Tobacco and Vapes Bill (Second sitting)
Caroline Johnson ExcerptsTuesday 7th January 2025
(1 year, 2 months ago)
Public Bill CommitteesRead Full debate Tobacco and Vapes Bill 2024-26 View all Tobacco and Vapes Bill 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 7 January 2025 - (7 Jan 2025)
The Chair
I welcome the panel again, although I was not here for this morning’s sitting. We will now resume by hearing oral evidence from David Fothergill, chairman of the Local Government Association’s Community Wellbeing Board, Professor Tracy Daszkiewicz, executive director of public health and strategic partnerships and vice president of the faculty of public health at Aneurin Bevan University Health Board, and Alison Challenger, tobacco and vapes lead at the Association of Directors of Public Health.
For this panel, we have until 2.40 pm. The floor is now open to any members of the Committee who wish to ask questions, but we would traditionally ask the Opposition spokesperson to ask the first question, so, Dr Caroline Johnson, the floor is yours.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Q
My first question is: do the local authorities have the resources they need to enforce these measures, if brought in? If they do not, what further resources do they need?
David Fothergill: I will take that one, if I may. First, thank you very much for the opportunity to come and speak to you. From a local authority perspective, we welcome the legislation, and we welcome the fact that it has been cross-party legislation—with the previous Government, and now with the current Government. The legislation will only be as good as the enforcement, and the question you ask is really important: have we got the resources to do it? We have to be sure that it is not a new burden—on either local authorities or retailers—that we cannot fund.
Therefore we would ask that we have time to implement, because we need to be able to consult with our retailers and our public to make sure that we implement in the right way. We would ask that it is viewed as a new burden, so that we can have additional moneys coming into the local authorities. We would also ask that we set up an apprenticeship scheme for trading standards services, to ensure that we are bringing through new people into trading standards—and environmental health, of course; we have to mention them. However, with time, focusing on those three areas, we will have the resources to make this successful.
Dr Johnson
Q
David Fothergill: The important thing is that we have the right consultation and the right plan for bringing through new trading standards. I think we would be alarmed if you said you were going to introduce this on 1 January next year, but if you said we had two years or slightly longer to implement it I think we would be much more comfortable.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Q
David Fothergill: We argued at the previous Committee hearing under the last Government—I think you may have sat on that Committee—that we needed a licensing scheme to make it effective. We still hold that view. We think that it is right. What we should not do, though, is to overcomplicate this. We already have licensing schemes. Many of you will have sat on licensing committees at local authorities. We have good local people who license alcohol outlets, taxis, gambling and gaming. We believe that licensing is the right route to go. While we think the legislation should be consistent, we do think there need to be local variations we can look at, so that we can bring in what works for our communities, very much as we do with the alcohol schemes.
Sadik Al-Hassan (North Somerset) (Lab)
Q
Alison Challenger: The short answer is yes, I think they do. The need not to have children exposed to the marketing of vapes is very important. At the moment we see that children are exposed to that marketing and are encouraged to get access to vapes, so it is important that this is brought into the Bill. I think what is currently in the Bill will help us to address that significantly.
David Fothergill: I concur. From a local authority point of view, we have argued long and hard about vapes and have spoken with your colleagues in the Department for Environment, Food and Rural Affairs about disposable vapes, which we have been very concerned about; so it is great to see this legislation moving forward.
The Chair
We will now hear oral evidence from Professor Linda Bauld, who is a Bruce and John Usher professor of public health and co-head of the centre for population health sciences at the University of Edinburgh. Thank you for being flexible and appearing earlier in today’s session. For this panel we have until 3.10 pm. If Members want to refer to Professor Bauld’s contribution and evidence, it will appear further on in your packs.
Dr Johnson
Q
Professor Linda Bauld: Thank you for the question. The first thing I would say is that I very much welcome the legislation. I also welcome the fact that it was introduced by the previous Government and then brought back by the current Government. I welcome the cross-party support I have seen. The academic community has contributed a lot of evidence to inform this legislation.
What I meant by those remarks was based on the previous Bill. There were areas that could be strengthened, and that is what we have seen in the current proposals—new measures are being introduced, many of which will need to be consulted on, and there are powers that can be acted on. In those remarks, I was thinking more about the implementation of the legislation and the regulations that will be required. A lot of that will need to be consulted on, but we need to ensure that we strike the right balance between what I see as the two primary priorities in this legislation: protecting young people and preventing smoking uptake. We must also protect young people from the harms of vaping, while also recognising the needs of the 6 million smokers we still have in the UK, who we need to support to quit.
I think the proof will be in the pudding. As all Members know, a lot of action will need to be taken forward to ensure that we get it right at the regulation stage. Certain elements of that will need to progress at pace to make sure we seize the moment to get it right.
Dr Johnson
Q
Professor Linda Bauld: As you know yourself, it is one of the leading causes of premature morbidity and mortality for the mother if she continues to smoke during and after the pregnancy. It is also a major cause of complications in pregnancy and for the baby, in terms of low birth weight and even stillbirth, along with a variety of other complications. The consequences of low birth weight are manifold in the health outcomes for the baby and the child. Finally, as you have heard from other witnesses, if the mother continues to smoke, or if other members of the household are smoking, that child is exposed to second-hand smoke in the home and is also three times more likely to become a smoker themselves.
As I think we heard from the CMOs—it could have been other witnesses—one of the great promises of the legislation is this prevention piece for young mums and partners, even pre-conception. We know that if we prevent smoking uptake earlier, the parents of the future are far less likely to smoke. The levels of smoking we have in pregnancy now are at around 9% or 10%. They have reduced a lot, but we can drive them down even further. It is important to make the connection between the smoke-free generation measures in this Bill and reducing smoking in pregnancy.
Dr Johnson
Q
I had a look at the evidence for how good people are at establishing how old somebody is. We are often told, “Don’t try to guess someone’s age—you can get yourself into a lot of hot water by doing that.” The research I found online showed that we are remarkably not very good at establishing how old somebody is. We are quite good at establishing if someone is of a similar age to ourselves, but beyond that, it is not that easy. What information do you have on the research in that field?
Professor Linda Bauld: I will speak just to the Scottish scheme. As we have heard from the previous witnesses, Challenge 25 is quite easy to implement. It is widely used and highly effective. The benefit of Challenge 25 is that you have got people who are obviously a number of years older than the legal age of sale for the product they are buying, be it alcohol or another product, and it includes anybody who looks roughly around that age, so asking to check age verification is actually very effective. As the regulations in this Bill are taken forward across the four nations, ensuring that we have robust age verification as part of the scheme could be effective.
Dr Johnson
Q
Professor Linda Bauld: I think we also heard this from previous witnesses, but as the legislation comes into place, it is really not about 34-year-olds versus 35-year-olds; it is about acting on the age of sale gradually, so that we are de-normalising tobacco use and stopping the start at an earlier stage.
By the time we get to the difference between the 34-year-old and the 35-year-old, you will have far lower smoking rates than we do at the moment. The modelling for the legislation that was carried out by the University of Sheffield for the Department of Health and Social Care suggests, as I think Hazel Cheeseman said earlier, that by 2040 we will have reduced the smoking rate among those aged 14 to 30 to 0.4%—down from 0.6% by 2030—so I think you are going to see very low rates. To go back to Challenge 25, age verification is something that we can build in, and, irrespective of how old you are, actually seeing proof of age will support this.
Andrew Gwynne
Q
Professor Linda Bauld: Thank you for that question, Minister. I have been working in tobacco control for almost 30 years, and the impact has been phenomenal. If you look back to the late 1940s and 1950s, 80% of men smoked in the UK. We have driven that down gradually over the years. We started to measure it in about 1974, and the level of smoking in the UK is now about 12% or 13%—the second lowest in Europe. The reason that we have achieved that is in line with what is being proposed in this legislation. It is about using comprehensive measures and implementing them over the years to regulate what I often call the four p’s: the product, the place, the price and the promotion. You are taking action on potentially all of those—including price, with the levy that is coming in, or the tax on vapes.
We have made a lot of progress, but we are not there yet. I think what you will hear from my clinical colleagues later is that in line with keeping that firm focus on prevention, as you are doing in this Bill, we also need to keep the focus on cessation and particularly on marginalised groups, deprivation, mental health and so on. The key is comprehensive tobacco control. Keep doing it, and that is what the Bill is adding to.
The Chair
We will now hear oral evidence from Lord Michael Bichard, chair of National Trading Standards, and Wendy Martin, director of National Trading Standards. We have until 3.30 pm with this panel. As you can see, because both the earlier panels finished earlier than expected, we have a fair bit of extra time for these two witnesses, if they wish to use it or if Members wish to ask more questions.
Dr Johnson
Q
Lord Michael Bichard: Good afternoon. We will try to be provocative, so we can keep this going until half-past three. It is as long as a piece of string, in a way. If you compare the penalties to those in some other legislation, they are a bit low. On the other hand, trading standards can prosecute if we find, for example, that someone is a repeat offender, and then I think the fines are up to £2,500.
The only thing we thought might be possible would be to have a higher level of fine for a second offence. I think the first offence is a £90 fixed penalty, but you could have a couple of hundred for a second offence. But we enforce; we do not fix the fines—we just do what you tell us. It is not an unreasonable figure, although it certainly could go up, rather than down, and we could have something for a second offence. Also, we could take action through prosecution for someone who was constantly offending.
Dr Johnson
Wendy, do you have any thoughts—
Lord Michael Bichard: Sorry, I did not hear that. The sound is not—
Dr Johnson
Q
Wendy Martin: Lord Bichard has spoken about the rather varying levels of fines that do exist. The other point worth making is that the issuing of a fixed penalty notice is not automatic anyway. A lot of the work, especially around first offences, would be to try to support businesses with advice on how to comply with the law. It is not the case that, immediately you find something wrong, there will be a fixed penalty notice. There are a lot of drivers for compliance, especially with legitimate businesses that want to comply. As we said, prosecution is an option and you have the £200 fixed penalty, but for longer-term or egregious offences—definitely for repeat offences—prosecution through the magistrates’ court is likely to be an option.
Lord Michael Bichard: One of the problems with prosecution is that it costs money. Therefore, if you can train retailers not to offend, that is a better outcome than having to issue a fixed penalty. For local authorities in particular, with their resource situation being what it is, the last thing they want is more bureaucracy around fixed penalties, prosecutions and all the rest.
Dr Johnson
Q
Lord Michael Bichard: Do we welcome that? Yes, I do. It is our task to take a proportionate position. Some people make mistakes, and there is probably no point in even a fixed penalty notice if someone has just made a mistake. As Wendy has said, training is probably a better option. However, if someone is clearly determined to flout the law, you need to increase the penalties.
Dr Johnson
Q
Lord Michael Bichard: This is not complex legislation. One of the points we want to make on behalf of trading standards is that we are used to doing this sort of stuff. We are used to doing it for tobacco and illicit cigarettes. It is not complicated. The main issue is, as you say, age identification. People are increasingly used to having to provide some identity or proof of age for all sorts of things. In terms of training retailers, that is about it: if they have any doubts, they need to seek identity.
Dr Johnson
Q
Wendy Martin: No training exists at the moment, because the law is not in place yet, but you are quite right that Challenge 25 is the industry standard in terms of current age-restrictive products, no matter what they are. Certain industry organisations, such as the Association of Convenience Stores or the British Retail Consortium, put on a lot of training programmes for members. There has been Government-funded training in the past. The Chartered Trading Standards Institute hosts a site called the Business Companion, which has good, simple guidance and information that is designed specifically for small businesses and is easy to read and digest.
There needs to be a change of mindset around needing to ask for a date of birth, rather than asking, “Are you 18?” There does need to be information out there, as long as it is not complex. It is a case of reinforcing that, but I think those routes do exist via those websites, industry groups and pre-existing information that needs to be updated. There should be as much communication as possible with the public and businesses as the Bill goes through and gets Royal Assent about what to expect and what is required.
Lord Michael Bichard: Again, we want it to be proportionate, because small businesses cannot afford to spend a huge amount of time in training rooms. I do not think personally that this requires profound, long-term training. It is pretty simple stuff. A lot of it can be done informally.
Dr Johnson
Q
Lord Michael Bichard: I try to make it a principle of my life not to go around asking for more money from Government or the Treasury, so that would not be my first response. However, you have to look at this in context. Trading standards resources have been reduced by about 50% over the last decade, and staffing in local authority trading standards has gone down by about 30% to 50%, so we start from a very low base.
The suggestion that has been made is that trading standards should get £10 million to implement and enforce the legislation. That sounds like a not unreasonable figure, but the way in which it is distributed is quite important. If it is going to be done on a one-year rolling basis, that makes it difficult for local authorities to employ staff; you need some stability if you are going to employ staff. We think that, if it will be £10 million, it needs to be on a four-year cycle so we know that for four years we have that money and can employ the staff.
The other issue to be concerned about is that local authorities that I know—I am a local authority man originally—have been under huge pressure. There is always a temptation to take whatever money is there and use it on the highest priority. If this money is to go to tobacco and vaping, I am afraid that it probably needs to be ringfenced. I know there are some local authority former members here who will not agree with that—I do not normally agree with it, because I think local authorities should have the space to make their own decisions—but if you want this money to go to tobacco and vaping, it will probably need to be ringfenced.
I will make two final points. I know it sounds like a detail, but quite a lot of money has to go on storage and disposal. We think it is about 50p to £1 for every vape. That has to come out of the £10 million. Finally—this is really important—some investment has to be made at ports of entry. That is probably the most important intervention of all. We depend on UK Border Force in particular to give us the intelligence to enable us to target our efforts. We are already responsible for product safety at ports, so we rely on UK Border Force. That needs to be properly resourced because, as you will appreciate, it has a lot of other important priorities. If it is going to be effective at port level, we feel that about 20% of whatever money we get needs to be spent there.
I say that with some knowledge, because I visited a couple of ports before Christmas just to see how the product safety stuff was dealt with, and I was pretty shocked. I went to Southampton and Dover, and I must say that on occasions I felt that whether or not we were successful was pretty random. As I say, we were often not getting the intelligence from UK Border Force to enable us to target our resource, and I understand why. We only have a very small number of staff at these ports. We should not underestimate how important port entry is and some money has to go to that. That is a long answer to your question: £10 million sounds like a lot, but if you put in storage, disposal and ports, that makes it look rather less generous, and it probably has to be ringfenced and done on a four-year basis if it is going to have an impact.
Dr Johnson
Thank you, that is a really helpful answer. We know that vapes are very difficult to dispose of and to recycle.
Andrew Gwynne
Q
Lord Michael Bichard: I think we do feel we will have the right powers, based on the fact that we are already doing some of this quite successfully. We seized something like 2 million vapes last year; we carried out 400,000 test purchases—which is how we check whether or not the legislation is being enforced—and we seized, I think, 19 million illegal cigarettes. So in a way, this is not new stuff for us; it is just bigger. We have the powers and we use them quite effectively. We know that HMRC thinks we are pretty effective in relation to tobacco. We like to think we are a good delivery agency.
Wendy Martin: There has been a lot of work in the development of the Bill and the associated Department for Environment Food and Rural Affairs legislation around the ban on single-use vaping products with officials, so we have worked together with them to try to get this to a good place in terms of enforcement powers.
The Chair
We will now hear oral evidence from Inga Becker-Hansen, who is policy adviser for retail products at the British Retail Consortium. For this panel we have until 3.50 pm.
Dr Johnson
Q
Inga Becker-Hansen: Good afternoon, and thank you for the opportunity to speak. The question was about age verification, I think—sorry, it is a bit quiet for me here.
Dr Johnson
Yes; what are the challenges in implementing the new regulations?
Inga Becker-Hansen: One of the key challenges of age verification is this idea of the rolling age for the smoke-free generation. At this point it is quite identifiable, with those under the regulation being 15, but in 30 years’ time if you have someone who is 45 versus 44 from the date of January 2009, it may lead to ID for each sale of a given product, if that makes sense. This will eventually lead to potential issues. Points of sale can be a flashpoint for violence and abuse against retail and shop workers, so it is a real concern for retailers that that could be an issue in the future in terms of the smoke-free generation and the ageing of that generation.
We would also like to highlight that a digital ID could possibly make things easier. The Department for Business and Trade is promoting the use of digital ID for alcohol consumption. That could potentially be included as a means of age verification to make the process easier for the average consumer and member of the public.
Dr Johnson
Q
Inga Becker-Hansen: Specifically for under 30 or 40 years old, I do not think we have anything. I imagine that with the Bill something would be implemented.
The Chair
Could I ask everybody to speak louder, please? The microphones are not very good at picking up the sound.
Inga Becker-Hansen: Okay, no problem. In terms of age verification for product sale, our members have lots of experience of the sale of tobacco and alcohol products. They have till prompts looking at the date of birth of the customer in the store. There are also badges, posters and mystery shoppers to ensure that they are compliant. Challenge 25 has been implemented since 2009, and our retailers are very compliant with it. There are due diligence procedures that are agreed with primary authorities. I imagine that in terms of identifying sales for people under 30 or 40, it would be a matter for retailers to discuss with their primary authority to identify the best route for that in store.
Dr Johnson
Q
Inga Becker-Hansen: In terms of the licensing scheme for smaller retailers, it is more about the administrative burden that there will be, and the cost of that. Smaller retailers may not have as much capacity with regard to the licensing scheme. It is quite difficult to comment on it at this point, because we do not know the full detail. If the licensing scheme were to bundle alcohol and vapes and tobacco, or if they are separate or together—those are all the kinds of questions your smaller retailers will have to take on board with regard to the licensing schemes and what they can and cannot provide for their customers.
It will affect revenue for smaller retailers, so it is something to bear in mind. There will be increased bureaucracy and increased costs. We would welcome the opportunity to discuss and contribute to the design of the scheme, but we do not know the full detail, so it is quite difficult to comment on how it will or will not affect smaller retailers specifically.
The Chair
We will now hear oral evidence from Matthew Shanks, who is the chair of the Secondary Headteacher Reference Group and chief executive of the Education South West multi-academy trust. For this panel, we have until 4.10 pm.
Dr Johnson
Q
Matthew Shanks: That is quite a large question, but I can answer it from an anecdotal point of view and from talking to colleagues around the country.
Vaping is a bigger problem than smoking within schools. Children who would not contemplate smoking—sporty children, dancers and so on—engage in vaping because they see it as harmless. It is easily accessible. It is very difficult to detect in schools in a way that cigarette smoking is not. It is seen as very fashionable in terms of the way it is advertised and promoted. I am not saying that this is happening in every school, every day, but we can report instances of children going out of lessons to vape in toilets or various places. Vaping is difficult to catch, because there is no smell, unless they use bubblegum, grapefruit or other such flavours. It is having a huge impact on discipline within schools—on ensuring that children are in lessons, or are in school in the morning on time, and not off-site at lunch time looking for places to vape and so on.
Dr Johnson
Q
It is difficult to prove what is in vapes. Again, there are instances of vapes containing illegal substances, but that is difficult to prove, because of their small size and where they can be secreted or hidden. There is evidence out there of drugs being contained in vapes—snus or Spice in the vapes—being quite addictive. Any kind of addiction leads to misbehaviour, particularly if you put that into secondary schools or among older children in primary schools.
Dr Johnson
Q
Matthew Shanks: To speak frankly, those vapes are not marketed at 40-year-old people who are trying to give up smoking. I do not think that vaping is marketed at people who are giving up smoking—it is not a cessation tool: it is a tool to encourage young people to engage in something else. I have talked before about this—it is almost the gateway from chewing gum to the next stage. Half a mile down the road, if you walk towards Trafalgar Square, a shop on the right-hand side—I passed it walking in—is full of colourfully arranged vapes, which do not look harmful; it looks like a sweet shop.
Marketing and selling a vape that looks like a mini pen drive or a highlighter is only done so it can be secreted and make it difficult to catch students with them. We have had instances where part of the vape can be slipped into a bra, so we cannot search and find it. As I was saying, it is difficult to know what is in the vapes or whether people are actually vaping, which leads to confrontation between teachers, children and parents.
More recently, one of the things we have found is that, although they are still fashionable, we have seen a lack of fashionableness around the single-use vapes, because of the impact on the environment and the hope that they will be banned. There is far more reluctance—with arguments caused—among children and parents not wanting to give up larger vapes, because they have paid for them, and that therefore brings parents into conflict with teachers when they want to claim back their children’s vapes. Sometimes those vapes are their parents’ vapes or, sometimes, vapes that they have spent a lot of money on. My view and that of colleagues that I am representing is that vapes are not being advertised to help people to cease smoking; they are being advertised to encourage people to take up a habit.
Dr Johnson
Q
Matthew Shanks: At the moment, there is a vacuum around an understanding of what vaping is and what it can and cannot do. I cannot talk to the health aspects, because I am not a health expert, but it is something that is not clear. Because it is not clear, that is enabling children to engage in it and parents to encourage children to engage in it. There are instances of parents giving it as a reward because it is not a cigarette and they therefore see it as being “safe”. I think the Bill will help with that.
What is really important is the messaging and the education around the harm that vaping can do to young people and to adults as well. We need to bring it back to the original reason why vaping came about in the first place, which, as far as I was concerned, was about ceasing smoking. Lots of my friends took up vaping to cease smoking. They do not vape any more or smoke, but lots of children vape who would never contemplate smoking.
Dr Johnson
Q
Matthew Shanks: Children are very clever, and they will find a way round. On the other hand, far be it from me to sit here as a teacher and talk about funding, but vape detectors would cost money. Smoke detectors are in schools anyway, so it is far simpler. I think children will find a way around it. We saw a real decrease in cigarette smoking with the advertising and marketing. I have been teaching for 30 years, and we saw a decrease in that, but you cannot win an argument at the moment with parents or children talking about the dangers of vaping. That is the hardest thing.
Andrew Gwynne
Q
Matthew Shanks: I think it will, but for some it will not unless it has the education behind it as well. I also think it is too easy for children to purchase vapes. It is all very nice to think of shopkeepers not allowing children to buy vapes or tobacco if they are under age. I am not denigrating them, but we have instances, for example, of a year 9 child who had a loyalty card for a vape shop. She is 13 years of age—she did not look 18—yet she is being sold that at the local shop. You go in and talk to the local shop and they say that no, of course they have not sold it to her, and then there is conflict there. We need to look at the legality of it and sterner punishment, for want of a better word, for people who are found to be selling.
The drop box online purchasing industry also needs to be looked at. I do not know how, but again, we know that people purchase vapes from those places. The education side is for parents, because parents and older brothers and sisters think it is safe and will therefore give them a vape. The Bill will help, but there are other things that could help as well.
The Chair
Now that things have settled a bit, I welcome Dr Laura Squire OBE, from whom we will now hear evidence. She is chief healthcare quality and access officer for the Medicines and Healthcare products Regulatory Agency. For this panel, we have until 4.30 pm, which is obviously 20 minutes.
Dr Johnson
Q
Dr Laura Squire: Thank you very much for that question—I welcome the chance to answer it. As you say, we are a healthcare products regulatory agency. That is what we are about. When a medical product comes to us, it has a medical purpose. For example, it might be something that is prescribed to help someone deal with issues of nicotine withdrawal and to get them off a product. That would be licensed as a medicine because the active ingredient in it is a medicine. The Medical Devices Regulations 2002 sometimes come into that too.
In order to give a licence to a product such as that, the manufacturer that has produced it will need to give us a dossier that has clinical and quality evidence in it—all sorts of things that go through a detailed assessment by our very skilled assessors, some of whom are medics and some of whom are skilled in pharmacy and also look at quality.
It is important to say that when we license any medical product, we do not say, “This product is safe.” We consider the risks and benefits of the product, and if the benefits outweigh the risks, we will give it a licence. We always say that medicines are not safe things, so if you do not need them for the benefits, do not take them.
The approach that we take on consumer products is very different. That is not an assessment process; it is a notification scheme that we undertake under the Tobacco and Related Products Regulations 2016, whereas before I was talking about the Human Medicines Regulations 2012 and the Medical Devices Regulations. Under the Tobacco and Related Products Regulations, we basically have a notification scheme. The manufacturer of a consumer e-cigarette would have to come to us and show that the product has the 20 mg, and that the refill container has no more than 10 ml, and then there are some limited labelling requirements. But we do not inspect or test that product; it is a data check to see whether those things are true, and then it goes on to the register. It is a very simple notification scheme, which is very helpful in terms of having a single record of what is out there on the market, but it is nowhere near the sort of assessment that we would do if it were a prescribed product that was proven to help people stop smoking.
The other role, once any product within our remit is on the market, is post-market surveillance. We have something called the yellow card scheme—people may have heard much more about it during the pandemic—whereby anybody can report a problem with a product. That covers consumer vapes, medical e-cigarettes and other nicotine-containing products that we might license.
We examine all the reports that we get, and if there is a signal that there is a problem, we sometimes issue a safety communication. We did that a couple of years ago when there was some evidence of lung damage. We have that role, and we often co-operate with other organisations where there is a need for enforcement. We heard from trading standards earlier, which does that. The roles are very different.
Dr Johnson
Q
Dr Laura Squire: I do not have any evidence of that, but it does worry me. We are an organisation that is about healthcare products, medicines, medical devices and blood products—that is our business—and it concerns me that people might think that vapes are safe. When I talk about risk-benefit, what I mean is that vapes are safer than tobacco; I do not think that anyone disagrees with that. However, vapes are not safer than nothing—and we do not actually know how unsafe vapes are, because there is a need for much longer-term study and understanding of the damage that they could cause.
My feeling is that, yes, there is potentially a misleading position with an organisation like ours, which is basically about healthcare products, running this scheme.
Andrew Gwynne
Q
Dr Laura Squire: I think we heard earlier about the different elements you need to make something work—licensing, regulations and registration—and I agree with that. I think it was also mentioned that registration is important to allow compliant businesses to check that the product that they have is compliant.
The significant problem with the notification scheme at the moment is that there is not an easy way to take something off the register once it is already on it. That is a problem, because if people are checking the current register, there might be something on it that we would quite like to take off but cannot.
There are powers to take things off the shelves, so if there was a recall issue, that could be dealt with. However, the main problem, or the primary thing in the Bill that I think needs to change, is having powers to take things off the register. Obviously, we must consult on the regulations themselves, but we welcome that change.
The Chair
For this panel we have Professor Steve Turner, the president of the Royal College of Paediatrics and Child Health, and Professor Sanjay Agrawal, the special adviser on tobacco at the Royal College of Physicians. We have until 4.50 pm for this panel.
Dr Johnson
Q
Professor Steve Turner: I will answer that question. Thank you for accommodating me; I have flown a long way. I thank Professor Bauld for reshuffling the order of the panels. I am passionate about this issue, and I am grateful to be able to contribute.
Vaping is harmful for children, and the evidence is accumulating. Vapes contain nicotine, which is harmful to us as human beings. You have heard previously from Matthew Shanks of the Secondary Headteacher Reference Group about the impact of vaping on children’s education. There are evidences of children coming to harm from vaping devices bursting into flames. There is a lot of talk about something called popcorn lung, which fortunately is very rare, but it is very serious and can affect children who vape. Collectively, there is already a substantial burden of evidence that vaping is harmful for children.
Dr Johnson
Q
Professor Steve Turner: The Royal College has 24,000 paediatricians in the UK and overseas, so we are a substantial college. We strongly support the Bill as it is. We believe that it provides the right protection for the most vulnerable members of our society—our children, who are our future—and that it is proportionate. We think the Bill as it stands addresses all the concerns that you just raised, and others.
Dr Johnson
Q
Professor Sanjay Agrawal: The majority of adults who vape have smoked, so they are using vapes to quit smoking. The amount of research that looks at populations who have never smoked, who have only vaped, is actually quite small—the longitudinal studies are still not there. We know from shorter-term studies that vaping can lead to things like coughing and throat irritation, but it is important to consider the alternative, which is continued smoking.
I estimate that, in the roughly 30 years since I qualified and started professional practice, about 3 million people in the UK have died from smoking tobacco. The intensive care unit in which I work and the lung cancer clinics that I do are full of people who have come to harm from accrued smoking. There should be no doubt that smoking combusted tobacco is the key thing that we want to prevent future generations being subjected to. There are still 6 million smokers in the UK, and we need to help as many of them as we can to stop smoking. Vaping is one means by which they can stop smoking, and that is really important.
Dr Johnson
Q
Professor Sanjay Agrawal: There are a few things to unpack there. First, a lot of people who smoke and who want to give up use vapes because they have tried other products and have not been able to give up, be that nicotine replacement therapy or tablet pharmacotherapy. One thing those people want to get away from is the taste of tobacco, and having flavours allows them to do that. Actually, other NRT products, such as gums and lozenges, also have fruit flavours—it is not just vapes. Flavours are an integral part of helping people to get away from smoking.
Equally, as we know, flavours attract young people to smoking, so it is really important that we limit the number of them. However, the flavour descriptors are perhaps more important: I think we need to make them bland. The Bill, as it stands, provides powers to restrict all sorts of elements related to vaping, such as the number of flavours, the descriptors, the packaging, the appeal and the advertising. Having bland descriptors and eliminating flavours that we know are popular among children would be really helpful.
Dr Johnson
Q
Professor Sanjay Agrawal: First, there is good survey evidence of what is popular among adult smokers who are using vapes to try to quit, so that is one helpful factor. Then there are flavourings that are potentially associated with harm. Cinnamaldehyde has been associated with harm, so that would be one, for example, that you would remove.
Dr Johnson
Q
Professor Sanjay Agrawal: No.
Andrew Gwynne
Q
Professor Steve Turner: Smoking is bad whether you are an active smoker or a passive smoker. Sadly, there are lots of children who still actively smoke, but there are many hundreds of thousands of children who are exposed to second-hand smoke in the home. There is undeniable evidence that that exposure is harmful. I do respiratory paediatrics. Asthma admissions are very common and are clearly associated with exposures.
We can look at natural experiments. For example, in Scotland we had the “Take it right outside” campaign, which was a smoke-free homes initiative. After that, there was a reduction in the number of children coming into hospital. When we brought in the ban on smoking in cars in Scotland, there was another reduction. On that whole-population basis, there is a lot of evidence of benefit to the population, particularly children, from smoking interventions. There are also benefits to the birth weight of children.
There is no doubt that there is a huge amount of harm from second-hand smoke, and anything that reduces the population’s exposure to second-hand smoke will benefit the whole population. As we heard earlier from Matthew, the headteacher, it is part of a package, and it is part of education as well. Smoking continues to be something that children should not do. Children should never vape. Children should never smoke. They continue to do so, and anything that we as a responsible society can do to stop that is to everybody’s benefit.
The Chair
For the record, our final witness is Andrew Gwynne MP, Parliamentary Under-Secretary of State for Public Health and Prevention at the Department of Health and Social Care. We have until 5.20 pm.
Dr Johnson
Q
Andrew Gwynne: Thank you for that question. I was not actually on the Bill Committee when the previous iteration of this measure went through Parliament, because I was the shadow Social Care Minister—I had been bumped away from public health, only to return to it in government.
The starting point is a recognition that the previous Government brought forward a Tobacco and Vapes Bill, which was incredibly foresighted of them. I thank those—including you—who supported that proposed legislation. We have to be mindful of the fact that the first thing we are seeking to do is to make the United Kingdom smoke-free, and smoke-free as soon as possible. As we heard from the chief medical officers from the various nations that make up the United Kingdom, tobacco is a killer. Our first target has to be driving down the instances of smoking and, as a consequence, of tobacco-related death and illness, and the harms caused by second-hand smoking. That is why the measures in so far as tobacco is concerned are far weightier than the measures in respect of vaping.
The other thing I would like to say in answer to your question—this is an important point; we are concerned about nicotine addiction—is that we need to get the balance right. We recognise that vaping is an important smoking cessation tool—as the CMO said, not all countries share that point of view, but in the United Kingdom we see it as an important part of the package to help people to quit smoking. There has been a very successful scheme in this country, the Swap to Stop initiative, and that is an important part of this.
We are really concerned about the scourge of child and youth vaping, however, and that is why we think that the measures in the Bill are proportionate, because we are tackling a specific issue: stopping children taking up vaping and trying to dissuade adults who have never smoked from taking up vaping. As the CMOs have said, vaping is better than smoking, but not vaping and not smoking is the best option of all.
This is a proportionate measure. As you know, we are seeking quite far-ranging powers, and that is to ensure that, across the four nations, we can react as industry reacts to these changes so that this Bill will be future-proof. If we were overly prescriptive, we would then have to come back to Parliament with further primary legislation. While we are not seeking to be nicotine free at this moment in time, there will be powers in the Bill that allow, at some stage in the future, the Governments that make up the United Kingdom to consult to go further. The aim now is to stop smoking, to get to our smoke-free targets and to crack down on childhood vaping.
Dr Johnson
Q
My other question is about advertising. You will be aware that I put forward an amendment to the Conservative Bill to try to restrict advertising, because I think it is important to try to restrict advertising to children. How will health professionals who are promoting vaping as an alternative to smoking specifically in a medical setting, not necessarily on the tube or the side of a bus, be protected from being criminalised?
Andrew Gwynne: This is an area in which this Bill really does build on the previous Government’s iteration of the Bill. I want to take the politics out of it and thank Members such as yourself who really pushed this last time round. We are able to do this because it was a commitment of the Labour party in the 2024 manifesto that we would ban the advertising of vapes and the promotion of vapes in sponsorship. There is 75% support for an advertising ban on vapes.
In terms of being able to promote vapes as a quit aid, of course, you will have read in part 6 of the Bill that it is only an offence if advertising is done in the course of business. That excludes the promotion of vapes as a quit aid. That is something that hopefully you will welcome.
Dr Johnson
Q
Andrew Gwynne: Oh, you will get me on my hobby horse, having mentioned bongs. All tobacco products will be covered by the measures in this Bill. Shisha is covered. Shisha is a harmful product, as are other tobacco products. In respect of paraphernalia, I have raised with officials and colleagues in the Home Office what I see as a potential issue: if this Bill becomes law, as I hope it will, and there is further consultation on the packaging and display of vapes, we could end up with a situation where vapes, like cigarettes and other tobacco products, are hidden behind cabinets in plain packages, but those same newsagents have bongs in the window. I am assured by my officials that bongs and grinders can also be used for the consumption of tobacco, and therefore will fall within the scope of the measures in this Bill in that they will not be able to be displayed.
Dr Johnson
Q
Andrew Gwynne: Well, we cannot easily do so. The powers in the Bill mean that we have a statutory duty to consult. As we have already heard, Wales already covers the areas that we wish to consult on in respect of England. Scotland, Northern Ireland and Wales will have their own consultations. But as far as England is concerned, the Government have been very clear that, should this Bill pass, we will consult on implementing smoke-free areas outdoors around children’s playgrounds and schools and outside hospitals.
Given the media interest and speculation over the summer as to outdoor areas to which the Government might extend the outdoor restrictions, including hospitality, it would not be possible for any Government to just wake up one day and decide they were going to extend these measures to x, y and z and for nobody to notice. It would be on the front cover of every newspaper and all over X, Facebook, Bluesky and other social media. People would be very aware of a Government’s intentions to extend outdoor smoking and we would be under a statutory duty to consult and to pursue secondary legislation, which is ultimately subject to a vote of the House.
Dr Johnson
Q
Andrew Gwynne: That is a really important question. It is why, at every opportunity today, I have been asking those with an interest in public health in Wales what lessons we can learn. We want to get this right. The reality is that alongside the package of enforcement we will bring forward—the registration; the licensing scheme; the fixed penalty notices—we have to approach this with a degree of proportionality, particularly to ensure that there is as good a compliance with the regulations as possible.
Most people are law-abiding citizens, and we saw with the indoor smoking ban introduced in 2006-07 that most people complied from day one. I really expect that most people will comply in respect of children’s playgrounds, schools and hospitals. I would hope that the enforcement agencies use a degree of discretion and proportionality at the outset to ensure that those not complying understand that they are potentially breaking the law and should stop doing what they are doing.
The Chair
We have about 15 minutes left, and five Members wish to ask questions. Could they do that briefly, and could we have brief answers too?
Tobacco and Vapes Bill (First sitting)
Caroline Johnson ExcerptsTuesday 7th January 2025
(1 year, 2 months ago)
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The Chair
We are now sitting in public again and proceedings are being broadcast. Before we start putting questions to the witnesses, do any Members wish to make declarations of interest in connection with the Bill?
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I am an NHS consultant paediatrician and a member of the Royal College of Paediatrics and Child Health.
The Chair
Sorry about the distracting noise; we are trying to sort that out.
We will begin by hearing oral evidence from Professor Sir Chris Whitty, chief medical officer for England; Sir Francis Atherton, chief medical officer for Wales; Professor Sir Michael McBride, chief medical officer for Northern Ireland, who will participate via Zoom; and Professor Sir Gregor Ian Smith, chief medical officer for Scotland. We have until 10.25 am for this panel.
Dr Johnson
Q
Professor Sir Gregor Ian Smith: First of all, thank you to the Committee for inviting me to give evidence. I think this is an incredibly important step. I have been concerned—
The Chair
I apologise, but I think people are struggling to hear over the noise; I certainly am. Could everyone enunciate more clearly and speak a little louder?
Professor Sir Gregor Ian Smith: First of all, thank you for the invitation to provide evidence. I think this is a really important step that we can take to protect children from vaping. I am very clear in my mind that vaping has a place in helping those already smoking to stop smoking. It has a place in smoking cessation, but children, young adults and indeed adults who have never smoked should never start vaping; there are too many uncertainties about the health consequences of vaping for that to be encouraged.
In restricting children’s access to vapes and reducing the attractiveness to children of some of the vaping products currently marketed, the Bill will protect children from the potential health consequences of vaping itself and from the potential of vaping to be a gateway to the use of other nicotine products, for which there is emerging evidence. I am certain that the Bill will help to protect children from the dangers associated with starting to vape.
Dr Johnson
Q
Professor Sir Chris Whitty: I think the first thing to say is that second-hand smoke is a very serious problem. I think that is underestimated among the general public because, if I am honest, the cigarette industry has been very successful in muddying the waters on this.
There are three key things that really make a difference. The first is the degree of concentration of the smoke. The second is the duration of exposure—let us say you sit next to someone for half an hour; the effect is more significant than if it had been just a couple of minutes. The third is the vulnerability of the people being exposed to it. That is one of the things that this Bill will help with.
Over 88% of the population do not smoke. There are roughly 6 million smokers still. There are significantly more people in the UK, non-smokers, who have medical vulnerabilities that mean that the smoke is particularly dangerous to them, perhaps acutely. They can be exposed to smoke and have an asthma attack, and that lands them in hospital. In severe cases it could land them in a very dangerous situation. The situation may also be chronic—for example, people living with diabetes already have a disease that is going to accelerate things like cardiovascular disease. If people are smoking on top of that, it will accelerate those things still further.
Although outdoor smoking is less in terms of passive smoking than indoor smoking, in most situations if you are close to someone, exposed for a long period or vulnerable, it can have very significant health impacts. In broad terms, if you can smell smoke, you are being exposed to significant amounts of smoke, and that is one of the things that the Bill is aiming to address.
I would like to make one additional point: the cigarette industry has been extraordinarily good at trying to pretend that to be pro-smoking is to be pro-choice. Nothing could be further from the truth. Smoking is highly addictive. Most smokers wish they had never started and want to quit, but they are trapped by addiction. Their choice has been taken away deliberately by these companies as part of their policy. And if you are talking about second-hand smoke, indoors or outdoors, the person downwind or next door has no choice at all at any point. They are exposed to the risks with no advantages at all. If you are pro-choice, you should be firmly in favour of the principles of the Bill. Frank, do you want to add to that?
Sir Francis Atherton: The only thing I would add is that there is no safe level of smoking. As Chris says, if you smell it, you are breathing it in, and there is no safe level. Obviously, indoors is worse than outdoors. The dose response is a big issue, but there is no safe level. I think that is a really important point.
Sarah Bool
Q
Professor Sir Chris Whitty: I might ask Michael to come in. I can have the first go and Michael might want to come in after that, because this is a critical point. Historically, the cigarette industry, despite what it claims, has always targeted children. It always deplores it in public, but if you look at its internal documents you discover that that is what it has been aiming to do. Most people, the great majority, start as teenagers before they are 20—you are, of course, correct. To refer back to Dr Johnson’s original question, the same thing is now being done with vaping and exactly the same playbook is being followed. You get people at their most vulnerable and you addict them. That is the aim.
However, were we to stop at, let us say, 21, the cigarette industry, which is extraordinarily good at regrouping around whatever regulations are in place, would simply regroup around 21. To go back to my very first point about addiction, if you are a 21-year-old and you start, you become addicted and then you wish you had stopped. That does not change the fact that your choice has been taken away. So the logic of saying 21, 25 or 30—various people have looked at various ages—is no better than the logic of the current situation.
The advantage of the current model, which was first put forward by Conservative Prime Minister Mr Sunak, to whom we should all pay great tribute on the basics of the Bill, was to ensure that current children are not addicted and do not have their choice taken away, but that rights are not taken away from existing smokers. That is the reason why this particular model was chosen. Michael, do you want to add to that? You are on mute.
The Chair
I call Caroline Johnson—apologies; I should have called you before the Minister.
Dr Johnson
Q
Hazel Cheeseman: That will be a really crucial question as this Bill progresses, and it was touched on by the chief medical officers. The nature of this Bill is that we are taking powers across a range of areas, which we know will help us to prevent the uptake of vaping among children, which we are all concerned about. We are restricting the marketing of vapes and the way they are branded, and taking powers around the design of products and in relation to flavours. It is important that those powers, as was discussed in the last session, are broad in the Bill and defined through further consultation and regulation, giving us that flexibility to shape policy going forward. We know from our experience in reducing smoking among children that the things that will work are reducing the appeal, reducing the availability and reducing the affordability of products. The Bill, alongside the excise tax that is planned for 2026, will take us a long way on that journey to addressing those aspects and reducing the appeal among children.
We also want to ensure that products remain available for adult smokers to switch to. We know from our own research that adult smokers have very inaccurate views at the moment about the relative harms from vaping compared with smoking. Part of the issue is the way in which products are branded and pushed in people’s faces when they go into every corner shop up and down the country. That prevents the understanding that these products might be valuable for smoking cessation and promotes the idea that they are a kind of lifestyle choice for teenagers. Removing the branding and the displays in shops will allow the message that these products could be valuable to help people stop smoking, and will allow that message to land more easily than it currently does. That will hopefully realign those misperceptions and get us back to the position that we were in in, say, 2019 or 2020, where these products were being used as a smoking cessation tool and not really being used by other groups in the population. If we can get back to that, that would be the ideal scenario. Hopefully, the legislation takes us a bit closer to that.
Dr Johnson
Q
Sheila Duffy: We see that socioeconomic inequalities and smoking rates are closely patterned. ASH Scotland’s work with low-income communities in Scotland suggests that people regret beginning tobacco, but find it hard to move away from it. It also identified the dangers of less regulated novel products such as e-cigarettes in enticing their children and grandchildren into the kind of addiction that they themselves so regret. One of the real strengths in the Bill is the ability to bring some of these tobacco-related products into the kinds of control and regulation that we have fought so hard over decades to get for tobacco products.
Sadik Al-Hassan
Q
Hazel Cheeseman: The purpose of the legislation is to reduce smoking. The Department’s projections in the impact assessment clearly show that, even on conservative estimates, it will achieve that goal over time. So the question then is, does that lead to displacement into other products? Given that the legislation is comprehensive in relation to tobacco products, it is to be hoped that it will not lead to displacement into other kinds of tobacco products, but it might lead to some displacement into other nicotine products. As the chief medical officer said in the previous session, it is unlikely that nobody will take up smoking in the affected age group. Some people will; some of the 15-year-olds who will be affected by this legislation have already tried smoking. So we need there to be a legal nicotine product that those people will be able to use, with the restrictions that are coming into place in relation to vaping and other nicotine products in this legislation. One would not expect the overall consumption of nicotine to be greater than it otherwise would be, if that makes sense, but there may be some displacement into other nicotine products as we transition away from smoked tobacco and from tobacco being used widely in that group.
Sheila Duffy: Dual use is a real concern in Scotland. Nearly 43% of people are dual-using cigarettes and e-cigarettes. The international longitudinal cohort evidence clearly shows a higher risk of progression to using combustible tobacco for young people that start vaping. I think this legislation has the real potential to move us away from that.
Suzanne Cass: We also have to remember that the killer in the room is tobacco. The generational ban is the most crucial part of this legislation that we need to push forward. Therefore, we need to keep our eye on the ball when we are looking at the health impact, and the potential public health impact, of this Bill, and to make sure that we focus on driving down that tobacco use.
Naomi Thompson: Just to reiterate what Suzanne has said, tobacco is the issue. The impact of tobacco was repeated multiple times in the previous session. If young people start, they continue, and they find it very difficult to stop. Therefore, if we can sort that, it is a great first step. There may be a small move towards other nicotine products, but we can work on that. Tobacco is the one that kills.
The Chair
We have the third panel of witnesses from now until 11.25 am. We will hear evidence from Dr Ian Walker, the executive director of policy at Cancer Research UK, and Sarah Sleet, the chief executive officer of Asthma and Lung UK.
Dr Johnson
Q
Sarah Sleet: In general, there is very little evidence around vaping, and we need a really considerable effort to get the evidence in place, but we do know that nicotine in general is not healthy for children, and vaping nicotine products will not be good news. We have some evidence about the harms that it causes—we know that nicotine in particular is very problematic for very young children and developing brains—but we do not have the same level of evidence base that we have with tobacco. That is why this Bill and the precautionary approach that it takes in terms of restricting children’s access to vapes and the attractiveness of vapes to children is very important.
Dr Johnson
Q
Dr Ian Walker: First, thank you very much for the opportunity to be here. I start by thanking Parliament for boldly introducing this Bill; it is genuinely world leading. I have spoken to organisations across the world that are envious of the position we find ourselves in. That is a very important question, and the answer is absolutely yes—I think this Bill will be very important in reducing the number of cancers caused by smoking tobacco. We know that there is no bigger thing we could do to actually influence that going forward for the next generation and generations thereafter.
As you have heard this morning, we know that we still have 6 million people smoking across the UK, and we know that we can expect hundreds of thousands of cases of cancer caused by smoking over the term of the next Parliament. As we move towards a truly smoke-free generation over the next 20, 30 or 40 years, we will absolutely expect to see the number of cancers caused by smoking—and, alongside that, the number of other illnesses associated with smoking—reduce.
Andrew Gwynne
Q
Dr Ian Walker: To start with smoking and cancer, the links between passive smoking and cancer, particularly lung cancer, are very clear. It is fair to say that there is less evidence around different scenarios that you might predict through this Bill, such as different outdoor environments and so on, but that is more because those studies have not necessarily been done. It is an important point to make that there is an absence of evidence, rather than evidence of absence.
You heard from the CMO of England this morning that if you can smell cigarette smoke, you are exposed to it. The direct risk, then, is linked to how long you are exposed to it, how concentrated the environment is, how close you are to it and so on. Nevertheless, passive smoking is harmful—not just for cancer, but for vulnerable people with many other conditions as well—so we are very much supportive of the introduction of smoke-free places and the ability to restrict people smoking in particular outdoor spaces.
Sarah Sleet: When it comes to people with lung conditions, second-hand smoke is incredibly important; it is a well-known, severe risk factor for people with lung conditions. About one in five of us in the UK will experience a lung condition—there are around 7 million people with asthma and about 1.6 million people living with chronic obstructive pulmonary disease. Those are two major conditions that are profoundly affected by second-hand smoking, and are clear risk factors in terms of deaths from asthma and people being hospitalised with exacerbations, so it is incredibly important that we deal with the issue of second-hand smoking. People said earlier that there is no choice about second-hand smoking, and yet it profoundly affects those with lung conditions. It is incredibly important that we ensure that we protect those vulnerable people as far as possible.
When it comes to the discussion about how far we should go in terms of smoke-free and vape-free places, we would consider going further than what has been suggested already and looking at other areas to make smoke-free. I know there has been discussion about hospitality and trying to balance the potential economic impact that has been talked about if we make the outside of hospitality places smoke-free. However, we think, given the balance between the public health impact and what we have seen with smoke-free indoor spaces and its impact on business, we could go further and should go further, there.
Oral Answers to Questions
Caroline Johnson Excerpts(1 year, 2 months ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Thank you, Mr Deputy Speaker. [Interruption.] I am sorry—that is the last time I will get called. Thank you, Mr Speaker.
Yesterday, in relation to the elective backlog, the Secretary of State said:
“Where we can treat working people faster, we will, and we make no apology for doing so.”—[Official Report, 6 January 2025; Vol. 759, c. 597.]
Labour politicians have struggled to define what they mean by working people, but his words have caused anxiety. Will he reassure those with disabilities that prevent them from working and retired elderly people who have worked all their lives that they will not be pushed to the back of the queue and that treatment will continue to be provided in the NHS on the basis of clinical need?
Wes Streeting
Of course, clinical need is paramount and must always drive decision making about who to treat when and the order in which people are treated. That is why I find the question posed so deeply disingenuous. [Interruption.] We inherited NHS waiting lists at record levels and waiting times that are frankly shameful. The shadow Minister should be apologising for her party’s record, and she should also apologise for the two-tier healthcare system that sees those who can afford it paying to go private and those who cannot afford it—working-class people—being left behind. That is the two-tier system that the Government are determined to end.
Dr Johnson
The Secretary of State needs to be careful with the words he uses, as you said, Mr Speaker, because his words did cause anxiety among people. It was not a disingenuous question; it was a genuine question to make sure that people are reassured.
It will not have escaped the Secretary of State’s notice that it is cold outside. Removal of the winter fuel allowance has reduced elderly people’s ability to follow the advice that he gave last week, which was to turn the heating on. What assessment has he made of the number of additional admissions caused by his removal of the winter fuel allowance? What effect is that having on the Government’s ability to deliver their reduction in elective backlogs?
Wes Streeting
What the shadow Minister neglects to mention is that the Chancellor has protected the winter fuel allowance for the poorest pensioners, and she has also put in place the warm home discount to assist people with their energy bills throughout the winter. If the shadow Minister does not support the decisions that the Chancellor took at the Budget and ahead of the Budget to raise vital investment for our health and care services, that is fair enough, but then she needs to tell people which NHS services she would cut or which other taxes she would increase.
NHS Backlog
Caroline Johnson Excerpts(1 year, 2 months ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Thank you, Madam Deputy Speaker—a very happy new year to you. May I also wish the grandmother of the hon. Member for Bury North (Mr Frith) a speedy recovery? I should declare an interest as a consultant practising in the NHS. My brother is a GP and I am on an orthopaedic waiting list, so I am one of the statistics.
I am looking forward to working constructively with the Government over the next year to deliver for patients across this country. The NHS has been looking after us for more than three quarters of a century. During that time, the practice of medicine has transformed. Cures have been found, and people are living longer and healthier lives. I thank all those staff who have been working in the NHS and social care across the Christmas and new year period.
We all recognise that the NHS is under pressure. We have an ageing population, patients with more complex needs and innovative, but expensive treatments. The pandemic added a huge strain to the NHS. Resources were redeployed away from elective care, and much elective care was postponed to reduce the spread of covid. For example, before the pandemic, 54 women had been waiting more than 12 months for a gynaecological appointment. By the time the pandemic was over, that number had gone from 54 to 40,000. That was replicated across other departments in hospitals across the country.
Although the NHS now treats 25% more patients than it did in 2010, waiting lists are sharply higher. We took steps as a Government to bring them down again. Those measures were working, though not as quickly as we wished. For example, the 18-month waiting list was virtually eliminated, and the 52-week list was steadily falling, despite industrial action. Meanwhile, in Wales, where Labour has been in power for more than 25 years, waiting lists continue to rise.
There is more to do, and no one is suggesting that the issues have been resolved. Waiting lists are still too high, and that is why we funded the £3.5 billion NHS productivity plan in full to upgrade IT, to expand the NHS app and to capitalise on the benefits of artificial intelligence. The Government were elected in July on the promise of a plan, but sadly the plan has still not yet been published. The Government were also elected on a promise to deliver 40,000 more appointments per week. I wish them huge success with that, but I am not optimistic. The Secretary of State has repeatedly been asked when those additional appointments will become available, but there have been no clear answers. Will the Minister please provide one, or tell us what progress has been made?
This morning we heard more about Labour’s elective reform plan. I was really pleased to hear that the Government will continue with many Conservative initiatives, which were working.
Jayne Kirkham (Truro and Falmouth) (Lab/Co-op)
Will the hon. Lady give way?
Dr Johnson
I will not, because I have a time limit.
I was pleased to hear that the Government will continue many Conservative initiatives, such as expanding the surgical hubs programme and extending the work of community diagnostic centres, but some of the other parts were a little confusing. Patients are to have a choice of where they are treated, but they already do. They are also to receive text messages to remind them of appointment times. That is great, but it is already happening. In fact, a look back through my phone revealed that the earliest text message I could find reminding me of an appointment for my child at Peterborough city hospital was sent on 28 July 2015, so this is not a new initiative. Patients are to get results online. Well, again, they already do. If the Minister has not seen that, I urge her to visit Addenbrooke’s hospital, where, via the MyChart system, patients can already log on and read their MRI or blood results or reports. Spreading good practice is to be welcomed, but it is not a revolution. It also faces significant headwinds.
The Government are to direct activity to general practice, but GPs are already rather busy and facing financial challenges caused by national insurance contributions. How will shifting pressure improve capacity? When will GPs be able to budget? Will the funding settlement be greater than their increased costs from national insurance contributions? If resources are moved to general practice, how will that deliver more secondary care appointments? One person can only do so much work. What is the Government’s plan for the workforce, which will be so key?
Of course, it is not just GPs who are affected by the national insurance contributions. The Secretary of State talked about record investment in hospices, but before Christmas the Minister was repeatedly unable to say whether that record investment would cover the rise in national insurance contributions that those same hospices are facing. Can she update the House now?
Patients are to have the choice on whether to have follow-up appointments, which will apparently reduce a million unnecessary appointments every year. Will that be a choice for patients to have a desired follow-up appointment that is not recommended by clinical staff—in which case, that could actually increase the number of appointments required—or will it be a choice not to have an appointment that a doctor or clinician has recommended? In that case, is that wise?
It is cold outside, Madam Deputy Speaker. In fact, this morning I woke up to blizzard conditions at my window. What estimate has the Minister made of the number of extra admissions that have occurred this winter for elderly patients who have been cold due to the removal of their winter fuel allowance?
Rachel Gilmour (Tiverton and Minehead) (LD)
Will the hon. Lady give way? She has heard me.
Dr Johnson
I have heard the hon. Lady but will not give way, because the Deputy Speaker has been clear about the time constraints in the debate.
Has the Minister made an estimate of the number of extra admissions caused by elderly people who are cold due to the removal of the winter fuel allowance, what impact that is having on hospitals, and how many elective appointments that would otherwise have occurred have been cancelled as a result? We heard the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) talk about his cancelled ENT list from this morning.
We have had six months of a Labour Government. They have cancelled the building of 24 hospitals, they have launched a series of reviews, they have significantly increased costs on indirectly provided NHS services because of national insurance, and they have re-announced what has already been happening, in some cases for many years. I am a doctor and I am a patient, and I really want the Government to succeed in improving the NHS; we all do—we have heard too many troubling tales from our constituents and again this evening—but stating aims does not make them happen, and launching reviews and press releases is simply not enough.
Hospice Funding
Caroline Johnson Excerpts(1 year, 3 months ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on hospice funding.
The Minister for Secondary Care (Karin Smyth)
I am grateful to the hon. Member for Sleaford and North Hykeham (Dr Johnson) for asking that important question. This Government want a society where every person receives high-quality, compassionate care from diagnosis through to the end of life. We will shift care out of hospitals into the community to ensure that patients and their families receive personalised care in the most appropriate settings. Palliative end of life care services, including hospices, will have a big role to play in that shift. Most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. The amount of funding that each charitable hospice receives varies both within and between integrated care board areas.
On children and young people’s hospice funding, the Minister for Care met representatives from NHS England and Together for Short Lives and one of the chairs of the all-party parliamentary group for children who need palliative care to discuss children’s palliative and end of life care, and that funding stream was discussed at length at that meeting.
This Government recognise the range of cost pressures that the hospice sector has been facing over a number of years, so today I am delighted to announce the biggest investment in hospices and end of life care in a generation. We are supporting the hospice sector with a £100 million boost for adult and children’s hospices, to ensure that those hospices have the best physical environment for care, and with £26 million in revenue to support children and young people’s hospices. The funding will support hospices and deliver much needed funding for improvements, including refurbishment, overhaul of IT systems and improved security for patients and visitors. It will help hospices in this year and next year in providing the best end of life care for patients and their families in a supportive and dignified physical environment.
Hospices for children and young people will receive that further £26 million in funding for 2025-26 through what was, until recently, known as the children’s hospice grant. We will set out the details of the funding allocation and dissemination in the new year.
We completely understand the pressures that people are under. To govern is to choose, and the Chancellor chose to support health and social care in the Budget. The alternative is not to fund. The sector has suffered from 14 years of underfunding, and we are righting that historic wrong. This Government are committed to ensuring that every person has access to high-quality palliative and end of life care as part of our plan for change. We are taking immediate action to make our healthcare fit for the future. I am sure that the hon. Member for Sleaford and North Hykeham and everyone in the House will welcome this announcement. I thank her for giving me the opportunity to give the House an early Christmas present.
Mr Speaker
Order. I think you might find that I granted the urgent question, but don’t worry, Minister. I call the shadow Minister.
Dr Caroline Johnson
After the confusion of yesterday, I welcome the fact that further details on hospice funding have been announced, albeit by our dragging them out of the Government on the very last day of Parliament before the recess.
On 30 October, the Chancellor decided to break her election promise by increasing employers national insurance contributions and reducing the threshold at which employer contributions are payable. It was later confirmed that hospices would not be exempt from the increase in costs. Now the Government have announced new funding for the sector, which they have the audacity to call
“the biggest investment in a generation”.
Let us be clear about what is going on: the Government are taking millions of pounds off hospices and palliative care charities, and then think those hospices and palliative care charities should be grateful when the Government give them some of that back. That is socialism at its finest.
We will look more closely at the funding announced today, but despite many questions from right hon. and hon. Members, to date the Government have refused to give any clear answers on how much their tax rises will cost hospices. I will try again: will the Minister please tell us how much the Government estimate they will raise from taxing hospices more? Was an impact assessment ever produced on how hospices will be hit, and how that will affect the care that they provide? Do the Government expect the funding that they have announced today to cover the additional costs in their entirety?
At the heart of this discussion are charities that provide compassionate care to terminally ill people in their final days, weeks and months. While hospices were left without information, Hospice UK reported that 300 beds have already closed, with many more closures to come. Does the Minister accept any responsibility for that? Ultimately, it is patients who will pay the price.
While we welcome this update for hospices, when will the Health Secretary come forward with more details on the many other health providers who have been hit by Labour’s tax increases, including GPs, community pharmacies and dentists? Will they be expected to be similarly grateful for getting back some of the money that the Government have taken from them?
Karin Smyth
To govern is, indeed, to choose. The Conservative party chose neither this sector nor any other health sector and it refused to govern. Within five months, we have not only increased the funding to the health sector to stabilise it but made today’s announcement.
Beneath all that, there might have been a welcome for the announcement—I am not entirely sure—whereas the sector is pleased to have the money. The chief executive of Hospice UK said:
“This funding will allow hospices to continue to reach hundreds of thousands of people every year with high-quality, compassionate care. We look forward to working with the government to make sure everyone approaching the end of life gets the care and support they need”.
The chief executive of Haven House children’s hospice said that it is
“very positive to hear about the government’s plan to invest significantly in the wider hospice sector; we hope that there will be as much flexibility as possible to determine locally how this new money is spent.”
This is an important issue for many hon. Members, and we look forward to working with the sector in the new year on the specifics of the announcement.
Cumberlege Review: Pelvic Mesh
Caroline Johnson Excerpts(1 year, 3 months ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Harlow (Chris Vince) on securing this important debate. I draw Members’ attention to my entry in the register of interests, as I am a practising NHS consultant, although in paediatrics rather than in any form of gynaecological surgery.
I begin by expressing my heartfelt sympathies to the women affected by injuries from pelvic mesh and, indeed, mesh in other sites, as we have heard about. Mesh is a surgical material and technically, therefore, a medical device, which was implanted in thousands of women to treat organ prolapse and urinary incontinence. However, in many cases, as we have heard today, it has caused serious long-term effects, including chronic pain, infections, organ perforation and, in some cases, permanent disability, which continues even after the mesh has been removed.
The exact number of affected women is still not known. Some have estimated the number to be 10,000, and today we have heard an estimate of 40,000. However, it is clear that it is a very large number of women. I echo the hon. Member for Chesham and Amersham (Sarah Green) in thanking Baroness Cumberlege, the Conservative peer who published the independent medicines and medical devices safety review in 2020. The review panel spoke to more than 700 women and their families from across the country. The document is exceptionally comprehensive, and it puts patients’ and families’ views at the heart of the review. Their experiences make for harrowing reading. The women speak of lives damaged, families put under immense strain, relationships destroyed, careers broken, financial ruin and chronic pain.
Last week, I spoke to a woman who is suffering after having had such mesh put in. Following the surgery, the skin never healed because of a low-level infection. That lady faces awful difficulties. The mesh is visible through the skin, from the surface. It is incredibly difficult to remove. Indeed, she has not been able to find a surgeon who is willing to even try to remove it, so she suffers in the house, unable to go out and experiencing infection after infection, an increasing number of which are resistant to some antibiotics. She knows that without the mesh removal, her prognosis is poor. It is an awful situation to be in, as I am sure the Minister will agree. I know he will be doing his best to try to help. Our healthcare system has to learn from those it has failed, such as that lady, and ensure that patients are put at the front and centre of healthcare so that this cannot happen again.
The Minister needs to focus on two things: how we help those affected by the mesh scandal, and how we prevent similar incidents with medical devices that we do not yet know the harms of, or that may not yet have been invented. People should not have to pay privately for treatment to rectify things that the NHS has done wrong. When someone has had a mesh put in and the mesh needs removing, the NHS should pay for that care. If the NHS cannot provide it, the NHS and the Minister must find a way of funding that care, provided by whoever can provide it, so that women are not financially out of pocket to the tune of tens of thousands of pounds for something that is not their fault.
The nine centres have been set up, and that is a good thing; they have been set up with a full multidisciplinary approach, which is also good. However, as we have heard, the outcomes are not 100% good in all cases. Surely it is intuitive that women should not have to see the same surgeon again. They should not be forced to make that explicit. It should be automatic, unless they want to see the same surgeon; it should be an opt-in system.
I urge the Minister to look at what the centres do. They provide help for women who have had pelvic mesh repair, but there are people suffering with mesh problems who have had mesh put into other places, for example near the rectum or in the abdominal wall. That may be women, but it may also be men, and they may suffer quite significant problems as a result. They need a centre, or several centres, of people who can support them and ensure that their mesh is removed, or their treatment needs are met, to stop the suffering they are experiencing.
We need a balance between ensuring that a similar scandal does not happen again and that long-term effects are picked up, and not restricting people’s access to new and innovative good treatments. In this place, we often have debates on treatments that are widely available, but not necessarily available here yet. We want to make good treatments available here quickly, but we need a robust system to identify problems as quickly as possible.
Part of that system includes the Medical Devices (Post-market Surveillance Requirements) (Amendment) (Great Britain) Regulations 2024, on which the hon. Member for Harlow, the Minister and others were recently involved in debate. When that statutory instrument was discussed in the Lords, the noble Lord Cryer said that the Government intended to introduce implant cards, and that the SI was part of a wider review of the regulation of medical devices that would be carried out in due course. Will the Minister give us some information on what that will entail? What are his thoughts on the process, and when will it happen? People need these things quickly.
I recognise the work that my right hon. Friend the Member for Wetherby and Easingwold (Sir Alec Shelbrooke) has done over a long time on many topics affecting women’s health, including the menopause and other concerns, and I congratulate him on that work. He represents female constituents very effectively. He talked about the fact that when surgeons inserted pelvic mesh, they often thought that it was the right thing to do. Only over time did it turn out not to be the panacea that it had been thought to be.
I remember in my medical training being told that a good surgeon is not just a surgeon who can operate well; the best surgeons are those who know when they should not be operating. It is very sad to hear that for many of the women, treatments that did not involve surgery could have been done instead, and that would have meant that those women did not suffer in the way they have done.
I highlight the point made by the hon. Member for Shipley (Anna Dixon) and my right hon. Friend the Member for New Forest East (Sir Julian Lewis) on the importance of research. When we are trying to resolve the problems caused by the mesh, we need to know that we are doing that in the most effective way. We need someone to look at the clinical outcomes and ask what we are doing, whether we are doing it in the best way and what other options might be available. This problem is not limited to the United Kingdom. What is being done elsewhere? Are there international comparators that do this better, and can we emulate what they are doing?
What we need from the Minister is rapid action to address the problems faced by women who have had this mesh put in. We need him to assure us that he is doing what he can to introduce proportionate regulations that will ensure that any other devices in use and in circulation across the United Kingdom do what they are supposed to do, and do not do any harm.
Graham Stringer (in the Chair)
I remind the Minister to leave two minutes at the end for the Member who secured the debate to reply.
Draft Human Medicines (Amendment) (Modular Manufacture and Point of Care) Regulations 2024
Caroline Johnson Excerpts(1 year, 4 months ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Mr Betts. I will be brief.
The Opposition note that the draft regulations are a response to a Conservative Government-launched consultation, more than 91% of respondents to which were supportive. As Conservatives, we welcome innovation and want to support UK patients getting early access to new and innovative treatments. I urge the Government to ensure that funding and hospital resources are available so that patients can benefit from them, and that businesses are structured so that they can use UK hospitals to innovate.
World AIDS Day
Caroline Johnson Excerpts(1 year, 4 months ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Sir Mark.
As we mark World AIDS Day, we are called to reflect on the progress that we have made, on the challenges that remain and on the road ahead in our collective fight against HIV and the stigma so often associated with it, especially in the past. The UK has much to be proud of in that effort. Through the introduction of an HIV action plan, we set ambitious goals, such as an 80% reduction in new HIV infections by 2025. Remarkably, we achieved the UNAIDS 95-95-95 target back in 2020: 95% of individuals were living with HIV diagnosed, or presumed to be living with it diagnosed; 99% of them were on treatment; and 97% were achieving good viral suppression. Those figures reflect the dedication of our healthcare professionals and the effectiveness of our public health strategies. When diagnosed early, people with HIV in the UK can now expect a relatively normal life expectancy. The disease is no longer the death sentence it once was. The hon. Member for Uxbridge and South Ruislip (Danny Beales) spoke about that.
Sadly, that is not the case worldwide. My right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) highlighted the starkness of the global picture. Last year, AIDS-related illnesses claimed as many lives as did the sum total of all wars, homicides and natural disasters that ravaged our planet. In parts of southern Africa, in countries such as Botswana and Zimbabwe, more than one fifth of the adult population live with HIV. Such figures remind us that the global fight against AIDS is far from over.
Troublingly, within our own borders, we are starting to witness a reversal of hard-won gains. A long and steady decline of HIV rates in the UK has suddenly and sharply risen in recent years. HIV diagnoses in England doubled from roughly 3,000 to a little more than 6,000 between 2020 and 2023, unfortunately reversing more than a decade of progress and throwing the Government’s goal to end HIV transmission by 2030 into some jeopardy.
We must focus on what is driving that resurgence. One key factor is a worrying trend identified by the World Health Organisation: a decline in condom use, especially in younger populations. Between 2014 and 2022, a survey of nearly 250,000 adolescents across Europe found that only 61% of sexually active young men and 48% of young women in England reported using a condom during their last sexual encounter.
The hon. Member for Uxbridge and South Ruislip talked about the success of PrEP, its greater availability and how it is an important tool in preventing HIV infections. It has undoubtedly saved lives. The Minister therefore has a complex challenge in how he will continue to promote lifesaving interventions such as PrEP while reinforcing the importance of safe practices such as the use of condoms. I am interested in the Minister’s plans to achieve that.
Another part of the answer is an effective testing strategy. As the hon. Member for Uxbridge and South Ruislip said—to quote more of his speech—it is about testing, testing, testing. I know that the Labour party like to have the same word three times in a row. Successive Governments have been working very hard to reduce stigma and normalise HIV testing through campaigns such as the “I Test” programme, which helped to normalise HIV testing as something routine and beneficial, both for the individual concerned and wider society. Such campaigns have largely been targeted at communities with a higher HIV presence.
The Conservative Government introduced opt-out testing, which has had a significant impact and is now available in 34 emergency departments across the country. It has identified hundreds of people who were previously undiagnosed or had been lost and followed up with treatment of HIV and hepatitis B and C. The identification of those cases helps the individual concerned and also helps to reduce transmission among the wider population.
What plans do the Government have to expand the testing into more areas of the country and into A&Es across the country so that we can find out what other undiagnosed cases might be out there? Between 2019 and 2021, the estimated number of undiagnosed cases in England declined, but opt-out testing has suggested that there are more cases than we realise. Does the Minister have plans to re-estimate the number of cases of undiagnosed HIV that may be out in the community waiting to be treated?
When one studies the statistics of new HIV diagnoses, it is clear that there has been a rise driven more recently by the migration of individuals who are HIV positive. I wonder what considerations the Minister has given to HIV testing for this population, and what plans he has to target measures to reduce HIV within that group.
Finally, I want to talk about education, which has been and remains a key pillar in protecting young people from HIV and AIDS and reducing the stigma associated with testing and living with HIV. We must recognise the extent to which the pandemic disrupted health outreach programmes and traditional learning, leaving many young people without access to vital information. It is important that young people feel comfortable seeking advice and accessing resources. I would like to take a moment to acknowledge the tireless work of organisations such as the Terrence Higgins Trust, the National AIDS Trust and local sexual health clinics, who have continued to provide lifesaving services under incredibly difficult circumstances. However, those organisations cannot tackle the crisis alone. Indeed, with the Government’s new Budget, they face high charges for national insurance contributions. The Terrence Higgins Trust employs more than 200 people. What conversations has the Minister had with the Treasury about exempting such charities from paying national insurance on their employees so that they can continue their good and lifesaving work, rather than just paying more tax into this Government?
We need to ensure that those charities have the funding and resources to expand their outreach, particularly in underserved and high-risk communities. On this World AIDS Day, let us reaffirm our commitment to ending this epidemic. Let us celebrate the progress we have made while recognising that there is still much work to be done. Let us ensure that future generations can live in a world that is free from the shadow of AIDS.
Tobacco and Vapes Bill
Caroline Johnson ExcerptsTuesday 26th November 2024
(1 year, 4 months ago)
Commons ChamberRead Full debate Tobacco and Vapes Bill 2024-26 View all Tobacco and Vapes Bill 2024-26 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Prevention is better than cure. As we have heard, smoking is a cause of many premature deaths and much serious ill health. That was why the previous Government introduced legislation to tackle it and restrict access to tobacco purchases for those born after 1 January 2009. This Bill builds on many measures in the previous one.
As we have heard, this is a Bill of two parts: tobacco and vapes. Those two parts have been received differently, a bit like Marmite and chocolate spread—part controversial, part pretty universally liked. The section on smoking and tobacco has proved to be a bit like Marmite—some people have liked it. My hon. Friend the Member for Harrow East (Bob Blackman) spoke eloquently of his passion for stop-smoking measures, his successful campaigning, and the previous Government’s success in reducing rates of smoking. My hon. Friend the Member for North Dorset (Simon Hoare) spoke eloquently about the balance between libertarianism and choice, and the need for order, societal norms and the protection of others in society. The hon. Member for City of Durham (Mary Kelly Foy) spoke about the dangers of smoking and the difficulties and challenges for people trying to quit.
On the other hand, other Members expressed concern about the Bill. The hon. Member for Lewes (James MacCleary) talked about how the Secretary of State might use powers relating to outside places where people may smoke. The hon. Member for Newbury (Mr Dillon) shared his concerns about how measures on the age of sale will work in practice. Those will indeed be clunky measures for shopkeepers to try to enforce, and will have an effect on the cohort of individuals who are just either side of the threshold, who will require ID throughout their lives. The hon. and learned Member for North Antrim (Jim Allister) spoke about how that measure will work in Northern Ireland, and although he received some assurances from the Minister, I am not sure that they were completely effective.
Although I confess that I do not like Marmite, it is a free vote this evening for Conservative Members, and I will support the Bill. The Secretary of State said in opening that 350 young people will start smoking today, most of whom will regret it, so why was 1 January 2009 chosen? I appreciate that that was the date in the previous Bill, but why did he choose it for his Bill too?
Let me move on to the area of chocolate spread—the part of the Bill on vaping. I think it was universally welcomed, and was supported by the hon. Members for Newcastle upon Tyne East and Wallsend (Mary Glindon) and for North Shropshire (Helen Morgan) among others. It includes measures to tackle vaping among children, on which I have personally campaigned. As others have said, the chief medical officer has been clear that for someone who smokes, vaping may be better, but if they do not smoke, they should not vape. As a Member of Parliament and a children’s doctor, I have been increasingly concerned about the sharp increase in children addicted to vaping and, more recently, to other nicotine products such as pouches. Schoolteachers have reported that children are unable to concentrate, or even complete a whole lesson, without visiting the bathroom to vape.
Sir John Hayes
I very rarely disagree with my hon. Friend. She is of course right about vaping, the effect that it has on children and the difficulty that schools have in managing it, as headteachers will no doubt have told Members across the House, but can she really go into the Division Lobby to support the Bill with this nonsense about age? The idea that someone aged 30 could smoke and someone aged 29 could not, and the idea that that could be policed or managed in any practical way, is just nonsensical. It was daft when the last Government introduced it, and it is daft now this Government have done so.
Dr Johnson
The challenge is that if we were to ban it altogether, we could risk criminalising people who were already addicted to tobacco products—adults who had made that choice. That is the reason why both present and past Governments put forward a measure to increase the age gradually, but I understand the points that have been made about the difficulties for shopkeepers and others in enforcing it over time.
I return to vaping. Doctors report a growing body of evidence suggesting that children may be having difficulty in school and suffering health problems as a result of vaping. A report from Healthwatch said that 31% of the more than 4,000 under-18s it surveyed were regularly vaping. Nicotine is a powerfully addictive product. Young people are particularly susceptible to it, so it is very important that we protect children from vaping and other nicotine products. After all, vaping is an adult activity; it is apparently designed to help smokers quit. While the industry may argue that the flavours and colours are enjoyed by adults—and they may well be—I struggle to understand why adults would want a vape flavoured like a unicorn milkshake, whatever a unicorn’s milk tastes like. The Healthwatch survey showed that fruit flavours are very popular with children, and the same has been repeated by various teaching unions, the British Medical Association, of which I am a member, Cancer Research UK and even a Government report from last year. I also do not see why an adult stop-smoking device needs to be disguised in the form of a highlighter pen, which could perhaps be hidden in a child’s pencil case, or created in the shape of a children’s cartoon character. Enticing and luring children into a lifetime of unwanted and potentially harmful addiction is immoral.
The Secretary of State is taking powers to regulate the flavours, colours and packaging of vapes, but how will he ensure that he stays one step ahead of an industry whose income depends on a new generation of addicts? He has taken quite extensive powers, which I know is of concern to some hon. and right hon. Members, but how and when does he intend to use them? What support will be given to children who are already addicted to vaping to help them quit?
Finally, while this is a free vote issue, I am pleased on a personal level to see some of the proposals that I put forward on the last Bill being incorporated into this one, particularly on the sponsorship and advertising of vending machines. Whatever our views on this Bill, it is a bold piece of legislation of good intention. It aims to improve the health of our nation and of our children in particular and to reduce smoking and prevent nicotine addiction in the young. It is not clear whether it will work, but we have to hope, for the health of all of us and our children, that it does.
Draft Medical Devices (Post-market Surveillance Requirements) (Amendment) (Great Britain) Regulations 2024
Caroline Johnson Excerpts(1 year, 4 months ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Mr Efford. I think we all understand the context of the IMMDS review. Having spoken on Sunday afternoon to a lady who is suffering having had a mesh put in—the skin has never healed over the top and she is facing difficulties—I fully understand the reasons for the regulations. We all want safety; we all want the equipment that doctors like me use to be safe. We also all want support for the science and technology sector, and we all want people in the UK to have early access to the very best new medical devices. As such, the importance of the regulations is not just that they are there and they are strong, but that they are proportionate and effective in their aims. I have a few questions in regard to that.
First, the MHRA will be sent lots of data—reports on 3 million medical devices at one, two and three-year intervals, depending on the type of device. Is the MHRA required to look at that data, or to check whether manufacturers are required to produce these reports, or even to check that manufacturers have produced these reports? If it does have such a requirement, does the MHRA have the resources to look at all this extra data and to review it? If it does not have such a requirement, what is the point?
The cost estimate in the impact assessment talked about £310 million over 10 years, but for 3 million devices that does not seem particularly high. Six months is being given for these regulations to become legally enforced. Is that long enough for businesses to prepare and for the MHRA to get ready to look at this?
How much of this cost will be passed to the NHS, and how much has the NHS budgeted for such costs? How will the NHS comply with the legal requirement to get patient experience data? The Minister talked about the importance of getting patient experience data where appropriate, so what will the exemptions be? If someone was having a Guedel Airway put in, they would probably be unconscious and might not be aware of how effective the device was—if they woke up it would probably be more effective than if they did not, I suppose, but it is quite difficult.
Confidentiality is also an issue. If a medical device like a new hip is being put into somebody, will the Government provide information to manufacturers on who has got their hips, or is the manufacturer expected to guess? Or is the NHS expected to act as a go-between, and if so, how will that work in practice?
The regulations are also a bit of a burden on small businesses. I notice the Government have made the decision, as evidenced in the impact assessment, to include all small businesses—even micro-businesses—under these regulations. Has the Minister considered whether that will incentivise businesses to set up elsewhere, in Europe or overseas, reducing UK innovation and reducing the likelihood that manufacturers will apply for a UK Conformity Assessed mark because there is more regulation in the UK than elsewhere? Will that delay access to new devices for our patients in this country? In particular, the “similar devices outside of GB” requirement requires even the smallest businesses to find out similar devices’ safety, around the globe. That is possibly something that a large multinational corporation could do, but a micro-business in, perhaps, Oxford or elsewhere would find it difficult to find all that information. The cost proportional to the business will be extremely high, which will reduce the number of new people entering the market.
Overall, the Government have the right intention to provide for patient safety. However, the longer period that safety has to be viewed over and the additional regulation compared to the European Union mean that, once again, the Government have chosen to take an EU regulation and gold-plate it, to the detriment of Britain, and ultimately potentially that of patients.
Andrew Gwynne
I thank the hon. Lady for her valuable contribution. These regulations introduce clearer, more robust requirements for post-market surveillance of medical devices, to improve patient safety and to signal a crucial shift in the way in which we manage medical devices in Great Britain.
The hon. Lady raised some important points. First, on the MHRA and whether it is appropriately resourced to cope with the likely increase in incident reporting as a result of this regulatory change, let me reassure her that the measures introduced in this instrument should not have a significant impact on MHRA capacity. Its systems and processes to provide regulatory oversight for vigilance reporting are already in place. The measures within this statutory instrument are expected to increase the volume of safety data reported to the MHRA. However, the accompanying improvements to data quality will support automation and reduce burdens associated with data analysis. To ensure that the MHRA’s systems for vigilance reporting are fully equipped to handle the new reporting requirements for manufacturers, we will verify system-readiness through comprehensive testing and validation ahead of the date of application of these regulations.
As the regulator for the whole United Kingdom, the MHRA is committed to protecting patient safety while enabling a regulatory environment in which the life sciences sector is able to innovate and to launch new medical products in the interests of public health across the UK. Contrary to the hon. Lady’s assertion that the regulatory burden will be increased and will therefore squash innovation, the opposite is the intention of this Government. The intention is to ensure that there is a clear regulatory framework throughout the United Kingdom—without having the disparities that we have at the moment—and to ensure that better, smarter use of the data will be available. The closer scrutiny of the efficacy of these medical devices will encourage innovation in medtech and in life sciences.
Dr Caroline Johnson
The Minister is saying that more regulation will encourage innovation. I am not sure I agree with that premise, but does he accept that these new regulations will lead to a higher regulatory burden on people wanting to set up medtech companies in the UK than in the EU or elsewhere?
Andrew Gwynne
We could get into a theological debate about the benefits or otherwise of regulations, but this statutory instrument will provide certainty and clarity across all four nations of the United Kingdom. It will provide a known framework for medtech and life science companies operating, or wishing to operate, in the UK. I see this as a good piece of secondary legislation to bring about the certainty that we want to give companies wishing to operate, or which are operating, in the United Kingdom, and to set up a common framework across our four nations. I see that as good. Regulatory divergence with another part of the United Kingdom is not, in my mind, good for business—particularly where a company wants to operate on both sides of the Irish sea.
On patient confidentiality and the cost estimates for the NHS, I hope the hon. Lady will forgive my having to write to the Committee on that point because the tablets of stone have not yet reached me from Mount Sinai.
On the hon. Lady’s question on innovation being reversed and whether people have long enough to prepare, we believe that the measures in the statutory instrument do give people long enough to prepare—not least because many of those companies are already operating in the parts of the United Kingdom that the instrument will bring our regulation in line with. Therefore the extra capacity that is needed in the system will not be to the detriment of the measures in this statutory instrument.
Dr Johnson
Parts of the UK are working to EU regulations, but does the Minister recognise that the statutory instrument he is bringing forward will introduce into the whole of the UK market, regulations that are not currently present in either the UK or EU markets?
Andrew Gwynne
I recognise that we are not only bringing Great Britain in line with Northern Ireland but adding other patient safety measures. If the hon. Lady is saying—I hope she is not—that the result of the Cumberlege review is that we do nothing in this area to improve the issues highlighted by it, she is within her powers to oppose these measures. However, we think not only that ensuring regulatory consistency throughout the United Kingdom is the right thing to do, but that this statutory instrument gives us the opportunity to start to put right some of the shocking, appalling things that we know have happened, as highlighted by the Cumberlege review. That is what these measures seek to do.
This Government are committed to the delivery of a framework for medical device regulation that prioritises patient safety—that is the crucial thing that we are seeking to do—and that gives patients access to the medical devices they need, and ensures that the United Kingdom remains an attractive market for medical technology innovators. We have an obligation to patients and the public to maintain the highest standards of safety and efficacy for the medical devices they rely on. These regulations are an important first step to deliver this framework, and they place patient safety at the forefront. They will enable not only the MHRA but the whole health system to better protect patients.
I am grateful to the hon. Lady for her contribution, and to Members across the Committee for considering these regulations today. I hope they will join me in supporting these regulations, so that we have consistency across the UK and put patient safety at the heart of medtech and life sciences.
Question put and agreed to.