Health and Care Bill

Christian Wakeford Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Alex Norris]

There is a danger that the right hon. Gentleman has missed the point. The reality is that for a decade there has been historically low investment in our health service, which of course has Barnett consequentials for Wales. That is the reality and why the system is as distressed as it is. I do not think he can put that at the door of the Welsh Government.

Let me come back to public health. Over the past five years we have removed £1 billion in public health funding, which means that the challenges in respect of childhood obesity, smoking, sexual health and access to drug and alcohol services are all developing and growing. The sad thing is that such cuts make an immediate local government saving for the Treasury but create greater costs for the public purse later, never mind the impact on people’s lives. They are the falsest of false economies. For all the talk of the end of austerity, last month’s Budget did nothing to tackle that reality. Indeed, local authorities are under greater pressure and the cycle will continue.

Being smoke-free by 2030 is a major national prize, and with that I turn to new clauses 2 to 11, tabled by my hon. Friend the Member for City of Durham (Mary Kelly Foy). She made an excellent case and has shown tremendous leadership on this issue, in concert with the hon. Member for Harrow East (Bob Blackman), through the all-party parliamentary group on smoking and health. They have given the Government a number of really good ways to improve our nation’s efforts and I hope we will hear from the Minister that they will be taken on.

Tackling smoking is a crucial part of not only improving the nation’s health but addressing health inequalities. A child born where I live, Nottingham, can expect to live seven years fewer than a child born here in Westminster. When it comes to healthy life expectancy, we can expect that difference to double. Tackling that inequality should be a core part of the business of this place. Nearly half that inequality is attributable to smoking—that is how pivotal this issue is.

Successive Governments have shown over the past 25 years that we can make inroads with public policy on smoking, but the benefits have been unevenly felt: the smoking rate among those in professional occupations is now down to just one in 10, so is well on track to meet the 2030 target, but incidence rates among those in manual or routine occupations remain a stubborn one in four, so we must now renew our efforts with that group of people who are, of course, disproportionately likely to use stop smoking services—the very services we have lost over the past decade. Of course, as my hon. Friend the Member for City of Durham said, the pandemic has posed new challenges, with a new group of people who have started smoking but would not otherwise have done so.

We have been promised a new tobacco control plan by the end of this year, but that promise looks a little less secure by the day—I hope the Minister will tell me I am wrong. We could get on with impactful interventions right away. The labelling and information interventions set out in new clauses 2 to 4 have very strong evidence bases from other countries, as my hon. Friend the Member for City of Durham said, and would be quick, easy to implement and impactful.

On new clause 4 in particular, we know that e-cigarettes and vaping are important quit aids, but we would not want them to be a gateway for children to smart smoking. We should be concerned about the 2021 YouGov research for ASH—Action on Smoking and Health—that suggests that more than 200,000 11 to 17-year-olds who had never smoked previously had tried vaping this year. As my hon. Friend the Member for City of Durham said, we must make sure that that age group does not take smoking through that route and that products are not targeted at it.

New clause 5 would tackle the bizarre loophole, which colleagues sometimes struggle to believe is true, that would allow the egregious practice whereby e-cigarettes or similar kit could be given free to someone under 18, although they cannot be sold. That is an extraordinary part of the law and I know that the Minister agrees it is daft—he said that in Committee, but also that he did not feel there was quite the evidence that it was a risk. Well, risk or not, I think the loophole should be closed, because I suspect that eventually someone will happen on it as a bright idea.

New clauses 8 and 10 are a beautiful support to any Minister who wants to improve smoking outcomes in this country, as I know this Minister does, but is conscious about the finances. This gives the Minister a chance, through a US-style polluter pays model, to fund all these interventions, including the restoration of the lost smoking cessation services in this country. He did not close the door to that in Committee when we talked about it, so I hope that he might tell us today that it is likely to form part of the new tobacco control plan. New clause 11 promotes a consultation on raising the age of sale, as we know that the older a person gets, the less likely they are to start smoking.

Let me turn to new clauses 15 to 17 and amendments 11 to 14 in the name of my hon. Friend the Member for Liverpool, Walton (Dan Carden). Colleagues will have been profoundly moved to hear him speak of his battle with alcoholism, and I know that his bravery has connected with people across the country. I associate myself with the remarks of my hon. Friend the Member for City of Durham regarding his entirely understandable absence from the Chamber today. With him in mind, I speak in support of those new clauses and amendments.

New clause 15 seeks to improve alcohol product labelling. This is overdue and it is popular. It is about not taking alcohol products out of people’s hands, but instead making sure that they can make an informed choice.

[Christian Wakeford (Bury South) (Con)]

While an energy drink carries not only calorific information but a health warning that drinking too much can have a laxative effect, alcoholic drinks carry no calorific information and no health warning. Does the hon. Gentleman agree that that is a damning indictment of where we are in society and that a change, which the amendment could make, is needed?

[Alex Norris]

I am grateful to the hon. Gentleman for that intervention. I completely agree with him. I would be the last one to police people’s consumption habits in the night-time economy for fear of being a hypocrite, but I do think that we should all have informed choice. What we have at the moment is inconsistent and unclear. We know that that frustrates people. A recent survey has shown that: 75% of people would like to know the number of units in a product; 61% would like to know the calorie information, as he mentions; and 53% would like to know the amount of sugar. We should give people the chance to have that full information to make their own decisions.

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I find it surprising that there was nothing in this Bill about tackling not just the health harms, but the social harms associated with alcohol abuse. Indeed, alcohol has not even been included in the definition of less healthy foods, despite that clearly being the case. There is no health argument for alcohol. I am not saying that people have to abstain, but the research many people cite about how having some alcohol is of health benefit over full abstention has all been discredited. That was because people who actually had alcoholic disease and were made to give up alcohol were put in the abstention group, and therefore brought their liver disease, their varices and everything else with them. More recent research shows that, unfortunately, alcohol does cause harm. It is only about 10 or 15 years since we learned about its association with breast cancer, my specialty as a surgeon, and with that it is absolutely the case that the more alcohol a woman drinks, the higher her risk of breast cancer.

[Christian Wakeford]

Obviously, as the chairman of the all-party parliamentary group on alcohol harm, I know that part of the issue with treatment—I am thinking in particular of new clause 16—is the stigma behind alcohol dependency and its still being seen as a personal choice. While we need to overcome the stigma of addiction, we first need to be having a conversation about alcohol. Does the hon. Member agree that, as part of the treatment, we need to be having this conversation on a national level?

[Dr Whitford]

I would say that really no one who has a health problem should be stigmatised. Having dealt over 33 years in the NHS with many people who were problem drinkers, I know that the public image of someone who abuses alcohol is quite a caricature. There will be many people across this House who drink more than is healthy for them and I have met many people as patients from the middle and upper classes who had serious alcohol problems, so we should get away from the stigma and the caricature. We will not spot everyone who needs to deal with alcohol just by looking at them.

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[Mr Deputy Speaker (Mr Nigel Evans)]

I call Christian Wakeford. Do you wish to remain seated?

[Christian Wakeford]

That is greatly appreciated, Mr Deputy Speaker.

I would like to put on record my support for amendments 11, 12 and 13, and new clauses 15 and 16. I also thank the hon. Member for Liverpool, Walton (Dan Carden). We have heard why he cannot be here; I wish him well with what is going on in his family.

These much-needed amendments and new clauses are aimed at reducing alcohol harm by introducing advertising restrictions, transparent alcohol labelling and support for effective alcohol treatment. Alcohol abuse leads to many harmful things, and deserves to be called the silent killer. I am chair of the all-party parliamentary group on alcohol harm, and the group has heard in our evidence sessions the stories of those affected by alcohol. It has the potential to destroy individuals, families and wider society. Alcohol has a very public face, but it harms privately. Hospital admissions and deaths from alcohol are at record levels, and have been exacerbated by the covid-19 pandemic. Some 70 people die every day in the UK due to alcohol. Alcohol harm is a hidden health crisis that needs to be recognised.

The Bill does not go far enough to stem the rising tide of this issue. For instance, the Bill introduces restrictions on advertising for “less healthy” products, such as sugary soft drinks, but the same restrictions do not apply to adverts for alcoholic drinks, despite alcohol being linked to more than 200 health conditions, as well as having very high calorie and sugar content. There is significant evidence that children who are exposed to alcohol marketing will drink more earlier than they otherwise would. Existing laws are failing to protect children and vulnerable people. In fact, four in five 11 to 17-year-olds have seen alcohol advertising in the past month. The advertising they are exposed to builds alcoholic brand awareness and influences their perceptions of alcohol. A forthcoming report by Alcohol Health Alliance found that seven in 10 young people recognise the beer brand Guinness, including more than half of 11 to 12-year-olds. Amendments 11 to 13 would ensure that alcohol was considered a less healthy product and was therefore liable to the same proposed restrictions as sugary soft drinks when it comes to advertising on TV, on demand and online.

Awareness of the risks of alcohol is low: about 80% of people do not know the chief medical officer’s low-risk drinking guidelines of 14 units a week; only 25% are aware that alcohol can cause breast cancer; and only 20% know the calories in a large glass of wine. I need only refer you, Mr Deputy Speaker, to the Six Nations championship earlier this year—you may have a slightly better recollection of it than I do. There was alcohol-related advertising on billboards around the stadiums. There were many billboards advertising alcoholic brands. There were also drink awareness campaigns, but they were not seen, due to where those advertisements were placed. People were seeing adverts for Guinness, but not for Guinness 0.0 or for drink awareness campaigns. This is something that the Government really need to look into.

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As with meeting the challenge presented by obesity, this Government are committed to supporting the most vulnerable who are at risk from alcohol misuse, and we have an existing agenda for tackling alcohol-related harms. As part of the NHS long-term plan, we have invested £27 million in an ambitious programme to establish or improve specialist alcohol care teams in the 25% of hospitals with the highest rates of alcohol-dependence-related admissions. This is expected to prevent 50,000 admissions over five years. We have also made the largest increase in substance misuse treatment funding for 15 years, with £80 million of new investment in 2021-22.

[Christian Wakeford]

I reiterate the comment I made earlier that the best way to treat alcohol addiction and dependency is to treat it like a mental health illness, because that is what it is. The best way to do that is to remove the stigma and put more money into mental health, but in trying to overcome the stigma, we need to ensure that there is parity between mental and physical health. If we treat the mental health issue, we treat the alcohol issue. We cannot do one without the other. Will the Minister commit today to going some way towards doing that and to putting more money into mental health to deal with this?

[Edward Argar]

I am grateful to my hon. Friend. He will know that this Government have continued not only to highlight and promote parity of esteem between mental and physical health but to increase the funding available to mental health, reflecting that reality on the ground. He is right to highlight that issue.

We have announced a comprehensive set of reforms to alcohol duty in this year’s Budget which, taken with the steps we have put in place on a public health basis, have put in place a strong regime to tackle the consequences of alcohol misuse. We do not feel that this Bill is the place to legislate further on this issue but, as I have said, I am none the less grateful to the hon. Member for Liverpool, Walton for his amendments and for this opportunity to debate them.

On amendments 11, 12 and 13, this Bill would introduce a 9 pm TV watershed for less healthy food and drink products and a restriction on paid-for advertising of less healthy food and drink online. Those amendments, tabled by the hon. Member for Liverpool, Walton, would expand the definition of a less healthy product to include alcohol. This would have the effect of making alcohol advertising liable to the watershed proposed for TV programme services and the online restriction on paid-for advertising.

I reassure the hon. Gentleman, through Opposition Members, that the Government have existing measures in place to protect children and young people from alcohol advertising through the alcohol advertising code. Material in the broadcast code and the non-broadcast code relating to the advertising and marketing of alcohol products is already robust, recognising the social imperative of ensuring that alcohol advertising is responsible and, in particular, that children and young people are suitably protected. If new evidence emerges that clearly highlights major problems with the existing codes, the Advertising Standards Authority has a duty to revisit the codes and take appropriate action. Furthermore, the Government introduced additional restrictions last year on alcohol advertising on on-demand programme services, through amendments to the Communications Act 2003.

Clause 129 and schedule 16 are aimed at reducing the exposure of children to less healthy food and drink advertising and the impact of such advertising on child obesity. Less healthy food and drink products—