COP10: WHO Framework Convention on Tobacco Control

David Jones Excerpts

Thursday 18th January 2024 Westminster Hall

[Mr David Jones (Clwyd West) (Con)]

May I say what a pleasure it is to serve under your chairmanship, Mr Vickers? I congratulate my hon. Friend the Member for Northampton South (Andrew Lewer) and the hon. Members for Ealing, Southall (Mr Sharma) and for Linlithgow and East Falkirk (Martyn Day) for securing the debate, and I thank the Backbench Business Committee for facilitating it. At the outset, I declare an interest as an honorary life governor of Cancer Research UK.

I agree entirely with my hon. Friend the Member for Northampton South that the stance the UK adopts at COP10 next month will be crucial to the future of tobacco harm reduction in this country. To their great credit, the Government have pursued a distinctive and very successful UK-made policy on smoking that has significantly reduced its prevalence in this country. Nevertheless, as we heard from my hon. Friend, 6.4 million people still smoke—around 12.9% of the UK’s adult population.

To help reduce smoking rates, the UK is taking a world-leading approach, supporting the principle of tobacco harm reduction. In particular, the UK takes the view that vapes can have an important role in reducing the prevalence of cigarette smoking. The Government have allowed vaping to develop on a market basis, and that has gradually taken 1.5 million people off smoking altogether.

As we have heard, the smoke produced by combustible tobacco represents the greatest threat to the health of smokers. The UK has therefore been keen to point smokers to alternatives to combustible cigarettes. As we heard from my hon. Friend, in April the Department of Health and Social Care announced that a pioneering “swap to stop” strategy would be rolled out across England, providing a million smokers with a vape starter kit, alongside behavioural support to help them quit. That approach has a history of success. The largest such programme to date was conducted in Salford in 2018, and it resulted in over 60% of participants being smoke-free after just four weeks.

While no one route can be said to be the only one to help smokers to quit, the fact is that, for many, vaping does work. I repeat the quote my hon. Friend mentioned from the chief medical officer for England, who said:

“If you smoke, vaping is much safer”.

However, he went on to say:

“if you don’t smoke, don’t vape.”

The 2022 Khan review made it clear that the Government should

“embrace the promotion of vaping as an effective tool to help people to quit smoking tobacco.”

However, one solution does not suit all smokers. It is important that the Government, and indeed the devolved Administrations, which have responsibility for healthcare in their areas, keep as many options open as possible to have the highest chance of success in reaching smoke-free status by 2030. That is the Government’s highly commendable ambition, and it must not be thwarted by the likely stance of the World Health Organisation in Panama.

The WHO opposes reduced-risk products, including vapes, heated tobacco and oral nicotine pouches, arguing that there is insufficient data to understand their effects. The WHO, to be entirely blunt, is being stubbornly backward. It does not accept any harm-reduction approach to smoking. It does not accept that smokers switching to vapes is a better choice. It does not accept British scientific consensus—for example, the Public Health England report stating:

“While vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals that are present pose limited danger”

and that

“best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes”.

The WHO’s stance, therefore, runs counter to the UK Government’s successful, evidence-based approach to tobacco harm reduction through the use of reduced-risk products to help to cut smoking rates. We must remember that the United Kingdom is one of the largest financial contributors to the FCTC, and the Government should not be afraid to remind the WHO of that. British taxpayers have in recent years provided millions of pounds to support WHO policies that are contrary to those operated by the United Kingdom.

The WHO’s approach is that nicotine products pose a risk to health and that the safest approach is not to use them at all. Well, of course—that is self-evidently the case. Non-smokers should never start using nicotine, but it is counterproductive to prevent adult smokers from accessing reduced-risk products in a world in which 1.1 billion people still smoke. That makes no sense at all.

As my hon. Friend the Member for Northampton South said, some of the proposals in the provisional agenda for COP10, published on its website, are a serious cause for concern. For example, item 6.2 aims to impose the same restrictions on the advertisement, promotion and sponsorship of reduced-risk products as on conventional tobacco products. That would limit the ability of the UK Government, the devolved Administrations and public health bodies to promote to adult smokers less harmful alternatives as part of a smoking cessation strategy. It should be noted that, in contrast, Sweden is set to become the world’s first smoke-free country, after seeing substantial reductions in smoking rates through the use of a wide range of reduced-risk products.

Item 6.3 on the agenda threatens to establish regulatory equivalence between combustible tobacco and reduced-risk products. That sends a dangerous, misinformed message that reduced-risk products are as harmful as, or more harmful than, combustible cigarettes.

[Sir Christopher Chope]

Is that not exactly what has happened in China? China is regulating vapes in the same way as tobacco, and we know that the WHO is controlled by Chinese interests. Should that not make us really alarmed?

[Mr Jones]

Yes, it certainly should, and it is another reason why the United Kingdom, which has significant influence within the WHO, should actually exert that influence, and I propose to discuss that a little later in this speech.

Misinformation about vaping is already an important and worrying issue. According to Action on Smoking and Health, four in 10 smokers in the UK now believe that vaping is as risky as, or riskier than, smoking. That is the consequence of the misinformation, and the WHO’s position simply compounds the misinformation.

In the teeth of this hostility on the part of the WHO, the Government should confirm what policy positions the UK delegation to COP10 will take, especially on the agenda items that I just mentioned. I hope my right hon. Friend the Minister, in her winding-up speech, will be able to assure us that the Government will challenge the WHO on the science head-on. Will she say, as my hon. Friend the Member for Northampton South has asked, whether a Minister will attend COP? I believe that a Minister should be there—I think she should take a slow boat to Panama. We need ministerial involvement at this conference. Will my right hon. Friend also say what policy positions she will be instructing officials to take, and will she undertake to provide a further statement to the House on the key outcomes—particularly where there may be an impact on health policy and smoking cessation strategies—after the closure of the conference? Critically, will she confirm that the UK delegation will oppose, and if necessary veto, any proposals that would impact on the UK’s world-leading and evidence-based approach to tobacco control through the successful use of reduced-risk products?

I repeat that we are a major funder of this organisation. If we are to meet our goal of being smoke-free by 2030, the Government, working with devolved Administrations, must ensure that adult smokers are provided with a wide range of reduced-risk products to help them to quit, such as vapes, including single-use vapes; heat-not-burn and heated tobacco products; and oral nicotine pouches. Different solutions will work better for different people. Japan, with heated tobacco, and Sweden, with snus, the organic form of nicotine pouches, have had even more success in reducing smoking than the UK, so vapes should not be the only solution. Indeed, these products have been even more successful in their home markets than vapes have been here. We should be learning from other countries’ experiences.

At this COP, there will be an attempt on the part of the WHO to create a global norm of treating harm reduction products, including vapes and heated tobacco, exactly like combustible cigarettes, as if they were equally dangerous, including by raising their excise duties to the same level. That would be a colossal disincentive to any smoker who might consider switching to a less dangerous choice. I hope my right hon. Friend the Minister can confirm that the UK will stand against what would be a reactionary and profoundly dangerous error.

The WHO should not be allowed to undermine the UK’s evidence-based and science-led approach to tobacco harm reduction. The UK’s successful use of vapes to reduce smoking rates is rightly seen as a model of success around the world. The UK delegation at COP10 must do all it can to oppose measures that may threaten that.

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Vickers. I understand that this is the third debate this week about tobacco and vaping, so the subject is getting a good airing. I confess that I was not expecting to have a debate about sovereignty and taking back control this Thursday when talking about smoking, but one always has to be prepared to be taken back, as the Minister says. Like colleagues, I thank the hon. Member for Northampton South (Andrew Lewer) for securing this debate, and I thank the right hon. Member for Clwyd West (Mr Jones), my hon. Friend the Member for Ealing, Southall (Mr Sharma) and the hon. Member for Christchurch (Sir Christopher Chope) for their contributions and the work they do in this area.

As we have heard, the convention on tobacco control was adopted in 2003 and came into force in 2005. It has since become one of the most rapidly and widely embraced treaties in UN history. It was developed in response to the globalisation of the tobacco epidemic, and a quick glance at the statistics tells us why. Tobacco kills up to half its long-term users. It is responsible globally for an estimated 8 million deaths per year, 1.2 million of which are of non-smokers exposed to second-hand smoke, yet the global market is still worth more than £800 billion a year. Tobacco remains the largest cause of health inequalities, accounting for as much as half the difference in amenable mortality between the most and least deprived communities in the country.

My hon. Friend the Member for Ealing, Southall highlighted the work that he has done, particularly on reducing smoking among minority and ethnic communities. In my constituency, the tobacco industry has historically employed many thousands of people and there is a long legacy of tobacco, which can be seen in the higher rates of chronic obstructive pulmonary disease and other smoking-related conditions in Bristol South. Tobacco costs the taxpayer tens of billions every year, putting increased pressure on the NHS and care system, as well as contributing to the productivity crisis through lost earnings, unemployment and, sadly, early deaths.

That is why the Labour party is committed to building a smoke-free future. It is why we have said that we will support the Government’s measures to raise the legal smoking age by a year every year, so that a 14-year-old today will never legally be able to buy a pack of cigarettes. It is also why we would make sure that all hospital trusts integrate opt-out smoking interventions into routine care, so that every interaction with the NHS encourages quitting. Unlike the hon. Member for Linlithgow and East Falkirk (Martyn Day), I am a former smoker who did have to quit. I pay tribute to the people who do it: it is a very hard thing to do.

This is a global issue, which is why we have to tackle it globally. We have seen the tactics of the tobacco industry over many years. Hugely profitable multinational companies will use their muscle in individual states—we have seen in Uruguay, Vietnam and elsewhere how they will behave —so working together seems to be the way forward. The establishment of the WHO framework two decades ago is an important milestone in tackling a public health hazard. It encourages parties to implement common-sense policies that have strong public support, such as protecting public health policies from commercial and vested interests; protecting people from secondary smoke; and bans on advertising and on so on. Those have been developed over many decades.

As we have heard, the next conference of the parties will be the 10th since the convention entered into force and will take place in Panama. Agenda items up for discussion will be articles 9 and 10 of the convention, on the regulation of the contents and disclosure of tobacco products, which is addressed by the UK’s Tobacco and Related Products Regulations 2016. We all seem very keen to send the Minister to Panama—the right hon. Member for Clwyd West suggested a boat, which would take her some length of time—so we are all interested in whether she is going, and, more specifically, how she will be instructing the UK delegation to approach these really important discussions.

Does the Minister have any plans to bring other nicotine products, such as nicotine pouches, into the regulatory process as part of the Government's forthcoming legislation? Many colleagues will have received letters from constituents about e-cigarettes and vaping, which will be discussed at COP10. We hear what they are saying. E-cigarettes are an important tool for stopping smoking. Evidence indicates that they are less harmful than cigarettes, and that their use shows a positive association with quitting smoking, as we have heard so eloquently from colleagues today—something we would support. Particularly in this month, January, many smokers are grappling with their new year's resolutions, and we fully support them in that journey however we can. We must acknowledge, however, that vaping is not risk free, particularly for people who have never smoked, and that there is a lack of evidence on the long-term health impacts.

As we have said many times in this House, we are particularly concerned about the rise in youth vaping. In just the past two years, the number of children aged 11 to 17 who vape regularly has more than trebled. Over 140,000 more children have taken up vaping since the Government voted down Labour’s proposed measures in 2021 to crack down on companies that brand and advertise vapes to appeal to kids. We want tougher regulation of those products and for a strong message to be sent to those companies trying to make a profit at the expense of our children’s health. I hope that Ministers, via their role in the WHO, will push harder for stronger and clearer messages, based on the latest data and evidence, and seek to regulate this market in a way that promotes quality and safety and, crucially, that protects young people.

Will the Minister use the forthcoming tobacco and vapes Bill to close loopholes that allow nicotine-free vapes to be sold to under-18s, and free samples of even addictive nicotine products to be given to children? Is she considering strengthening the powers of the regulator, the Medicines and Healthcare products Regulatory Agency, to deal with the number of illegal vaping products circulating on the UK market today? She is welcome to our policy—will she back our proposal to ban companies from branding and advertising vaping products in a way that is appealing to children?

Just as the last Labour Government led the way on tobacco control, so will the next, with a road map to a smoke-free Britain. We want to make sure that hospital trusts integrate opt-out smoking cessation interventions into routine care, making every clinical consultation count. We will legislate to require tobacco companies to include information in tobacco products that dispels the myth that smoking reduces stress and anxiety, and tackle the rapid rise in youth vaping, on which the Government have failed to act so far. To tackle health inequalities and rescue the NHS from 14 years of decline, we need bold measures to tackle smoking and improve public health.

[Mr David Jones]

Could the hon. Lady say what measures she proposes to put in place to tackle the issue of youth vaping?

[Karin Smyth]

I am sure the right hon. Gentleman took great notice of the Labour party conference, where we announced a ban on targeting, and advertising and marketing to, young people. We think that where there is a will, there is a way. The ban on smoking, which I remember very well from when I was part of an NHS trust, was an incredibly difficult thing to do and enforce. But when the Government make clear that the targeting of young people is completely unacceptable, the market will react. We want to work with companies to make sure that happens. That is our plan for doing that and for getting the NHS back on its feet and making it fit for the future.

--- Later in debate ---

[Dame Andrea Leadsom]

I will look into my hon. Friend’s concerns and respond to him in writing. That is probably the most helpful I can be, because that is not something that I have been briefed on. I am, as are all hon. colleagues across the House, concerned about the undue influence of China on public policy that finds its way into national policies. I am grateful to him for raising the issue.

[Mr David Jones]

Does my right hon. Friend know why the WHO exhibits such hostility to the harm reduction measures that the United Kingdom Government are putting in place?

Independent Medicines and Medical Devices Safety Review

David Jones Excerpts

Thursday 8th July 2021 Commons Chamber

[Mr David Jones (Clwyd West) (Con)]

May I, too, commend the Backbench Business Committee for securing this important debate?

My constituent Mrs Jennifer Meakin was pregnant with her third child, Daniel, when she was prescribed Primodos as a pregnancy test. Daniel was born on 14 September 1974, with severe birth defects. He had an occipital swelling containing brain cells and fluid, which had leaked out when the neural tube was developing, and he was categorised as spina bifida. Daniel has undergone five major brain operations. By any standard, he is severely disabled. Equally, by any standard, the challenges experienced by the Meakin family since his birth over 47 years ago have been enormous.

Hormone pregnancy tests first came on to the market in the early 1960s, and approximately 1 million prescriptions were dispensed. As early as 1967, warnings were made available to the Committee on Safety of Drugs that such tests were unreliable, might cause neural tube defects of the sort that afflicted Daniel, and could precipitate an early abortion. However, a 1967 CSD press release reported:

“The consensus of expert opinion is that there is no scientific evidence to support the view that the hormones used in pregnancy tests can cause congenital malformations.”

The IMMDS report comments on that very forthrightly, stating:

“Given the concerns raised, the non-essential nature of HPTs and the provision of risk-free alternative tests…the CSD…should have recommended the withdrawal of the indication for use as a pregnancy test in 1967.”

However, it was not until June 1975 that a general warning was issued by the Committee on Safety of Medicines, the statutory successor to the CSD, about the possible association between hormone pregnancy tests and an increased incidence of congenital abnormalities, with an explicit recommendation that doctors should not prescribe hormonal preparations for pregnancy tests. That was some eight years after concerns about the tests were first raised and eight years after the date when, according to the report, the CSD should have recommended that Primodos should not be used as a pregnancy test—and sadly, of course, it was after Mrs Meakin was prescribed the drug for that purpose.

The report makes two specific recommendations in relation to Primodos, which I strongly endorse: first, the establishment of specialist centres for all families adversely affected by medicines taken in pregnancy, to provide integrated medical and social care in one place; and secondly, an ex gratia scheme, to provide discretionary payments. Families who have been afflicted by this scandal for half a century need all the support that they can get. It is a tribute to their persistence and indefatigability that they have pursued their campaign for so long. The report rightly observes that, although causal association has not yet been established, families such as the Meakins have suffered stress, anxiety, psychological harm and the general toll of fighting for recognition. They have, in short, put up with almost unbearable adversity.

The Government did the right thing recently when they confirmed a commitment to lifetime support for the thalidomide victims. I say to my hon. Friend the Minister that the Government would, similarly, be doing the right thing now if they were to establish a support scheme for the families affected by Primodos. I strongly urge them to do so.

Tobacco Control Plan

David Jones Excerpts

Thursday 10th June 2021 Westminster Hall

[Mr David Jones (Clwyd West) (Con)]

It is good to serve under your chairmanship, Mrs Miller. I congratulate the hon. Member for City of Durham (Mary Kelly Foy) and the APPG on securing this debate. I declare an interest: I am an honorary life governor of Cancer Research UK.

Smoking is, of course, a significant cause of ill health and death in this country, and the Government should be congratulated on the progress they have made to reduce the incidence of smoking, but the rate of reduction is sadly still not enough. A recent Cancer Research UK report found that, at current quit rates, the UK will not reach its smoke-free target until 2037 at the earliest—seven years late. To meet the target, quit rates will need to increase by some 40% over the next 10 years. In other words, we are at risk of enduring several more years of heartbreak for families, strain on the NHS and avoidable deaths—a pattern that can, and of course should, be broken.

Three months ago, I was fortunate enough to be selected for a Westminster Hall debate on this issue. I made the point then that the tobacco control plan was our chance to break that pattern. Now is our opportunity, and if we are to seize it, the control plan must be ambitious. I would like briefly to propose three courses that I believe should form part of the plan’s recommendations.

First, the key issue with smoking is, of course, the smoke. An evidence-based policy that seeks to assist the 7 million cigarette smokers in the UK must put forward alternative products to combustible tobacco. Continuing to raise awareness of those products is key, so I suggest that the plan should facilitate the use of cigarette pack inserts and online communications as ways of reaching smokers directly. E-cigarettes and other alternatives to combustible tobacco save lives, and we should make sure that that message reaches every smoker in Britain.

My second point is about access to those alternative products. E-cigarettes have been hugely important in the fight against smoking, and I commend NHS England for promoting them to smokers. The strategy is based on evidence, and has a proven positive effect on the health of the nation. In 2017, more than 50,000 smokers who would otherwise have carried on smoking stopped with the aid of a vaping product.

The tobacco control plan should advise what else can and should be used to assist smokers to quit, in addition to e-cigarettes. That is crucial when we consider that, for all the impact vaping has had, 50% of people who have tried e-cigarettes go back to smoking. We should not limit our response to one weapon. Nicotine pouches, heated tobacco and other emerging products are there to be used, and their efficacy and utility should be the subject of urgent study. The tobacco control plan should embrace the new products and allow for more measures for companies to promote.

Thirdly—this relates to my previous point—the plan should contemplate legislation for a new robust regulatory framework that can cover all the products within the market. We should not allow our focus to be narrowed to e-cigarettes alone. New products are entering the market, and the UK must be open to the kinds of innovations that save lives.

I have two brief final points that I wish to make, to which I hope the Minister will respond. First, there is a slight lack of clarity about whether the new plan will take account of the conclusions of the post-implementation review of the Tobacco and Related Products Regulations 2016 and the Standardised Packaging of Tobacco Products Regulations 2015. On Monday, I received a written reply from the Minister, in answer to a written question, which said:

“Evidence gathered from this Review will be considered as part of the development of the new TCP.”

I hope the Minister will confirm that all the evidence from the review will be fully reflected in the plan.

Secondly, I return to a point I made in the previous Westminster Hall debate—that is, the opposition of the World Health Organisation, which has called for a ban on reduced risk alternatives to combustible tobacco. To listen to that call would run counter to the success in smoking reduction that has been achieved in the UK, and I strongly urged the Government to stand up to the WHO at COP9 and to advocate a change in policy from it.

Smoke-free Society by 2030

David Jones Excerpts

Tuesday 23rd March 2021 Westminster Hall

[Andrew Rosindell (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. I remind hon. Members participating virtually that they are visible at all times to each other and to us here in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks. Members attending physically should clean their spaces before they use them and as they leave the room.

[Mr David Jones (Clwyd West) (Con) [V]]

I beg to move,

That this House has considered reduced-risk smoking products and proposals for a smoke-free society by 2030.

It is a pleasure to serve under your chairmanship, Mr Rosindell, albeit from such a long distance. I am pleased to see the Minister there too. At the outset, I declare my interest as an honorary life fellow of Cancer Research UK.

This is not the first occasion on which I have raised the need to pursue the goal of a smoke-free society. I raised it previously in a Westminster Hall debate in 2019. I continue to pursue this issue because the ills of smoking continue to persist and they will continue to trouble our society for many years to come unless we take action now.

Today, I speak with hope. This year, we have an opportunity that we must embrace. Our exit from the European Union has provided us with the opportunity to take control of our own policy to improve public health, to contribute to the Government’s levelling-up agenda and to enhance the United Kingdom’s reputation as a world leader on tobacco harm reduction. The Minister’s Department is currently reviewing the regulations that have in recent years transposed the EU’s tobacco products directive into UK law and the Minister has committed to producing a new tobacco control plan this summer. I hope that in her remarks today she will set out what progress the Department has made in the process and confirm the plan’s anticipated publication date.

Since the last Westminster Hall debate that I secured on this issue in June 2019, the Government have committed to delivering a smoke-free society by 2030. There is no time to waste, and nor should we waste the opportunities that we have this year. The needs of the 7 million people in the UK who, sadly, still smoke must remain at the forefront of our minds. If my right hon. Friend the Chancellor is listening, I am sure he will be pleased to hear, especially in these difficult times, that nothing I propose this morning will require any expenditure by Her Majesty’s Treasury.

It should, of course, go without saying that smoking kills. While the number of people who smoke has fallen in recent years, the problem is still real, and it is a problem that reflects inequalities. We might not all see it in our constituencies, but there are large parts of the country where smoking rates remain troublingly high. The health costs of tobacco consumption fall disproportionately on the poor, ethnic minorities and those suffering from mental health conditions. Disadvantaged communities across the country are being left behind and the inequalities gap is getting worse.

In addition, statistics from the Office for National Statistics show that intention to quit has gone down almost year on year since 2015. Analysis by Cancer Research UK indicates that the Government are not on track to meet the new smoke-free 2030 target. In fact, its modelling predicts that adult smoking prevalence in England will not reach 5% until 2037. The pace of change needs to be around 40% faster than projected to deliver the ambitious target, so now is the time to act. It is time to make use of our newly restored policy making freedoms to make a difference with the forthcoming tobacco control plan.

The Minister’s predecessor closed the last Westminster Hall debate on this issue by saying:

“We will continue to be driven by the evidence.”—[Official Report, 26 June 2019; Vol. 662, c. 335WH.]

I am sure that approach is something that the Minister will be happy to endorse now, and it is something that I believe will set us on the right course to make the difference. Making a difference starts, first, with understanding that the fundamental problem with smoking is the smoke—the combustion. Acknowledging that should be the core principle under which we regulate. While it will always remain the case that smokers should aim to quit completely, if they are unable to do so, there are now many non-combustible alternatives that they can try, which will be less harmful to them.

Secondly, making a difference means that we cannot take our foot off the pedal in introducing further barriers to cigarettes and other combustible tobacco products. I am not generally an advocate for high taxes, but I can see the benefit of using taxation to increase the price gap between combustible and non-combustible products. We must do more to secure our borders to ensure that smugglers from abroad do not profit from health inequalities here.

Thirdly, and most importantly, making a difference means helping smokers who cannot quit smoking to change to something that is less harmful for them than cigarettes—products that are not combustible. The forthcoming tobacco control plan gives us the opportunity to take a fresh look at the new products and innovations in the UK, as well as those that we could have now that we have left the European Union. To make the most of that range of products in a sensible and controlled way calls for the creation of a new, reduced-risk smoking products category, to provide a robust regulatory framework.

It is important that products be regulated and controlled to ensure that they are used in the right way, but they will not be sufficiently effective if we do not get the information about them out to smokers. We have made great progress on tobacco harm reduction over recent years, but both those elements—regulation and information—should be addressed if we are to give ourselves the best chance of reaching the smoke-free 2030 goal.

We have seen great results from e-cigarettes, and Public Health England recently found that in every region of England quit rates involving a vaping product were higher than those for any other method. However, while they have worked for many smokers, e-cigarettes are not a panacea. In fact, nearly half the smokers in Britain have tried vaping, but did not continue. Now the number of vapers is falling, which should be a cause for concern for us all.

There are two measures that the Government can take to address the issue. The first concerns communications. Existing communications are not cutting through. When it published its annual vaping report last month, PHE said:

“Thousands more could have quit except for unfounded safety fears about e-cigarettes.”

Does the Minister agree that we could do better at communicating directly and clearly to smokers the harm reduction benefits of e-cigarettes and, indeed, all reduced-risk alternatives? The Government could, for example, allow the use of cigarette pack inserts or even online communications as ways to reach smokers directly.

The second measure concerns the nicotine level in e-cigarettes. The EU imposed a seemingly arbitrary 20 mg per ml limit on e-cigarettes, under its directive. The fact is that many smokers do not find that sufficiently satisfying to lead them to make a permanent switch away from combustible cigarettes. Now that we have the freedom to do so, we should look at setting our own limit at a level that would make the products more effective.

E-cigarettes will, however, never be the answer for all smokers. Nicotine pouches, which have been on sale in the UK for only a year or so, have rapidly grown in popularity. Around 100,000 people already use them. I understand that a reason for that is the success of point-of-sale advertising and the ability to advertise online. At present the products are not regulated beyond our general consumer protection laws, so they could benefit from being part of a sensible framework.

The use of heated tobacco in the UK continues to grow. Sales increased by 270% in the past year alone. The benefit is that there is still tobacco in the product, but it is not combustible. As I mentioned in the previous debate, 70% of heated tobacco users give up smoking altogether, but at the moment smokers cannot hear about those products, as they can hear about others. That is where smokers could benefit even more from receiving the targeted information that I mentioned earlier, online or from shopkeepers.

Finally, snus is another tobacco product and is currently not legal in the UK owing to a ban imposed by the EU. In Scandinavian countries such as Sweden, which are exempt from the EU ban, the availability of snus has had an enormous positive impact on smoking levels. Lifting the ban would show that our policy is driven by evidence, making the UK the true global leader in tobacco harm reduction. If all these smoke-free products were part of the controlled framework, with the same regulations, we would give smokers the best possible chance of moving away from cigarettes and we would give the country as a whole the best possible chance of achieving a smoke-free 2030.

Before concluding, I must touch on the opportunities that Brexit offers us in tobacco harm reduction. Every two years, we send officials from the Minister’s Department to the conference of parties to the World Health Organisation’s framework convention on tobacco control, a body that has taken positions that run completely counter to our own. Worryingly, just last month the WHO proposed a ban on vaping. The Minister will undoubtedly have noted the remarks of Clive Bates, an expert and the former director of the anti-smoking group Action on Smoking and Health, who said that that proposal was “irresponsible and bizarre”.

When we have attended the COP before, we have had to conform to the views of the EU grouping. This year, we will be attending, albeit perhaps only virtually, in our own right. This is the opportunity that I urge the Minister to consider. We have a strong story to tell on tobacco harm reduction at home, and we now have the freedom and ability to embrace bold, innovative new policies, such as those I have suggested this morning; so will we simply go along to get along at the COP, or will we do what is right by taking a bold and progressive stance in favour of tobacco harm reduction and proudly defend our own domestic position? I believe there is much that the world can learn from our approach, and I therefore urge the Minister to make the tobacco control plan one that will help us to deliver a smoke-free 2030, and one that we can showcase to the world later this year.

Covid-19

David Jones Excerpts

Wednesday 11th November 2020 Commons Chamber

[Mr David Jones (Clwyd West) (Con)]

Amid all the damage caused by the coronavirus pandemic to public health, to the economy and to social wellbeing, arguably the biggest impact has been on residents of care homes and their families. Care home residents, among the most vulnerable members of our community, have been disproportionately impacted by covid-19. According to the Office for National Statistics, up to 30 October about 28% of covid-related deaths recorded in England and Wales were in care homes. It is therefore fully understandable that care home providers should be cautious about visits to their homes by family members. However, it should also be remembered that many care home residents are living with dementia. Being deprived of visits causes disorientation and distress to them and, equally, to their families.

My constituent Mrs Kathy Barham of Ruthin has described to me the impact that visiting restrictions are having on her family. Her mother, Mrs Mavis Addison, lives in a care home in Wallasey. She is a widow and has lived all her life in Wallasey. Until 2016, she lived independently, but she was then diagnosed with dementia and moved into a residential care home. That did not mean that she stopped enjoying life. Every weekend, Mrs Barham would travel from Ruthin to visit her, take her out for afternoon tea and meet friends and family. Mrs Addison’s life was good. She was happy, and she was living well with dementia.

Visits from family members are extremely important to those living with dementia. In fact, the Government’s own guidance acknowledges that. However, since the lockdown was imposed some eight months ago, Mrs Addison has not seen her daughter or any other member of her family. Distressingly, Mrs Barham now says that her mother is simply giving up because of the enforced lack of contact with her closest relatives, and that is surely the case for many thousands of other people who are living with dementia around our country. It is a sad, distressing and, I suggest, inhumane state of affairs.

The campaign group Rights for Residents, of which Mrs Barham is a member, is calling for an end to the current restrictions on visits to care home residents. Hospitals are managing to provide safe visits, and the Government could, frankly, do more to facilitate equally safe visits to care homes. But the sad truth is that, frequently, the families of care home residents are allowed to visit their loved ones only if they have become so ill that they are receiving end of life care. Indeed, after the easing of restrictions in early summer, care home residents became the only group in our society who continued to endure prolonged enforced separation from their families.

Rights for Residents is calling on the Government to pursue a more humane and nuanced approach to the treatment of care home residents. It asks for the Government to produce guidelines that encourage care providers to find safe ways to visit, rather than ones that in many cases are interpreted so as to impose blanket bans on contact with families. It suggests that key worker status should be granted to relatives, as was suggested by the hon. Member for Upper Bann (Carla Lockhart), with access to the same testing regime as care home staff to facilitate the resumption of regular indoor visits. It also asks the Government to consider ways of developing an indemnity regime for care providers against legal action should the virus be brought into a care home—it is frequently the fear of litigation that inhibits visits to elderly people in care homes—and to develop updated comprehensive guidance that focuses on protecting vulnerable people against the appalling prospect of simply dying of loneliness.

Covid-19 is a dreadful disease, and it has inflicted illness and death on large numbers of our fellow citizens. It has, however, also brought mental anguish and distress to thousands of the most vulnerable and their families. With winter fast approaching, it is time for the Government to put in place a new visiting regime that gives proper consideration to the needs of care home residents and their families, and they could do worse than listen to the recommendations of Rights for Residents.

Heated Tobacco

David Jones Excerpts

Wednesday 26th June 2019 Westminster Hall

[Mr David Jones (Clwyd West) (Con)]

I beg to move,

That this House has considered Government policy on heated tobacco.

May I say how pleased I am to serve under your chairmanship, Mr Gray? I immediately declare my interest as an honorary life fellow of Cancer Research UK.

Smoking remains a terrible public health problem in the United Kingdom. The Government recently referred to it as the “continuing tobacco epidemic”. It is the country’s principal cause of cancer and single greatest cause of preventable illnesses and avoidable deaths. Some 7.4 million people in this country smoke, and smoking is the cause of around 100,000 deaths every year. There is a mistaken perception that the problem of smoking has largely been addressed, which might be because smoking, like many other societal ills, does not affect everyone equally. The smoking rate remains around 25% in many of the poorest areas of the country, whereas it is around 5% in more prosperous areas. In my constituency of Clwyd West, the rate is above the national average, at 17% to 18%.

The Government are to be commended for their achievements on smoking, and indeed for their ambitions for the future. Since 2010, Conservative-led Governments have brought the smoking rate down from 20.2% to 15.5%, which is a significant accomplishment. The Government are to be applauded for their ambition to lower smoking rates to 12% by 2020. Although they have not set yet a target date, the Government aim eventually to create a smoke-free generation, which they define as less than 5% of adults smoking. However, the challenge today is far greater than it was a decade ago, because smokers with a higher level of motivation to quit will have done so already. Those who remain have withstood years of public health campaigns and societal pressures, as well as the rise of e-cigarettes as an alternative to smoking.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Gentleman on bringing this important matter to the House for consideration. Does he agree that advice must be provided first about smoking cessation, rather than about vaping or any other alternative method? Does he also agree that although there are no long-term indications of the effects of vaping, whether burned or heated, the chemicals that are used will not be neutral, and there will therefore always be an element of concern and a need for greater research?

[Mr Jones]

Clearly, the ideal is for people to give up smoking altogether, but there are ways of reducing it. I will go into that in my speech. The hon. Gentleman makes a point to which I shall also refer: there is a need for research on the effects of alternatives to combustible tobacco.

E-cigarettes have had a revolutionary effect on efforts to reduce smoking rates in this country, and credit must go to the Government for facilitating that. E-cigarettes have had a highly positive impact on helping smokers to quit. In 2010, a particularly enlightened member of the behavioural insights team, David Halpern, influenced the Government’s decision not only to resist banning e-cigarettes—other countries were poised to do so—but to seek deliberately to make them more widely available. David Halpern advanced the principle of harm reduction: it is more effective to give somebody a reduced risk product than to insist unrealistically on immediate total abstinence. An expert in harm reduction, Professor Gerry Stimson of Imperial College, has supported that argument, pointing out that it is easier to persuade people to do something if that thing is enjoyable rather than a painful chore. He said:

“For those trying to stop smoking, e-cigarettes have profoundly changed the experience. For the first time quitting cigarettes is no longer associated with being a ‘patient’ and personal struggle.”

[Mark Pritchard (The Wrekin) (Con)]

I am grateful to my right hon. Friend for securing this important debate. As a non-smoker, I think there is nothing worse than sitting outside a café in London or Shropshire and having my lungs full of somebody else’s smoke, or indeed trying to walk to Parliament and taking in a street full of smokers’ smoke. Having said that, I am a libertarian—if people want to smoke, they should be free to do so. His substantive point on public health education is absolutely right: the campaign against smoking is not over. In my constituency of The Wrekin, 19,000 people still smoke. Does he agree that public health is important?

[Mr Jones]

I do indeed. I will also comment on my hon. Friend’s point about other people having to endure smokers’ smoke. One point that the Government make in their response to the Science and Technology Committee’s report is that heated cigarettes are far less offensive to other people than combustible cigarettes.

Consumers’ principal reason for using e-cigarettes is to give up smoking. According to Action on Smoking and Health, 62% of ex-smokers use e-cigarettes for that purpose, and the majority of users have successfully quit smoking. However, it might well be that we have now passed the apogee of the e-cigarette effect. According to the Office for National Statistics, the number of new e-cigarette users peaked at 800,000 in 2013-14. Since then, the number has approximately halved every year, down to 100,000 in 2016-17. It is not the case that the remaining smokers do not want to quit; the ONS reports that nearly 60% do. For some, however, the experience of using e-cigarettes does not come sufficiently close to that of smoking to be an adequate substitute. In this context, I urge the Government to consider the alternatives.

In Japan, heated tobacco is proving very successful in helping smokers to quit. Evidence there shows that 70% of heated tobacco users give up smoking altogether. That is a better conversion rate than for any other alternative nicotine-containing product on the market.

[Mr Charles Walker (Broxbourne) (Con)]

I have been a smoke-free person for 15 years, but it took me 12 years to get there. I had various failed attempts to give up smoking because it was a choice between smoking and chewing gum, which really was not a successful pathway—it took me 12 years before I could finally give up. Any method that helps the process has to be a good idea.

[Mr Jones]

I am very pleased to hear that. Of course, it is debatable whether chewing gum is more or less antisocial than smoking—particularly in its effect on pavements.

The heated cigarette process uses an electronic device that heats tobacco, producing an aerosol that tastes like tobacco, and it delivers nicotine in a similar way to a cigarette. Importantly, however, it is not a product of combustion. Tests on heated tobacco carried out by the tobacco industry and scrutinised by the Committees on Toxicity, Mutagenicity and Carcinogenicity of Chemicals in Food, Consumer Products and the Environment found a reduction of up to 90% in the number of toxic chemicals emitted by heated tobacco compared with combustible cigarettes. That is not greatly dissimilar to Public Health England’s finding that e-cigarettes are up to 95% safer than combustible cigarettes.

Heated tobacco is currently sold in the UK, but there is no independent research to validate its use. Members of Parliament have said that research is needed, and the Government have agreed. As I mentioned a few moments ago, the Science and Technology Committee’s July 2018 report highlighted the need for independent research. It identified the opportunity for the Government to

“help fill remaining gaps in the evidence on the relative risks of e-cigarettes and heat-not-burn products”

and support a long-term research campaign that would be overseen by Public Health England and the Committee on Toxicity to ensure that health-related evidence is not dependent solely on the tobacco industry.

The Government’s December 2018 response to the report was favourable. They accepted the recommendation and undertook to

“review and consider where there are gaps in evidence for further independent research”.

They went on to say that they are

“committed to providing the outputs of research to the public on the risks of e-cigarettes and novel tobacco products.”

They also committed to including heated tobacco in their annual review of e-cigarettes. However, this year’s e-cigarette review contained no mention of heated tobacco.

We are falling behind our international peers on this front. The United States Food and Drug Administration recently produced research that concluded that heated tobacco is

“appropriate for the protection of the public health because, among several key considerations, the products contain fewer or lower levels of some toxins than combustible cigarettes.”

It reported up to 95% lower quantities of certain toxins.

My question to the Minister is this: will the Government commit to producing or supervising independent research into heated tobacco this year? We are talking about a matter of personal choice for smokers, but the Government have a duty to inform them about the available alternatives. We have seen the value of e-cigarettes in helping people to quit smoking, and if there is a prospect that heated tobacco could help to bring down smoking rates further, are we serving the interests of public health by not carrying out the promised research? Might not an approach akin to the innovation principle, as opposed to the precautionary principle, ultimately lead to fewer smokers? If it might, should we not, like David Halpern, seize the opportunity?

The research will not happen by itself. The responsibility to produce it lies with the Government, as they have acknowledged. From 1 July, we will be acknowledging heated tobacco in the tax system. Is not now an appropriate time for the Department of Health and Social Care to ensure that the new tax category goes hand in hand with independent research on the efficacy of heated tobacco in bringing down smoking rates and its impact on public health? It may be suggested that the lack of funding is an issue, but I urge the Government to consider requiring tobacco companies to pay for the research to be carried out, thereby circumventing the need to apportion departmental budgets to it.

The reduction of harm from smoking must remain a top priority for this and any other Government. I therefore hope that the Minister will respond positively to my suggestion.

--- Later in debate ---

[Seema Kennedy]

The right hon. Gentleman makes an important point. Those of us who represent seats in the north and the devolved nations know that in some communities a very high proportion of people—particularly older men—are still smoking. Smoking cessation services are obviously part of the conversation about public health that the Department will be taking forward to the spending review.

My right hon. Friend the Member for Clwyd West has argued that it would be timely for the Government to commission independent research into heated tobacco products’ potential for harm reduction. Obviously, if the tobacco companies were paying for it, it would not be independent. The right hon. Member for Rother Valley (Sir Kevin Barron) has set me an interesting challenge on tobacco levies. The new levy is being introduced in a few days, and I will definitely keep that under review.

The primary focus of our research at the moment is e-cigarettes, because heated tobacco is still very new on the market in this country. We will keep it under review and we will monitor the evidence through Public Heath England’s reviews. I agree entirely that it is important to look carefully at the evidence of harm reduction. I assure the House that we are, and will continue to be, led by that evidence.

Heated tobacco products are regulated under the Tobacco and Related Products Regulations 2016 as novel tobacco, in accordance with the EU’s tobacco products directive. We know far more about e-cigarettes than we do about heated tobacco products. The research and evidence base is still in its infancy, and is mainly conducted by the tobacco industry. We asked the Committee on Toxicity to research the toxicological risks of heated tobacco products and compare them with those attributed to conventional cigarettes. It reported in December 2017, and the evidence suggests that heated tobacco products still pose a risk to users. There is likely to be a reduction in risk for cigarette smokers who switch to heated tobacco products, but quitting tobacco entirely is the most beneficial thing that anybody can do.

We have asked Public Health England to update the evidence base on e-cigarettes and other novel nicotine delivery systems annually. The PHE 2018 evidence review also had a comprehensive chapter on heated tobacco. It concluded the same as the Committee on Toxicity. As my right hon. Friend the Member for Clwyd West said, it stated that e-cigarettes are less harmful than heated tobacco. The latest PHE evidence review in February 2019 did not cover heated tobacco products, essentially because there was insufficient new evidence since the previous review in 2018.

My right hon. Friend pointed to the experience of other countries. I agree that we must look beyond our shores and learn lessons, but we must also acknowledge that there are different contexts in which heated tobacco products are used. For example, Japan has banned e-cigarettes, but it has introduced heated tobacco products, which have made an impact there. The Food and Drug Administration in the United States has permitted the sale of heated tobacco products, but is yet to pronounce on whether Philip Morris International may make claims of reduced risk for its IQOS product. I believe, therefore, that we need to be cautious about assuming that heated tobacco products are likely to find a large market in the UK.

I recognise that more independent research on heated tobacco products would be helpful for understanding their relative risks. The Department and its arms’ length bodies will consider research proposals in this field, but at present none has been forthcoming. I need to be clear that such proposals would need to demonstrate good use of public money. We will continue to monitor the international evidence and develop our policy as such evidence develops.

[Mr David Jones]

I have listened carefully to what the Minister has to say. It seems that the Government’s position now is identical to their position six months ago, when they published their response to the report of the Science and Technology Committee. Is that right? Has nothing moved?

[Seema Kennedy]

There is a definite need for more research to be done on heated tobacco products. Only through proper, independent research can we draw different conclusions. However, my right hon. Friend has raised a very important issue about these products, which are helping certain people in this country and other jurisdictions to quit smoking. He has set me a challenge and I will certainly ask my officials to look closely at the issue.

It is important to remember that heated tobacco products are tobacco products, and we must apply suitable caution. Although switching from traditional cigarettes is likely to reduce risk, the best approach is to quit entirely. The Government remain committed to helping people quit smoking and promoting reduced-risk products where it makes sense for smokers. We will continue to be driven by the evidence.

Question put and agreed to.

World Autism Awareness Week

David Jones Excerpts

Thursday 28th April 2016 Commons Chamber

[Mr David Jones (Clwyd West) (Con)]

I, too, congratulate my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan), not only on securing the debate and not only on the excellent work she does as chairman of the all-party parliamentary group, but on her wonderful work in piloting the Autism Act 2009 through the House. It was ground-breaking legislation, and it has done a tremendous amount to improve the lot of adults with autism in England. I must say in passing that it is a matter of concern to me that it has not been followed by similar legislation in Wales, but the good news is that all the parties involved in the current Welsh Assembly elections except, sadly, the Labour party have committed themselves to the introduction of a Welsh autism Bill, and I hope very much that Labour Assembly Members will work with their colleagues to bring that about.

Notwithstanding the passing of the 2009 Act, however, there is still much work to be done to ensure that people with autism and their families receive the support that they need, and, crucially, that understanding of the condition continues to develop. We must bear it in mind that autism was not formally recognised as a condition until the late 1940s, and that serious research on the condition did not begin in earnest until the 1960s. In 1970, an American study concluded that one child in 14,000 was autistic, but more recent US studies have shown that one child in 68 has some form of autism. A very recent study in Korea—the first study of an entire tranche of the school population—concluded that one child in 38 between the ages of seven and 12 had some degree of autism. It is therefore becoming increasingly clear that the condition is far more prevalent than any of us had thought.

As my right hon. Friend mentioned, it is estimated that between 600,000 and 700,000 people in the United Kingdom—approximately 1% of the population—are affected by autism. That has an economic as well as a human cost. A study by the London School of Economics in 2014 estimated that the cost of autism to the British economy was approximately £32.1 billion a year. Let me put that into perspective: the economic cost of cancer is estimated to be about £12 billion a year, while the figures for heart disease and strokes are £8 billion and £5 billion respectively.

As other Members have observed, if we had greater awareness and more understanding of the condition, more of us might recognise that people with autism are a very under-utilised resource. The recent article in The Economist that was mentioned by the right hon. Member for North Norfolk (Norman Lamb) pointed out that high-functioning people with autism often have a high degree of focus that enables them to spot patterns or errors in data that are not readily recognised by other people and that makes them attractive employees for software firms. Even people who are more significantly affected by autism can hold down jobs successfully. They often benefit from working in highly structured environments, sometimes thriving on jobs of a repetitive nature.

Employers need to realise that that resource can be tapped, which will often mean creating conditions in which people with autism can work. For example, they must understand the need for people with autism to require clear instruction. My right hon. Friend mentioned the excellent video produced by the National Autistic Society, “Too Much Information”, which shows a boy with autism being overcome by the general sounds that are experienced in a shopping centre. Employers should start to understand that people with autism may benefit from quieter working conditions: the sound of a telephone or chatter can prove distracting to the extent of being unendurable.

It is clear that more needs to be done to improve understanding of this condition. Since 2014, the Government have spent some £325,000 on limited awareness work, but that is a very small sum. A lack of understanding on the part of employers and potential colleagues presents autistic adults with a major barrier to finding and staying in work. It is therefore encouraging that the Department for Work and Pensions and the Department of Health have set up a joint unit to help people with autism to find and stay in work while also improving their health. Those are important initiatives, but, as I have said, more needs to be done.

More work is needed to try to identify the causes of autism, which are still not well understood. Research on twins suggests that genetic factors may be a cause, but it has also been suggested that there may be environmental causes, such as pre-natal exposure to viruses or air pollution. Continued research is essential. The United Kingdom currently spends just £4 million a year on autism research, compared with £590 million on cancer, £169 million on heart disease, and £32 million on strokes. World Autism Awareness Week gives us an opportunity to reflect on what is clearly a far more widespread condition than was previously thought, and to do more in our power to address it.

Fibromyalgia

David Jones Excerpts

Wednesday 1st July 2015 Westminster Hall

[Alok Sharma]

Yes, of course; the hon. Gentleman is absolutely right. A common theme is emerging among colleagues participating in the debate.

Let me describe fibromyalgia. It is a long-term condition that causes pain all over the body. As well as widespread pain, people with fibromyalgia may have increased sensitivity to pain, fatigue, muscle stiffness, difficulty sleeping, problems with mental processes, headaches and problems with their bowel and stomach.

[Mr David Jones (Clwyd West) (Con)]

I congratulate my hon. Friend on securing this debate. He mentions the severe pain that sufferers endure. My constituent, Mrs Joanne Kirkby, suffers from this terrible condition. Is he aware that most of the pain relief treatment centres in mainland Great Britain are within England and that if a patient comes from Wales, it is necessary to go through an extremely lengthy and complicated bureaucratic process to access treatment at, for example, the Bath pain relief centre?

[Alok Sharma]

My right hon. Friend makes a very good point. Perhaps the Minister will comment on where treatment is available and where pain clinics are situated.

The exact cause of fibromyalgia is unknown, but it is thought to be related to abnormal levels of certain chemicals in the brain and changes in the way the central nervous system processes pain messages carried around the body. It is also suggested that some people are more likely to develop fibromyalgia because of genes inherited from their parents. In many cases, the condition appears to be triggered by a physically or emotionally stressful event, such as an injury or infection, giving birth, having an operation, the breakdown of a relationship or the death of a loved one. The key point is that anyone can develop fibromyalgia, although it affects about seven times more women than men.

The condition typically develops between the ages of 30 and 50, but can occur in people of any age, including children and the elderly. Exactly how many people are affected by fibromyalgia is not clear, although research has suggested that it could be a relatively common condition. Some estimates suggest that nearly one in 20 people in the UK may be affected by the condition to some degree. Of course, one of the main reasons it is not clear precisely how many people are affected is that fibromyalgia can be difficult to diagnose. There is no specific test for the condition, and the symptoms can be similar to those of a number of other ailments.

Living with fibromyalgia can be incredibly debilitating. Ahead of today’s debate, a number of local people emailed me about their experiences of coping with fibromyalgia. I want to read out some extracts from the heartfelt and moving words that they sent me. A father of young children writes:

“I have had Fibromyalgia for a couple of years now. My life and that of immediate family has changed significantly in adapting to and attempting to cope with my condition.

I am unable to continue working as a qualified accountant, as my ability to read, write and concentrate have all been significantly affected. I suffer with ‘Fibro-fog’, a difficulty in recalling words or train of thought where the mind goes blank...I find it impossible to switch off from the pain, as it is constantly moving as though it is being scattered around my body.

I, and many of the members of the Reading Fibromyalgia group, experience the lack of understanding of others due to the ignorance relating to this condition that we suffer. As we appear whole there is often a lack of compassion from others and we can be made to feel as though we are malingerers. I have always had a strong work ethic and believe in setting a good example to my children; if I could work then I would work.

My hope now is that there will be a greater understanding of Fibromyalgia and how limiting this condition can be on the individual.”

A female sufferer writes:

“My typical day starts with trying to get my body working. My joints are so stiff with pain that I have to sit on the side of the bed and massage my shoulders, lower back, my knees, elbows and hands. It takes an hour to get showered and dressed. I do feel a failure if I have to get my husband to come and help me.

After having problems with pain, exhaustion and fatigue for several years, they then turned into depression, stress and anxiety. My G.P. finally diagnosed me with Fibromyalgia.

In 2013 I went along to our local Fibromyalgia Support Group…I went in the room and saw that there was ‘nothing different’ with these people. I was reduced to tears to find that they were all like me, young and old, male or female, and that I was ‘Not a Fraud’.”

Another submission that I received was from a male sufferer. He writes:

“Living with Fibro is often difficult and it’s like we have a volume control button that is broken at maximum setting—sometimes the pain and stiffness abate with medication, exercise where we are able to do so and so forth but it always comes back later in the day or within a day or two of doing too much activity.

Depression in people with Fibro is common”

because of

“the life we used to live but many no longer can. This adds to the stress and tension and it can become a vicious circle. Exhaustion is common as well.

The lack of understanding and sympathy from other people including importantly the medical profession makes it all the harder to bear. Yet Fibromyalgia has been recognised by the World Health Organisation since the 1970s as a chronic and long-term health condition. Thousands if not millions of people worldwide have Fibro either diagnosed or not so but they display the symptoms.

Yet people still think we’re making it up, which is very disheartening to us; some even are abusive to us because they don’t understand.”

Ahead of this debate, I spoke to many fibromyalgia sufferers, and colleagues who have contributed have clearly done the same. They will have heard the same things as I heard from constituents and in emails from people across the country, detailing their own experiences of coping with this debilitating condition. Three common themes emerge. First, fibromyalgia is not well enough understood by GPs and the medical profession, as the hon. Member for Strangford (Jim Shannon) said, and there seems to be no significant research effort to find a cure. Secondly, as a result, there is no consistency of approach or care across the country in helping sufferers to deal with the effects of fibromyalgia—exactly the point made by my right hon. Friend the Member for Clwyd West (Mr Jones). Thirdly, the condition is not well enough understood by the general public or employers, and sufferers have told me that they have faced discrimination in the workplace as well as the wider community. That is completely unacceptable.

I want to mention the good work of the Fibromyalgia Association UK, which today merges with FibroAction to speak up with a louder voice for sufferers of fibromyalgia, provide national helplines and raise awareness of the condition with GPs. Although knowledge is inconsistent within the GP and health community, there are pockets of excellence. Last October, I was invited to the one-year anniversary celebrations of the re-launched Reading fibromyalgia support group. There I met with Dr Antoni Chan, a consultant rheumatologist and physician at the Royal Berkshire hospital, who gave a presentation on the ongoing research aimed at understanding the condition and developing treatments. I also met Dr Deepak Ravindran, a consultant pain specialist at the Berkshire pain clinic. The clinic offers a comprehensive service, starting with expert diagnosis and followed up by medical treatment, which is complemented by good support from specialists in physiotherapy and psychology—a truly multi-disciplinary approach. I pay tribute to Dr Chan and Dr Ravindran for the excellent work they are doing to help fibromyalgia sufferers in Berkshire.

As a result of that meeting, I wrote to North and West Reading clinical commissioning group last November, providing a copy of the pamphlet on fibromyalgia that Dr Ravindran has produced and asking the CCG to promote understanding of the condition among the local general practitioner community. Dr Ravindran recently informed me that the need for an integrated and collaborative approach to managing fibromyalgia has been recognised locally, and a community pain service in the Reading area will start in September. That will be a collaboration between the Royal Berkshire hospital and the Berkshire healthcare NHS foundation trust, and its vision is to provide fibromyalgia-specific pain management programmes. That is good news for fibromyalgia sufferers in Reading and Berkshire, but, as other colleagues and I have remarked, the approach is inconsistent across the country.

I have three asks for the Minister and the NHS. First, education and knowledge of fibromyalgia must be improved among GPs and other healthcare professionals, and awareness of new diagnostic criteria must be increased and disseminated more widely. Secondly, strategies that provide an integrated and holistic service with patient empowerment as key must be promoted and developed, because patients need to be involved in decision making and the management of their condition. Thirdly, the aim should be to set up a network of fibromyalgia clinics across the country, so that patients who have had a flare-up of the condition have somewhere to go for treatment other than A&E or hospital.

My final point is about raising awareness of the condition more generally. Jeanne Hambleton, a freelance journalist and health writer, has informed me that last year she wrote to two well-known TV soap operas and asked whether one of the characters could be diagnosed with fibromyalgia to raise viewers’ awareness of the condition. Sadly, she did not hear back from the producers of either programme. I have no doubt that many people watch debates on Parliament TV, but it is safe to venture that many, many more watch soap operas. If the producers of “Casualty” or “Holby City” are watching the debate, they may want to get back to Ms Hambleton about her suggestion. I look forward to the Minister’s response.

--- Later in debate ---

[George Freeman]

The hon. Gentleman makes an excellent point, and he is helping to raise awareness today. I will pass on the points made today to the team at NHS England with responsibility for this issue. The answer to the question on awareness is to support debates such as this, and to promote the work of the charity and the patient advocacy groups.

The routine assessment of pain is a required competency for all healthcare professionals. However, patients who remain in high levels of pain after conventional approaches to treatment have failed are able to access specialised pain services, which are nationally commissioned by NHS England. Patients referred to such services receive multidisciplinary team care from clinicians with expertise in pain management.

[Mr David Jones]

The Minister heard my earlier intervention, and he now mentions specialised pain relief centres, most of which are located in England. He also heard my points about the bureaucratic difficulties experienced by patients living in Wales when accessing such centres in England. Will he liaise with his colleagues in the Welsh Government on whether a smoother path can be achieved for patients from Wales?