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.

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[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.

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[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.

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[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.

Tobacco and Vapes Bill (Second sitting)

Caroline Johnson Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[Kirsten Oswald (East Renfrewshire) (SNP)]

Q We heard in an evidence session earlier about the challenges in schools, with children vaping in increasing numbers. There is an impact on their education because of their becoming addicted, and that causes challenges in their interactions with the learning process. Do you think that the measures in the Bill are sufficient to deal with that growing problem? Do you have a view on whether we have a handle on the quantum of that problem, and are the measures on advertising sufficient to try to remedy that?

Greg Fell: Yes, in part, in terms of the measures in the Bill. I would treat vapes like I would treat cigarettes in terms of colours and marketing, with plain packs out of sight behind the counter and strongly enforced. I would take care, though: we use and want to continue to use vapes as a route out of smoking cigarettes, so getting the balance right remains important, but I would be quite aggressive about the regulation and the deterrent.

Education in schools by itself will not be sufficient. It might or might not be effective, but it will not be sufficient. Action on Smoking and Health has co-produced with a number of local authorities a range of resource packs for parents, teachers and others, which are fairly widely used, but they are not sufficient by themselves to stop the rise in young people vaping, so we need strong regulation with the enforcement of that to boot.

Cllr Fothergill: It is not part of this Bill, but it is part of LGA policy that we would like to see a ban on disposable vapes. There are 5 million sold every week, with the vast majority sold to younger people. The vast majority are thrown away. Those that are thrown away responsibly finish up in one of our recycling lorries where the lithium batteries cause major problems with fires. It is not part of this legislation, but we think that that needs to be tackled separately; I think it will be.

Greg Fell: One point that I just remembered on the resource pack that has been widely circulated to headteachers and schools: a line was taken in that to tell the truth—not to over-egg the pudding but to tell the truth and say what we do and do not know, because in my experience scaring kids usually switches them on to something rather than turning them off something. In the pack, we have also told the truth about the methods and tactics that the tobacco industry has used to get kids hooked on vapes, and that as a rule makes kids pretty angry. It certainly makes parents pretty angry when they realise what has happened.

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

Q If I may, Mr Fell, I will bring you back to the issue of passive vaping. You talked about there not being so much evidence on the harms of passive vaping compared with passive smoking, which is correct. Of course, smoking has been around much longer for the effects to be understood. However, there are papers, published in reliable journals such as The BMJ, saying that those people—in particular, young adults who do not smoke or vape—who are exposed to passive vaping do get an increase in bronchial symptoms.

Greg Fell: Agreed.

[Dr Johnson]

Q There are effects. One reason why a former Government brought in the ban on smoking in enclosed public spaces was so that people would not be forced to experience such a risk, either at work or socially, which was one that they did not want to take. Would you, as a director of public health, support a ban in enclosed spaces for vaping, too?

Greg Fell: Possibly. I would need to go back to the science and have a really careful look at it. There is the danger of unintended consequences and turning people away from vaping as a route out of smoking. Outdoors it is not a thing; indoors—for me, it is a carefully balanced thing and I would want to go back to read the science. It is a while since I have read it, to be fair.

[Dr Johnson]

Q If someone cannot smoke in a pub, why would not being able to vape in a pub make them smoke?

Greg Fell: I am thinking of my logic now, and would agree. What I would not want is for somebody to not switch from smoking tobacco to vaping because they fear they would not be able to vape in a pub. That would be the unintended consequence I would try to avoid.

[The Chair]

David, do you want to add anything?

Cllr Fothergill: I have nothing to add.

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[Preet Kaur Gill]

Q Is there anything you want to say on the age-of-sale verification process?

Adrian Simpson: In the large retail sector, we have worked on things such as Challenge 25 for many years, so we are used to challenging consumers buying products. One thing that we would like to make clear is that this can be a very controversial issue. We know that challenging consumers for proof of age leads to violence and aggression against shop workers. We think it would be beneficial if a long period were given for these regulations to come into effect, to give retailers the chance to educate their staff on these issues and to educate consumers.

[Dr Johnson]

Q I want to ask you about the licensing regime. You have to have a licence to sell alcohol and tobacco, and some have suggested that you should have to have a licence to sell nicotine full stop because it is an addictive substance. That would mean that you would need to have a licence to sell vapes, partly as a way of making them less accessible to children in the places that they may be sold. Would you support that?

Adrian Simpson: It is not an issue that we have discussed at any length in the British Retail Consortium. We are aware, of course, that there are parts of the UK where licensing is required for certain tobacco products. We are well used to the alcohol licensing that has been going on for many years. Unfortunately, I cannot comment on whether the whole sector would be in support of that. We would perhaps need to see how a potential licensing system would operate before we gave our full support to it.

[Dame Andrea Leadsom]

Q Thank you so much for being here. You will be aware that, in putting together legislation, huge effort is made to be balanced and not excessive and to make it doable and achievable, nowhere more so than for those who are trying to enforce it.

May I press you a bit further on the point that Preet made about whether the fines are sufficient? You have said that it is a bit complicated and will require some lead-in time—which is obviously provided, with the 2027 date—to give appropriate training to shop staff. The quantum of the fine was intended to enable on-the-spot fines, rather than having lengthy litigation because the person who incurs the fine does not have the cash and needs to go away, may or may not pay it, may or may not have to be pursued, may or may not have to go to court, and so on. Understanding that there are different views on all sides, is the balance just about right or, if you could have put your own wish list together, are there things that you would have done differently?

Adrian Simpson: We would have liked to see more education provided to retailers who might have broken the rules. A fine can be life-changing for someone who is given one, so we like to see whether there might be a way around that; perhaps the shop worker could be educated first, rather than going straight to a fine, if at all possible. We would like to see that balance of education before strict enforcement, if possible. That would be our wish.

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[The Chair]

Colleagues, we might be voting fairly soon, so short questions, please, and concise answers.

[Dr Johnson]

Q My question follows on from that of my colleague. Lincolnshire police measured what was in vapes confiscated from children in my constituency. They found chemicals like diethylene glycol diacetate, antifreeze, Steol-M, poster varnish and others. As I understand it, when they look at a vape in a box, one of the challenges for enforcers is being able to tell whether it is a real, legitimate vape that contains what it is supposed to contain or a fake vape that contains a whole load of nonsense and potentially harmful chemicals. How could the legislation help you with that?

Secondly, someone showed me on packets of cigarettes recently that there is a scannable code, and trading standards have a special scanner that they can scan that with. Would that sort of thing help on so-called legitimate vapes?

Kate Pike: Potentially. The track-and-trace legislation on tobacco that enables us to scan a packet of tobacco and find out if it is where it should be—it is tracked all the way through the system—could potentially work on vapes. It would be very complicated to bring in—well, not complicated; it would be a big exercise to bring in track and trace for vapes, but it is potentially something. As you know, there is a consultation out at the moment for vapes to become an excise product, so it could possibly be that we introduce track and trace alongside that for vapes.

If you look at a vape and you look at the packaging, there are lots of red flags that tell us if it is illegal. We can usually tell by the packaging alone. We are doing some market surveillance work at the moment for vapes that look as if they should be compliant; they are notified to the MHRA, to check the ingredients. So far, touch wood, we are not finding too many issues in those nominally compliant vapes. But there are so many illegal vapes out there. It is actually quite easy to see that they are illegal, when you see them. We do know how to identify them at the moment, but obviously it could become more difficult. We will just have to make sure that the new regulations are still enforceable when they come in. For example, if there is a ban on types of flavour, we would want that to be really clear. We do not want to have to go round sniffing or tasting. It needs to be clear by the description, rather than just some sort of guess along the lines of, “Is that strawberry bakewell-flavoured?” It would be very difficult for us to manage that.

[Kirsten Oswald]

Q I do not know if others have had this experience, but I am aware that I am increasingly being advertised at online by products that, although I am not really sure what they are, are certainly connected or proximate to tobacco or vapes. That leads me to wonder whether there are any tobacco, vaping or other connected or related products that are not covered by this Bill, which you think perhaps should be.

Kate Pike: I think the Bill is really good at closing some of those loopholes. It will include an age restriction on 0% nicotine vapes, for example. There are other nicotine products, such as the little nicotine pouches. The popular term is, I think, snus, but we know that snus is already banned in this country. The enabling regulations to put a regulatory framework around products like that will be really helpful. These industries are very innovative, so we just need to make sure that we are keeping up with our regulation. I think that the enabling regulation powers will enable us to keep up with new products, but it is continually little steps, and regulation chasing after innovation. We would like it to be the other way round, really.

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[Mary Glindon]

I would just like to say that vaping is 95% safer than smoking.

[Dr Johnson]

Q I proposed a ten-minute rule Bill to ban disposable vapes last February, so I am delighted to see that the Government have brought in an statutory instrument to do exactly that. I am disappointed, but not surprised, to hear you say that industry is doing its best to circumnavigate the regulations before they are even brought in.

I have two questions. First, how do we ensure that the regulations are flexible enough for us to be able to stay ahead of such measures? Secondly, could you say a bit about the effect on wildlife? My hon. Friend the Member for Penrith and The Border (Dr Hudson) has talked about puppies picking these things up in their mouths and the danger they can pose if the puppies bite into them. Could you talk a bit more about the danger that they pose to wildlife when they are thrown away?

Laura Young: Of course. On the regulations, I think that we have to think creatively and innovatively about some of the workarounds that might be being used. We are already seeing charging ports just being popped on the bottom. Of course, that might mean that the battery can be recharged a few extra times, but if it cannot be refilled with the solution, it is still, in practice, a single-use item and will have to be thrown away eventually.

The issue is about ensuring that we look at the builds and make sure that they are modular and that the circular-economy principles that we want to achieve are set in stone. I think that that means working as best as possible with the retailers and the manufacturers—although that will be really difficult—and looking to other initiatives, whether that is single-use plastics bans or treaties on plastic, one of which has just come to an end globally, to see what we can do.

I will tell you a story about the wildlife. A wildlife photographer, a birdwatcher, was taking some images of a marine bird doing a very normal activity, which was picking up a shellfish—what looked like a razorfish—and dropping it from a height to smash it open to get some delicious dinner. But after this young gull had failed multiple times, this photographer realised that, unfortunately, what it was actually picking up and dropping was a disposable vape. We are seeing not only domestic animals, such as cats and dogs and things that we love as pets, getting hold of disposable vapes and potentially breaking them open, but actual wildlife being impacted—picking them up, thinking they are shells on the beach, and trying to eat what is inside them.

That is just from the very short time that we have been paying attention and looking out for this, and from keen birdwatchers capturing it, so we know that there will be extensive wildlife impacts. We are only now scrambling around to try to find more evidence, but we know that it is already happening, and that that is just one example. The photographs are on Twitter, if anyone did want to go and find them. It is sad, but it is definitely the reality of what we are seeing.

[Mary Kelly Foy]

Q Just a very quick question: would you agree that this is symptomatic of the throwaway society that we live in? We have disposable vapes, plastic toys with happy meals and toasters—all small appliances that do not last long enough. They are all thrown away and are damaging the environment. I know that, in Durham, all sorts of electronic devices are thrown in the river, and that is interfering with wildlife.

Tobacco and Vapes Bill

Caroline Johnson Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Elizabeth Truss]

My hon. Friend makes absolutely the right point. There are double standards in this debate. My view is that it is absolutely right that we protect the under-18s from these potential dangers before they have full decision-making capability, but we should allow adults to exercise that freedom. It seems to me that the medical establishment, the national health service and others working in the health industry have unfortunately been captured by this gender ideology, which is preventing them from seeing the truth of what is happening. That is why the Cass report is welcome. If only the hon. Member for Ilford North (Wes Streeting) had shown the same level of interest in dealing with the issue of young people and puberty blockers that he has shown in pursuing his crusade against smoking—he was not saying this a few years ago.

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

As my right hon. Friend will know, I was in the Chamber on that Friday listening to the filibustering, and was unable to contribute to the important debate on puberty blockers. I support her Bill and am grateful for the Cass report.

In reality, there are some products that are banned for adults—things such as cocaine and heroin—so society as a whole has made a choice that some products must be banned for adults as well as children. It is about where we draw the line. My right hon. Friend said that people should be able to do whatever they want as adults, but in fact unless we want to liberalise laws on drugs and allow people to have heroin, cocaine and everything else—perhaps she does—a line has to be drawn somewhere, and it is just a case of where.

[Elizabeth Truss]

I certainly do not support the liberalisation of those drugs. We know that people who become addicted to heroin and cocaine are a huge danger to other people and to their families; it destroys society. That is not the level of danger that tobacco poses, so those are very different scenarios.

I will come to my conclusion, because I know that a lot of people want to speak in the debate. What I ask is that Members do not just follow the instructions of the health lobby. We have heard about what the chief medical officer says. I know from being a Government Minister that there are often schemes pushed by officials and civil servants because, fundamentally, there is a belief that government knows best. I want Members of Parliament to think not just about what happens if we ban smoking for people who are over the age of 18, but about the implications for shopkeepers who have to identify whether people are the right age. Will it mean that people have to carry ID into shops with them into their 40s? What are the practical implications? It is a very dangerous precedent to start saying that some adults can have the freedom to smoke and some cannot. That is a fundamental problem. It is fundamentally unconservative, it is unliberal and I will not be supporting the Bill.

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[Kirsten Oswald (East Renfrewshire) (SNP)]

I am pleased to speak here today in favour of the Bill, part 2 of which specifically relates to Scotland, because smoking is the leading cause of preventable death in both Scotland and the UK. We know that, so we are surely duty bound to act and prevent harms. To be clear from the outset, I want us to help people to stop smoking. Smoking cessation, as well as preventing future harm, requires our action.

Dr Ian Walker, executive director of policy at Cancer Research UK, has correctly pointed out that nothing will have a bigger impact on reducing the number of preventable deaths in the UK then ending smoking. I will not go into detail about the terrible reality of the health impacts of smoking. We have heard about them already today, particularly powerfully from those who have worked directly in the medical environment. We have seen significant successes where we have acted on smoking in the past. I remember when the ban on smoking in indoor public spaces came into effect in Scotland, a first in the UK. It was a bit controversial, but not for long. It has undoubtedly hugely improved our environment and, importantly, our health outcomes. We have seen an important decrease in the numbers of smokers, but let us be real—there are still far too many lives being destroyed by smoking.

I am very glad that Scotland has been in front of the curve on these issues, whether that be with the indoor ban, the overhaul of tobacco sale and display, the ambitious goal of a smoke-free Scotland by 2034 or an issue that I have often spoken about here, the consultation on disposable vapes. The direction of travel is welcome. The SNP welcomes the collaborative step towards creating a smoke-free generation. It is not just us—the public are looking for action too. Action on Smoking and Health tells us that the largest poll of public opinion conducted to date—over 13,000 adults were polled—found 69% in support, including over half of all current smokers.

I watched with some despair—a little bit like I watched some of the proceedings in the House today—media interviews this morning where the right hon. Member for South West Norfolk (Elizabeth Truss) said some of the things she repeated here in the Chamber. She said:

“I don’t know why this legislation is being brought forward”.

I would have thought that was pretty obvious really, but let me help her with that: it is to stop people dying. She then said, as she has again during the debate, that this is “unconservative” legislation. To be fair, I know absolutely nothing about being a Conservative and I am very much OK with that, but what a bizarre statement. Surely regardless of our varying political views, we can look at the health impacts of smoking and say they is not the future we want, and not the damage, harm and heartbreak we want for future generations.

Let us be clear that any arguments put forward about personal choice or personal freedom make no sense at all when we are talking about children and a highly addictive substance. Smoking is not a free choice; it is an addiction. Nicotine is a horribly addictive substance. That is why this is a positive and necessary move, and one widely welcomed, including by Asthma and Lung UK. That organisation points to the significant harm to future generations if we do not act now, and highlights the enormous cost to the NHS if we do not take this preventative action when we have the opportunity to do so.

Scottish Government Public Health Minister Jenni Minto MSP has welcomed the Bill, pointing out that Scotland has been a world leader on a range of tobacco control measures. While there has been a steady reduction in the proportion of people smoking, we know it still damages lives and kills more than 8,000 people a year in Scotland. If we do not act, we know perfectly well what the impact of that inaction will be.

We also know that smoking causes and exacerbates health inequalities, which is exactly why we need to have a tobacco-free Scotland. Indeed, Mark Rowland, chief executive of the Mental Health Foundation, points out:

“Smoking harms disproportionally affect those with poor mental health and stopping smoking has been shown to be as effective as anti-depressants. The Tobacco and Vapes Bill is a once in a generation opportunity to prevent the known mental and physical harms that smoking causes and regulate commercial interests from undermining the health of future generations.”

Asthma and Lung UK notes that the harms of tobacco are not equally distributed. In fact, smoking is responsible for half of the difference in life expectancy between the richest and poorest in society. That generational nature of tobacco addiction means that children born today to parents who smoke are four times as likely to take up smoking themselves and to find it harder to quit. So the impact of smoking in terms of generational inequality and harm is clear and known, and we should aim to change that.

I am grateful to Asthma and Lung UK, and to the many other groups that sent me briefing materials. The breadth and range of organisations, including many medical and health groups, that have been in touch to urge me to support improvements in health and to stop future generations becoming addicted to tobacco, is very interesting and speaks to the wide spectrum of those determined to stop this harm, including, as we have heard, a majority of the public and retailers.

I would like to spend a little time talking about vapes, particularly disposable vapes. To nobody’s surprise, I am going to be positive in my support for any and all measures to arrest the tidal wave of children vaping, which should absolutely chill us all. The health impacts on children are terrifying, and that is only the ones we know about. My view is very firmly that all disposable vapes should be banned now, immediately. We should deal with the utmost urgency with the significant harms these devices are causing to our environment and to eye-watering numbers of children. Which of us can seriously say they are confident it is not their children? Members are deluding themselves if they believe that is the case.

[Dr Caroline Johnson]

As the hon. Lady knows, as we worked on this subject together, I brought forward a ten-minute rule Bill to ban disposable vapes last year. The measures in that Bill do not form part of the legislation today, because this is health legislation, but the banning of disposable vapes forms part of a statutory instrument that has been brought forward as environmental legislation. Does she welcome that?

[Kirsten Oswald]

I am grateful for the hon. Lady’s intervention. As she knows, it is important for us to look at disposable vapes in the round, including their devastating environmental effects as well as the terrible impacts they have on the health of our young people. Whichever angle we look from, these are devices of which we have no need and that we should get rid of as soon as possible, before they cause any more harm.

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[Sir Jake Berry]

My hon. Friend is quite right. That is the legal position under the law in this country if we have capacity, no matter how bad the decisions we make. Constituents have contacted me about elderly relatives who are making poor financial decisions, but because they have capacity they are free to make those decisions, albeit bad ones in some cases.

[Dr Caroline Johnson]

Will my right hon. Friend give way?

[Sir Jake Berry]

I will not. I have given way once and want to stick to my time. I will not support the Bill, because I believe in freedom.

My second point is about mandate. The Prime Minister does not have a mandate to bring forward this legislation, and no Labour or Liberal Democrat MPs—in fact, no MPs in the House—have a mandate to vote for it, because it was not in our manifestos. We are just months away from a general election. If people believe that this measure is so important, they should put it in their manifestos. The Conservative party could put it in our manifesto and let people vote for it.

The powers that we have in this House of Commons are not ours; they are lent to us by our constituents between general elections. We are quite rightly getting to the point where we have to return those powers to our constituents and try to persuade them that we have done a good enough job to get them back. Before we start giving away their freedoms and liberties, let us at least give them the opportunity to have a say.

There is one addiction in this country that I am even more concerned about than the addiction to nicotine: the addiction of the Government to telling people what to do. I want to live in a free society where I am free to make both good and bad decisions. As people go through the Aye Lobby to support the Bill this evening—I shall be going through the No Lobby—I ask them to cast their mind back to the last time we were all washed through the Aye Lobby together on a wave of health and science and righteous hope to keep people safe, which was during the covid pandemic.

I am proud of furlough and all sorts of things, but I regret closing schools. It was the wrong thing to do, but I was washed along on that wave. I opposed some of the covid proposals. People should look back to that and think, “That was the last time we took people’s freedoms away from them. Did we always get it right?” In my view, the answer is no. We got lots of things right, but we also made lots of mistakes. As people march through the Lobby, they should think about whether in fact they urgently need to support the Bill or whether it should wait until after a general election—we may have a different Government then, if polls are to be believed—when the British public will have at least had the question put to them.

The addiction of our Government to telling us what to do goes beyond whether we should smoke. During covid, they determined who we could go to bed with, whether we could sit in the park and read a newspaper, and whether we could go to work. We are now told how we can heat our homes and whether we can drive an older diesel car in London. Unfortunately, we live in a country where those freedoms—those freedoms that are not free—are being eroded every single year of our lives. That is not something that I am comfortable with, and it is not something that I am prepared to support.

There are good bits to the Bill, but we cannot allow the fact that good bits of legislation have been annexed to this terrible legislation, which in my view will not work, to force us to support it. The Government could bring in the vaping measures on their own, and I would support them. I just do not support the creeping ban on tobacco. When people reach the age of 18 in a free society, they must be free to choose for themselves.

I will finish with this. If Members find themselves in the No Lobby tonight—I hope I will see a few colleagues in there—they should keep in their mind that freedom is the sure possession of those alone who have the courage to defend it. In my view, by voting no tonight, we defend the freedoms of our constituents and our country. It is the right thing to do, and I look forward to seeing as many colleagues in there as possible.

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

I rise in support of the Government’s Bill. One of the first speakers this afternoon was my hon. Friend the Member for Bosworth (Dr Evans), who talked about his first job in respiratory medicine. My first job as a doctor was in adult respiratory medicine, too, and I spent a lot of time looking after patients with chronic obstructive pulmonary disease, intermittent claudication and lung cancer, and that taught me that smoking causes not just premature death, but substantial, debilitating, miserable disability that can go on for many years. I therefore support the Government in doing all they can to reduce the number of smokers.

Some people have talked today about the freedom for an adult to choose to do what they want, but we already make changes to what adults can do. We already restrict their freedoms. For example, we tell adults that they must put a seatbelt on when they get in the car. They must wear a helmet when they ride a motorcycle. They cannot drink alcohol before they get in a car, and they cannot drive down the motorway at 150 mph. So we already make restrictions for people’s safety on that basis.

I do think that gradually increasing the age is inelegant, as my hon. Friend the Member for Winchester (Steve Brine), the Chair of the Health and Social Care Committee, put it, and will be challenging to enforce. But the alternative—to ban smoking outright—would be difficult, because it is an addictive substance. If we banned an addictive substance overnight, we would criminalise those already addicted. By doing it in advance and gradually increasing the age, we will instead not criminalise people for being addicted, because they will not get addicted in the first place, at least in principle.

I want to focus most of my remarks on vaping. I have been campaigning on vaping for some time, because I am concerned about the snowballing number of children who are addicted to it. Indeed, last year I introduced a ten-minute rule Bill to try to ban disposable vapes, which have been the most attractive vapes to children and cause the most environmental damage. At the time, 1.3 million vapes a week were being used—it is now up to 5 million. They are almost impossible to recycle in practice because the lithium batteries are difficult to recycle, and the nicotine gets soaked into the plastic, which makes that difficult to recycle as well.

I understand the need for adults to have something to help them stop smoking, but vapes are not just a stop-smoking device; we should look at them as an alternative addiction. Earlier in my campaigning, when I spoke to the industry, I said, “What is it with all these flavours?” I was told, “Well, the thing is, if someone tries to stop smoking using nicotine gum, they use the nicotine gum—or something—as a stop-smoking device. So they go from smoking, to gum, to nothing. If we give them vapes that taste of tobacco or are bland, they go from smoking, to vaping, to nothing. If we give them cherry cola-flavoured vapes, they go from smoking, to vaping cherry cola, to vaping mango and to vaping blueberry. They remain one of our customers and continue to use our product.” The industry is trying to create a new generation of addicts to make itself billions of pounds.

I can understand why the industry wants to make the money, but the way it is doing so is, in my view, immoral. In particular, its marketing of these things at children is immoral. A grown-up may wish to have a cherry cola-flavoured vape, but he or she does not need to have a unicorn milkshake-flavoured cherry vape shaped like SpongeBob SquarePants. That is why the flavours are important, and I welcome the Government’s measures to deal with flavours, colours, shapes and packaging.

What are the risks of vaping? As others have said, education is really important on that. For our children, in the short term, its powerful addiction causes problems with concentration, with some having to leave lessons because they cannot cope until the end of a double lesson without vaping. In some cases, as we have heard, it causes chest symptoms and can cause collapse. In the long term, the simple answer is that we just do not know.

A recent University College London study showed that DNA methylation—modification of DNA—occurs in people who vape. Does that show that vaping causes cancer? No, it does not. Time will tell us that, but it suggests at least that it might. That is why we must be extremely careful with our children. Adolescents will always experiment with substances because it is in the nature of adolescence to experiment with boundaries, but we need to ensure that we take as much care of them as we possibly can.

In particular, I welcome clause 10, which will allow the provisions to be extended to other nicotine products. The industry is making billions of pounds, and it will continue trying to flex to try to keep people addicted to nicotine. We can see that today. A search on the internet shows that Tesco is selling 20 nicotine pouches for £6.50. Those tiny pouches of up to 12 mg of nicotine—about 10 cigarettes-worth—are placed under a person’s gums and will release those 10 cigarettes of nicotine over an hour. They are sold in flavours called “Ice Cool”, Bergamot Wildberry”, “Mocha” and “Elderflower”. Does the House see a pattern here? That will be the next thing, and that is why I welcome the clause, which will allow the Government to reflect, if they want, on new forms of nicotine use.

I have some questions for the Minister. The Health Act 2006 prevents smoking in enclosed public spaces, on public transport and in certain other areas. Why has that not been extended to vaping? Also, as I was walking through Westminster the other day, I saw a big red Transport for London bus advertising vaping—something I have written to Sadiq Khan about. I wonder whether the Government plan to extend vaping regulations not just to what the package looks like but to the advertising itself.

[Kirsten Oswald]

Will the hon. Lady give way?

[Dr Johnson]

I will not, because I have only a minute left.

The hon. Member for York Central (Rachael Maskell) mentioned the advertising at Blackburn Rovers; again, sports advertising while children are watching is not helpful.

I have a final question for the Minister. Given that this is urgent, we are seeing so many children starting vaping and we want to stop people smoking as soon as possible, why are we waiting to bring in the regulations? Why not bring them in to affect children more quickly?

Cass Review

Caroline Johnson Excerpts

Monday 15th April 2024 Commons Chamber

[Victoria Atkins]

As I have said, we hope to expand it to Bristol later in the year, and there will be a further three or four sites across England. However—this is a really important part of the report—this is not just about specialist services but about giving clinicians the necessary confidence to look after children and young people who may well be presenting at their clinics or surgeries with this condition as one of a number of conditions. We want to give them back that confidence, and the comfort of knowing that they need not just go down the narrow pathway of specialist services. Of course that will be appropriate for many, but we want to treat the whole child rather than treating just this particular condition, as has happened in the past.

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

I must first declare my interest as a practising NHS consultant paediatrician whose practice sometimes involves caring for children with the condition we have been describing.

The Cass Review makes for sobering reading. This is an example of ideology being allowed to trump evidence and safeguarding. Let me give the Secretary of State a specific example. Individuals have thwarted the attempts of those working on the report to conduct research that would give them a better understanding of the outcomes for some children. I am pleased to hear that those people are now co-operating, but we should note the contents of a letter from John Stewart, the national director of specialised commissioning, which is appended to the report. He says that although NHS England wrote to the chief executives and medical directors of all NHS trusts, the research data was not released. One of the duties of doctors that are specified by the General Medical Council is to

“Engage with colleagues to maintain and improve the safety and quality of…care.”

May I ask the Secretary of State who exactly blocked that data, what investigations will be carried out to find out which individuals were responsible, and how they will individually be held accountable for their actions? How was it possible for them to do this in the first place, and what is she doing to ensure that data cannot be blocked in the same way in the future?

Illegal Vapes

Caroline Johnson Excerpts

Tuesday 16th January 2024 Westminster Hall

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

I congratulate my hon. Friend the Member for Darlington (Peter Gibson) on securing this important debate.

Hon. Members will not be surprised by my presence or to hear my stance on this issue. For more than a year now I have championed the fight against youth vaping, an epidemic that is spreading like wildfire. These sleek, colourful contraptions, once touted merely as a smoking cessation tool, have become ubiquitous. They are not just in shops, but litter our streets and are hidden away in our children’s bedrooms and classrooms. According to a recent NASUWT survey, a staggering 85% of teachers reported vaping as an issue among their students. Teachers in my constituency have spoken of pupils struggling to concentrate because of their nicotine addiction and having to leave lessons for vape breaks—let us remember that these are not hardened junkies but schoolchildren.

I propose a number of solutions to this growing problem, including banning the sale of disposable vapes, removing them from public displays in shops and banning the bright colours and sweet flavours, which prolong the addictive effects and are so attractive to children. I welcome the Government’s work and commitments in this area, and I particularly thank the Minister for her commitment to stopping children vaping and her broader commitment to children and their health. However, we need to go further, and I would like the Government to extend the existing restrictions on cigarettes to vaping in public places to ensure that no one, least of all children, becomes an unwitting victim of second-hand vapour.

Coupled with that, we must impose tougher regulations on the advertising and marketing of vaping products. I have previously spoken out against the sponsoring of sports teams and the pervasive advertising that glamourises vapes. I would like to see these products taken off the side of Transport for London buses, off prominent displays in corner shops and away from sports stadiums. Instead, they should be put discreetly away behind the counter, as the medical type of smoking cessation device they are supposed to be.

Moving on to the specifics of today’s debate on illegal vapes, vapes can be illegal for one of two reasons. They are either illegally composed and perhaps have no self-extinguishing mechanism, excessive quantities of nicotine or more puffs than allowed. However, they may also contain harmful toxic chemicals. Last spring, Lincolnshire police took a selection of vapes from children and tested them. These are just some of the chemicals they found: diethylene glycol diacetate, aviptadil, 2-methoxyethyl acetate, poster varnish, Indian snakeroot and antifreeze. Those were all being inhaled by children using vapes in Sleaford.

The other way vapes can be illegal is that they can be sold illegally to children under the age of 18. Indeed, vapes can be illegal in both the ways I have mentioned. Newspapers locally are reporting an example of a police officer in Sleaford who recently stepped into a local shop to stop illegal vapes being sold to children. Those products were illegal not just because they were being sold to children, but because they contained much more than they ought to.

The next question is what we can do about this. We have talked about ways in which we can tackle the use of vapes. I welcome the vapes enforcement squad the Government put together with £3 million earlier this year, but we need more. There is no registration scheme for selling vapes, in the way there is for alcohol and tobacco. I would like to see a registration scheme for vapes, tied to alcohol and tobacco, specifically to disincentivise unscrupulous sellers. If they lose the vaping licence, they would also lose the alcohol and tobacco licence. I would also like to see an increase in on-the-spot fines, from £2,500 to £10,000, so that there is a significant disincentive to this behaviour. Let us face it, these people are making money out of this, and that is why they are doing it—they are making money out of selling illegal things to children that will harm them.

Another idea is an import tax. It has been proposed to me that one challenge facing Border Force is that vapes are not subject to excise. If they were subject to excise controls, Border Force would be able to intercept some of the illegal vapes. That is much more challenging because there is no excise duty on vapes. Also on the issue of tax, I am a Tory and would normally advocate cutting as many taxes as possible, but I think there is a place to put tax on vaping devices. Even with tax, they would still be potentially much cheaper relative to their nicotine content than cigarettes, making them a cheaper option for a genuine adult smoker who wishes to quit, but they would be more expensive for children, taking them out of the realms of pocket money.

In summary, this issue demands bold action, as it did when I first stood up to discuss it a year ago. I urge the Government and all hon. Members to join me in ensuring that vapes are used as a cessation device, as they are supposed to be. Only by toughening our response to a rogue industry can we protect our children from the suffocating grip of addiction.

--- Later in debate ---

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

It is an honour to serve under your chairmanship, Sir Mark. I thank the hon. Member for Darlington (Peter Gibson) for securing this important debate, and the many colleagues who have made excellent points, including my hon. Friend the Member for City of Durham (Mary Kelly Foy) who is a great campaigner on this issue.

Many Members have focused their remarks on the impact of vaping on children, and they are absolutely right to do so. The Opposition recognise the value of vapes as a stop-smoking tool. They have their place. The chief medical officer put it bluntly:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape”.

But the CMO has also been blunt about the epidemic rise in youth vaping in recent years. Nicotine addiction is in no one’s interest apart from the companies that profit from it. Certainly no child should be vaping. We do not even know some of the long-term risks of the ingredients used in vapes, and certainly not when inhaled by young people whose lungs and brains are still developing.

However, I am afraid to say that the Government have been asleep at the wheel. In 2021, as we have heard, Labour voted for an amendment to the Health and Care Act 2022 to crack down on the marketing of vapes to children. Since then, as Labour has found, 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. Does the Minister regret that her Government and MPs voted against the amendment in 2021?

The issue is that it is now 2024 and we still have no legislation in place. It is bad enough that so many children are using these products, but, as other Members have said, it is even worse when we consider how many products on the market are illegal in their own right. As the chief medical officer has warned, those products can contain dangerous chemicals such as lead and nickel. Some contain nicotine when claiming they do not, or harmful tetrahydrocannabinol chemicals found in cannabis. To be clear, in most cases that amounts to a failure in enforcing existing regulations, and it really is shocking.

Last year, Inter Scientific and the BBC conducted an analysis of vapes confiscated from schoolchildren, and found that the vast majority did not meet UK product regulations and were actually illegal. In a separate analysis of 300 products seized by various trading standards around the country, they found that 88% were non-compliant with UK regulations; 23% had a nicotine strength over the legal limit; 15% contained lead, which when inhaled can damage children’s central nervous system and brain development; 100% contained nickel; and 33% contained nicotine, despite being marketed at 0%, which absurdly means that they can be sold to children. Can the Minister tell us what she will do to crack down on the influx of illegal vapes so that dangerous products are not falling into the hands of our young children?

From speaking to experts in the industry, I have heard that there has been an influx of illegal vapes into the United Kingdom in recent years. One expert I consulted said they think that around 6 million illegal vape products have flooded the UK in the last 12 to 24 months. Can the Minister comment on why the UK seems to be targeted more than many other countries, and where she thinks these products are coming from? Until now, UK regulations have largely inoculated us from public health scares such as the spate of hospitalisations from popcorn lung in the United States, but does she share my concern that if we do not get a grip on illegal products flooding our markets, we could face something similar here? Lastly, can she comment on what she has learned from the Government’s consultation about the percentage of vapes circulating in the UK that are illegal under the 2016 regulations? If it is anything like the 88% found by Inter Scientific, we have a very big problem.

A glaring issue that many have identified is enforcement. As we all know, trading standards is stretched and Border Force is evidently not stopping the import of illegal vapes in sufficient numbers. However, the Government have not made their job easy. One issue is the confusing regulations. I know that the Government have said they will act to close the loophole that means that while it is illegal to sell vapes to children, it is fine to hand them out. We have heard less from the Government on the fact that it is also currently legal to sell nicotine-free vapes to under-18s, which is of serious concern. Labour has been vocal on this issue. As I have flagged, these 0%-nicotine vapes in fact often do contain nicotine or other harmful chemicals. Will the Minister confirm that the Government will take action to ban those vapes being sold to children? It strikes me as a blatant loophole that is giving unscrupulous companies scope to hook young children on their products as a gateway to addiction. These 0%-nicotine vapes are out of the scope of the regulations, meaning they do not need to be registered with the MHRA. Will the Minister now require all manufacturers to notify vape products regardless of nicotine content to the MHRA? This would allow for a complete database of products where currently it is not possible to say which products are legal or illegal, which really undermines enforcement action.

Speaking of the MHRA, we must also recognise that the relevant authorities are not always empowered to do what is needed to crack down on those breaking the rules. It strikes me as a serious shortcoming that as long as producers complete notification requirements with the regulator, their product is allowed to go on the UK market without being tested as a whole. The MHRA—the regulator—does not have powers to test products to determine whether they are even compliant with what producers claim are in them, nor to remove notifications once published.

The fact that under this Government children are using vapes with nicotine in them is pretty scandalous, given what we know about the lack of regulations. I say that because when the producer of Elf Bars was found to be selling products that had larger tank sizes than allowed, the regulations did not provide the MHRA with the power to remove the product from the market, as the product notifications said that it was compliant. That is farcical.

This matter is a huge concern not just for me, but for most Members across the House. Will the Minister say whether she is looking at this as part of the legislation? Will she consider allowing the MHRA to use notification fees for testing and enforcement and giving it the powers to remove notifications from publication and, if necessary, take products off the market? Likewise, does she believe that Border Force has the powers that it actually needs? Will the Minister finally tackle the issue of youth vaping, as we have heard about from many Members, by doing what Labour has called for for years and banning vapes from being branded and advertised to appeal to children? We have all seen the displays in our local off licences, with flavours like gummy bear and unicorn shake, looking like colourfully packaged pick ‘n’ mix products at pocket-money prices. These really do need to be banned.

[Dr Johnson]

The hon. Lady is making some very good points about the regulations that need to be brought in to protect children. I do not think anybody thinks that the colours and flavours are not there in some ways to attract children—how many adults are going to want a unicorn milkshake-flavoured vape, whatever that tastes like? On that point specifically, would the Labour party support legislation brought in by the Government to ban all but one colour and to severely restrict the flavours available?

[Preet Kaur Gill]

What has been marketed at children, definitely, is the different flavours. However, I appreciate that adults do choose different flavours as part of their whole smoking cessation, so we need to look at the evidence in the round once we are looking at the Bill. I would be keen to hear at what the Government say on that and to look at the evidence base. We need to look at the ingredients, the make-up of colours and how we get those flavours—it is about what those ingredients actually mean. We have to ensure that we have a proper evidence base on that issue.

[Dr Johnson]

I was talking to an industry representative about the issue of flavours in particular, and he told me that when a smoker decides to quit, they often start with a tobacco-flavoured vape. When their sense of smell and taste improves because they have stopped smoking, they then no longer like the taste of the tobacco vapes, so they move on to cherry cola or some other flavour. That actually can persist their addiction. The concern about removing the flavours is that instead of stopping using the vapes, people will continue—

[Sir Mark Hendrick (in the Chair)]

Order. Interventions are meant to be short. The hon. Lady has already spoken, and we still have the Minister to come. She requires 10 minutes at least, and it is now 5.19 pm. I suggest to the Opposition spokesperson that she makes an end to her speech fairly quickly.

NHS Winter Update

Caroline Johnson Excerpts

Monday 8th January 2024 Commons Chamber

[Victoria Atkins]

I am so sorry, I do not know who the hon. Lady is referring to. On the Conservatives’ plans, at the 2022 autumn statement we announced up to £7.5 billion of additional funding—an historic increase—and we did not stop there. This summer, we announced an additional £600 million, which brings it up to £8.1 billion of additional funding over two years. That will support our care workforce, and the majority of the funding will end up in the pockets of the amazing people who provide care and support to the patients we are all concerned about.

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

I declare my interest as a member of the BMA and an NHS consultant who has worked during the industrial action. Let us make no mistake that these strikes are causing suffering to patients, both adults and children. The derogation process has not worked because, as the Secretary of State said, the BMA has not returned junior doctors to work when they have been asked to—where there has been a risk of dangerous harm to patients. The first duty of any Government is to protect their citizens, so when will the Secretary of State bring forward the minimum service levels to protect patients from these dangerous strikes?

[Victoria Atkins]

First, I sincerely thank my hon. Friend. I was in contact with her over the weekend when she had come off a very long shift in emergency care, looking after patients locally. I have nothing but admiration for her and the many, many other people who stepped in at short notice to cover urgent and emergency care in our NHS during the strikes. On minimum service levels, she will know that we have already introduced them for ambulance services—something that was opposed by the Labour party—but we have just closed the consultation on minimum service levels in hospitals and we are, of course, carefully analysing the responses. Again, the point that 40—four zero—patient safety mitigations were made by NHS leaders yet only two were granted by the BMA, is very, very worrying when it comes to how seriously the BMA is taking concerns about patient safety.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 5th December 2023 Commons Chamber

[Helen Whately]

I assure the hon. Member that we are investing in the national health service and, in particular, supporting it to prepare for this winter, ensuring there is more capacity in the system. There will be 5,000 more beds in hospitals around the country this winter, as well as 800 new ambulances on the road. But we are also doing things differently. The future of healthcare is not just about hospitals, but about caring for more people out of hospital. For instance, we are investing in proactive care, so that in every neighbourhood, the people who are more likely to go into hospital are known and reached out to, and the care is available for them. That is one of the things we are doing to ensure that people receive care when and where they need it.

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

Sleaford and North Hykeham is a beautiful rural constituency, but living in a rural area means people are further from specialist medical services, which is a particular challenge in the winter months when the roads can be difficult to travel on. As the winter approaches, what is the Minister doing to ensure that constituents in rural areas are well looked after?

[Helen Whately]

My hon. Friend makes a very important point about the additional challenges in rural areas. I want to ensure that this winter people get care when they need it and get it faster. We are already seeing progress on that. For instance, we are investing in making sure there are more ambulance hours on the road, and we are seeing ambulances get to people quicker—in fact, this October, they got to people 20 minutes faster than last October. Ambulance handover delays are reducing and we are already seeing progress in A&E, where people are being seen faster, too.

Building an NHS Fit for the Future

Caroline Johnson Excerpts

Monday 13th November 2023 Commons Chamber

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

Waiting lists are rightly one of the Government’s top priorities. To the best of my knowledge, Mr Deputy Speaker, you could not perform a knee replacement—one of the most waited-for operations—and if I were to give you £1 billion, I suspect that you would still be unable to do so. Too often, debates focus on money and how much has been put into the NHS—the Government have put record amounts into the NHS—but it is about more than money; it is about people.

On this, the 75th year since the NHS was founded, the workforce plan is a milestone in the NHS’s history, and one that I am very pleased to see. It is an essential step towards creating a more productive health service where we can expand training and recruitment while retaining the amazing pool of talent that we have in the NHS. My constituents will be particularly pleased to see the plans to increase the number of dentistry students by 40%, because many are struggling, as has been said, to see dentists. We will also double the number of GP training places by 2031, which is welcome.

These changes will take time, because doctors take a long time to train. One of the first things that the Conservative Government did was to put in place steps to open the new Lincoln medical school. It has opened and is training doctors, and it will not be long before the first new doctors will graduate, which is excellent news for my constituents. I am also pleased for my constituents that we have got a new diagnostics centre opening in Grantham, which will accelerate patients’ diagnoses and treatment.

I have been pleased to hear in the last few days about the streamlining of processes for clinical trials. That will help us to find the new treatments and diagnoses that will be the miracle cures. The Health and Social Care Committee recently visited Singapore, where we met a professor who had identified the benefits of chimeric antigen receptor T-cell therapy and treated Oscar, the little boy from Worcester whom many of us will remember from the news. Thankfully, he has recovered from his leukaemia. Such groundbreaking, world-beating discoveries will be made only if we make it easier to conduct safe clinical trials. However, we also need to look at how we incentivise people to do them.

The NHS has advertised roles for equality and diversity staff at more than £90,000, yet there is currently an advert for a professor of synthetic biology at Cambridge University—they will lead global clinical research—for a little over £67,000. We need to look at how the state values the people who will bring about world-leading discoveries and how it can support them in their quests so that our brightest children will want to do that not just through moral desire but, essentially, to turn their A-levels into cash.

The NHS has been crippled by strikes this year, and more than 1 million appointments have been cancelled. That is not helping with waiting lists, and patients are being left to suffer. Cancer diagnoses are being delayed, and patients’ conditions, when they are in pain, are being left unrelieved. As a paediatrician, I understand the desire for better working conditions and more money, but I cannot understand morally the desire to leave patients behind in order to achieve that. Morally, I do not agree with the strikes and I support the Government’s prioritising patients and their commitment to maintaining minimum service levels during industrial action.

[Mr Ranil Jayawardena (North East Hampshire) (Con)]

Does my hon. Friend agree that people often forget about the huge amount of pension rights quite understandably provided to people in public service? Junior doctors who are continuing their action do not take account of the huge benefits that they will accrue in later life.

[Dr Johnson]

I should mention that I have an NHS pension, but my right hon. Friend is right. The Government took a big step earlier this year to improve pensions, by changing the tax regime to make it easier for more senior doctors to remain at work and not feel they have to give it up because of punitive tax levels. Ultimately, doctors are paid well—they could be paid better, of course—but for me it is a moral question: morally, I do not think it is right to leave patients in order to advocate for more money.

I am pleased by the steps that the Government are taking to crack down on tobacco products. The proposal will not please everyone, but it shows the Government’s boldness and earnestness when addressing public health issues. Prevention is better—and usually far cheaper—than cure. A preventive approach to smoking will reduce the burden on our healthcare system and improve people’s quality of life. Colleagues will not be surprised to hear that I am especially pleased by the Government’s commitment to restrict the sale and marketing of vapes to children. I am glad that the Government have included some of my proposals in their upcoming consultation on vaping, including regulating their flavours, branding and visibility in shops, as well as giving local authorities the power to issue on-the-spot fines for those selling them to children.

I am glad that the Government are consulting on banning the sale of disposable e-cigarettes, which time and again have been the vape of choice for children. I was shocked by figures published last year that found that 1.3 million vapes are thrown away every week in the UK. Subsequent figures released in September show that, staggeringly, in the space of just one year that number has more than tripled to 5 million every week. Those disposable vapes would fill this Chamber from top to bottom twice over every single week—heaven forbid, Mr Deputy Speaker. That is the scale of the problem we are dealing with.

The UK risks falling behind if it does not seize the agenda quickly. I eagerly await the results of the Government’s consultation, as I know many colleagues do. Sometimes, it can be difficult to find issues on which figures from across the political spectrum are strongly aligned, but I am confident that the House will unite behind the Government’s recent proposals on vaping.

[Jackie Doyle-Price (Thurrock) (Con)]

My hon. Friend is making some compelling points. It strikes me that disposable vapes are often available at the point of sale where we used to find things such as chewing gum and packets of Polo mints. That makes it very easy for children to access them. Does she think that regulating point-of-sale products is a massive tool to tackle the problem? Let us remember that established tobacco companies have to have their multi-use vapes on sale behind the screens that tobacco is sold behind.

[Dr Johnson]

I completely agree that putting vapes where children can see them makes them more available and makes children want them more. That is why they need to be in plain colours and flavours and out of the sight and reach of children. My understanding is that that is part of the Government’s consultation, and I hope they legislate and make regulations as soon as they can.

Overall, the King’s Speech is a good one, and I am proud to support it.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 17th October 2023 Commons Chamber

[Will Quince]

We are continuing to support NHS England in increasing cancer treatment capacity. As I say, I recognise the importance of early diagnosis and treatment of cancer. NHS England has instructed integrated care boards to increase and prioritise the diagnostic and treatment capacity for cancer. As of the middle of this year, we have 93 additional surgical hubs that are currently operational and 123 additional community diagnostic centres, which have delivered more than 5 million additional tests since July 2021, but we know and recognise that we need to do more.

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

Members will know from my entry in the Register of Members’ Financial Interests that I am an NHS consultant and a member of the British Medical Association. I congratulate the Minister on the work he is doing to reduce waiting lists, but BMA strikes have led to the loss of more than 1 million appointments, have delayed the reporting of scans, including scans for cancer, and have disrupted people’s chronic long-term condition treatment. What is he doing to ensure that there are no further strikes? What talks is he having on minimum service levels to expand the provision if further strikes do take place?

[Will Quince]

I thank my hon. Friend for her question, which is better directed at the BMA. However, she is right to suggest that we are taking action on minimum service level legislation. We recognise that industrial action means that services are under increased pressure, with appointments and treatments being cancelled because of the strikes. The NHS is taking action, prioritising urgent and cancer care, and will of course continue to do so. It will do its best to maintain appointments and elective procedures, wherever possible, but she is right to say that these strikes and the actions of the BMA are having a devastating impact on patients.

Countess of Chester Hospital Inquiry

Caroline Johnson Excerpts

Monday 4th September 2023 Commons Chamber

[Steve Barclay]

Again, I agree. It is extremely important that we have the right levels of escalation and the right routes available to those raising concerns. I have already signalled to the House a number of safeguards that have already been put in place following various reviews, including the Francis review. Indeed, I spoke to Sir Robert about the lessons from his report, as I have with a number of other chairs in recent weeks. It is important and a number of safeguards are already in place, but of course the inquiry will look at how those fit together and whether any further steps are required.

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

I welcome the dashboard the Secretary of State has announced, which will identify outliers so that trusts that have abnormal events can be looked at, but in this particular case the fact that events were happening unexpectedly was identified, staffing analysis was done and seven consultants raised that this was a problem. They identified Lucy Letby as potentially causing this harm and they were repeatedly, repeatedly and repeatedly ignored. We also need to bear it in mind that, if they had not been ignored, some of these babies might not have died, and that is not good enough. As the Secretary of State seeks answers to how this can be prevented, I urge him to focus on three things: how he can develop clear lines of medical, nursing and managerial accountability; how he can prevent poor managers from moving from trust to trust to evade such accountability; and how, if seven consultants find themselves in a similar position in future, they can escalate beyond their trust—outside their trust—to get some attention.

[Steve Barclay]

A number of steps have already been taken; I am thinking, for example, of the role of medical examiners working in conjunction with the role of the coroner. Those are the sort of areas that the inquiry will look at: the roles of the coroner, the medical director, the Royal College of Paediatrics and Child Health report in 2016, who had sight of that and what action was taken, and the role of the board, including the non-exec lead, in terms of issues around patient safety. So a range of areas will be looked at, which is the whole purpose of having this inquiry. A number of steps have already been put in place, but it is important that we learn the lesson where clinicians have raised concerns and those concerns were not acted on.