Maternity Services: Gloucestershire

Caroline Johnson Excerpts

Wednesday 9th October 2024 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Sir Christopher, and I congratulate the hon. Member for Cheltenham (Max Wilkinson) on securing this important debate. Childbirth is a really special event. It has been described today as the best moment of someone’s life, and that description is often used. It is a special moment in the lives of not just the parents and of course the child, but the wider family and friendship group—the birth of a baby is enjoyed by everybody.

I have been privileged to attend many births over my career as a doctor, although aside from the births of my own three children, they have generally been skewed towards where things have not been going to plan—it is not, I hasten to add, that that is a result of my presence, but more that my presence is a result of things not going to plan. The work of the NHS—its midwives, its obstetricians and the wider team that look after women and their babies—is by and large exceptional. However, we hear stories of where things go wrong and we need to minimise those as much as possible.

Essentially, the talk of whether Cheltenham needs a midwifery centre comes back to the pull and tug that I have seen throughout my career between the centralisation and the localisation of services in general. When services are centralised, it can be argued that there is an increase in expertise and an increased volume of cases, which makes people more familiar with emergencies because they happen more frequently. More specialist services can also be offered for those with high-complexity and low-volume problems. There can also be more support from staff, because there are more staff present in the unit. However, centralised services can feel more remote, they can be too far away for people living in rural areas and they can feel too impersonal, particularly for a procedure such as giving birth. In a local unit, people may feel more comfortable and know the staff, and there may be a close-knit team. However, as our veterinary colleague, the hon. Member for Winchester (Dr Chambers), so amply described, if things go wrong, people can be a long way from the help they need. So there is that balance and that push and tug.

As has been mentioned, choice is important to women who are making informed consent choices on where to give birth, based on the information they receive. The hon. Member for Cheltenham has made a good case for why the balance may not be as it ought to be in Gloucestershire; the Government should look carefully at that.

I was sorry to hear of the experience of the hon. Member for Gloucester (Alex McIntyre) with his new-born baby. As a paediatrician, I am familiar with the need to weigh all the factors in the balance: the fact that a baby has gone home and may have picked up a viral illness that has brought them back in again; the risk to the baby from going on a children’s ward where the impact of disease is more predominantly based in infection and infectious conditions than in older age groups and adult wards; and the risk of putting a baby on a neonatal unit and introducing the virus to that unit, which could make the babies already there so very unwell. We need to think carefully about a solution to that, so that people do not go round and round in circles, as the hon. Member for Gloucester described, being passed from pillar to post. I am sure that was a frightening experience for him and I am sorry that happened.

I now turn to other issues raised today. The hon. Member for Stroud (Dr Opher) talked about the importance of community midwives. Even though my eldest is now 17 and my youngest nine, I still remember my post-natal midwife Marie and the care she gave. Sometimes, maternity care focuses a little too much on what is going on in a hospital when what happens in the community is also very important.

The hon. Member for Thornbury and Yate (Claire Young) suggested that we could have a midwifery in-patient unit with mothers and babies and only one member of staff. I am afraid I do not agree with her on that. The hon. Member for Winchester raised the concept of two simultaneous emergencies. If there is only one member of staff, how do they go on a break, or what if they are in the bathroom when they are needed? If we have a unit, unless it is attached to a major centre with more staff, we need that second person.

As of December 2023, there were 2,361 full-time equivalent midwives working in the NHS’s trusts and other core organisations in England. That is an increase of 3,707—18.9%—since 2010. On the one hand, the birth rate is falling and the number of midwives is rising, but I recognise that the births that are taking place are more complex in some ways than they used to be. At the spring Budget, there was a further investment of £35 million to improve maternity safety over the next three years, including £9 million for brain injury.

I asked the Minister, at the previous debate on maternity safety on 4 September, whether she would commit to that money being spent and I have not received an answer. I asked her several questions during that debate, including whether she could confirm that the Government would proceed with the fortification of bread products with folic acid to protect babies from spina bifida. I asked her about the non-essential communications budget, which the Chancellor had said on 29 July would essentially be cut, and whether that was affecting public health budgets. Those budgets are very important, particularly around optimising public health messaging regarding chronic illness and conditions such as diabetes and obesity before conception. I have not received an answer to either of those questions.

I also raised the NHS saving babies’ lives care bundle, which was due to be updated on maternity early warning scores and tracking tools, to ask the Minister whether that was on track. Again, she has not written to me as promised with the answer to that question. I asked her whether she would be supporting the healthcare safety investigations branch and about the £35 million budget I have just described. I have not received answers to any of those questions more than a month later; none of my staff can find any correspondence from the Minister. Can she answer those questions today, or at least commit to doing so by the end of the week? We have waited quite a long time.

My final question last time was about the group overseeing maternity services nationwide, because following the East Kent report—I was the Minister when that was published—Dr Kirkup’s recommendations were accepted. Maria Caulfield, then Minister for Women’s Health, set up and chaired a working group to review the work being carried out by a whole range of programmes to improve maternity and neonatal care and implement those recommendations. I asked her who would go on to chair the group and whether she could guarantee that the work would continue, but I still have not received an answer. It would be helpful for the Minister to answer the questions raised in the last debate as well as in today’s.

Sepsis Awareness

Caroline Johnson Excerpts

Wednesday 9th October 2024 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate the hon. Member for Ashfield (Lee Anderson) on securing a debate on this very important topic. I should also declare an interest as an NHS consultant paediatrician. I have cared for and continue in my work to care for people with this condition.

I would like to thank Abbi for coming today. It was an honour to meet earlier today and to hear her story from her MP, which highlighted both the difficulties she faced in getting good immediate care for sepsis and the consequences of that. I commend her for the bravery she has shown in coming today and for raising this issue for the benefit of other people. This debate will increase awareness, which is a very positive thing.

I remember sitting in the Chamber earlier this year when the former hon. Member for South Thanet re-entered Parliament to a standing ovation—an exceptionally rare occurrence in the House of Commons. It is truly humbling to reflect on the journey that he has been through in such a short space of time. Little over a year ago, he had no outward signs of sepsis at all. He has now become one of the most well-known advocates for people with it. His case brought renewed attention to this disease, which kills nearly 50,000 people in the UK every year. As the hon. Member for Ashfield said, that is around the same number of people who die from bowel, breast and prostate cancer combined.

The case of our former colleague speaks to not only a remarkable recovery but the suddenness with which sepsis can utterly change someone’s life. As many people have said today, early identification is vital. Under the previous Government, awareness of sepsis improved significantly, as did the clinical recognition of symptoms, screening rates and the administration of antibiotic treatment, but there is much more to do.

I want to commend the UK Sepsis Trust and other public campaigners who played a significant role in improving awareness among the general public. A recent YouGov survey showed that the UK has high levels of public awareness compared with other countries. Will the Minister say what steps the Government will take to work with NHS England and patient groups such as the UK Sepsis Trust to raise public awareness, so that people can more easily identify the signs of sepsis? I have also asked this of another Minister, but have not yet received an answer. The Chancellor said that she was cutting the communications budget—can the Minister confirm that those cuts will not affect the important public health messaging for campaigns like this? It is important that we do not cut budgets that will save people’s lives and, indeed, save the NHS money. It is also important to raise awareness not just across the general public, but among health professionals, including medical staff in both hospitals and communities.

The national early warning score has been introduced and is being rolled out, along with the sepsis six, which was developed with the UK Sepsis Trust. The six—oxygen, cultures, antibiotics, fluids, lactate management and urinary output monitoring—must all be carried out within the first hour. Has the Minister established how well those measures are being rolled out across the UK, and what is he doing to ensure that is being done effectively? The National Institute for Health and Care Excellence updated its guidance earlier this year. Will the Minister update the House on how effectively that guidance has been implemented across the UK? Martha’s rule was introduced before the election; the rule relates to the ability for people to get a second opinion from another health professional if they remain concerned about their loved one or themselves. Will the Minister update the House on the work the NHS is doing to roll that out, too?

Research is the cornerstone of transforming sepsis care, and the last Government invested more than £1 billion through the National Institute for Health and Care Research. It is important that we research the causes of and treatment for sepsis, but we must also research new antibiotics, because we are starting to see antibiotic resistance to infections. If we do not invest in antibiotic research, new antibiotics will not be developed—we are essentially asking people to develop a drug to be kept on the shelf for when we need it, and there is no money in that, so it will not get commercial take-up. It is therefore important that the Government invest in that.

The UK Sepsis Trust is calling on the Government to publish data on the sepsis care pathway so that we can see where it is performing well and where it is performing less well. I urge the Government to do that. It would be helpful if the Minister could confirm today that they will do so.

As we close the debate, let us remember what we are fighting for. Sepsis takes the lives of 50,000 people every year. It strikes suddenly and often without warning, as Lord Mackinlay’s case reminds us so powerfully. Early identification and rapid treatment are the keys to saving lives; we have made strides, and awareness is growing, but we must do more. We must continue to improve recognition, strengthen control and push forward with life-saving initiatives. I urge the Government today not just to maintain their commitment but to strengthen it by partnering with NHS England, publishing more data, researching the causes of sepsis and ensuring we can fight this disease together.

[Sir Christopher Chope (in the Chair)]

I thank the Front Benchers for sticking to their five minutes, which means the Minister now has 10 minutes; there will hopefully also be a couple of minutes for the proposer to reply.

NHS Performance: Darzi Investigation

Caroline Johnson Excerpts

Monday 7th October 2024 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I am mindful of the need to be brief, but I wish to congratulate the hon. Members for South Norfolk (Ben Goldsborough), for South West Norfolk (Terry Jermy), for Esher and Walton (Monica Harding), for Gloucester (Alex McIntyre), for St Neots and Mid Cambridgeshire (Ian Sollom), for Mid Dunbartonshire (Susan Murray), and for Basingstoke (Luke Murphy) on excellent maiden speeches.

When I first heard that the Government had commissioned Lord Darzi to conduct a report on the NHS I wondered two things: why has this report been commissioned, and why has a former Labour Minister been asked to do it? The answer to the first question is still somewhat unclear after this debate. Much of the information is publicly available, and Labour had access to the civil service for six months before the general election, as is routine to help with planning. Before the election, in its manifesto Labour claimed to have a plan, and the Secretary of State said that he and the Government have a 10-year plan to reform and modernise the NHS. In the draft speech that I brought to this debate I was going to say that I assume that is the case, so where is that plan and when will it be published, but during the debate the Secretary of State said that he will soon meet to engage with patients and staff who will write the plan. Does it exist, or is it yet to be written? Given that Lord Darzi specifies that policy suggestions are outside the remit of his report, and notwithstanding the amount of time and dedication he has put into it, what primary purpose does it serve? Is it simply a political statement to cover the right hon. Gentleman’s plan and an increase in taxes in the Budget when it comes?

[Ben Coleman (Chelsea and Fulham) (Lab)]

Will the hon. Lady give way?

[Dr Johnson]

I will not because there is not much time. A potential answer to the second question of why a former Labour Minister has been asked to conduct the report is its silence on a number of issues, for example on increasing the number of medical students. I could not find any reference in the report to the five additional medical schools that were commissioned and opened by the former Conservative Government, and whose first new doctors have recently graduated. Indeed, I found no mention of the NHS workforce plan at all.

My constituency mailbag, no doubt much like that of Members across the House, is full of letters from elderly people who are frightened that their homes will be cold this winter, and that they will become ill, or perhaps even die, as a result. It is notable—again, perhaps this answers my second question—that despite being published two months after the Government’s announcement about the winter fuel allowance, the Darzi report appears to be silent on the subject. The chief medical officer said that,

“cold homes and fuel poverty are directly linked to excess winter deaths”

in his annual report from 2023. Is it remarkable that this report by a former Labour Minister does not mention cold homes? Perhaps it does not recognise the impact of such a decision because no impact assessment has been made.

On 29 July, I asked the Chancellor of the Exchequer what estimate she had made of the impact that her winter fuel payment changes would have on the NHS. Her answer implied to me that that was something that had not been given enough consideration. On 5 September I submitted a written question to the Secretary of State, asking whether he would make an assessment of the winter fuel payment changes on a range of factors relating to the NHS and the health of elderly people, including hospital admissions, deaths, GP appointments and so on. The answer to whether he will do something or not is clearly “yes”, “no”, or “I have already done it”, but it seems the Government struggled to answer that question and I would be grateful if the Minister could do so today: will the Secretary of State make an assessment of the various effects of the changes to the winter fuel allowance and the consequent cold homes on the NHS and the health of elderly people?

Earlier, the Secretary of State said that investment without reform would reduce productivity. He even said that it was “killing with kindness.” Actions, however, speak louder than words, so what substantial productivity gains come with the junior doctors’ 22% pay rise? None. What productivity benefits arise from a significant increase in the wages for train drivers? None. The NHS and the Government are now facing potential future industrial action from groups seeking similar pay deals. The Government’s willingness to take money from pensioners and give it to already well-paid train drivers suggests that such union demands will be successful, further creating a vicious cycle of industrial action that will ultimately be damaging to patients.

I fear that the Labour party sees the Darzi report as a political bludgeon rather than as a blueprint for any meaningful reform. There are undeniable challenges within the NHS—something that I as a doctor see—and we must be honest about them, but instead of a constructive conversation on policy, Labour brings partisan attacks to the table. We now need real leadership, specific reforms, and the courage to make the tough decisions that will keep the NHS suitable for generations to come.

Preventable Baby Loss

Caroline Johnson Excerpts

Wednesday 4th September 2024 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Ashfield (Lee Anderson) on securing the debate; the stories he read were very emotive.

Many people witnessing birth for the first time describe the experience as the miracle of birth. It is indeed the most wonderous occasion. I have been honoured to be present at the birth of many hundreds of babies in my work as an NHS doctor. Unfortunately, birth is an unpredictable process, and the hon. Member for North Shropshire (Helen Morgan) is right that we should focus not on natural birth but on the outcome of a healthy mother and child.

Birth does not always go smoothly. Generally, and increasingly as I became a more senior doctor, I attended only the very high-risk deliveries—those when things go wrong. In a job focused on saving lives, the opportunity to do so at birth is perhaps the most rewarding, but sadly, despite the best efforts of the whole team—midwives, obstetricians, paediatricians and allied professionals—some babies die, and that leaves a hole in the families that, as others have said, does not go away.

I spoke in the baby loss debate in 2022 as the responsible Minister, and I am reminded today of the words of Hayley Storrs, which were read by the hon. Member for Leeds East (Richard Burgon):

“What people fail to understand when someone loses a child, it is that you have lost a lifetime. First days at school, first steps, graduations, what their favourite story would have been, birthdays, Christmases.”—[Official Report, 25 October 2022; Vol. 721, c. 65WH.]

That very moving account has stuck with me. It reminds us that this pain endures, so we must do all we can to prevent it.

I pay tribute to my NHS colleagues who strive every single day to ensure that pregnancy and birth lead to the happy, healthy outcome that we all want. Politicians and the Government must do all we can to support that. We must hold the NHS to account when it fails to uphold the very highest standards.

I also pay tribute to the many great charities, such as Sands, Tommy’s and Bliss, which have been mentioned by others, that do such great work in this area. I was proud to run the London marathon with a constituent earlier this year to raise money for Bliss, and I am grateful for the support it provided to him.

We must focus relentlessly and systematically—starting at pre-conception, as the hon. Member for Sheffield Hallam (Olivia Blake) said—on every single factor that can cause or increase the risk of baby death. That includes reducing teenage pregnancy, smoking and obesity; ensuring that there is chronic illness optimisation, so that if someone has diabetes, it is optimally managed before they conceive; making medication changes if needed, so that someone is not taking teratogenic drugs at the onset of pregnancy; and ensuring that women are aware that folic acid should be taken before and during the early parts of pregnancy. Before the general election, the Government consulted on the fortification of flour with folic acid to reduce the number of babies who suffer from a shortage of folic acid during pregnancy. Can the Minister confirm whether this Government will go ahead with the proposed legislation to fortify bread products?

Additionally, the Chancellor has said that she will stop all non-essential communications. Many of the messages we are talking about are public health messages that need public communication strategies. Can the Minister confirm that this essential form of communication is not affected by the Chancellor’s restrictions on communication costs?

NHS England introduced the saving babies’ lives care bundle, which currently focuses on six areas: smoking; the assessment of foetal growth during pregnancy; awareness among parents and families that a reduction in foetal movements can be a significant warning sign; expertise training for cardiotocography monitoring during labour and pregnancy; the reduction of premature birth; and the management of diabetes to ensure that people have optimal control. The NHS had a plan to update the bundle to introduce maternal early-warning schools and tracking tools. Can the Minister confirm whether it is on track to deliver that? Can she also confirm that the saving babies’ lives care bundle will be updated this year and at regular intervals, as evidence improves on how we can best reduce the number of baby deaths?

Two years ago, as Minister, I delivered a statement to the House on behalf of the Government regarding the outcome of Bill Kirkup’s independent review of maternity services in East Kent. His report was very sobering. Those tragic events revealed failings—failings seen previously elsewhere, which should and must not be repeated. In response to the review, the Government set up a group chaired by Maria Caulfield, then the Minister for Women’s Health, to oversee the work being done to improve maternity services nationwide, including by implementing the recommendations in Dr Kirkup’s report. Can the Minister confirm that the group’s work will continue under the new Government? If so, can she confirm who will lead it?

Can the Minister confirm that she will support the work of the healthcare safety investigations branch, which investigates all cases of stillbirth and life-changing injury, to see what lessons can be learned and how care can be improved?

Other have talked about the Sands and Tommy’s “Saving Babies’ Lives” report, and particularly about workforce issues. The previous Government invested heavily in increasing workforce numbers, building five new medical schools. That takes time, but it will ultimately increase the number of obstetricians and paediatricians. The number of midwives also increased. There were 23,361 full-time equivalent midwives in NHS trusts and other core organisations in 2023, which is an increase of 19% since 2010. Births fell in England and Wales during a similar period. In the spring Budget, the Government committed £35 million to improving babies’ care, £9 million of which was related to preventing brain injury. The remainder related mostly to funding 160 additional posts in midwifery and neonatal care. Can the Minister confirm that that investment will proceed in order to support the care of pregnant women and babies?

In summary, it is almost 10 years since the Government launched the maternity safety ambition. While that goal has not yet been achieved, from 2010 to 2022, the stillbirth rate fell by a fifth, the rate of maternal mortality fell by a fifth, and the rates of neonatal mortality for those babies born after 24 weeks fell by 36%. Those statistics are a good achievement, representing many hundreds of families who will now enjoy watching with love as their children grow, thrive and develop. We must build on that now to ensure that many more families—all families—have the same opportunity.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate the right hon. Gentleman on his position. I should declare that I have been working in the NHS for 23 years, currently as an NHS consultant paediatrician. I look forward to using that experience in my new role as shadow Minister of State to scrutinise the Government constructively.

Under the new hospital programme, the previous Government had already opened six hospitals to patients, with two more due to open this financial year and 18 under construction. The Government are now putting that at risk by launching a review of that work, delaying those projects, which are vital to patients across the country. Could the right hon. Member please confirm when the review will be completed?

[Wes Streeting]

First, I welcome the hon. Lady to her new post. I must say I preferred her much more as a Back-Bench rebel than a Front-Bench spokesperson, but I have enormous respect for her years of contribution to the NHS and the experience that she brings to this House. I always take her seriously.

However, on this one, once again I say to the Opposition that they handed over an entirely fictional timetable and an unfunded programme. The hon. Lady might not know because she was not there immediately prior to the election, but the shadow Secretary of State, who is sitting right next to her, knows exactly where the bodies are buried in the Department, where the unexploded bombs are, and exactly the degree to which this timetable and the funding were not as set out by the previous Government.

NHS

Caroline Johnson Excerpts

Thursday 23rd May 2024 Commons Chamber

[Victoria Atkins]

I most certainly do, and it is a pleasure to hear that my hon. Friend, who is such a great campaigner in his constituency, has that as a clear target for his area to represent his constituents. On the recruitment of general practitioners, we have set out, through our long-term workforce plan, our ambitions—and, importantly, the plans underlying those ambitions—to ensure that we recruit even more doctors, nurses, midwives, dentists, and so on, to build the NHS of the future. My hon. Friend might want to share this fact with his constituents: since 2010, there are more than 41,000 more doctors in our NHS in England and more than 73,000 more nurses. Those are figures to be proud of.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I associate myself with the good wishes that have been sent to you this morning, Madam Deputy Speaker.

Prevention is, of course, better than cure, so will my right hon. Friend confirm that she is doing all that she can to ensure that the Government’s world-leading Tobacco and Vapes Bill is passed during the wash-up? She knows of my concern about children’s exposure to vaping. If the Bill will not be passed through wash-up, will she confirm that a Conservative Government would act quickly, once re-elected, to protect our children from deadly nicotine addictions?

[Victoria Atkins]

I am very grateful to my hon. Friend, who, of course, brings her professional expertise into the Chamber. On the Bill, she will appreciate that we are at a very delicate stage, which I am not allowed to say anything about at the Dispatch Box, but she should be confident of my commitment, and that of the Prime Minister, to this important legislation and to a smoke-free generation.

Tobacco and Vapes Bill (Fifth sitting)

Caroline Johnson Excerpts

Committee stage
Thursday 9th May 2024 Public Bill Committees

[Preet Kaur Gill]

Right. However, that brings me to my second point. The Bill provides a number of powers for the Secretary of State to make secondary legislation, particularly on vapes. It is therefore important that we think carefully about how to achieve the objective of stopping young people from getting addicted to nicotine in the first place. Whoever the Government are after the next election, they will likely inherit those regulations, and some of them can be deceptively tricky to get right.

I want to ensure that whoever the next Government are, they have the powers they need to get a grip on this issue given that so recently this Government have not done so—when one in three vapes on the market is illicit, when youth vaping has trebled in two years, and when gaping loopholes in the law have undermined enforcement and put children at risk.

Vaping is a valuable stop-smoking tool, but those trends are a serious concern. There are areas where the Bill can be strengthened, and I hope the Minister will listen closely to our arguments. The Bill is an opportunity to think about not just the public health challenge as it manifests today, but the challenge we will face in 10 years’ time. That is what a real agenda on prevention must do.

When the last Labour Government took office, one in four people in the country was a smoker. Every pub we walked into was clouded with the fumes, and one in 10 of our 11 to 15-year-olds smoked. When we banned smoking in public spaces and raised the age of sale to 18, we were met with a lot of opposition. Some of the charges put to us were like the ones we heard on Second Reading: that the law would be unenforceable, that it was an attack on working people and their culture, that it would fuel the illicit market, and so on. None of them held up.

Today the idea that children should be allowed to smoke or that non-smokers should have to tolerate deadly second-hand smoke is unthinkable. No one would think of making those arguments now. Just as the opponents of that legislation were wrong then, they are wrong now. Since 2007, the number of people who smoke has been cut by almost a third. The percentage of 15-year-olds who smoke regularly has dropped from 20% to 3%, and our understanding of second-hand smoke has grown. There has been a culture shift around where it is acceptable to smoke. Even at home, people go outside to smoke instead of smoking in front of their children. The year after the smoking ban came into effect, there were 1,200 fewer hospital admissions for heart attacks according to The BMJ.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Could the hon. Lady tell me about the consumption of nicotine among people once the Government had brought in the smoking ban in public places? Was there a reduction in nicotine consumption among the people who continued to smoke because of the restrictions on where they could do so?

[Preet Kaur Gill]

I have just said that after the smoking ban came into effect, there were 1,200 fewer hospital admissions for heart attacks. We saw a drop in people smoking—the data from The BMJ is already out there. By working towards a smoke-free future by progressively raising the age of sale, I hope that this Parliament can leave a similar legacy.

I turn to clause 1 and its equivalents for the devolved nations—probably the most important clauses in the Bill. Clause 1 of course changes the age of sale for tobacco products from 18 to a set date of 1 January 2009, meaning that anyone born on or after that date will never be able to legally buy cigarettes. It will progressively raise the age of sale by one year every year, so that the generation who are 15 now will—we hope—never smoke.

When the shadow Secretary of State, my hon. Friend the Member for Ilford North (Wes Streeting), proposed the measure in January 2023, it was because we know that it will take fresh, radical thinking on public health to take the pressure off the NHS and get our ambition for a smoke-free future back on track. The rationale for the progressive approach, compared with what some MPs have argued for in raising the age of sale to 21, is that it is a radical but realistic way of phasing out tobacco over time. It means that no one loses a right they already have, but it does not limit its ambition to young people —there is no safe age to smoke.

I hope that a lead-in time of three years will be enough for us to get support to those under-18s who already smoke, so they are not affected by the time the legislation comes in. Will the Minister say whether she is planning a targeted campaign to ensure that we reach those young people, perhaps by working through schools? Almost two thirds of long-term smokers began smoking before they were 18. University College London has calculated that every day around 350 young adults aged 18 to 25 start smoking regularly, risking being trapped in a lifetime of addiction and premature death. The vast majority of smokers and ex-smokers—85%—regret ever starting in the first place, but it is infamously difficult to quit. Stopping people from starting is the single best way of saving them from a lifetime of potentially deadly addiction.

I reject the suggestion that the legislation will be uniquely difficult to implement or enforce. Labour raised the age of sale in 2007, and that is well understood and widely enforced.

Shopkeepers are already used to enforcing age of sale legislation, and we have initiatives like Challenge 25, so it would not be until 2034 that we enter the uncharted territory of routinely checking the age of customers who look 26 years old. I would expect by then that we would already be beginning to see a considerable reduction in the number of people still smoking under that age, but even then, arguably this legislation makes implementation easier: instead of having to ask for someone’s ID to compare their birth date against the current date, which involves doing maths in one’s head, it will be as simple as checking against one static date every time. I do not want to insult the intelligence of anyone working in retail, but that has formed part of the arguments of some of the Bill’s opponents, so I really want to call that out.

As for the right to feel protected and confident in their jobs, there is no doubt that violence against shop workers has risen in recent years, but that is why we in the Opposition have long campaigned for violence against shop workers to be a separate criminal offence. As with much recent legislation, I am glad that the Government have seen sense and followed Labour’s lead on that, too.

I know that some libertarian Conservative MPs have a philosophical objection to this legislation—the Business and Trade Secretary is one—but let us be honest: if we had known the social, public health and economic harms of smoking that we now know, would we not have legislated in similar terms long ago? Let us be clear: addiction is not freedom. The impact of second-hand smoke on the children of smokers is not freedom. It is certainly no freedom if, as is the case for two thirds of long-term smokers, one’s life is cut short as a result of smoking. It should be a source of pride if, from having the highest smoking rates in the world, we can successfully introduce genuinely world-leading legislation to phase out tobacco for good.

I want to make some brief remarks on other clauses. I have no substantial concerns about clause 2. For the Bill to work, it cannot be possible for adults over the legal age to buy tobacco on behalf of others who cannot buy it. It is obviously right that the clause avoids criminalising children by specifying that it applies to over-18s in its alignment with the commencement date in 2027. I see no issue with that.

I do, however, have questions about implementation. We have spoken a lot about physical retailers but less about online retailers. This is undoubtedly an enforcement challenge and I wonder what the Minister can say on that. In response to the consultation, the Government said that they were exploring how to enhance online age verification so that young people under the legal age cannot buy age-restricted products online. What progress have the Government made since the consultation response was published in February?

On clause 37, I want to pick up on the specifics of the Scottish age verification policy. Will the Minister explain the Government’s view on introducing additional requirements for retailers to establish an age-of-sale policy in the rest of the United Kingdom, in addition to the requirements in clause 1? I understand that the Bill would require the existing Challenge 25 policy to stay in effect in Scotland with legal force until the end of 2033, at which point over-25s will be within the legislation’s scope and then 1 January 2009 would take precedence again.

Finally, on clause 41, we support the amendment to Scottish regulations to include herbal cigarettes. Herbal cigarettes may not include tobacco or nicotine, but they are still harmful to health. Their smoke still contains cancer-causing chemicals, tar and carbon monoxide, similar to a tobacco cigarette. I am glad to see an alignment of approach across the UK nations on the point that no smoking product should be left out of the Bill’s scope. We also have no problem with the inclusion of clauses 48 and 49 to change tobacco control laws in Northern Ireland to align with the approach that we have discussed.

I reiterate that the Opposition support these clauses and we will reject attempts to amend them that would water them down. I would be grateful if the Minister responded to my questions.

--- Later in debate ---

[Dame Andrea Leadsom]

I appreciate the clear cross-party support for the measures in the Bill. I understand that hon. Members will have views on ways to amend or strengthen it, but I urge the Committee to appreciate how little time we have. As we heard clearly from last week’s evidence sessions—from the chief medical officers from all parts of the United Kingdom and from so many medical professionals—this is a very good Bill, so let us not make the perfect the enemy of the good. Let us get this through.

I very much appreciate the welcome of all colleagues, and I assure them all that I will take away any suggestions and requests and come back with clear answers. Where something is relatively simple to do, we will seek to do that, but equally, as Members will appreciate, it is not always possible to accept every suggestion, no matter how well-meaning—and I absolutely accept that, in this Bill, it is always well-meaning.

I will answer the points that hon. Members specifically raised. The hon. Member for Birmingham, Edgbaston asked about how we will encourage young people to quit smoking at an early stage. She will be aware that there are lots of measures to try to help people to stop, including the financial incentives that we are providing, particularly for those expecting a baby and their partners. There are also the quit aids to help people to swap to stop—to move to vapes, which I think we all recognise can be a useful quit aid. They are not harmless, but are less harmful than smoking cigarettes.

We are working at pace with online retailers on how to support them to ensure age verification, and I hope that we will be able to say more about that. The issue of duty-free sales is a tricky one, as my hon. Friend the Member for Harrow East will appreciate, because we do not want to put the burden of legality on the purchaser. The idea is that it should be illegal to sell, and, of course, we have jurisdiction only in the United Kingdom, but I take his points on board and will come back to him on that.

The hon. Member for York Central is right that we need to do everything we can to stop advertising. There are already very strict rules around advertising, and smoking and vaping are severely restricted when it comes to advertising to children. But I think—I hope that the hon. Lady will agree—that the vaping measures, including the powers to limit packaging, flavours and in locations in stores, will do a lot to reduce the appeal to children, which I know we are all incredibly concerned about.

[Dr Johnson]

I say, first, that I fully support this Bill and what it intends to do. Having worked in respiratory medicine in my very first job as a doctor, I saw far too many people suffering from and dying of respiratory illness, and suffering through the final years of their life due to respiratory illness caused by smoking. I think this is excellent legislation.

My right hon. Friend talked about advertising being quite restricted, but, with vaping, we see sports teams—rugby teams and football teams—using vaping brands as adverts for children. These are not recreational substances, or should not be recreational substances. They are supposed to be quit aids and do not need advertising where children can see them.

[Dame Andrea Leadsom]

My hon. Friend makes an extremely good point. She will be interested to know that I have recently written to the Advertising Standards Authority to ask about how well it considers enforcement to be working, and what more it can do to enforce the already strict regulations. I am happy to share its response, when it comes, with all members of the Committee.

--- Later in debate ---

[Dr Johnson]

I welcome clause 3. It is sensible that we protect children from having easy access to products that we have decided should be age-restricted, and it is clearly sensible that tobacco products be age-restricted —that is part of the purpose of the whole Bill. However, clause 3 does not extend to vaping products or other nicotine products. We know that the use of such products is becoming increasingly prevalent among children.

As the Minister knows, I have tabled new clause 16, which would create the same offence for nicotine-containing products or vaping products to be sold in vending machines because they are age-restricted. It is not usual to have age-restricted products in vending machines and it is my view that children would quickly find a way round machines that are supposed to check their age. Will the Minister look at that sympathetically?

[Dame Andrea Leadsom]

The purpose of clause 3, as with a lot of the clauses that we will debate in line-by-line consideration of the Bill, is to tidy up the statute book for the whole tobacco regime, both to align all four nations and to make sure there is a clear understanding of the law where it relates to tobacco, tobacco products and vaping. The fundamental purpose is to tidy up the statute book by restating it with clarity at this critical time.

My hon. Friend the Member for Sleaford and North Hykeham made a point about vaping and vending machines. As she will be aware, the Government are taking powers in the Bill to look at issues such as location of sale, packaging and flavours. It was felt that it was important to have further consultation under those powers to look at issues such as whether vaping products should be sold in vending machines. It will be debated at a future time under those regulations. The key point is that we have clarity in the Bill.

[Dr Johnson]

I thank the Minister for that information. She talks about location of sale. I understood location of sale to refer to a geographical location, rather than a method of sale, such as through vending machines. Could she be clearer on that point?

[Dame Andrea Leadsom]

I will get back to my hon. Friend on that point, which is a good one. This clause and many others are intended to tidy up the statute book, rather than to introduce new subjects that would be more appropriately considered somewhere else.

--- Later in debate ---

[Preet Kaur Gill]

First, I want to make some general points about these first vaping-related clauses of the Bill. We agree fundamentally with the Government in their efforts to find a balance by phasing out tobacco use and cracking down on youth vaping while being careful not to undermine the proven success of vaping as a stop-smoking aid. There is no doubt, however, that the rise in youth vaping is a serious concern.

My main question about the Government’s response is “What took them so long?” Labour proposed measures more than two years ago to stop vapes being branded and marketed to appeal to children, but that was blocked by the Government. I am glad that the Government have listened to us. I hope that they will continue to do so as we debate the Bill; I firmly believe that some of its provisions can still be strengthened.

I am pleased by the inclusion of clause 7. Coupled with clause 34, which defines a vaping product in a way that includes non-nicotine vapes, it will tackle a substantial loophole that we have been calling on the Government to close for a long time. Youth vaping is a serious and growing issue. In 2021, Labour voted for an amendment to the Health and Care Bill to crack down on the marketing of vapes to children. Since then, according to the most recent survey by Action on Smoking and Health, the number of children aged 11 to 17 who are vaping regularly has more than trebled. That is more than 140,000 British children. Meanwhile, one in five children have now tried vaping. In clause 7, a couple of issues therefore intertwine.

I think most people would be surprised to learn that it is legal to sell non-nicotine vapes to children, which could so obviously be designed as a gateway to addiction to the real thing, as the Minister mentioned. It is doubly concerning when we think about the illicit vapes that end up on British shelves. Testing by Inter Scientific, from which we heard last week, has found that a considerable percentage of seized vaping products that it tested contained nicotine, even when they were marketed as 0%.

That is highly concerning. It means that for the past several years, we may have seen a spate of accidental addictions among children. According to survey data from ASH, 9.5% of vapers aged 11 to 17 exclusively puff on so-called 0% nicotine vapes. Analysis of that and of data from the Office for National Statistics suggests that at least 40,000 child vapers could have been exposed to nicotine-containing vapes without their consent, becoming accidentally addicted by illegal products masquerading as nicotine-free that, under existing regulations, they are allowed to buy. That is an important testament to why not just regulation, but effective enforcement— especially over the illicit market—is vital to the success of the Bill.

The two-tier system of regulation for nicotine and non-nicotine vapes is not robust. The exclusion of non-nicotine vapes from the Tobacco and Related Products Regulations 2016 is important for a few reasons. Primarily, it is confusing and more difficult to enforce the rules on the ground if it is not clear which products contain nicotine and which do not. As 0% nicotine vapes are out of the scope of the current regulations, they do not need to be notified through the Medicines and Healthcare products Regulatory Agency process, on which trading standards officers often rely to identify illicit products. I raised that point with the Minister in a debate in January and am keen to seek clarity. Does the Minister think that all producers should have to notify vape products, regardless of nicotine content, to the MHRA?

I note that clause 71 provides the power to extend the notification process to non-nicotine vapes, but the Government have not, to my knowledge, explicitly expressed a view on the matter. Will the Minister do so now? In theory, including non-nicotine vapes in the notification process should allow for a complete database of products. Currently, it is difficult to identify which products are legal or illegal, which really undermines enforcement action.

As we heard in evidence, the impact of vaping products on the developing bodies of children has the potential to be very harmful. It is vital that we take every step to make sure that our systems of regulation and enforcement are as robust as possible to stop a new generation of products hooking our children on nicotine and harming their long-term health. We absolutely support the clause, and I am keen to hear the Government’s view on the issues that I have raised.

I have no substantial comments to make about clause 8. It is a common-sense reapplication of the principles of clause 2, which we have debated and which I support.

Clause 9 will finally address a loophole that I regret to say the Opposition raised in an amendment to the Health and Care Bill in 2021; I am glad that it is now receiving the Government’s attention. Our 2021 amendment would have prohibited the free distribution or sale of any consumer nicotine product to anyone under 18, while allowing the sale or distribution of nicotine replacement therapy licensed for use by under-18s. The then Minister rejected the amendment. To quote my hon. Friend the Member for City of Durham:

“There was no evidence of a serious problem, but the Minister sympathised with the argument for preventive action.”—[Official Report, 22 November 2021; Vol. 704, c. 56.]

Two and a half years later, it is clear what a widespread issue this has become. It goes without saying that Opposition support clause 9, which will close the loophole, as well as clause 44, which will introduce powers for the Scottish Government to extend the existing powers to regulate the free distribution of vapes and other nicotine products such as pouches, as mentioned by the Minister. Likewise, clause 51 will mean that age of sale restrictions can be extended to non-nicotine vaping products.

Finally, clause 53 relates to the free distribution of vapes and nicotine products in Northern Ireland, whether or not they contain nicotine. As I have discussed, I am very concerned that that has presented a loophole that has undermined enforcement, so I support a consistent approach across the United Kingdom. May I ask the Minister to set out what the words “in the course of business” will mean in practice when it comes to the free distribution of harmful products, given that we would expect any person caught out by the provision to argue that there is no “business” in giving away something for free? Of course, we know that that is not true in the case of addictive products, but I will be grateful if the Minister can reassure me that the clause will do in practice what it needs to do. Can she also please reassure me that it will not prohibit under-18s from accessing nicotine replacement therapies?

I reiterate that the Opposition support these clauses, but I am very interested in the Minister’s views on how the Bill should affect the notification process for vapes.

[Dr Johnson]

I welcome the clauses. I have been very concerned about the number of children who are taking up vaping and about its effects. We have heard in evidence, both in the Health and Social Care Committee and last week in this Committee, about the dangers of vaping for children who have never smoked. The chief medical officer has made it extremely clear that for someone who smokes, vaping may be better for them, but that someone who does not smoke should not vape. These measures will help to reduce the number of children who have access to such products, which is good. They will also close the loopholes for free samples and non-nicotine vapes, which can provide a gateway to such awful addiction.

We have also heard how nicotine in general is not just very addictive but harmful to children’s developing brains, and how getting them hooked early makes it more difficult for them to quit in the long term. We have heard about how children in schools are struggling to concentrate when leaving lessons to consume nicotine, which is having an impact on their education and wellbeing. We have heard from health experts about small particles going into children’s lungs, without our knowing what the long-term effects of that might be. I welcome any clause that will help to reduce the number of children vaping.

I do have one question. The cross-heading before clause 7 is “Vaping and nicotine products”, but clause 7 only makes it an offence to sell a vaping product to a person under the age of 18, rather than also making it an offence to sell all other nicotine products, although the capacity to do so is set out later in clause 9. I am just wondering why the Minister is taking a power to restrict nicotine product sales but is not actually doing so. We are starting to see that children at school are using nicotine pouches that are available in all sorts of different flavours. I can see nicotine pouches becoming the next way for the industry to try to hook children on nicotine. Has the Minister considered getting ahead of the game by saying that nicotine products cannot be sold to children at all?

[Kirsten Oswald]

Is the hon. Lady reflecting, as I am, on the comments that we heard in evidence about the link between professional footballers and some of these products? There is an obvious interest and attraction in these kinds of products for the very young people we are concerned might take up vaping.

[Dr Johnson]

Yes. Sportspeople, as we know, are very influential on young people. To promote products that are potentially harmful to children is morally wrong, in my view. They need to be careful to think about the effects that they may be having on children.

My question to the Minister is whether she will consider extending clause 7 outright to include nicotine products for children. We need to support children who are smokers or vapers and wish to quit, but those children can get nicotine replacement products from their GP on prescription. There is no need for those products to be sold to children.

Tobacco and Vapes Bill (Sixth sitting)

Caroline Johnson Excerpts

Committee stage
Thursday 9th May 2024 Public Bill Committees

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

We support clause 10 as a tidying provision that ensures that the additional restrictions on the sale and free distribution of vaping products to under-18s can be extended to other nicotine products in England that have the potential to cause similar harms. It provides that the measures in clauses 7 to 9 can be extended to emerging products such as nicotine pouches, and clause 43 makes similar provisions for Scotland.

It is clearly not right that addictive nicotine products can be sold and freely distributed to children. Awareness of the products is growing, and legislation needs to keep up. According to research by Action on Smoking and Health, awareness and usage of nicotine pouches is higher among younger adults, and just over 5% of 18 to 24-year-olds have tried one. As with vapes, the marketing of nicotine pouches is likely to be attractive to children and young people, with similar branding to sweets and soft drinks. At present, a loophole means that it is not illegal to sell them to children, so I support the measures to close it.

Will the Minister set out her intentions with regard to the use of the new powers, and what conversations she has had with devolved nations on the issue? Will she also explain the Government’s view on the potential harms from the use of nicotine pouches? Does she believe that these products could have value as a stop-smoking aid, like vaping? What merit does she see in including the products in regulations similar to the tobacco-related products regulations for vapes? If she intends to introduce regulations on nicotine pouches, can she set out her intended timescale for that?

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I support clause 10. We heard compelling evidence from Professor Gilmore last week about the tactics the industry uses to try to get young people addicted to nicotine, so that it can continue to profit from their buying the products for the rest of their lives. We also heard from Professor Gilmore about emerging evidence showing that exposure to nicotine at a young age, particularly as a teenager, can rewire the brain, making it more difficult to quit. I therefore welcome the powers in clause 10 that allow the Government to be flexible and respond to changing techniques in the market in order to stop children becoming addicted to nicotine, but why do we not just make it illegal to sell nicotine of any kind to children?

[Rachael Maskell (York Central) (Lab/Co-op)]

I appreciate being called to speak to clause 10, which is a very important part of the Bill. As we have heard many times already, the industry will look at every possible mechanism to try to bring about a new generation of people who are addicted to nicotine and make it harder for them to quit. That goes not just for people under 18 but for those in later adolescence and adulthood.

My concern is with products already on the market that are being taken up quite readily. Next week, the Health and Social Care Committee will look at the public health measures being taken in Sweden. We will see how nicotine pouches—snus, as they are referred to there—are being used as an alternative to smoking, really quite extensively.

[Dr Johnson]

Does the hon. Lady agree that nicotine pouches are starting to be marketed to young people in a similar way to vapes, with an increasing amount of flavours, a relatively inexpensive price per unit and horrifyingly high levels of nicotine?

--- Later in debate ---

[Rachael Maskell]

I am grateful to the hon. Member for that, and I agree that we want to be able to adapt as soon as the market does, but right now the industry is promoting nicotine pouches and we must ensure that we take the earliest opportunity to bring them into the scope of legislation, so that the industry does not just think, “Well, we’ve got six months now to promote our product.” Given the way the industry is behaving, this is a bit like a game of cat and mouse, and we need to do whatever we can to ensure that we are ahead of the curve, whether that is through primary or secondary legislation.

I ask the Minister to ensure that the regulations are brought forward expeditiously and that the first set—we may need further sets; I appreciate what the hon. Member for Harrow East says—is introduced in the shortest time possible. Can she tell the Committee what the timescale will be for that, so that we know how quickly these other products will be brought within the scope of the Bill, ensuring that young people are protected?

[Dr Johnson]

I agree with the hon. Lady and with my hon. Friend the Member for Harrow East. Clause 10 applies to clauses 7, 8 and 9, giving the Government flexibility on all three. As the hon. Lady said, it is great to have the flexibility to bring in regulations to amend clauses 8 and 9, but on clause 7, can she think of any good reason why we would want to be able to sell nicotine products to under-18s?

[Rachael Maskell]

The hon. Lady is following up on a theme that I probed at earlier stages of the Bill, notably on Second Reading. I believe that we need to look at stringent measures, so that people do not have their choices restricted by the addiction that they adopt. It is really important that young people today, or anyone else who engages with these products, do not get addicted at an early stage. We have to look at the issue of the impact of addiction in that wider realm, as we are doing on the Health and Social Care Committee, which is looking at products that are addictive and harmful to health in connection with the public health measures that we are scrutinising.

The hon. Member for Sleaford and North Hykeham makes an important point, and at a later stage of the legislative process I hope to examine how we address the drug nicotine and its harmful impacts on young people and more widely. Addiction has been utilised by people who exploit the lives of others for their own profit, and we need to ensure that they do not get the opportunity again with children, young people or adults. They plague those who live in the greatest deprivation in our country, driving them to more harmful addiction. I therefore welcome the legislation, but I believe that we can go further. Given the industry’s activities right at this moment in trying to find new ways around legislation before it is even on the statute book, the Committee needs to be wise about ensuring that it does not get that opportunity.

--- Later in debate ---

[Dame Andrea Leadsom]

The hon. Lady is absolutely right; they vary from 2 mg to 150 mg per pouch. I imagine that that variation would make it hard to provide a complete comparison, but she is quite right that education will be a big part of the implementation.

[Dr Johnson]

I think that most parents in my constituency would be horrified to think that nicotine pouches are available for sale to children. I appreciate that the Bill takes the power to ban nicotine products other than vaping products at a later date, but I would grateful if the Minister could explain why we should not ban the sale of nicotine to under-18s full stop. I do not understand why and in what circumstances anyone would ever wish under-18s to have nicotine sold to them.

--- Later in debate ---

[Dame Andrea Leadsom]

All I can say to the hon. Lady is that she has heard me, and I am determined to bring that forward as soon as possible. There are good reasons for not putting the provision on the face of the Bill, which are to do with future-proofing. I can only give her my absolute assurance that, as soon as humanly possible, I will bring the regulations forward for consultation where necessary and for implementation where not.

[Dr Johnson]

I am grateful for the Minister’s answer, but I am still a bit confused. I can see the point she makes about the industry and the need to remain flexible; that is really important and why we support clause 10 —particularly in relation to sections 8 and 9, which are about the purchase of products on behalf of children. I welcome the fact that later in the Bill we will see restrictions on the appeal of the packaging of vaping and tobacco products, which will help to make them less attractive to children.

However, I still do not understand why any product containing nicotine would need to be available to children and why that would not be on the face of the Bill. If we were to specify nicotine pouches in the Bill, I see that that could be got around by calling them “nicotine gum” or something else, but if it said, “Nicotine—full stop—cannot be sold to under-18s,” that would be difficult to work around, because no nicotine product could be sold to under-18s. I expect that if I did a survey of parents in my constituency, most would presume that that was already the law.

[Dame Andrea Leadsom]

My hon. Friend makes a good point, which I will take away and reflect on. We have obviously already aired the discussion about the benefit of taking powers as opposed to putting something in primary legislation, but she makes a good point and I will come back to her.

--- Later in debate ---

[Rachael Maskell]

If I might be so bold, I think the Minister is making life slightly complicated for herself. We know the impact that taking smoking products out of the line of sight of people who go into shops or supermarkets has had. Putting them in closed cabinets has very much had the effect that we would want. People do not see the products, but they have to request them; they are not on display for people to just glance an eye over. They are simply not there in the line of sight.

If the same legislation applied to all vaping and nicotine products, that would make things simpler for shopkeepers and supermarkets. They already have the shelving and the shutters; it is not as if they would have to make a financial investment in new shelving. They would not have to do anything different—just pick up the vapes and put them into a contained, enclosed space. I do not see any reason why that could not be in primary legislation, because it would be so simple, and I believe the expectation of the public is already there.

I walked down a street in York just the other day, and almost every shop had their little vape display. Putting them behind the counter, behind screens, behind shutters, would be the simplest method of dealing with that. We know it is effective for smoking. There is no reason why tobacco products should be dealt with at a different standard than vaping products when people go to purchase them, and we would get the effect of “out of sight, out of mind”. We know how much the industry spends on packaging to draw the eye to products, and how powerful that is. Putting them out of sight would have the required effect of reducing people’s thinking about those products.

Simplifying and bringing the legislation into line, for shopkeepers, the public and for us as legislators would meet the public expectation that this is what will happen. I do not think we need separate legislation to deal with vapes one way and smoking products another. Let us just pool it together, make it simple and say that this is about protecting the public. I do not think anyone will bat an eyelid.

[Dr Johnson]

I rise in support of clause 11 on restricting the display of vaping and nicotine products. I have been horrified to see that after the Government, with good intentions, made it difficult for children to see sweets at the counter, to reduce pester power and help protect them from obesity, the sweets were in many cases replaced by vapes. The Government are doing exactly the right thing in taking the powers to look at displays. As has been mentioned, the ability and flexibility of doing so through regulations means that we can move swiftly when the industry seeks to get round the latest rules. I think that is great.

I have two examples for the Minister. Would they be covered by paragraph (1)(c)? The first is a mini-mart in Grantham. The entire shop window is covered in pictures of things such as Kinder chocolate, Haribos, fruit and very large-size vape devices in bright colours. I was in WH Smith in Nottingham last weekend; this is a shop that sells children’s books, children’s toys, sweets and children’s stationery, yet at the till there is a very large video display of vape adverts immediately behind the shopkeeper’s head. Will these two types of advertising and display be covered by the regulations?

[Dame Andrea Leadsom]

Again, I appreciate the sentiments expressed and associate myself with all of them. The hon. Member for York Central requested that we put in primary legislation that vapes must be behind the counter. It is clear from the impact assessment and the consultation that that is the intention. However, as my hon. Friend the Member for Sleaford and North Hykeham points out, the reason for taking the powers is that doing so allows us to stay ahead of the next place they might be sold, for instance outside the shop, on a bus or outside a school—we can imagine all sorts of other ideas. It is important to have the regulations to get ahead of other ideas, rather than saying, “They shall be behind the counter.” That is why we are taking regulatory powers right across the Bill, so that answer holds for all the areas in which we are taking powers: we are taking them to stay ahead of an industry that has shown itself to be very imaginative and brutal in its determination to addict children. We need to stay one step ahead, and that is the plan.

--- Later in debate ---

[Dame Andrea Leadsom]

My hon. Friend highlights exactly the challenge, which is the balance between helping adults to stop smoking, where turning to vapes can be the most successful tool in the toolkit, and preventing children from ever taking up and becoming addicted to nicotine.

[Dr Johnson]

I have a question, but I appreciate that the Minister may not know the answer. Adults who wish to stop smoking have many smoking services that they can go to for advice, such as their GP or pharmacist. Other mechanisms of giving up smoking, such as Nicorette gum and nicotine patches, are available, but they are nowhere near as widely advertised as vapes. Does the Minister think that smokers are unaware of them?

[Dame Andrea Leadsom]

That is a very tricky question to answer. I certainly think that stop-smoking services are fully aware of all the different alternatives that an individual can take up. There is of course the question raised in previous discussions, which nobody has raised today, about whether there should be a prescription-only vape. Many people would say, “No, I want the convenience of buying a vape. I don’t want to have to go and get a prescription, argue why I need it, and so on. I’d rather just buy one.” There is a genuine issue of convenience and accessibility, but my hon. Friend is absolutely right that it is vital that stop-smoking services set out the whole array of different choices to help adult smokers to quit, and that will include vapes. The evidence is that vapes are particularly successful in helping adults to quit smoking.

[Dr Johnson]

My point was about that balance between protecting children and making adult smokers aware that they can use vapes to quit or to change their habit to one that may be safer for them. There seems to be a reluctance to apply stringent methods that would protect children in order to protect adults. My point on advertising was really about whether adults are any less aware of gums and patches because they are not as floridly advertised as vapes. Do we really need to be as sensitive in protecting adults, or should we prioritise the protection of our children?

[Dame Andrea Leadsom]

Intellectually and morally, I completely agree that we need to protect children, and that is the priority. I think the Bill will do exactly that. We are taking the powers to restrict the flavours, the location and the accessibility, and we are massively ramping up enforcement. All of the measures that we are taking are exactly designed to strike the right balance between helping adults to quit smoking and protecting children.

I want to address one other point raised by the hon. Member for Birmingham, Edgbaston on vending machines, and I think the hon. Member for East Renfrewshire also raised it. There will be powers taken in the Bill to limit the use of vending machines for vapes. At the moment, the evidence is that it is not a real problem; vapes do not tend to be sold in vending machines. We need to take the powers, as I have already said, so that we can stay ahead of whatever approach is taken next by the tobacco industry.

[Dr Johnson]

May I push on that point? Does that mean that the Government will accept new clause 16—the vending machine clause?

[Dame Andrea Leadsom]

We are not at that point yet. We will come to those amendments and new clauses as and when.

Question put and agreed to.

Clause 11 accordingly ordered to stand part of the Bill.

Clause 12

Restricted premises orders

Question proposed, That the clause stand part of the Bill.

--- Later in debate ---

[Dame Andrea Leadsom]

I am grateful to the hon. Member for Birmingham, Edgbaston for bringing this discussion to the Committee, and I fully appreciate the sentiment behind the amendment. I completely understand why it is attractive to raise the fixed penalty notice and make it more material to the individual, but I urge hon. Members to take into account the fact that local trading standards take a proportionate approach to tobacco and vape enforcement. The Bill proposes fixed penalty notices of £100 to enable trading standards to take swifter action by issuing on-the-spot fines, rather than needing to go through lengthy court processes. Littering, parking or under-age alcohol sales attract on-the-spot fines. The proposal in the Bill is for £100, or £50 if it is paid within two weeks. That avoids people thinking, “I can’t pay this, so you’ll have to pursue me through the courts.” That creates an incentive for these issues never to come to court, and it can clog up court time and so on. I fully appreciate the hon. Lady’s point, but this is about practicality.

I find it slightly odd that the hon. Lady says £100 is affordable but £200 is not. I would be shocked to get a £100 on-the-spot fine, and I am sure she would, too. Most retail workers would find a £100 fine to be quite devastating vis-à-vis their daily cost of living. I fully understand the sentiment behind the amendment, but £100 is in line with the precedent set by penalties for comparable offences. The fixed penalty notice for under-age alcohol sales is £90. If the penalty were raised to £200, as the amendment suggests, trading standards could issue higher on-the-spot fines, but how many of us have that kind of money on us? It would push a person into severe difficulty. As we have discussed, there is a very swift escalation—it is a “two strikes and you are out” policy—and there is the ability to take the business to task, too, so I think the current penalty is actually quite stringent.

[Dr Johnson]

The Minister will not be surprised to hear that I think we must always consider the most stringent possible fine for selling these things to kids. Will she confirm that, in the event that someone is selling age-restricted tobacco and vaping products to children, the shop worker, who is unlikely to be on a particularly high income, could receive an on-the-spot £100 fine, which they would have to pay immediately; and that the shop premises can be taken to court, and if necessary, enforcement can result in the shop not being able to sell these products at all? In addition, under clause 1 an individual can be taken to court for selling these products and can get a level 4 fine. There is a whole range of options, from on-the-spot fines, which may be relatively low and can be used if the trading standards officer wants to quickly remind someone not to make such mistakes in future, to much more severe penalties for those who are more persistent or deliberate.

[Dame Andrea Leadsom]

My hon. Friend is exactly right, and I will run through the levels of fines for the benefit of hon. Members.

--- Later in debate ---

[Dr Johnson]

Will the Minister give way?

[Dame Andrea Leadsom]

I will make progress, if that is all right—I will give way before I finish. I just want to ensure that hon. Members are aware of the facts.

Clause 25 states that funds received from fixed penalty notices issued in relation to the offences in the Bill will be retained by local authorities and must be used in connection with their functions under the Bill. That means that if trading standards issue a fixed penalty notice, the local authority will retain the funds from the fixed penalty notice, and those funds must be used by the local authority to support the enforcement of tobacco and vape legislation. That allows local authorities to cover the enforcement costs of issuing fixed penalty notices, and to reinvest any remaining funds in enforcement regimes.

Clause 26 provides the Secretary of State for Health and Social Care and Welsh Ministers with the power to change the amount of a fixed penalty notice and the percentage discount for early payment as set out in clause 24. The power provides flexibility for Ministers to adapt the amounts specified and will future-proof fixed penalty notices, ensuring that they remain an appropriate and proportionate enforcement tool to deter offenders.

[Dr Johnson]

I thank the Minister for giving way. The purpose of the penalties is presumably to punish those who have deliberately acted against the rules, and to be a deterrent against those who consider doing so. I am satisfied that the Minister has thought very carefully —I know she has—about the level at which the fines should be set. She has come up with £100, but can she reassure me that the Government will monitor to see whether that is sufficient and, if it is not, that they will increase it accordingly using the regulations provided for under the Bill? Secondly, when an individual is deciding to break the rules and to sell an age-restricted tobacco product to a child, could they know whether they would be dealt with under the fixed penalty notice or under clause 1, which carries a much bigger and more deterring fine?

[Dame Andrea Leadsom]

I can give my hon. Friend the reassurance that she seeks. With regards to the issuing of fines and whether the shopkeeper would know, it will be for trading standards to have the total range of enforcement tools that are available to them, including being able to impose a fine of up to £2,500 upon conviction in a magistrates court, as well as the other, potentially unlimited fines that we have discussed—for breach of a restricted premises order—or, indeed, this on-the-spot fine, which hon. Members will appreciate is a much faster way to provide swift and immediate punishment of offenders. Its escalation has already been set out—two offences in two years leads to the restricted premises or sale order.

Tobacco and Vapes Bill (Third sitting)

Caroline Johnson Excerpts

Committee stage
Wednesday 1st May 2024 Public Bill Committees

[Trudy Harrison]

Q Thank you both for powerfully and poignantly outlining the preventable impacts of smoking-related disease and illness on adults. I want to ask about pregnant women. In Cumbria, 12.3% of women at the point of giving birth say that they are smoking. Given the evidence-based proof, why is that still the case? I am left asking why we have we left it so long to have these conversations and bring the Bill forward.

I would like to understand the power of addiction to be able to make the point that this is a pro-choice Bill. It will give women more choice against that addiction that they are enduring at the most important point of their lives, when they are unable to make that choice for themselves.

Kate Brintworth: I absolutely agree with you. As I have said, pregnant women go to extraordinary lengths to protect themselves and their babies. They change what they eat and drink and how they behave in myriad ways to ensure that they are doing the right thing, yet it has proven very difficult to shift the figures you describe—I think nationally it is a little over 7% of women who are still smoking. That is a poignant demonstrator of just how difficult it is and how addictive nicotine is, when all women want to do is the right thing for their children. That is why all the chief nursing and midwifery officers across the four countries are united in support of the Bill, as our medical colleagues are, because we see the damage wrought across families and generations. We are 100% behind it.

Professor Sir Stephen Powis: It is important to re-emphasise the point made repeatedly by the chief medical officer for England: smoking and nicotine addiction takes away choice. When you are addicted, you do not have the choice to simply stop doing something. It is an addiction. It is a set of products that removes choice, and in removing that choice, people are killed.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Q I want to ask you about vaping, particularly among children and pregnant women. First, to Kate, are you aware of any research into which chemicals from vaping may be transported from the mother’s blood through the placenta and into the baby, and whether that has any effect, or is the research too early to be able to tell us that information? For Professor Stephen Powis, could you tell me what research NHS England is supporting into the effects of vaping on children?

Kate Brintworth: The information that we have so far suggests, as it does across all areas of healthcare, that vaping is safer than smoking. What we do not have is the long-term data that we have on smoking to give us the confidence to describe the harms clearly. That is something that we need to keep observing and understanding so that we can give people the best-quality information.

Professor Sir Stephen Powis: NHS England is not a primary funder of research but we are an evidence-based organisation, as I described earlier, particularly on the use of vaping for smoking cessation. We are very keen that the evidence base, particularly on vaping, is expanded. We would support research in terms of calling for it to be undertaken but also in terms of supporting the NHS as a delivery mechanism for the context in which that research is done.

We very much want to support further research because, as you know as a paediatrician, this is an area where the evidence base is emerging but there is more to do. It is not as complete as the evidence base for smoking. It is really important, even with the passage of this Bill, that that evidence base grows and that we in the NHS support the generation of further evidence where we can.

[The Chair]

Thank you. That is a good point at which to say that this session has ended and to thank our witnesses for all the information they have provided.

Examination of Witnesses

Professor Kamila Hawthorne and Professor Steve Turner gave evidence.

--- Later in debate ---

[The Chair]

I call Dr Caroline Johnson.

[Dr Johnson]

As a declaration of interest, I am an NHS consultant paediatrician and a member of the Royal College of Paediatrics and Child Health.

[The Chair]

Thank you. I call Preet Kaur Gill.

--- Later in debate ---

[The Chair]

I call Dr Caroline Johnson—you have all been so kind to one another, we are now ahead of time.

[Dr Johnson]

Q Professor Turner, Dr Helen Stewart from the Royal College of Paediatrics and Child Health gave evidence last summer to the Health and Social Care Committee, of which I am a member. She talked about some of the passive effects of vaping on children, such as in the toilets on school premises, where many children had been vaping in an enclosed environment, and children with asthma and other lung conditions were frightened to go into those toilets because their conditions were triggered by being in the presence of second-hand vaping.

Do children breathe in second-hand chemicals when they are proximal to adults vaping, or in an enclosed environment? If they do, what effect does that have on children’s lungs? Would you, or the royal college, support a ban on vaping in public places in a similar way that we currently ban smoking?

Professor Turner: I think that vaping in schools and school toilets is a big problem. First, it means that fire engines come out and that disrupts school. As you say, there are some children whose asthma will get set off by exposure to vapes, for example. So I think that it is a big problem, and you have already heard from schools. We are still not sure what components of the exhaled second-hand vape, if you will, are causing symptoms, but, as you described, that happens.

On your third question about banning vaping in public spaces, I would not have an opinion on that. If they are being used by people who are nicotine-addicted to help to come off their nicotine addictions, I would not be unhappy with that. Most of the second-hand vape is water vapour, but if you walk behind somebody who is vaping, you can tell what the taste is, so there are chemicals in there. I think that banning them in public spaces, at this point in time, is something that I would not have a strong opinion on.

Professor Hawthorne: I think we are on a journey, over the years, towards stopping smoking as a nation, so this Bill looks like a great step forward. I think that it is a landmark suggestion, and now that New Zealand has backtracked, I think we will be ahead of the game.

Professor Turner: And we have a proud record of doing this, from a legislative point of view.

Professor Hawthorne: Also, to some extent, sometimes, when you make a big step—which this is—you then might want to stop and wait, consolidate, check and gather more data before you make the next step.

[The Chair]

If there are no further questions, I thank the witnesses for their evidence. That brings the morning’s session to an end. The Committee will meet again at 2 pm this afternoon, here in the Boothroyd Room, to continue taking oral evidence.

Ordered, That further consideration be now adjourned.—(Aaron Bell.)

Tobacco and Vapes Bill (First sitting)

Caroline Johnson Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[The Chair]

That is more of a boast than a declaration of interest.

[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.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)]

I am a practising psychologist, and I also chair the all-party parliamentary health group.

--- Later in debate ---

[Rachael Maskell (York Central) (Lab/Co-op)]

Q Public health messaging is most effective when it is simple. Should the restrictions on vaping being advertised on football shirts, for instance, be in line with those on tobacco advertising, and should there be similar restrictions on where people can vape as there are for smoking?

[Dr Johnson]

I want to ask about the passive effect of vaping. We know that if you are proximal to someone vaping you can smell the blueberry flavour, or whatever it is. Do you have any evidence on the passive health effects of vapes?

[The Chair]

Could we start with Michelle Mitchell, please?

Michelle Mitchell: I think Deborah is going to pick up on vaping.

Deborah Arnott: Actually, I think that question is best put to Professor Ann McNeill, who you are seeing this afternoon. It is a really technical question and needs to be answered by a scientist. In principle, though, as Michelle has pointed out, what cigarette smoke has in it—tar, nicotine and carbon monoxide—is much more harmful than any passive effect from vaping. It may be unpleasant, with the flavours, but that is something else.

--- Later in debate ---

[The Chair]

I call Dr Caroline Johnson, and this will be the final question.

[Dr Johnson]

Q In the Health Committee, of which I am a member, we heard evidence that some schoolchildren with lung diseases, such as asthma, were not able to visit school toilets during the day because the overwhelming smell of people vaping in there was triggering their asthma. Have you heard anything about that? Do you have any evidence about asthma in children or adults being triggered by vaping?

Sarah Sleet: We have heard anecdotally that people have had issues with being around vaping, but there is not any robust evidence as to whether it genuinely triggers asthma for some of those people. It is an area we want to look into a bit further, but I would say that here is a clear case of where the law is that children should not be vaping. We need to ensure that enforcement is in place, as far as possible, to prevent that from happening.

[Dr Johnson]

Q Is that an absence of evidence, or does evidence exist but is inconclusive?

Sarah Sleet: I am not aware of any serious evidence that has been gathered around this at this stage. It probably needs to be looked at.

[The Chair]

I thank the two witnesses for being not only concise, which enabled us to get through all the questions, but informative. I am sure we have benefited from the evidence you have given.

Examination of Witnesses

Matthew Shanks and Patrick Roach gave evidence.

--- Later in debate ---

[The Chair]

A very brief final question from Dr Caroline Johnson. We have to finish at 10 past 11, so I ask the witnesses to bear that in mind.

[Dr Johnson]

Q I want to ask about flavourings because we have heard that flavourings may encourage some adults to switch. We know that where adults stop smoking using vapes, flavourings might prolong their addiction to vapes, and we know that flavourings entice children to vape. Some people say that we need to keep the flavours for the adults; some people say no flavours because they entice children. To govern is to choose, so which do you think is the most important—supporting adults to stop smoking or protecting children from starting vaping?

Matthew Shanks: A simple question to finish with—thank you! I think you can have both, because I would. If you look at the way cigarettes are marketed—behind a shelf with the pictures of the damage they cause—that is different from the way vapes are marketed, with their colourful packaging and excellent flavours that appeal to children. If you change the way they are marketed, you could have both, because you could still help adults with the flavourings but not make them appealing to children.

Patrick Roach: A simple answer: protect children from harm.

[The Chair]

I thank the witnesses for giving us a very particular perspective that we have not previously heard about on how all this impacts on teaching and the education sector in general. We are grateful for that, and I am sure the Committee found it helpful.

Examination of witness

Paul Farmer gave evidence.