tobacco 32%. The tobacco tax gap in that period was estimated at £2.4 billion, so clearly the illicit trade undermines our tobacco control strategy.

The involvement of the major tobacco manufacturers in the illicit trade is a major concern. Their involvement is evidenced by the fact that their genuine products—not counterfeit ones, or so-called cheap whites—form the largest share of the illicit market. The Scottish Government have committed to continue to support strong national and local alliances to tackle illicit tobacco. In 2009, the enhanced tobacco sales enforcement programme was introduced to enable the Scottish Government and trading standards officers throughout Scotland to work with Her Majesty’s Revenue and Customs to tackle the availability of illicit cigarettes and their sale to people under 18.

As we all know, there is an open border between England and Scotland, and if the amount of illicit tobacco rises in England, it will affect Scotland, as well as Wales and Northern Ireland. Scotland needs a commitment from the UK Government that they will ensure that local authorities in England are adequately resourced to conduct the fight against the illicit trade. At present, that is absolutely not what we appear to have.

[Bob Blackman]

The hon. Gentleman makes a powerful point. Does he concede that the tobacco companies themselves deliberately overproduce products for certain countries, knowing that they will be brought into the UK by illicit means and sold as illicit products? The tobacco companies themselves have a key role in this.

[Martyn Day]

The hon. Gentleman makes a good point. The tobacco companies are indeed the villains in this scenario.

For the last 20 years, the UK has had an effective and well-resourced anti-smuggling strategy, and HMRC’s tax gap estimates have fallen by about a half since the peak in 2000, but there is every reason to fear that that success is under serious threat and that the progressive reductions in the market share of illicit tobacco may soon go into reverse. That is already suggested by recent small upticks in HMRC’s figures.

There is a specific problem for local authorities. Figures from the Chartered Trading Standards Institute published at the end of last year showed that the total budget for trading standards across Great Britain had fallen from £213 million in 2009 to only £124 million in 2016, and that the number of trading standards staff had fallen by more than half. That means that the chance of catching someone selling illicit tobacco or supplying it to an unscrupulous retailer or local consumers is significantly reduced. Information from local enforcement action can be used to help to track the supply chain, and less information means less tracking and intelligence, which cannot be in the interests of either public health or the public finances.

I urge the UK Government to make rapid further progress at the European and international level. The EU’s revised tobacco products directive establishes a new traceability system for all tobacco packaging, and that requires a coding system that can be accessed by enforcement officers to give information about the movement of products through the supply chain from manufacturer to retailer—this addresses the point made by the hon. Member for Harrow East (Bob Blackman). The system also requires security features to prevent tampering and ensure that products are genuine.

The European Commission has been carrying out consultations and research on the system’s specifications. While I consider its current proposals to be largely constructive and sensible, there are tobacco industry systems that the manufacturers are desperate to see states adopt to implement the directive requirements. The coding system developed by the four major manufacturers is known as Codentify, although it has now been hived off to a nominally independent company. In my opinion, it does not fulfil the requirement for independence in the protocol to eliminate illicit trade in tobacco products. That protocol explicitly requires Governments to take responsibility for control measures, rather than relying on industry self-regulation, which has clearly failed to deliver in the past. I therefore ask the Minister to confirm that the UK Government intend to participate in the European traceability system, and also to state clearly that they will work to ensure that its specifications include robust requirements for independence from the tobacco industry. The industry must not control the traceability system, either directly or indirectly through proxies.

A global tracking and tracing system is offered by the World Health Organisation’s illicit trade protocol, which was rightly negotiated as the first subsidiary treaty under the framework convention on tobacco control. The EU system will have to be consistent with the protocol, but it is obvious that a working global system would be even more effective than one that is confined to the EU. The protocol also contains other important provisions on control of the tobacco supply chain, including the requirement for manufacturers to conduct due diligence with their customers and to keep proper records of their transactions.

The UK Government have stated that they will become a party to the protocol on numerous occasions, including in their new tobacco control plan, and I welcome those statements, but they are yet to do so. I ask the Minister to give a clear commitment that the UK Government will move rapidly to ratify the protocol. A date for ratification would be excellent. It certainly needs to happen before 10 July 2018, which is the deadline if the UK is to be able to participate in the first meeting of the parties in October 2018 in Geneva.

Like others who have spoken, I welcome the tobacco control plan for England. It is not perfect, but it does represent a real commitment to tackling the smoking epidemic. I trust that it will also strengthen continuing co-operation with the Scottish Government, as well as the Welsh and Northern Ireland Governments, in addressing this No. 1 public health priority. However, the approach still needs to be strengthened and supplemented, and action against illicit trade is at the top of my “to do” list.

I very much hope that the Minister will be able to make the commitments that I have called for today, along with other Members on both sides of the House, and I look forward to the arrival of the first truly smoke-free generation throughout the United Kingdom.

Oral Answers to Questions

Bob Blackman Excerpts

Tuesday 4th July 2017 Commons Chamber

[Steve Brine]

I will have to look into the exact point that the hon. Gentleman raises, but I should like to welcome him to his place. I worked closely with his predecessor, and the hon. Gentleman has a tough act to follow. When we publish the tobacco control plan, there will be clear local tobacco plans as part of it. We in the Government can give the best evidence of what works, but we need to recognise what is needed in each local area. I know that he has specific needs in his local area in relation to tackling this issue.

[Bob Blackman (Harrow East) (Con)]

I welcome the Minister to his place. Does he agree that it is vital that anyone who approaches the national health service with a smoking-related disease should be pointed towards smoking cessation services? Does he also agree that it is vital that local authorities continue to run those services?

[Steve Brine]

Yes, absolutely. Local authorities have an obligation to do that, but as I said to the new hon. Member for Ipswich (Sandy Martin), it is important that local plans come forward alongside the new national plan. Local solutions are needed for different areas, and that will be the case in my hon. Friend’s borough just as it is in my area of Hampshire.

NHS Shared Business Services

Bob Blackman Excerpts

Tuesday 27th June 2017 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

My right hon. Friend has confirmed that the contract has now been taken in-house. Can he also confirm that it is a totally different operation and that none of the people who were involved in making the decisions is now involved in making the decisions on the current service?

[Mr Hunt]

I can absolutely confirm that.

CQC: NHS Deaths Review

Bob Blackman Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

The right hon. Lady is absolutely right. I will take away with me the question of what the legal responsibilities will be for people in adult social care settings. One thing the report highlights, which I had not particularly anticipated, was the problem that a number of people with learning disabilities are cared for in multiple settings, so if there is a tragedy, the place where the tragedy happens may not be the place responsible for what went wrong. Often, the person’s previous care provider never even finds out that that person has died. One thing that Sir Mike Richards talks about is making sure that all care providers are informed promptly when something happens, so that there can be a multi-institution examination of what went wrong.

[Bob Blackman (Harrow East) (Con)]

I welcome my right hon. Friend’s statement and the measures that he has announced. I have been supporting the family of a constituent who died unexpectedly in hospital, and they have suffered at every step along the way. There has been a wall of silence, the trust has refused to co-operate and the CQC has refused to investigate. Every step along the way, the family have been frustrated. That has been made even more important by the fact that the son of the deceased is a doctor in the NHS, and he knows that processes have been badly handled. All he wants is for the NHS to learn from its mistakes. Will my right hon. Friend undertake to say what he will do about the number of unexplained deaths that have occurred in the NHS over the past few years, and whether any of those cases can be examined by an appropriate authority?

[Mr Hunt]

I am happy to look personally at the case that my hon. Friend talks about. I think he speaks for all patients and families who have suffered tragedies when he says that the only thing people want is for lessons to be learned. A more challenging issue is that staff sometimes do not feel empowered to speak out in such situations, and they worry about the consequences. A number of trusts have an outstanding learning culture that is really supportive of staff, but that is not the case everywhere. One of the big lessons from today is that we must work out how to spread that positive culture across the NHS.

Cancer Strategy

Bob Blackman Excerpts

Thursday 8th December 2016 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

Thank you for calling me in this debate, Madam Deputy Speaker. It is always a pleasure to follow my hon. Friend the Member for Castle Point (Rebecca Harris), and one benefit of this type of debate is that we learn something that we did not know before. I, too, congratulate the hon. Member for Scunthorpe (Nic Dakin), who introduced the debate. I know that he has been a doughty campaigner, particularly on behalf of pancreatic cancer sufferers, since we were both elected, and the way he introduced the debate was fitting and appropriate. I also pass on my best wishes to my hon. Friend the Member for Basildon and Billericay (Mr Baron) and his family at this difficult time. It is a surprise not to see him in this Chamber for a debate such as this, but we understand the circumstances.

I want to start by paying tribute to Greg Lake, the rock star who, sadly, died yesterday after a long battle with cancer. To me, he was one of the icons. He founded King Crimson, and one of the first albums I bought was “In the Court of the Crimson King”. He then went on to form the supergroup Emerson, Lake and Palmer, and he also produced the iconic hit “I believe in Father Christmas”, which we hear at this time of year. I want to put that on the record because it is appropriate that we remember that people are suffering and dying as a result of cancer literally every day.

I declare my interest as chair of the all-party group on smoking and health, and I note that the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) raised a number of the issues set out in the briefing that has been circulated quite widely. I want, however, to build on some of the things that have taken place. One of the key recommendations of the UK cancer strategy, which was founded not a year ago, as the title of this debate suggests, but 18 months ago, was that the replacement tobacco control plan should be published within a year. The last tobacco control plan expired a year ago, and we were promised a replacement in the summer. I know that “the summer” can stretch, but stretching it to Christmas is a bit of a long stretch. We recently had an excellent debate in Westminster Hall, where we briefed the new Minister, the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), on all the key issues relating to tobacco control. She promised that the new plan would be published soon, and she did so again when I raised it with her at Health questions. It will not surprise today’s Minister to learn that the one thing I have to ask is to be given a date for the new plan—he should not tell me, “Soon”.

I now come to a significant fact. The Prime Minister said in her first major speech, on the steps of Downing Street, that she would be

“fighting against the burning injustice that, if you’re born poor, you will die on average nine years earlier than others.”

Smoking is responsible for half the difference in life expectancy between rich and poor in this country, so if we can cut smoking rates, we will help deliver the Prime Minister’s ambition. I ask the Minister to make sure that we get this tobacco control plan as quickly as possible.

We know that smoking is the greatest preventable cause of cancer worldwide. It accounts for more than one in four cancer deaths in the UK and for a fifth of all cancer cases. Smoking increases the risk of getting 14 other cancers and is responsible for more than 80% of cases of lung cancer—the cancer that is the biggest killer in this country. It also has the worst five-year survival rate. Therefore, from that perspective, if we can cut smoking, we will cut the causes of cancer.

I wish to declare an interest in this matter. As I have said in this place on more than one occasion, both of my parents died, in 1979, of smoking-related diseases. They both died of cancer because they smoked virtually every day of their lives. I heard the hon. Member for Poplar and Limehouse say that he gave up in 1980. I still remember those terrible days when my parents died, and I want us to get to a position where no one has to suffer what my family and I had to suffer.

[Rebecca Harris]

Does my hon. Friend agree that those Members who said that we should not bring in a ban on smoking in cars with children because it was unpoliceable may now regret that? Children are policing that measure very well indeed.

[Bob Blackman]

When the change in law came through, a number of people objected to it, saying that it would not be enforceable. I remember back to my childhood when both of my parents were smoking in the car in front of me. It was difficult then as a child to say, “Please, will you not smoke, because I do not like it?” It was just easier to open the window. I do not want children to go through that. It is right and important that we changed the law in that way, as we know that second-hand smoke is a key killer of young lungs. It was a significant development—and a development that people did not think would happen. People did not think that we could introduce this change and get it through both Chambers, but I am delighted to say that we did it and that it was the right thing to do.

[Jo Churchill]

I thank my hon. Friend for providing such a powerful case. I could not agree with him more. To my way of thinking, banning smoking would do me, but we probably cannot go that far. Does he agree that the broader point of health economics is also important? Lung cancer is not the only issue. There is also emphysema, pulmonary disease and so on. If we sort out the tobacco issue, we could make much broader savings across the health service.

[Bob Blackman]

There are aspects of that with which I agree. The reality is that tobacco is the only product in the world, which, if used in the way that was intended, will kill us. Therefore, controlling it is vital.

We know as well that those with complex medical needs have the highest smoking rates. I am talking about people who are unemployed, who have mental health conditions, and who are in prison. I am also talking about the people whom I am championing at the moment—the homeless. All of them are much more likely to smoke than others, and they are also more likely to have the most health problems as a direct result. It is quite clear that the most disadvantaged members of society are more likely to smoke and therefore suffer cancer and other health-related problems as a result. Clearly, we need to take action. Quitting smoking reduces the likelihood of having cancer. It is also key that lungs can recover if one gives up smoking. We must encourage people to give up smoking and, more importantly, to try to prevent young people from ever starting. The hon. Member for Strangford (Jim Shannon) told us what happened to him as a five-year-old. I would not advocate that as a shock treatment. None the less, it is quite clear that stopping people starting to smoke is the best way forward, rather than trying to get them to give up later in life.

The recent report “Smoking Still Kills”, which was endorsed by no fewer than 129 organisations, recommended that, as a target, we should reduce adult smoking to less than 13% by 2020 and to 5% by 2035. I take the point made by my hon. Friend the Member for Bury St Edmunds (Jo Churchill): that is not ambitious enough. We should be going for a smoke-free Britain, or, rather, a smoke-free United Kingdom. I must get my phraseology correct.

To achieve that target, we need mass media campaigns, which the Department of Health has ceased. We need stop-smoking services to be encouraged, promoted and funded across the UK, and local authorities should enforce the necessary activities and to do their job. We know that mass media campaigns are extremely effective and cost- effective in prompting people to stop smoking and in discouraging young people from starting. In 2009 we had funding of just under £25 million for anti-smoking campaigns, but by 2015—last year—that had been reduced to £5.3 million. That is a false economy.

If we had much better funding for mass media campaigns, I am sure we could reduce the incidence of smoking far more. Equally, we know that stop-smoking services across the UK have been highly effective in reducing smoking rates. Smokers are up to four times more likely to quit if they have support from specialist groups and smoking services, compared to quitting cold. The hon. Member for Poplar and Limehouse referred to when he gave up smoking, and he can remember the time and the date when he did so. Most people who have smoked in their adult lives have difficulty giving up and they need help and support. We should ensure that that is available.

The sad fact is that right across the UK smoking cessation services are either having their funding reduced or being closed altogether. That is extremely regrettable. I suggested to the Chancellor that by putting just 5p on a packet of 20 cigarettes and using that money to fund smoking cessation services we could provide all the money that is needed to continue smoking cessation services across the United Kingdom. That, to me, would be a very sensible investment indeed.

Funding for trading standards has fallen from £213 million in 2010 to £124 million now; the teams have been cut to the bone and the number of staff working in trading standards has been reduced radically. That means fewer local controls to target illicit tobacco in the way we should, to prevent some very nasty products from being used by people across the United Kingdom. That is a retrograde step. We need to invest in those services to make sure that we deliver better health outcomes.

We desperately need a new tobacco control plan and programme so that we can see the radical targets that are needed and the investment required across the United Kingdom. We should be setting out our stall—we want a smoke-free United Kingdom not by 2035 or beyond, but by 2020 or 2025. We can achieve it with the right programme. The key point is that if we deliver this plan, we will cut the rate of cancer deaths and the number of people suffering from cancer, which will reduce the burden on the national health service and allow us to take that money from the health service to use on the more difficult cancers that colleagues have mentioned. Those cancers are difficult to spot, difficult to treat and need specialist drugs and specialist treatments.

[Henry Smith]

My hon. Friend is making the powerful point that if we reduce preventable cancers, we can redirect resources to the difficult cancers. It is a fact that more than 230,000 people in the United Kingdom suffer from blood cancers. As in the case of pancreatic cancer, which the hon. Member for Scunthorpe (Nic Dakin) mentioned, if we could better treat those difficult cancers with those resources, we could go so much further.

[Bob Blackman]

Clearly, the priority has to be to eliminate what we can eliminate. If people smoke, they put themselves at risk of cancer—as I said, 14 different cancers are affected by smoking. If people stop smoking, it eliminates that risk. Equally, through diet, people can eliminate some of the risks. However, there are cancers that are not affected by smoking or diet. Therefore, if we can reuse resources and concentrate on the detection or treatment of the more difficult cancers, the health of the nation must be improved.

I bring my remarks to a close by saying that I hope we will get an answer in a few minutes to the question we are all asking: may we please have a date—with a day, a month and a year—when we will get the tobacco control plan?

Oral Answers to Questions

Bob Blackman Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Jeremy Hunt]

We have tried to speed this up with the cancer drugs fund, which helped 84,000 people in the last Parliament, but we always keep the NICE procedures under review and I take on board what the hon. Gentleman says.

[Bob Blackman (Harrow East) (Con)]

We recently had an excellent debate in Westminster Hall on the Government’s tobacco control strategy. When will they publish the new strategy, which was promised for publication this summer?

[Nicola Blackwood]

The UK is a world leader in tobacco control and we have a proven record in reducing the harm caused by tobacco. We should be proud of the fact that smoking rates among adults and young people are at the lowest ever level, but my hon. Friend is right to push for the tobacco control plan because there is unacceptable variation. We are working on developing that plan, which we will be publishing shortly.

Tobacco Control Plan

Bob Blackman Excerpts

Thursday 13th October 2016 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

Thank you, Mr Brady, for calling me to speak; it is a pleasure to serve under your chairmanship.

It is also a pleasure to follow the speech made by my right hon. Friend the Member for Rother Valley (Kevin Barron), as I will call him in this context. I thought that it was thoughtful and, as always, well argued in its treatment of the data.

I place on the record my congratulations to the hon. Member for Stockton North (Alex Cunningham) on securing this debate, and I also congratulate my colleagues on the Backbench Business Committee on allowing it to take place. No doubt the Health Department considers itself extremely challenged by having to respond to a debate in Westminster Hall and to two debates in the main Chamber on the same day.

I also put on the record my congratulations to the Financial Secretary to the Treasury, my hon. Friend the Member for Battersea (Jane Ellison), on all the work she did for public health. Indeed, a lot of the reforms that have been made and that we are talking about today came under her stewardship.

I also congratulate the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), on securing her ministerial position. We are all looking forward to hearing her speak later on. As she is a former chairman of the Science and Technology Committee, I suspect that she will examine the scientific data and the important evidence before moving on; we look forward to that taking place.

On that subject, I echo what has already been said, namely that smoking is the No.1 public health challenge in the UK. As has been mentioned, there are almost 100,000 premature deaths every year across the whole country as a result of smoking. The fact that adding together the number of deaths caused by the next six biggest causes of preventable deaths would still not exceed the number of deaths caused by the No.1 cause of preventable death suggests that we have to address this matter. However, there is a risk that, because of the success of the tobacco control programme over the last five years, people will think the job is done. Well, I have to say that it is most certainly not done.

I declare my interest as the chairman of the all-party group on smoking and health and, as someone who has been an avowed anti-smoker all my life, I will continue to oppose smoking. I take the view that there are two categories of people here. We have to help people to stop smoking, but even more importantly we have to prevent people from starting to smoke, because we know that once people are addicted it is a very difficult job for them to give up their addiction.

As the hon. Member for Totnes (Dr Wollaston) said, we have been very successful. In the 1970s, more than 50% of the adult population smoked; that figure is now down to below 20%. That is good news. However, it still means that there is a stubborn minority and we have to get across to them how damaging it is to their health to continue smoking.

Success in this area has not happened by accident. Governments of all persuasion— including the current Government, the coalition Government before that and the Labour Government before that—have done enormous amounts of work to reduce the prevalence of smoking. Health professionals have also contributed to that, as have civil society organisations.

The position now is that the tobacco control programme finished at the end of last year. That is the reality and we need to see the new programme as soon as possible.

On this side of the House it is not unusual to hear people argue that the smoking habit is none of the Government’s business. Of course, it is an important source of tax revenue, but some people say—they are not necessarily employed or funded by the tobacco industry—that those who choose to smoke understand the risks, and have exercised their free consumer choice. I would say that informed choice and people understanding the damage they are doing to themselves is up to them, but that does not mean that we should not increase the pressure on those individuals to understand the damage they are doing to themselves and to others by continuing to smoke. I seek to make sure that we continue with the regulations and ramp up the tobacco control programme. We will soon see a situation where all cigarettes and hand-rolled tobacco are sold in standardised packaging, which has been a huge advance. We should take credit for that. Together in this Chamber, we changed Government policy through the force of our argument and the data that we provided in evidence.

I am sure that my right hon. Friend the Prime Minister is among the group that understands that the state and the Government have to interfere in this process. In her recent speech, she said that

“government can and should be a force for good…the state exists to provide what individual people, communities and markets cannot; and…we should employ the power of government for the good of the people.”

I say that she is absolutely right, and that, on tobacco control, the position is quite clear. In her very first speech as party leader, she promised to fight

“the burning injustice that, if you’re born poor, you will die on average 9 years earlier than others.”

That injustice is a clear issue for tobacco.

It would be very hard to find a more dysfunctional market than the one controlled by four of the most profitable companies in the world, who make their money selling products that they know will kill half of their lifetime customers—products that have been carefully designed to deliver a highly addictive drug, as fast as possible, to the brains of their users. If anyone were attempting to invent such a drug today, they would not get away with it, but these companies are quite clear in what they set out to do. The estimates by the US National Center on Addiction and Substance Abuse of capture rates for both legal and illegal drugs demonstrate that point powerfully. Capture rates are the percentage of users who report that they have become dependent on the drug at some point. Tobacco has a capture rate of almost a third, more than for heroin, cocaine, alcohol and cannabis. It is clear that the tobacco companies deliberately set out to ensure that their customers are addicted to the drug.

Dependency is a combination of physical and psychological factors. Social and economic factors, such as the relative availability of different drugs, when and where they can be used in a socially acceptable way, and how affordable they are, all have an impact and smoking is therefore a major contributor to poverty and health inequality. As the Marmot review concluded in 2010, smoking in the UK accounts for about half the difference in life expectancy between different social classes, and so the important commitment that the Prime Minister has made to tackling what she rightly calls this “burning injustice” cannot be met without further action on reducing smoking rates.

In my borough, Harrow, analysis based on the 2015 integrated household survey shows that about 13% of the working-age population smoke, which is above the UK average, and equates to about 25,000 people. Of the roughly 15,700 households in Harrow that include a smoker, 2,700 fall below the poverty line. About 1,000 would rise above that line if all smokers in poor households were to quit. A lot of people refer to my borough as a nice, leafy borough, but it is important to understand that there are levels of deprivation all across the country—with respect to the hon. Members opposite, it is not confined to the north and the industrial cities.

Despite that fact, I am displeased that Harrow Council has decided to consult on stopping the smoking cessation services in an attempt to save money, but I am pleased that a large petition has been initiated by consultants at Northwick Park hospital with the aim of combating that and preventing it from happening. As my hon. Friend the Member for Totnes noted, stopping smoking cessation services would be a stupid move and would increase pressure on the health service and on individuals.

I would also add that, whatever one’s views on Brexit, the reality is that over the last five years more than 10,000 adults from eastern Europe have come to live in my constituency and almost all those of adult age smoke. The tobacco control programme needs to include encouraging people to give up by reaching parts that have not been reached previously.

One important lesson that we have learned from previous control programmes is that efforts to reduce smoking must be sustained and progressive; sustained because, as I have said, nicotine is a powerful drug, it increases dependency and requires powerful interventions to persuade people to quit; and progressive because people who continue to use tobacco after the control programmes are in place can be said to have discounted their effect. For example, many smokers quit after the introduction of the workplace ban in 2006, but most did not. The need for progressive steps is particularly important when it comes to tax and price policy, because the economic impacts of tax rises on reducing demand for tobacco products depend not simply on absolute price levels, but on affordability. If taxes rise more slowly than incomes, tobacco will become more, not less, affordable and consumption will tend to rise, not fall.

That point is well understood by the four major tobacco companies, which routinely use what they call “overshifting” as a pricing device. When the Government put up taxes, the companies raise the price of their so-called luxury brands by more than the amount required by the tax increase, while raising the price of the economy brands by less than the tax increase, or in some cases not at all, so that as many low-income smokers as possible are encouraged to continue with their habit or to start smoking in the first place. That has resulted in increasing brand segmentation in the tobacco market, and was cheerfully admitted by the companies in written evidence in their recent unsuccessful court challenge against standardised packaging. One of the most important secondary benefits of standardised packaging, over and above the removal of the last permitted form of advertising and marketing of tobacco products, is likely to be the gradual collapse of this approach to marketing. The brand value of a luxury packet of cigarettes is likely to be greatly reduced when it can no longer be highly designed, but instead must consist of drab, olive colours and large photos of diseased lungs and eyeballs. It is likely to mean that future tobacco tax prices are more effective in encouraging smokers to quit, as the different brand values and prices collapse towards a middle price. If we increased tobacco prices above the escalators and ensured that the money was given to public health for prevention and cessation measures, it would be welcome.

Tobacco control policies work best in combination and should not be planned and assessed in isolation. For example, standardised packaging will no doubt encourage many smokers to try to quit, but most quit attempts fail. Smokers who try to quit have a much greater chance of success if they can get help from stop smoking services and a prescription for nicotine replacement products, whether that is patches, gum or electronic cigarettes. That will all help towards people quitting, and so it is extremely disturbing to see the results from Action on Smoking and Health’s latest survey of tobacco control work in local authorities.

ASH asked control experts from 126 local authorities about their smoking policies and budgets. Its evidence shows that funding is being cut back in two out of five areas and that half of all services are being reconfigured or commissioned, which largely seems to be with the intention of saving money, not saving people’s lives and improving their health. I completely understand the need to control public expenditure, and I know that that often requires local authorities around the country to make difficult decisions, but if that leads to closures and reductions in this vital area of public health work, there is definitely a need for some very urgent rethinking.

[Alex Cunningham]

Colleagues in clinical commissioning groups in my area tell me that they would love to spend much more money on preventative services, but they are too busy spending money on treating and curing people to invest in the longer term. Does the hon. Gentleman think there is a case for providing ring-fenced funding for public health and saying, “Let’s spend this great tranche of money now and do the preventative stuff, and get the benefits 20 years down the road”?

[Bob Blackman]

We should remember that when public health was devolved to local authorities, the money was ring-fenced. I pointed out to Ministers at the time that removing that ring fence would put at risk all public health expenditure, which can be squeezed. I think that is precisely what is happening. We are in danger of undoing all the good work that local authorities have done on public health by allowing that to happen. I, too, would welcome a ring-fencing of money for purposes such as this. We can see clearly that this is a particularly good, important service.

I am also concerned about the progressive reductions in the money spent on mass-media campaigns. As has already been mentioned, the money is going down. In 2015 we spent less than a quarter of the amount that was spent in 2009, and it looks like the spending is going to fall again this year. As has been mentioned, the Stoptober campaign is now only going to be online, with no television advertising. The benefit of large-scale television advertising is that it reaches people who are likely to smoke, so we need to look at that again.

Given the appalling damage that the tobacco industry causes, and given that those major companies are vastly profitable, I cannot see why they should not be asked to make a greater financial contribution to help solve the public health disaster that they worked so hard to create. I cannot imagine a more obvious application of the principle that the polluter should pay. I would very much like to see that commitment included in the new, overdue control plan for England.

Colleagues will remember that last December, when we had a Backbench Business debate on this subject, the previous Health Minister, my hon. Friend the Member for Battersea, announced that the tobacco control programme would be published this summer. I know that spring extends as far as November in some Government quarters, but in this case summer seems to be extending into next year. I am seriously worried, because we have reached the autumn and there is no plan in place and no date for publication. The previous plan was an excellent means of combating the appalling diseases, including cancer, pulmonary diseases, vascular diseases and various other things that are caused by smoking. It helped to improve matters and added many years to the lives of thousands of people across the UK.

Some colleagues may think that an intervention in the market is not required, but I think one is needed more than ever before. Since the programme was first published in 1998, the fall in our smoking rates has been similar to that of Canada and Australia, as has been mentioned. In France and Germany, which do not have comprehensive strategies, the rates have hardly changed in 20 years. The evidence shows that these programmes work, and that where there is no programme there is no movement forward.

The UK has an excellent record on tobacco control. The Department of Health was rightly given the prestigious Luther L Terry award last year by the American Cancer Society for its global leadership on the issue, and the UK was ranked as the world’s most successful country on tobacco control by the Association of European Cancer Leagues. We should never forget that two of the biggest tobacco firms in the world, British American Tobacco and Imperial, are based in the UK, along with Gallaher, which is now an important part of Japan Tobacco International. We simply cannot sit back and watch smoking rates fall in the UK while the tobacco industry puts more time and money into increasing consumption in developing countries.

The next conference of parties of the World Health Organisation Framework Convention on Tobacco Control takes place in India in November—next month. We are in an Indian summer, and the tobacco programme will be published in the summer, so what would be better than publishing the plan in advance of the conference in India? That would set the UK, once again, on the world leadership level.

I hope that my hon. Friend the Minister, in her response, will give a firm and early date for publication. I hope that the plan will set ambitious targets to cut heath inequalities, deal with the funding crisis affecting tobacco control work in local authorities and set specific targets to reduce smoking among vulnerable groups, including, as my hon. Friend the Member for Totnes said, pregnant women and people with mental health problems. The targets for the past five years of the programme seemed difficult, but they have all been achieved, so we should set challenging targets now that will lead to a smoke-free Britain. That has got to be our ultimate aim.

I strongly believe that tobacco control is an essential part of policy. It will enable the Prime Minister to achieve her commitments on good government and reducing health inequality. I pay tribute to the work of colleagues from all parties and in both Houses, who pressed the need for tobacco control legislation on sometimes reluctant Governments, which I consider to be one of the most important political and social advances during my time in Parliament. I hope that that work will continue until the death, disease and misery caused by smoking is finally consigned to the past. I look forward to hearing positive news from my hon. Friend the Minister about when we are going to set out the new challenges for the industry and the Department.