Standardised Packaging of Tobacco Products Regulations 2015

Debate between Earl Howe and Lord Naseby

Monday 16th March 2015 Lords Chamber

[Earl Howe]

My Lords, this has been a very powerfully argued debate. I am grateful to those noble Lords who have welcomed the regulations for the many supportive points that they have made. I also thank my noble friend Lord Naseby for setting out his objections and concerns with his customary clarity and courtesy. Several noble Lords have already done part of my job for me in responding to my noble friend’s critique, but I believe it to be incumbent on me to address directly all the matters that he raised, as well as the questions posed by other speakers.

I turn to the issue of the illicit trade and the evidence from Australia. Contrary to what the tobacco industry would have people believe, the evidence from Australia does not show an increase in the illicit market in that country following the introduction of plain packaging. There have been a number of criticisms of the tobacco-funded reports on that issue. It is therefore useful to consider the data provided from official Australian government sources. Official data from Australia on the use of illicit tobacco show a drop in those aged 14 years and over currently smoking illicit tobacco following the introduction of plain packaging. From 6% using illicit tobacco in 2007, the figure dropped to 5% in 2010 and then to under 4% in 2013—after plain packaging had been introduced.

A study published in BMJ Open analysed data from smokers before, during and one year after the introduction of plain packaging in Australia. The proportion of smokers reporting current use of illicit tobacco did not change significantly after plain packaging was introduced. I assure the House that the Government have looked very carefully at the potential impact on the illicit market. Tackling tobacco smuggling is a government priority. I can tell the noble Lord, Lord McFall, in particular, that, due to the fantastic work of HMRC and others, there has been a long-term decline in the tax gap for tobacco products over the past decade. The potential impact of standardised packaging on the illicit trade was considered extensively by HMRC, Sir Cyril Chantler, the Select Committee’s inquiry on smuggling, the Trading Standards Institute and RUSI. They all concluded that standardised packaging will not have a significant impact on the illicit market. HMRC has undertaken a detailed assessment of the potential impact of standardised packaging on the illicit market, which is the most comprehensive and reliable information available. Its assessment is that:

“We have seen no evidence to suggest the introduction of standardised packaging will have a significant impact on the overall size of the illicit market or prompt a step-change in the activity of organised crime groups.”

The Trading Standards Institute, which has extensive experience of tackling illicit tobacco at retail level, said in its consultation response that it,

“is aware that the tobacco industry regularly argues against standardised packaging for the reason that it will inevitably lead to an increase in the illicit tobacco trade. The Institute does not regard this as a valid argument”.

My noble friend referred to the system known as Codentify. That system is a voluntary security feature developed and controlled by the tobacco industry. We know that HMRC is starting to make use of the system to assist in identifying illicit tobacco. We are working across government to ensure that anti-counterfeit systems that are useful to HMRC and other enforcement agencies now and in the future can continue to feature on standardised packs. That will require such anti-counterfeit systems to be put on to a statutory footing.

My noble friend suggested that the prevalence of smoking had increased in Australia and that standardised packaging had not helped. Australian government figures show that smoking prevalence is in fact at an all-time low since the implementation of standardised packaging, with a 15% drop between 2010 and 2013. This change is likely to be attributable to the cumulative effects of a range of policies, including standardised packaging.

My noble friend also referred to the study by Kaul and Wolf apparently showing that smoking had increased among teenagers. The Kaul and Wolf report was funded and its release was closely directed by Philip Morris International, part of the tobacco industry. It was based on a specific survey of population smoking that is not intended to provide reliable estimates of smoking among teenagers, and the sample size was very small. It also compared figures immediately before and after implementation, and the effects of standardised packaging are more likely to be gradual. It is not a reliable study, we suggest, from which to draw any conclusions.

My noble friend Lord Blencathra urged the Government to wait for more evidence from Australia. He may like to know that studies in Australia have found that smokers buying standardised packets reported being more likely to prioritise quitting than smokers using fully branded packs. Calls to quit lines have increased. Smoking has decreased in outdoor cafes and fewer packs are being displayed on tables.

What has happened to tobacco sales in Australia? There have been suggestions that sales have gone up. Sales of tobacco can be measured in many different ways—sales by manufacturers to wholesalers, wholesalers to retailers or by retailers to consumers. Different pictures of sales emerge depending on the source of the data and the timeframe. In fact, official government data from Australia suggest that a continuing decline in per capita consumption of tobacco products has taken place. Commonwealth Treasury figures show that excise and customs clearances of tobacco declined by 3.4% in 2012-13, and that is generally regarded as the most reliable indicator of population sales.

I turn now to the print industry and my noble friend’s complaint that more time should be given to the print industry to enable a proper lead-in period. Standardised packaging is not a policy that has been sprung on the print industry. It has been under discussion since 2008 and two public consultations have been held on the subject, as I mentioned earlier. The regulations would come into force in May 2016, which provides the print industry with a lead time of over a year. I confirm to my noble friend Lady Tyler that the regulations will be implemented at the same time as the European directive is transposed in May 2016, so the industry does not have to undergo two changes to its manufacturing process.

The previous changes to tobacco packaging, such as the requirement for picture warnings in 2008, showed that a 12-month period in which to sell through old stock is appropriate and that stock sells through more quickly than one year. In answer to my noble friends Lord Naseby and Lord Blencathra, it is not true to say that standardised packaging will make it easier to copy packs and therefore make things easier for counterfeiters. Standardised packaging would remain complex to counterfeit. The packs will continue to feature large and complicated to reproduce picture health warnings and will retain all the security features currently on packs, including covert anti-counterfeit marks. The European Union directive includes provisions on the printing of labels. As I said, we have given very careful and measured consideration to that. We believe that the synchronised introduction of the provisions in the directive with the coming into force of these regulations is a sensible course.

Mention was made of intellectual property issues. As I said earlier, we have given very careful and measured consideration to all legal aspects of the policy, and this includes intellectual property aspects. These regulations regulate the use of tobacco branding, which includes trade marks. I emphasise that we regard tobacco as a unique consumer product in this context because it is a uniquely harmful consumer product. For the record, we do not consider that these regulations breach intellectual property laws or our international obligations in relation to trade marks.

I listened with care to my noble friend Lord Geddes, who argued from experience of his National Service that plain packs would not deter smoking. He referred to “Blue Liner” cigarettes, which I was interested to hear about. However, there are several key differences with regard to our proposals. First, the regulations we are considering mandate health warnings, which did not appear on “Blue Liner” cigarettes. Secondly, there is the colour of the packaging. Our regulations take into consideration the extensive market research the Australian Government undertook to determine the most effective designs for standardised packaging. Of the eight different colours tested during the research, dark brown packaging was the least appealing and thought to contain cigarettes most harmful to health. After carefully considering the research, our regulations adopt the same dull brown colour as the packs required in Australia.

The noble Viscount, Lord Falkland, referred to the possibility of unintended consequences. We believe very firmly that the benefits of these regulations far outweigh any of the unintended consequences that might come from introducing standardised packaging. In some cases, we are not convinced that certain predicted unintended consequences are anything more than scare stories. The department has run two consultations on standardised packaging, which contributed to our understanding of all the relevant factors in making our decision.

My noble friend Lord Blencathra queried the Explanatory Memorandum. I think he might have been referring to the impact assessment, which was rated green by the Regulatory Policy Committee, meaning that it is fit for purpose.

The noble Lord, Lord Hunt, asked about public support for standardised packaging. Multiple surveys have shown that the public support it. A YouGov poll in spring last year, with a representative sample of 10,000 people, found that 64% of adults in England supported standardised packaging while 11% opposed it. Even among smokers, more people were in support of or neutral towards standardised packaging than opposed it. After the implementation of standardised packs in Australia, support for the policy increased from 28% to 49% among smokers. Survey data from Australia show that more smokers approve of the policy than oppose it.

The noble Lord, Lord Stoddart, made a point that I have heard him make powerfully before—that alcohol is, in fact, the most addictive and harmful drug, not tobacco. I just say to him, as mentioned in my speech, that all smoking is addictive and harmful to health, and half of regular smokers are eventually killed by smoking-related illness. That is simply not true of other consumer products such as alcohol. Tobacco is being treated uniquely in regulatory terms because it is a uniquely harmful consumer good. All smoking is addictive and harmful to health. Therefore, to be absolutely clear, we see the introduction of standardised packaging as a unique approach to tackling smoking and its appalling effect on public health. It fits within a comprehensive tobacco control policy.

We are proud that smoking rates are the lowest ever recorded in this country, and my noble friend Lord Naseby was right to point that out. However, we cannot rest on our laurels. In other parts of the world we have seen that if Governments take their foot off the pedal with tobacco control, smoking rates can go up. For the good of public health, we want to continue our policy action to see smoking rates continue to fall, which is why I once again commend these regulations to the House.

[Lord Naseby]

My Lords, I should like, first, to thank my noble friend on the Front Bench for addressing the four points that I raised and were vital to be addressed. I shall comment on only two short matters because I sense that the House wants to move on.

My first comment is on youth smoking, which a number of Members raised. One may dispute this or not, but the facts are that the Australian Institute of Health and Welfare has stated that youth smoking rates have not declined as a result of standard packaging; in fact, they are at a seven-year high. Secondly, there is the matter of illicit tobacco consumption, which is the issue that worries me most. One has only to go round a building site in the United Kingdom today. I recently did so and checked a bit. Illicit tobacco is being offered on many building sites in this country; it is costing the Revenue and genuine companies a great deal. Not only that, when we look at Australia specifically, which we have done this evening, we see that by mid-2014 in that country illicit tobacco consumption stood at an unprecedented 14.7% of the market—25% higher than it had been in 2012. Whatever anyone says, as far as the industry is concerned—after all, it knows exactly how many cigarettes are produced and sold—that is a crucial area, and a crucial area of public health. Unless someone does something about that, we may well find increasing numbers of counterfeit cigarettes imported into this country. That will have an effect on public health because they kill even quicker than the genuine ones do.

I am grateful to all those who have taken part. I particularly thank my noble friends who have supported me this evening. Some home truths have been spelt out by the noble Lord, Lord Stoddart, the noble Viscount, Lord Falkland, the noble Earl, Lord Erroll, and a number of other colleagues who have supported me. The key issue, however, is a little wider than the tobacco industry, because what this Motion does, if it goes through—I imagine that it may well do so—is totally to undermine intellectual property rights, which are the very foundation of our modern capitalism. Intellectual property rights are fundamental to every business and defend a company from rogue competition—wherever it may come from—and, in my view, from totally misguided Governments on occasion.

I have to decide whether to divide the House. I take note of the fact that in another place nearly 25% of that Chamber voted against the Motion. I sense this evening that about 25% are against this Motion and I thank that 25% for the support they have given me. Nevertheless, it does not seem to me to be terribly productive for us all to march through the Lobbies and for me to get only 25% of the vote, or thereabouts, so with the leave of the House I will withdraw my amendment.

Francis Report: Update and Response

Debate between Earl Howe and Lord Naseby

Wednesday 11th February 2015 Lords Chamber

[Earl Howe]

I am grateful to the noble and learned Lord. NHS guidance has consistently made it clear that, where confidentiality clauses are used, they should go no further than is necessary to protect the legitimate interests of both the employer and the employee. There are circumstances when a gagging clause is appropriate, but local policies should always prohibit the inclusion of confidentiality clauses in contracts of employment and settlement agreements that seek to prevent an individual making a disclosure in the public interest, in accordance with the Public Interest Disclosure Act. Such clauses are often referred to as gagging clauses. If such clauses were to be included in a severance agreement or settlement, they would be deemed void in any event. We have made it amply clear to NHS organisations where the boundary lies between those two types of confidentiality clause.

[Lord Naseby (Con)]

Is my noble friend aware that the question of patient safety, which is emphasised, is fundamental to all this? In contrast, the number of claims for medical negligence continues to rise—in the past year, it did so by 18%—and now costs the NHS well over £1 billion. Has the time not come to have a thorough review of how such medical negligence claims are handled and who is behind some of them? Perhaps it is ambulance chasers. In any case, is not arbitration possibly the way forward, such as happens in essence when a coroner looks at a difficult case?

[Earl Howe]

My noble friend makes a series of very good points. We are, as he knows, extremely concerned about the rising level of litigation costs in the NHS. My department is consulting on proposals for how the duty of candour can be further incentivised by requiring trusts and foundation trusts to meet a proportion of the cost of negligence claims in cases where they have failed to be candid. We are also committing up to £35 million so that the NHS Litigation Authority can support trusts in implementing their safety improvement plans where those plans show a likely reduction in the number of higher-volume and higher-value claims over the medium to long term.

London Health Commission: Smoking

Debate between Earl Howe and Lord Naseby

Thursday 15th January 2015 Grand Committee

[Earl Howe]

Undoubtedly it is extremely helpful although I am sure that the noble Lord would be the first to acknowledge that there are considerations that Sir Cyril did not address, which we obviously have to do across government before taking a final decision.

[Lord Naseby]

Can my noble friend assure those of us who take a detailed interest in this that the decision will be based on the independent evidence from Australia after two years of implementation against the yardsticks that that Government set?

[Earl Howe]

I am grateful to my noble friend. I was about to answer the question posed by the noble Lord, Lord Faulkner, on exactly that point. Evidence and experience continue to emerge from Australia, as my noble friend rightly said. I can reassure noble Lords that my department is looking very carefully at the evidence as it emerges. We will introduce standardised tobacco packaging if, having considered the evidence both here and around the world and other relevant information, we are satisfied—I emphasise “satisfied”—that there are sufficient grounds to do so.

The UK leads the world in supporting smokers to quit, and local authorities are now responsible for providing “stop smoking” services in their communities. The Government have continued to invest in tobacco marketing campaigns to encourage smokers to quit. Your Lordships may have seen Public Health England’s latest campaign that is currently running. Our “Stoptober” campaign has become hugely successful, encouraging smokers to quit for a whole month, giving them a significantly better chance of remaining smoke-free for good. Today, we offer smokers information and support through a range of media, including through the internet and mobile telephone applications.

A new European tobacco products directive has been agreed and will come into force in 2016. The new measures cover labelling, ingredients, tracking and tracing, e-cigarettes, cross-border distance sales and herbal products for smoking.

Making tobacco less affordable is proven to be an effective way of reducing smoking prevalence. The Government continue to follow a policy of using tax to maintain the high price of tobacco at levels that have an impact on smoking prevalence. In the Autumn Statement, my right honourable friend the Chancellor of the Exchequer announced that the Government will consult on whether to introduce a levy on tobacco manufacturers and importers. That consultation is now under way.

The Government have taken sustained action to reduce levels of illicit tobacco, and over the past decade, the illicit market has declined significantly. In the past two years, nearly 3.6 billion illicit cigarettes and 1,050 tonnes of rolling tobacco have been seized. Local authorities continue to take their own action against illicit tobacco, which is to be welcomed.

Smoke-free legislation, implemented in 2007, has had beneficial impacts on health. I would say to my noble friend Lord Naseby, who mentioned this, that the legislation has been highly successful in terms of public health and it continues to be popular and well complied-with, on the whole. The Government have no intention of amending this important legislation along the lines suggested by my noble friend. As I said, levels of compliance and public support for the law are high. While smoke-free legislation covers enclosed work and public places, local authorities may wish to take action to limit smoking in open-area environments. That is a recommendation in the London Health Commission’s report. However, I do not believe that changes to smoke-free legislation would be needed to achieve this. I commend local authorities across England for the commitment they have shown to reducing tobacco use; for example, more than 80 councils have signed the Smokefree Action Coalition’s Local Government Declaration on Tobacco Control.

My time is up. I will finish by saying that the Department of Health has worked actively to support the implementation of the World Health Organization’s Framework Convention on Tobacco Control, including protecting tobacco control from vested interests, and is today regarded as a global leader in the implementation of effective tobacco control policies. The UK deserves that reputation and I am proud to be able to share with your Lordships the news that the Department of Health has just been named as the winner of the American Cancer Society’s prestigious Luther L Terry Award for exemplary leadership by a government ministry in the field of tobacco control.

NHS: Health and Social Care Act 2012

Debate between Earl Howe and Lord Naseby

Wednesday 9th October 2013 Lords Chamber

[Earl Howe]

I can give the noble Lord an absolute assurance on both those counts.

[Lord Naseby (Con)]

Surely my noble friend can confirm that, broadly speaking, the tendering processes under the Act have gone well and are broadly within budget. Although there are various dimensions to the tendering process as raised by my noble friend from the Liberal Democrat Benches, nevertheless, in broad terms, we are well satisfied with the way that it has gone. If there are differences and small amendments are necessary, will my noble friend confirm that those will be looked at speedily?

[Earl Howe]

My Lords, I agree with my noble friend in that I am not aware of any tendering process that has gone horribly awry. Certainly the Government are always open to looking at any provisions that are not working as they should, but I am not aware of any.

Smoking: Cigarette Packaging

Debate between Earl Howe and Lord Naseby

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

My Lords, we want to keep a close eye on what is happening around the world before making a decision. We are keeping standardised packaging under active consideration. It has been newly introduced in Australia, and other countries are intending to follow suit, so it is sensible for us to see what we can learn from other countries’ experience. The impacts could be several. They could include, for example, health benefits, as well as impacts on businesses such as retailers and tobacco manufacturers, and could possibly bring about a change in attitude to smoking.

On the risk to children, the noble Baroness is of course absolutely right. Evidence suggests that action needs to be taken to reshape social norms around smoking so that tobacco becomes less desirable, less acceptable and less accessible, particularly to the young. That is why we are committed to ending tobacco displays in shops. We have a TV-led marketing campaign to encourage smokers not to smoke at home or in cars and we have banned the sale of tobacco in vending machines, which has removed a source of cigarettes that underage smokers could access as often as they liked. There is a range of work going on.

[Lord Naseby]

May I—

--- Later in debate ---

[Lord Naseby]

I congratulate my noble friend on not rushing in to another unproven restriction on the consumption of alcohol, particularly one which has legal dimensions that affect intellectual property rights. Can he confirm that consumption of cigarettes is already falling, and that we are already spending something like over £50 million on tobacco control? Is not the greatest problem at the moment illegal smuggling of cigarettes into this country, which costs the Revenue a huge amount of money—close on £200 million—and is consumed principally by young people?

[Earl Howe]

My Lords, smoking rates in the UK are lower than those in many comparable western societies, but our reductions in prevalence still lag behind those in countries such as Canada and the United States, and in some Australian states. Overall prevalence is gradually coming down, but we still need to worry about smoking take-up by the young. There is no doubt that smoking is a significant cause of health inequalities in the UK.

On illicit trade, the story is quite positive. In 2000 around 21% of the UK’s cigarette market was illicit, whereas the latest estimate from HMRC for 2010-11 is that around 9% of the cigarette market is illicit. That is too much; nevertheless, we are heading in the right direction.

Health: Degenerative Brain Diseases

Debate between Earl Howe and Lord Naseby

Wednesday 5th June 2013 Lords Chamber

[Earl Howe]

My Lords, I am glad to know that. It provides a telling and important example of how this can be done in a sensitive way, and in a way that best meets the requirements of researchers. If there is a possibility of planning in advance the donation of a brain—or, indeed, any organ—it is much easier for the family and gives the patients themselves much satisfaction.

[Lord Naseby]

Is my noble friend aware that a great deal of work is being done through the EMEA and, through that organisation, by a number of countries in Europe? As one who has raised the issue of orphan drugs before, can we, on this occasion, make sure that NICE co-operates with these other bodies and we do not start duplicating work across the whole of Europe?

[Earl Howe]

My Lords, I am aware that NICE co-operates with its counterpart bodies not only in Europe but in other parts of the world; its work has an international dimension. As the same time, I say to my noble friend that NICE is seen as a world leader in its field. Many other countries look to NICE for the methodology that it adopts.

NHS: Private Companies

Debate between Earl Howe and Lord Naseby

Monday 11th February 2013 Lords Chamber

[Lord Naseby]

My noble friend mentioned tariffs. Will it be a tariff across the whole of England or will it reflect the differing costs, particularly in overheads, of, say, an operation in London and an operation further north?

[Earl Howe]

My Lords, there are tariffs that are nationally set and others that may be locally set, but there is scope to vary even the national tariffs if there is a good reason to do so on the grounds of local variation in costs. There is some flexibility in the system, but the main basis of the policy, as I stressed earlier, is that, where competition occurs, it should be on the basis of quality and not price.

Tobacco: Control

Debate between Earl Howe and Lord Naseby

Tuesday 19th June 2012 Lords Chamber

[Lord Naseby]

To ask Her Majesty’s Government whether they will meet representatives of non-governmental organisations, the tobacco industry and retailers to discuss tobacco control issues, publishing the minutes of such meetings, in line with both the requirements of Article 5.3 of the World Health Organisation Framework Convention on Tobacco Control and the practice of the European Commission and other member states.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, Health Ministers consider all meeting requests carefully. Article 5.3 of the Framework Convention on Tobacco Control requires the Government to protect the development of public health policies from the vested and commercial interests of the tobacco industry. The tobacco industry is welcome to share its views on tobacco control issues with us in writing at any time.

[Lord Naseby]

My Lords, that is a depressing Answer. How is it possible that in a country that believes in freedom of speech, a highly regulated and legitimate industry employing thousands of people and providing millions of pounds of revenue for Her Majesty's Government can be treated quite so shabbily when the Government are developing new regulations affecting plain packaging, which affects intellectual property, and are involved in consumer safety? I ask my noble friend to think again and to receive representations. The Government may not want to agree with those representations, but surely it is the legitimate right of every elector and every employer in this country to make their representations in person to Her Majesty’s Government.

[Earl Howe]

My Lords, we welcome the views of tobacco companies, retailers and all those with an interest in tobacco-related policy. Ministers in other departments may have legitimate reasons to meet the tobacco industry—I understand that, from time to time, they do—but Health Ministers and Department of Health officials would have a good reason to meet tobacco companies only if a specific matter, as opposed to general issues to do with tobacco control, demanded that. We would have to think carefully whether there was a good reason.

NHS: Risk Register

Debate between Earl Howe and Lord Naseby

Tuesday 15th May 2012 Lords Chamber

[Earl Howe]

My Lords, we do not agree with that. We have, as I have mentioned, published a document setting out a summary of all the risks in the register and the mitigating actions associated with each category, but we resist publishing the risk register itself at present. It is essential that officials are able to formulate sensitive advice to Ministers, making frank assessments and using direct language, without the fear of causing unnecessary embarrassment for the Government or damage to their area of policy. That is the essence of the reason.

[Lord Naseby]

Is my noble friend aware that there is nobody more passionate about the NHS than I am, but that a great many people outside want civil servants and other advisers to Ministers to point out the whole extremity of risks in any policy, whether it is policy A, B or C? At the end of the day, they expect Ministers to look at those risks and take appropriate decisions. Against that background, therefore, the strategy that my noble friend is following is understood outside by the ordinary public. It may not be understood by the lobby groups; nevertheless, it is the public whom we serve.

[Earl Howe]

My Lords, I am very grateful to my noble friend, and he is right. The risk assessment process, carried out by civil servants and detailed in these registers, is an integral part of the formulation and development of government policy. It is in the public interest that this process be as effective as possible. We are clear that where policy is sensitive, that necessitates confidentiality.

NHS: Management Consultants

Debate between Earl Howe and Lord Naseby

Monday 13th February 2012 Lords Chamber

[Earl Howe]

The noble Lord is, I think, insinuating some impropriety on the part of McKinsey and, perhaps, on the part of civil servants. I know of no such impropriety. Indeed, as I said earlier, there are clear and strict rules about transparency and openness. Declaring hospitality received is something that all civil servants and Ministers have to do. The results are published regularly. I will of course ask the question of McKinsey, which I have not yet had time to do. If I discover that there is any substance to the questions that the noble Lord has asked, I shall of course write to him and place a copy in the Library, but I very much doubt that I shall find any substance to them.

[Lord Naseby]

My Lords, as the Question refers to consultants and not to any specific consultant, is it not a fact that consultants provide a good interim role of management, suggestion or policy for consideration for Her Majesty's Government rather than their taking on ever more central staff? Is that not particularly appropriate, bearing in mind that the Prime Minister held a consultation on the whole of the Bill, as a result of which, as I understand it from listening to the debates in this House, changes have been made to the Bill which will have to be implemented pretty quickly? One can understand why consultants are brought in at the centre of the National Health Service. Surely on the whole it can only be healthy to have consultants there to speed up the implementation of this very important Bill.

[Earl Howe]

My noble friend is quite right. As I said earlier, the use of consultants—provided that that use is judicious and they are engaged in open competition processes—can be very cost-effective. It is a very flexible way of obtaining high-class advice without incurring long-term costs.

Tobacco

Debate between Earl Howe and Lord Naseby

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, I wonder too.

[Lord Naseby]

My Lords, the Minister says that the control of illegal importation of tobacco is showing progress. Is it not the reality that the vast majority of illegally imported tobacco and cigarettes is being consumed by young people, and that while the official statistics may show one thing, all the evidence, when I inquired of the tobacco industry on this particular aspect, is that this is still the major problem in terms of young people taking up smoking?

[Earl Howe]

My noble friend is absolutely right that that is where the problem principally lies: 320,000 young people experiment with smoking or take it up every year. That is a very serious rate of incidence and it must be tackled at every possible level. The tobacco control plan sets out a concerted programme of action to try to do just that.

Health and Social Care Bill

Debate between Earl Howe and Lord Naseby

Monday 19th December 2011 Lords Chamber

[Lord Naseby]

My Lords, the Deputy Speaker called the amendment and it was agreed, but I did not specifically hear that Clause 240 should stand part. If I may, I will intervene briefly on whether the clause should stand part, particularly the additional functions under subsection (1)(a). It states:

“NICE may do any of the following … acquire, produce, manufacture and supply goods”.

I have a query for my noble friend on the Front Bench. We are well aware that in the past some hospitals have manufactured certain generic medicines and marketed them, which has caused the normal market for medicine and pharmaceuticals to be disrupted. Secondly, we are aware, particularly recently, of certain hospitals that have been selling medicines in another market, which has caused disruption to that market and particular difficulties for parts of the country where there has been a shortage of medicines.

I may be wrong but, as I read it, this clause means that NICE will be in a position to manufacture directly, maybe even under a licence. I see that under paragraph (f) NICE will be able to,

“exploit ideas and exploit intellectual property”.

Can we be quite clear? Is my noble friend really saying that NICE, the adjudicator of value for money and all the other dimensions in the Bill to do with pharmaceuticals, medicines et cetera, will manufacture certain medicines on the side? That does not seem to be part of the role of the regulator. It seems, frankly, to be virtually direct labour within the context of NICE. I would be most grateful if my noble friend would respond. If he is not able to respond today, perhaps he will respond on Report or write to me.

[Earl Howe]

My Lords, I hope I can assist my noble friend. Clause 240 enables NICE to undertake additional functions, such as supplying new services and exploiting intellectual property. These functions must be related to the provision of health and social care. They seek to reproduce the income-generation powers that NICE currently enjoys as a special health authority and do not therefore represent an expansion of its powers. NICE may do this for any number or type of organisations, including the private sector and overseas Governments. This clause allows NICE to charge for carrying out these additional functions on an appropriate commercial basis.

In the White Paper Liberating the NHS: Report of the Arm’s-Length Bodies Review, the Government stated that,

“where appropriate, arm’s-length bodies will be expected to exploit commercial opportunities and maximise commercial discipline across the sector”.

NICE may carry out these additional functions provided that they do not have an impact on its ability to carry out its functions. We do not envisage, and nor does NICE, that the performance of any of these functions will interfere with its normal work programme. I hope that that is helpful to my noble friend. It is certainly not the case that NICE will be manufacturing medicines, as I think he feared.

--- Later in debate ---

[Earl Howe]

The noble Lord is exactly right. He will know from his time as a Minister with responsibility in this area that NICE has steadily grown its reputation overseas, and that with that have come opportunities to sell its services in a number of quarters. We simply want to see that continue.

[Lord Naseby]

I understand that and I understand the point made by the noble Lord, Lord Hunt. Nevertheless, to the best of my knowledge, NICE has never manufactured, and presumably from what my noble friend has said is not going to manufacture, in which case perhaps “manufacture” can be deleted from the Bill when it returns on Report.

[Earl Howe]

I will take advice on why “manufacture” is in the Bill and come back to my noble friend.

National Institute for Health and Clinical Excellence

Debate between Earl Howe and Lord Naseby

Wednesday 14th December 2011 Lords Chamber

[Lord Naseby]

To ask Her Majesty’s Government what, if any, changes there will be in the procedures of the National Institute for Health and Clinical Excellence as a result of the recent life sciences Statement.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the Government’s Statement on the life sciences set out a range of actions to support the adoption and diffusion of innovation in the NHS. This includes a commitment to establish, through the National Institute for Health and Clinical Excellence, an advice service to support medical technology companies in demonstrating the value of their products, and measures to improve NHS compliance with NICE guidance. It is for NICE to consider any changes to its procedures as a result.

[Lord Naseby]

Is my noble friend aware how welcome the Statement on life sciences was both to patients who suffer from chronic diseases and indeed to the pharmaceutical industry? However, that welcome is tempered by the statement that my noble friend has just made, because, quite frankly, NICE is and has been a dead hand on development for many medicines. I note that the current chairman has been in position for 12 years, and is scheduled to stay for another two, while the chief executive has been there for 12 years, and is scheduled for an unlimited term beyond that. Many charities have commented on NICE, and I will quote briefly from Sarcoma UK: “In the UK the delays caused by NICE can add years to introduction and mean patients die waiting”. Against that background, will my noble friend ensure that NICE has a new, younger and more modern management?

[Earl Howe]

My Lords, I need to put on record that I have every confidence in the senior leadership of NICE. The current chair and chief executive have overseen NICE’s development into an organisation of global repute that provides robust, independent guidance on a range of issues. Continuity of leadership can be a very good thing, and I believe that it is in this case, where the leadership is of the highest calibre. I would also say that significant improvements have been made to the timeliness of NICE appraisal guidance on new drugs. NICE is now able to issue draft or final guidance for a significant majority of the drugs that it appraises within six months of a drug being licensed. That is extremely good, considering the complexity of some of these assessments.

NHS: Waiting Times

Debate between Earl Howe and Lord Naseby

Tuesday 22nd November 2011 Lords Chamber

[Earl Howe]

My Lords, in the first quarter of the current financial year, 0.4 per cent of occupied bed days were taken by patients who were delayed while waiting for a care package. That picture has deteriorated over the past year but that deterioration masks some variations. Some hospitals have improved dramatically and others have started reporting for the first time. It is not possible to compare this year’s figures with the previous year, although these are very important figures which we do monitor.

[Lord Naseby]

My Lords—

[Lord Naseby]

My Lords, is it not strange that the figures show that certain hospitals consistently get nowhere near meeting the 18-week target? What action are the Government going to take to help those hospitals ensure that they perform like the average?

[Earl Howe]

Yes, my Lords, my noble friend is right. Five hospitals account for a very significant proportion of the number of patients waiting for longer than 18 weeks. We are working with those hospitals to look at ways in which that performance can be improved. We know that it can be because many hospitals are more than achieving the desired standard.

Hospitals and Care Homes: Hydration

Debate between Earl Howe and Lord Naseby

Monday 7th November 2011 Lords Chamber

[Earl Howe]

My Lords, I think that mandating a blanket approach to hydration from the centre, as it were, will not have the effect that we want, which is to deliver the person-centred improvements that we all want to see. Having said that, I know that there have been some important developments. As I have just said, providers are now required by law to have policies in place that protect people in hospital, and the regulatory body charged with overseeing compliance—the CQC—has been equipped with tough powers of enforcement. My right honourable friend the Secretary of State instigated a whole succession of unannounced inspections of NHS trusts, and there are further ones on the way. We are also looking at changing the NHS constitution in relation to the issue of whistleblowing. So a lot is going on, but there is a limit to what central government can do. It is in the end up to staff and managers on the ground.

[Lord Naseby]

Is my noble friend confident that today’s nursing training understands and re-emphasises the great importance of having a hydration policy?

[Earl Howe]

My Lords, I asked my officials that very same question. I thank my noble friend. My advice is that all preregistration training for nurses contains instruction and information about hydration and how to make sure that people have enough to eat and drink while in a care setting.

NHS: Medical Records

Debate between Earl Howe and Lord Naseby

Wednesday 7th September 2011 Lords Chamber

[Lord Naseby]

To ask Her Majesty’s Government whether they intend to continue to computerise all NHS medical records.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the Government aim to continue to computerise NHS medical records so that patient experience is enhanced, patient care is made more efficient, and patient safety is improved. However, we recognise the weakness of top-down, centrally imposed IT systems. Although elements of the programme have been successful, the policy approach taken has failed to engage the NHS sufficiently. The findings of recent reviews will contribute to planning currently under way for future informatics support to the modernised NHS.

[Lord Naseby]

Is my noble friend aware that the current programme for the NHS database has cost over £6.2 billion, has taken 10 years and is currently totally unworkable? Is he aware of any other country in the world that has attempted such a project and succeeded? As far as I can see, no other country has even attempted it. Would it not be far better if Her Majesty’s Government bit the bullet and scrapped the whole scheme, as they did with the RAF’s Nimrod programme, which was itself a brave decision?

[Earl Howe]

My Lords, I can well understand my noble friend’s acute disquiet over this matter, particularly in light of the recent report from the Public Accounts Committee. The view we have taken is that some very good things have been achieved so far, particularly from the national elements of the programme, but it is equally clear that the top-down policy approach taken to the computerisation of the NHS has not delivered the benefits at local level that everybody was hoping for and has failed to engage the NHS sufficiently. Those are the things we are now concentrating on: making sure that the governance of the programme is sound; learning lessons from what has happened; and achieving value for money.

Tobacco Advertising and Promotion (Display and Specialist Tobacconists) (England) (Amendment) Regulations 2011

Debate between Earl Howe and Lord Naseby

Monday 11th July 2011 Lords Chamber

[Earl Howe]

My Lords, I had planned to carry on and cover that point. In broad terms, the impact of this is being recalibrated, and we will publish further figures in due course.

Experience across the world shows that success in reducing smoking prevalence requires a comprehensive approach; the tobacco control plan for England sets out our strategy for the next five years, and it therefore includes a range of initiatives that will help to reduce smoking uptake and in particular help us to achieve our national ambition to reduce rates of regular smoking among 15 year-olds in England to 12 per cent or less by the end of 2015, from 15 per cent in 2009.

The Government are taking the following actions to reduce smoking by young people. We will end tobacco sales from vending machines on 1 October this year. This will remove an easily accessible, and often unsupervised, source of cigarettes for under-age young people. The Government will review sources of tobacco for young people. The Department of Health has commissioned an academic review of the evidence about this. The report will be completed late this year and we will then be able to determine what further action might be needed to reduce under-age access to tobacco. We will encourage and support the effective enforcement of the law on under-age tobacco sales by local authorities, and encourage local authorities and their partners to play an active part in helping to change social norms around smoking, particularly through using behavioural insights. We will also explore whether the internet is being used to promote tobacco use to young people and, if so, to consider what more can be done on a global level. In addition, as part of a new tobacco marketing communication plan to be published later this year, we will explore ways in which to provide young people with information about risky behaviours that can affect their health, including tobacco use, and to help them to resist pressures to take up smoking. This work is likely to involve digital media, because of their popularity, and reach among young people.

I impress on the House that the regulations that we are debating tonight are only one part of a concerted effort to reduce smoking prevalence among young people. My Written Statement set out how the regulations will be further amended, and I want to reassure the House and other interested parties, in particular retailers with large stores, that the Government will publish draft amending regulations as soon as possible. These will set out how the legislation will work in detail. By moving forward in this way, we believe we have struck the right balance between improving public health and supporting businesses during these difficult economic times. This is in keeping with our deregulation agenda, while continuing to make long-term progress to protect public health.

The noble Baroness, Lady Morgan of Drefelin, asked me specifically who would benefit from the delay in implementation. Our decision to delay implementation will most benefit the micro and small businesses that are so vital to communities across this country, and the delay is entirely in line with the principle set out in the Government’s growth review.

We have also heard about how the tobacco industry has been involved, and has involved others, in lobbying against tobacco control legislation. While we want to be sure that all voices are heard in debates on new legislation and policies, there is an inevitable tension between policies that are intended to reduce smoking prevalence and the interests of those who profit from the promotion and sale of tobacco, including tobacco companies and, to a lesser extent, retailers that sell tobacco products. I am sure noble Lords will agree that we need transparency in lobbying.

The Department of Health works hard to develop workable, balanced tobacco control policies and invites views, not least through formal consultation exercises, from all those with an interest in, or who may be affected by, proposed policies, including retailers. However, as set out in the tobacco control plan, the Government take very seriously their obligations as a party to the World Health Organisation’s Framework Convention on Tobacco Control. The FCTC places treaty obligations on parties to protect the development of public health policy from the vested interests of the tobacco industry. To ensure transparency, in future all organisations with which the Department of Health liaises on tobacco control, including through responding to consultation exercises, will be asked to disclose any links with, or funding received from, the tobacco industry. We want all parties that engage with the Government to be honest and transparent when it comes to vested interests.

[Lord Naseby]

Can the Minister clarify why whoever is lobbying should not disclose where their funding is coming from. Why is it specific to the tobacco industry? There are all sorts of bodies out there with views which may not seem obvious to the Government but underneath there is some objective. Why not have total transparency so that anybody who lobbies discloses where the money has come from?

[Earl Howe]

My Lords, the principle behind my noble friend’s question is certainly unarguable. He makes a very good point that if somebody is concealing the true basis on which they are making representations then that is clearly undesirable. I will take his point back to my colleagues in the department. Nevertheless, in this particular case the mischief lies in the obfuscation that we have seen on the part of the tobacco industry; I am not aware of any other obfuscation that has been at play in this context.

NHS Reform

Debate between Earl Howe and Lord Naseby

Monday 4th April 2011 Lords Chamber

[Earl Howe]

My Lords, we are clear that the essential functions of the primary care trusts should continue. That includes monitoring clinical governance within primary care. Having said that, I am sure that the noble Baroness will agree that clinical governance in the primary care context has not been all that it might be, which is why we believe that the new arrangements will considerably strengthen that governance.

[Lord Naseby]

My Lords, does my noble friend agree that it was common knowledge that PCTs needed reorganising because they were not meeting patient needs? Furthermore, doctors themselves found that the PCTs were getting in the way of treating their patients properly. Frankly, had not PCTs also created a huge bureaucracy, so that money was being soaked up in bureaucracy rather than being used for patient care?

[Earl Howe]

I agree with every word my noble friend said. It is illustrative of the truth of his remarks that, in the final year of the Labour Government, the administrative costs of the NHS rose by no less than £220 million. The rise in administrative costs was exponential. My noble friend is right: at the moment we largely have an NHS that is managerially and administratively led, rather than clinically led. We want to reverse that balance.

Health: Preventable Sight Loss

Debate between Earl Howe and Lord Naseby

Tuesday 29th March 2011 Lords Chamber

[Earl Howe]

My Lords, I join the noble Baroness in welcoming the formation of the Macular Disease Society, and I can assure her that my department will wish to engage closely with it; I think that it is a very positive development. Reducing avoidable sight loss is clearly an issue that we have to take seriously. The prevention of sight loss will be an aim of work undertaken across the new public health system, as I have indicated. At national level we are proposing that Public Health England will design some specific public health services including screening, as has been mentioned, and locally we propose new responsibilities for local authorities.

[Lord Naseby]

As financial resources are limited, is not avoidable sight loss an absolute public health priority? Is it not better to spend money on that than restricting small and large retailers further in terms of their display of tobacco in a market that is declining in any case?

[Earl Howe]

My Lords, I will simply say to my noble friend that public health clearly has an important contribution to make to reducing avoidable sight loss by addressing the obvious risk factors for sight loss, but also by delivering on our general public health outcomes, such as reducing smoking and obesity and diabetes, all of which are associated with the development of eye disease. The tobacco strategy has a direct bearing on this question.

Health: Passive Smoking

Debate between Earl Howe and Lord Naseby

Tuesday 30th November 2010 Lords Chamber

[Earl Howe]

My Lords, that is the very question that we want to look at. Of course, tobacco companies regard their brands as a form of marketing and they attach value to the intellectual property that they consider to be in those brands. However, the issue from a public health perspective is whether the design of a pack actually entices non-smokers to take up smoking or indeed deters smokers from giving up. That is the question that we will examine.

[Lord Naseby]

Is my noble friend aware that the oldest member of Surrey County Cricket Club last year claimed that his longevity was due to a combination of smoking fags and good sex?

[Lord Naseby]

Well, that was not his view.

Furthermore, in relation to intellectual property, which is what we are taking about with packaging, is it not a very brave Government—even a coalition Government—that interfere with international laws that are already on the statute book to protect intellectual property, which is basically what packaging is?

[Earl Howe]

My Lords, of course my noble friend is right that there are legal issues inherent in this whole question, which we will look into very closely.

On his first point, it is always a pleasure to hear of someone who has lived a long time in good health despite smoking. However, I say to my noble friend that the Royal College of Physicians estimates that more than 300,000 primary care consultations are recorded each year across the UK for conditions in children due to exposure to second-hand smoke.

Health: Spending Review 2010

Debate between Earl Howe and Lord Naseby

Tuesday 26th October 2010 Lords Chamber

[Earl Howe]

The noble Lord raises two issues: access to new medicines for sufferers from cancers, particularly rarer cancers; and prescription charges. On the first, he will know that we have already created a cancer drugs fund to enable those people who cannot access cancer drugs to apply for funding for those drugs. That was part of the spending review announcement made last week. On the issue of prescription charges, we are looking for ways to make the system fairer than it is at the moment. We have not implemented the previous Government's plan to exempt all people with chronic conditions. Frankly, it was not affordable in the current context. However, we are looking at other means of creating fairness in the system.

[Lord Naseby]

Is my noble friend aware how important it was that he re-emphasised that there had been absolutely no change in the targets for dealing with cancer patients? Is it not surprising to him that the opposition spokesman was not aware of that fact? If we are to have a further report before the end of the year, will it include a review of NICE’s attitude to all cancer drugs, and of their availability to NHS patients?

[Earl Howe]

My Lords, we believe that there is a long-term role for NICE, not least in the area of assessing the clinical effectiveness of drugs. In the longer term, we believe that the problem that my noble friend identifies can be addressed more satisfactorily by a system of value-based pricing for medicines, which will mean that the price of a medicine will reflect its value to the patient, as assessed. That is a longer-term exercise that we cannot bring in in a hurry, but we are extremely conscious of the problem that my noble friend alludes to. Having said that, I stress that NICE will remain at the centre of our plans to roll out quality in the NHS.

Health: NICE

Debate between Earl Howe and Lord Naseby

Wednesday 14th July 2010 Lords Chamber

[Lord Naseby]

To ask Her Majesty’s Government whether they plan to review the management and procedures of the National Institute for Health and Clinical Excellence to ensure that patients suffering from the most prevalent conditions of cancer and Alzheimer’s disease are properly treated.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, our White Paper, Equity and Excellence: Liberating the NHS, published on 12 July 2010, sets out our commitment to renew the National Institute for Health and Clinical Excellence and, through primary legislation, to re-establish it as an executive non-departmental public body. Legislation on NICE will be included in a health Bill in the autumn.

[Lord Naseby]

The Minister’s Answer is extraordinarily welcome. So far as concerns those suffering from cancer and similar problems, is he aware that according to a report called Exceptional Progress?, published in March this year, fewer than four out of nine of the drugs put forward were refused by NICE, which left 16,000 patients with nowhere to go, whereas if they had been French or German those drugs would have been available? Furthermore, is he aware that there is currently great criticism of the processing, structures and methodology used by NICE and that, against that background, his news that the organisation is to be totally reformed is enormously welcome?

[Earl Howe]

My Lords, I am grateful to my noble friend. It is important for me to state that the Government respect the independent expertise provided by NICE and we think that it should be allowed to continue to issue guidance free from political interference. That is a point of principle. However, we also think that there are failings within the wider system regarding drug pricing and drug access. We are determined to address that but we are clear that NICE plays a vital advisory role.