Tobacco and Vapes Bill (Second sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Euan Stainbank (Falkirk) (Lab)]

Q Do you believe that the generational smoking ban might cause an increase in the use of other nicotine products such as vapes, smoke-free tobacco or even illicit products?

Alison Challenger: We are ultimately trying to reduce the harm caused by smoking—that is the big killer, and we really would not want to lose sight of that. The Bill also brings in elements around the second-hand smoke agenda. It is important to recognise that there are many vulnerable people who would potentially be harmed by breathing in second-hand smoke, so we welcome the fact that the Bill includes that element. As for whether it will increase vaping, it is really hard to know at the moment how that will work out. Potentially more people might switch to vaping, but ultimately, the Bill brings in a progressive approach to taking out smoking tobacco, which is to be welcomed.

[Dr Danny Chambers (Winchester) (LD)]

Q You might not have the answer here, but do you have a rough estimate of what it costs the NHS financially to deal with passive smoking and second-hand smoking every year?

Alison Challenger: I do not have the actual figure, but it is significant. One of the early benefits of the Bill going through will be the impact on children, particularly around asthma. Obviously, second-hand smoke will be exacerbating some of those respiratory illnesses, particularly for children. There is a considerable burden on the NHS as a result of breathing in second-hand smoke. We must also consider those who have cardiovascular disease and those who have existing respiratory illness. It is not always evident that somebody is vulnerable, so it is really important that the measures in the Bill serve to protect those who are vulnerable from inhaling second- hand smoke.

[Dr Chambers]

Q I am assuming that from a public health point of view, looking at the epidemiology, certain communities and demographics will be more greatly affected by this. Is that something that you are mindful of? How do you see the Bill changing health inequalities?

Alison Challenger: We are very mindful of that. Some of the statistics we give around smoking prevalence are an average smoking prevalence for often quite large geographical areas. For my own area in west Sussex, our local survey suggests there is a variance of 4.3% in our most affluent area compared with 16% in our least affluent area. Those are still averages. We also know that in households in the most deprived part of our area, 40% of children are exposed to cigarette smoking from a parent or carer. That is through our own survey.

The point I am trying to make is that there is very much a health gradient, and in those who are most disadvantaged and living in our most disadvantaged areas, we see both higher rates of smoking and more children exposed to that smoking. Those children are more likely to take up smoking if they have been exposed to it.

[Jim Dickson (Dartford) (Lab)]

Q This is to Councillor Fothergill. Are there any circumstances you can envisage where local enforcement would not be enough and the Secretary of State would need to utilise the powers granted in the Bill under clauses 130 and 131 to intervene?

David Fothergill: We have discussed this outside the room, and I think the area we would be most concerned about is illegal sales online. Our local teams could not get into those, and therefore we might need more national resources to break into how people are bringing illegal substances into the UK.

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[Dr Chambers]

Q Dr Ahmed asked almost word for word what I was going to ask, but from a population medicine point of view, do you have a rough estimate of how much smoking is costing the NHS and how much would be saved if the measure was implemented properly?

Professor Linda Bauld: I do not have in front of me the cost to the NHS—other witnesses will probably have it at the tip of their tongue—but it is substantial. If you look at the number of admissions to hospital from smoking, there are over 500,000 every year in England, and we still have over 75,000 deaths. By reducing smoking prevalence, you are going to see very significant impacts and cost savings.

The other thing we know from our research, as previous witnesses have said, is the effect on productivity and workplace absence. As you all know from your constituencies, smoking is also driving some of the loss of people from the workforce in their 50s, early 60s or even younger that we have seen recently. I think that you will see cost savings and an impact on productivity.

The final thing that I would say on that, despite not having the figures in front of me, is that this is an area that causes such a burden to the NHS. One of the things that our CMOs did not make clear earlier, although they said it indirectly, is that if you look at non-communicable diseases in the UK, smoking is the only risk factor that is linked to all four of our NCDs—respiratory conditions, cancer, diabetes and heart disease. It is the only one that is directly linked to all of those. If you think about all of those diseases, and the burden of disease that Sir Gregor mentioned, of a 21% increase by 2040 in my own nation of Scotland, we are going to make an impact on that, and that will achieve cost savings for the NHS—and, importantly, for social care.

[Dr Chambers]

That is well articulated. Thank you.

[Dr Cooper]

Q Thank you for coming along this afternoon. You mentioned the New Zealand case. Could you talk briefly, in case anybody does not know, about what happened and why the standards were dropped? What learnings might we take from that for our legislation?

Professor Linda Bauld: I think there are political aspects to that, which I will not comment on, but obviously the understanding was that it was a very comprehensive and ambitious set of measures that was introduced. Like this Bill, it was about not just the smoke-free generation but other measures as well, including, interestingly, on the density of retail outlets, which might be something for another day or another, potential future measure. A new Government came in and decided not to take it forward.

The learning that we need to take from that, from my understanding and from speaking to colleagues there, goes back to the CMOs’ evidence about the lobbying that is going to occur. The tobacco industry and partners around the industry are very powerful, so persuading colleagues that this is undermining choice and that it will be a burden in terms of regulation, cost to retailers and so on—those were the arguments that were used in New Zealand.

We need to keep a watchful eye, as we think ahead to the regulations and the next steps for the legislation, that we do not open that door too widely and allow those arguments to become too powerful. As you heard earlier, that industry is continually looking for new recruits to replenish those it loses through morbidity and mortality, and that will happen in the UK as well unless we get this right.

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[Andrew Gwynne]

Q The Bill seeks to reduce youth vaping. How do you think we can best achieve that while not deterring adult smokers from quitting?

Professor Steve Turner: That is a really good question. I think that the balance in this Bill—between supporting the 6 million smokers to quit and not engaging children in nicotine addiction—is the right balance. Going back to what I was saying earlier, getting the message across to young people is a multifaceted intervention that requires education as well as legislation. It is a really difficult balance, but I do believe that the Bill, as it is, has that balance just right.

[Dr Chambers]

Q Thank you for coming all the way down from Aberdeen; I worked there for a few years, so I know it is a long way. We have been trying to ask some panellists approximately what this issue is costing the NHS. As a consultant, in your clinic, doing respiratory paediatrics, what proportion of your patients are in some way involved with smoking or second-hand smoking?

Professor Steve Turner: The impact on the whole of society of second-hand smoking in children is complex, but there are various pieces of the jigsaw. First of all, children come to the clinic, are admitted to hospital, come to the emergency department, or go and see the GP, so there is that healthcare side. If any of you have children, however, when your child is off school, that has implications for you as a family; there are some difficult discussions over breakfast about who is going to work and who is not. Therefore, there are a number of different impacts on us as a society, economically and to the NHS from second-hand smoking.

I am not clever enough to put a number on it, but it is a lot bigger than I think people know. I do know that £46 billion is the number cited as the direct health cost to the NHS of smoking—it is almost too big to consider—but I suspect that the wider societal cost will probably be a magnitude greater than that.

[Dr Chambers]

Q Is there a ballpark figure for a general day? When you have a list of paediatric respiratory cases, are maybe 10% or 20% due to this?

Professor Steve Turner: The children who are exposed to second-hand smoke in the home are over-represented among children with respiratory symptoms. Parents do not want their children to smoke, so they feel torn. They are conflicted: they are addicted to nicotine, but they do not want their children to smoke, and having a smoke-free generation will address that almost impossible parental conflict.

[John Whitby]

Q The Bill makes it illegal to sell vaping products to under-18s, and to proxy-buy vapes for children, but it does not make it illegal for under-18s to buy vapes. What is your view on that?

Professor Steve Turner: I support the Bill as it stands. I think that the onus has to be on the vendor not to sell, not on criminalising the customer or the child.