Tobacco and Vapes Bill

Euan Stainbank Excerpts

Consideration of Lords amendments
Monday 23rd March 2026 Commons Chamber

[Jack Rankin]

I am not suggesting that at all, sir. I am suggesting that the generational smoking ban that applies to smoking adults—I have never met a smoking adult who did not know that smoking was bad for them—is an illiberal policy that will create two tiers of adults. There is absolutely nothing wrong with people making decisions that we individually might think are bad for them. The evidence suggests the same, but people should be perfectly able to make those decisions should they choose to do so.

As legitimate businesses struggle, less scrupulous operators will inevitably fill the gap. The rapid growth of seemingly dodgy vape shops is a real concern for my constituents in Windsor, and it will be a concern for the constituents of Members right across the House. On the high street in Windsor, there are eight such shops. This is not a response to the demand for vapes, so we should ask whether fraud, money laundering or organised crime are taking place. We already have much evidence to say that they are. During a mystery shopper exercise in Windsor and Sunninghill, I witnessed the sale of illicit tobacco in three shops—it was alarmingly easy to obtain. The price difference explains why: a pack of illicit cigarettes can cost as little as £3.50, compared with £16.75 at retail. If such activity is taking place openly today, that raises the question of what else might be happening behind the scenes, and where this activity will go under the Bill.

The Bill risks turbocharging an already thriving black market. Tobacco receipts are down by £414 million, or 10%, in the last six months alone, and have fallen nearly 30% over the past decade, far outpacing the decline in smoking rates. More than one in four cigarettes consumed in Britain are now illicit, amounting to about 2 billion cigarettes each year, and the international evidence, including from Australia, should serve as a warning. Members who are sceptical should spend time with their local trading standards office to see the reality for themselves. That is why hundreds of retailers backed an amendment, tabled by Lord Murray of Blidworth, that would have replaced the generational ban with a minimum age of sale of 21. That would have been more enforceable and less costly. Naturally, that amendment was rejected.

Hospitality businesses have voiced real concerns about provisions in the Bill. That sector is so important to the economy in Windsor, and it is already struggling: since the 2024 Budget, job losses in the sector have made up around 50% of job losses overall. UKHospitality has said that many businesses have no capacity to absorb additional costs. Labour has hiked alcohol duty, is banning smoking and is considering health warnings on alcohol. Labour hates fun—it is no wonder that landlords are barring MPs from their pubs.

Amendments tabled in the other place by Lord Sharpe of Epsom would have protected our beer gardens from being designated as smokefree and allowed the advertising of products that do not contain tobacco in age-gated venues, in a similar way to the amendments that I tabled in the Commons. Those amendments would have gone some way towards reassuring pubs and venues that the Government are not completely set on destroying them. Again, those amendments were rejected—or am I to understand that the Government have U-turned on that?

Before I conclude, I will briefly raise one further concern regarding the powers granted to Ministers to prohibit cigarette filters in future. The justification for this measure remains unclear, and it is yet another example of the broad and—I would argue—excessive powers that this Bill contains, including the host of Henry VIII powers it grants. Through this Bill, the Government have teed themselves up to bring in further puritan measures in the coming years without needing to consult this House. Any such steps will simply exacerbate the growth of the black market and the decline in duties collected.

Smoking rates are falling naturally, but this Bill may well reverse that trend, as it limits access to quit aids. It will likely mean less revenue for the Treasury as the black market grows, and it will cost our high street businesses billions. The amendment process has done little to address, or even acknowledge, those concerns. However, I will end on a more positive note by saying that I welcome Lords amendment 80, which requires a review of the Bill within four to seven years of its implementation. I believe that review will vindicate me in many of the concerns I have raised today and provide a future Government with the opportunity to address or, indeed, repeal those aspects of the Bill that prove most unworkable—not that I believe this Bill will get that far. It will not survive a change in Government, which will happen at the next opportunity afforded to the Great British people.

[Euan Stainbank (Falkirk) (Lab)]

I refer hon. Members to my entry in the Register of Members’ Financial Interests and my position as chair of the responsible vaping all-party parliamentary group, in which I succeeded my hon. Friend the Member for Newcastle upon Tyne East and Wallsend (Mary Glindon).

As a member of the Bill Committee and part of the envious generation who will precede the smokefree generation this Bill promises, I welcome its return to the House and welcome the Minister for Public Health, my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), to her place. It cannot go without saying that we also welcome the immense contribution of her predecessor, my hon. Friend the Member for West Lancashire (Ashley Dalton), and her mammoth work in guiding the Bill through Report and Third Reading. Finally, I welcome the contributions of Members from all parts of the House to the Bill.

It is critical that the powers enabled by the extensive secondary legislation that this Bill provides for are employed with our constituents’ health at the forefront of Ministers’ minds. My primary hope is that the Bill will drastically bring down smoking-related illness and early death, which are still far too prominent among smokers in this country. It has been proven by all currently available evidence that for smokers, switching to vaping is a substantially preferable and healthier choice than continuing to smoke. To put it simply, if you do not smoke, do not vape, but if you do smoke, switching to vaping is a far preferable choice for your health. That is a message we should never tire of repeating, especially considering that four in every 10 smokers still believe that vaping is just as harmful as smoking, if not more harmful, despite the scientific and medical consensus.

As we pursue a smokefree generation for those turning 18 at the turn of the year, the Government must recommit at every opportunity—including through this Bill—to rebutting this harmful misunderstanding of the relative harm of vaping through both words and actions. Lords amendment 72 acknowledges this by providing a defence for public authorities to the offences in clause 113 on advertising that would enable the ongoing use of vapes and nicotine products for the promotion or protection of public health. I note that that defence applies only to non-branded vaping and nicotine products. When she sums up, will the Minister clarify whether the amendment would permit the use of flavoured vapes or nicotine products in pursuit of the promotion or protection of public health? The written and verbal testimony of ex-smokers across the country who have made the switch to vaping is clear that they rely on flavours to quit, to stay quitting, and to quit for good.

When we consider the use of secondary powers as part of the powers available to Ministers under the Bill, we must fairly balance the crucial public health objective of getting adult smokers to quit for good against the rising concerns about youth vaping across the country. It is the sadly too common gaudy and immediately apparent displays in shops, the ridiculous flavour descriptors and the packaging associated with illicit manufacturing and retailing that are driving youth vaping far more than the flavours themselves. We talk about the proliferation of vape shops on high streets, but it is the illicit and unregulated market that we must pursue as a priority. We certainly should not group that market with specialist retailers that pursue strong age verification, muted displays, safe storage and the ability to support smokers to quit.

On enforcement, Lords amendments 9 to 13 make necessary clarifications on the definition of an enforcement authority in England and Wales. Lords amendments 14 to 20 subsequently clarify where the responsibility to issue fixed penalty notices sits. Enforcement of this Bill will be necessary if it is to achieve its aim to crack down on illegal and illicit vape products, but we must not forget that the proliferation of the illegal vaping business is still concentrated at points of entry to the UK market. We must pursue that important objective, because we cannot prejudice public and consumer opinion against the sale of legal vapes from the regulated industry by allowing them to be displayed alongside illicit and unregulated products that we all want to see off the shelves of our local corner shops. Those are the products that are driving youth vaping, not the regulated ones. We must therefore ensure the adequate resourcing of Border Force, trading standards and local enforcement authorities. Will the Minister provide detail on how the Government will seek to achieve that within the scope of this Bill?

Lords amendments 21 and 22 to clause 38 are a welcome step. They permit relevant local enforcement authorities to retain the sums and reinvest them in connection with their enforcement functions, rather than those sums going to the national Consolidated Fund. Can the Minister clarify the purposes for which those funds can be utilised? As I understand it, they can be used only in connection with the enforcement function and not to support swap-to-stop schemes or any broader activity. I would appreciate that clarity when she winds up.

The need for enforcement against illicit retail practices has rightly become an increasingly salient issue, especially in Scotland following the tragic fire earlier this month in Glasgow. While it is important for us to state that no cause of the fire has yet been definitively established—that is rightly for the relevant authorities to investigate— will the Minister expand on how secondary legislation and associated Government action around trading standards could better enable local authorities to enforce against the illicit practices that the Bill seeks to address? How will the Government encourage retailers to drag themselves up to the best practice of specialist retailers on display, storage and age verification?

To conclude, the Bill’s primary aim to create a smokefree generation is welcome. I welcome that it will directly make that generation healthier and happier, and enable them to live far longer than those who preceded them. We must do all that, however, while enabling the millions of adult smokers in Britain to quit quicker and to get healthier.

[Robin Swann (South Antrim) (UUP)]

I welcome the Minister to her place. I worked with her predecessors when I was Health Minister in Northern Ireland, when this Bill first came about. I am sorry to disappoint the hon. Members for Windsor (Jack Rankin) and for City of Durham (Mary Kelly Foy), because this legislation started its iterations under the previous Government. Very little has changed between what was debated then and what is before us now, because it is the right thing to do. It is the common-sense thing to do for the health of the entirety of our nation.

I remember having those conversations with the then MP for South Northamptonshire, Dame Andrea Leadsom, who was passionate about what the Bill would bring about. She was receiving the same advice as I was from chief medical officers across the nation about how the cessation of smoking across generations would dramatically change not just health, but the income of many families. In respect of that four-nation approach, I seek reassurance again from the Government—I have received reassurance on this from the last Government and this Government—that the Bill will apply equally in Northern Ireland and all parts of the nation.

Oral Answers to Questions

Euan Stainbank Excerpts

Tuesday 24th February 2026 Commons Chamber

[Wes Streeting]

I apologise to the shadow Secretary of State for not having replied to his letter—let me make sure that I do that. There is no disagreement across the House on the substance of the issue. I am absolutely supportive of the project and I want to fund the research, but we have to make sure that the research proposal meets the standards and has the confidence of our funders. We are working with the team to try to get the proposal over the line, but that is the only obstacle here—it is certainly not a political decision.

[Euan Stainbank (Falkirk) (Lab)]

T4.   Many people in Falkirk face barriers to accessing treatment because they are juggling often contradictory bits of paper regarding appointments across different health boards. What assessment has the Minister made of this Government’s NHS digital transformation strategy for improving treatment, compared with the strategy being pursued by the Scottish Government for the healthcare that is available to my constituents?

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

This UK Labour Government, at least, are spending billions of pounds upgrading the digital architecture of the NHS in England. That means that over 90% of GPs now offer appointments online, and by 2029 we will have a single patient record for patients and their clinicians to access all their information. That is in contrast with the digital desert that exists in Scotland, which is why it is time for Analogue John to move over and make way for Anas Sarwar as First Minster to save Scotland’s NHS.

World Stroke Day

Euan Stainbank Excerpts

Tuesday 28th October 2025 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

It is a pleasure to serve under your chairmanship, Ms Vaz. I thank the hon. Member for Twickenham (Munira Wilson) for securing this timely debate and wish her mother well in her recovery. It is not easy to channel personal pain for the greater good, but the hon. Member has done so, along with my hon. Friends the Members for Stratford and Bow (Uma Kumaran) and for South West Norfolk (Terry Jermy). They can be assured that their articulation in this place of their personal experience will prevent strokes and lead to their faster treatment. Often, debates such as this can increase awareness and reduce the threshold at which people contact the NHS and the ambulance service for help.

The hon. Member for Twickenham asked me to address a number of issues, and I will do so before I get into the bulk of my speech. One was about data capture. Although I am responding on behalf of the public health Minister, my hon. Friend the Member for West Lancashire (Ashley Dalton), I am the Minister responsible for digital health and data, so I can assure the hon. Member that the interconnectivity of data among primary care, secondary care and social care is important to me, both for ease of access for the patient and for learnings and auditing. She can be assured of my personal commitment that that is the way forward in the new iteration of a modern health service.

The hon. Member also asked about physiotherapy and disability reduction. I can reassure her that, through the workforce plan and our upgrading of the digital architecture, we are working intensively to see how we can bring world-class physiotherapy to all and not just to some. Part of disability reduction is timely access to cutting-edge treatments, which no longer involves clot-busting; it now involves clot removal, in the form of thrombectomy. Thrombectomy services are planned to be totally universal in England by April 2026. I hope that answers some of the questions the hon. Member for Sleaford and North Hykeham (Dr Johnson) asked about those services.

[Euan Stainbank (Falkirk) (Lab)]

Does my hon. Friend agree that we need a plan in Scotland to install 24/7 emergency thrombectomy care across the country as soon as possible? I believe the objective is 2031, but we should be pushing the Scottish Government to go further and faster on that.

[Dr Ahmed]

My hon. Friend must have read my mind. As I was saying, our plan is only for England. Hon. Friends have already articulated the fact that in Scotland, despite the best efforts of clinicians in Glasgow, Edinburgh and Dundee, there has not been the ability—or the intent from the Scottish Government—to bring forward a proper 24/7 stroke thrombectomy service. That means that the time of day that Scottish patients have a stroke determines the outcome. They are literally being dealt a roulette wheel of care: 20th-century care out of hours and 21st-century care within office hours. It is simply unacceptable, and the UK Government stand ready to assist the Scottish Government in any way, shape or form they require to make sure that access to the highest quality of care is as available to patients in Scotland as it is to those in England.

Duchenne Muscular Dystrophy

Euan Stainbank Excerpts

Thursday 12th June 2025 Commons Chamber

[Chris McDonald]

Yes, my hon. Friend is absolutely right about that. Time is muscle, as she says. Sadly, because the drug is currently only available, in the areas where it is available, to lads who are ambulant, the waiting time has meant that some lads out there who would have qualified for the drug now no longer do so. That is, frankly, heartbreaking. Of course, the use of one’s legs is not the only thing people are concerned about. We need to be able to use our arms to be able to dress ourselves, feed ourselves and brush our teeth, and givinostat could help with that.

It is very disheartening that while coping with all of this, families, parents and carers and so on are having to fight for access to the drug on a trust by trust basis. They have done that with the support of all the Members in the Chamber tonight. I am very grateful for the fact that they have turned up, because I know families are watching.

I also want to mention some Members who have approached me who would have loved to have been here but cannot be due to other commitments in the House. My hon. Friend the Member for Newcastle upon Tyne East and Wallsend (Mary Glindon) has campaigned on this subject for many years and chaired the all-party parliamentary group. A constituent of my hon. Friend the Member for Basingstoke (Luke Murphy), who has the disease, visited Parliament on Monday and was so pleased to see on the Annunciator that we were having this debate. My hon. Friends the Members for Bury North (Mr Frith) and for Bury South (Christian Wakeford) worked together to ensure that Manchester university NHS foundation trust does now provide the drug to their constituents. William from Codicote, a constituent of my hon. Friend the Member for Stevenage (Kevin Bonavia), is living with Duchenne. The hon. Member for Chester South and Eddisbury (Aphra Brandreth) has been supporting Mr and Mrs Binns, whose son Jack has Duchenne. They do not yet have access to givinostat and are trying to get it. I have also had representations from my hon. Friend the Member for Beckenham and Penge (Liam Conlon), the hon. Member for Westmorland and Lonsdale (Tim Farron) and my hon. Friend the Member for Altrincham and Sale West (Mr Rand).

We can see that there is broad support across all parties in the House, with Members working with their constituents to try to secure this drug which is free of charge—free of charge—to the NHS. We have heard that provision is very patchy across England. There is some central co-ordination in Scotland, but no lad in Northern Ireland can access the treatment.

[Euan Stainbank (Falkirk) (Lab)]

I thank my hon. Friend for securing this debate. It is important to acknowledge quality of life with this drug, but we also have to acknowledge that many people with Duchenne are living with 24/7 care needs, including my constituent, Dylan Phillips, who lives at the excellent care home in Glenbervie. Does my hon. Friend agree that those living with Duchenne in Scotland should be protected as they would be in England under continuing healthcare schemes, rather than having to bear the cost of their social care and living on only £35.90 a week with universal credit and adult disability payment, as they do not qualify for continuing healthcare in Scotland?

[Chris McDonald]

The important thing for us to consider here is that with only 1,100 or 1,200 lads and young men in the country living with the disease, and only 500 boys eligible for the treatment, we could at least expect some consistency in approach across the whole of the United Kingdom.

Prevention of Drug Deaths

Euan Stainbank Excerpts

Thursday 27th March 2025 Westminster Hall

[Euan Stainbank (Falkirk) (Lab)]

It is a pleasure to serve under your chairmanship, Dr Murrison. I thank the hon. Member for Strangford (Jim Shannon), and I associate myself with the remarks from Scottish colleagues about Christina McKelvie.

Between 2010 and 2023, 333 people in Falkirk lost their lives to drug misuse. Our worst year was 2018, when 43 people died. Every one of those people was a family member—someone’s child or parent—tragically or prematurely taken. Part of the reason why that number is so high is that Scotland has the greatest number of drug deaths anywhere in Europe. I want to use my speech to talk about where we have gone wrong and what we have started to get right.

Although I acknowledge that it was only one tool in the arsenal of public health responses, medication-assisted treatment such as methadone has been shown to reduce overdose deaths significantly. The abandonment of Scotland’s 10-year drug strategy decades ago is a failure that should teach us the lesson of never returning to unscientific moralising drug policy. We should focus on real action and harm reduction. More recently, harm reduction policies such as naloxone distribution have saved lives by reversing opioid overdoses in Falkirk. The Falkirk Alcohol and Drug Partnership has taken incredible steps in encouraging the awareness and use of naloxone, and I pay tribute to its lead officer, Phil Heaton. We should go further on harm reduction.

Safer drug consumption facilities are proven to reduce overdose deaths in other countries. They have been piloted in Glasgow, as my hon. Friend the Member for Glasgow West (Patricia Ferguson) explained. The sites provide medical supervision, sterile equipment and a gateway to treatment for those ready to take the next step towards recovery, instead of wrongly expecting people to go cold turkey, which does not work. Harm reduction saves lives.

Drug addiction is not a spontaneous phenomenon: it is deeply intertwined with social and economic conditions. People in Scotland’s most deprived areas are more than 15 times more likely to die from drug misuse than those in the wealthiest areas. We need a holistic approach that looks at root causes: poverty and deprivation.

When looking at drug deaths, we must also think about demographics. Many of those dying today in Scotland first became addicted in the 1980s and 1990s, during the economic shock of deindustrialisation, and are maligned with stigma and a lack of support. The average age of drug-misuse death has increased from 32 in 2000 to 45 today. Now in middle age, the health of that generation is failing fast, making them more vulnerable to fatal overdoses. We need to look at the demographic changes and where we are failing.

Addiction treatment, chronic disease management, financial support for the disabled and mental health services are all essential factors. I acknowledge that this is not an easy issue for Governments to tackle. It is wrapped in dozens of policy points and often involves those Governments find it the hardest to reach. Most of all, it is an issue of injustice, of lack of opportunities and of general social failure. We need to listen to our communities and take real action.

Tobacco and Vapes Bill

Euan Stainbank Excerpts

Report stage
Wednesday 26th March 2025 Commons Chamber

New clause 2 would represent a huge step towards removing 3.9 billion cigarette butts from our ecosystem, combating the blight on our beaches and streets, the stain in our streams and the rubbish on our roads. It is an environmental no-brainer. It is also a parliamentary no-brainer, as it has massive public support. I hope the Government can see the merit in supporting it today.

[Euan Stainbank (Falkirk) (Lab)]

I declare an interest as an officer of the APPG on responsible vaping.

I was asked by a teenage member of my family over the Christmas break what my biggest regret is, and I undoubtedly go back to the evening at an empty—a party, for anybody unaware of the Scottish parlance—back in 2016, when I first took a draw off a cigarette. I know all too well the addictive power of nicotine, and I promised when I was sent here by the people of Falkirk in July that I would do everything I could to prevent another generation from being so easily exposed to it. Sadly, I must say that some of the amendments proposed may jeopardise that near universally supported ambition in our communities.

There is no safe way to consume nicotine, and we have known for near a century that smoking tobacco will in the long term be incredibly damaging to the health of a person. If we pass this Bill and slowly but surely cut off the tobacco industry from new customers, we will see lower occurrences of cancer, fewer heart attacks, fewer strokes and less illness in our communities. Points raised by hon. Members about the black market are important, and I look forward to hearing the Minister’s response, but they do not undermine my support for the generational ban in this Bill.

For all the reasons articulated, I do not support the various attempts in amendments to alter the generational smoking ban. In Committee, I saw an attempt to alter the scope of the Bill to set the age of sale at 25. I see similar attempts on the amendment paper to change the age of sale to 21, or to scrap the generational smoking ban altogether. I doubt it will come as a surprise to my constituents, who are well aware of my leanings, but for me the freedom for our bairns eventually to be allowed to smoke something that may ultimately kill them does not fall into the philosophical sphere of inalienable liberties.

Saying that, I will don the cloak of alternatively minded colleagues momentarily. For all but the last three days in Committee, I was 24 years old. The shift in the age of sale proposed in Committee would have deprived me of a liberty I already have and that regrettably I exercised extensively in my younger years. Depriving adults of their liberty in the name of liberty does strike me as an odd argument for opponents of a generational smoking ban. This generational smoking ban does not deprive anyone of a liberty they currently hold, but shifts tobacco into the category of inaccessible substances for those who never had, or will have, the right to begin with. The “liberty for our bairns to eventually be able to start smoking” campaign would get short shrift from parents at the school gates of Falkirk, or from those sitting at the bedside of loved ones dying decades prematurely. No smoker wants their bairns to start smoking.

[Catherine Atkinson (Derby North) (Lab)]

There is growing concern about the use of vapes as a tool to entice children into sexual exploitation. My probing amendment, new clause 5, was prompted by a police officer in Derby concerned about this national issue. I am grateful to the Minister for meeting me to discuss it. Does my hon. Friend agree that we must acknowledge the use of vapes to groom children, and ensure that licensing authorities and the police work together to crack down on any retailers connected to such activities?

[Euan Stainbank]

My hon. Friend identifies an important point about the protection of young people, and I would be very interested to hear the Minister address it in her winding up.

Non-smokers should never vape, but we should acknowledge that vaping can help a hell of a lot of smokers to quit, and that the evidence base we have on relative harm shows that vaping is far less harmful than tobacco smoking. The consolidation of vaping into a more utilitarian device used solely for the cessation of smoking is something we should pursue. That necessitates measures that stop the worrying rise in young people getting their hands on vapes in the first place. During evidence in Committee, Trading Standards articulated that online age gating has a far lower failure rate than sales over the counter. We heard from various sources about how vapes are still far too easy for our bairns to get their hands on through proxy or underage counter purchases. There is still work to be done to put the onus on the vaping industry to safeguard our bairns.

That why I put my name to new clause 6 and new clause 7, tabled by my hon. Friend the Member for Newcastle upon Tyne East and Wallsend (Mary Glindon). They would permit the Secretary of State to make regulations mandating vape retailers to sell only vapes that include approved age-gating technology, allowing adults to lock their vapes and prevent bairns being able to use them. That would align with and strengthen the Bill’s objectives of deterring underage use by seeking to extend protection away from the point of sale to the point of use. I will ask Ministers to commit to meet me and the all-party parliamentary group to discuss how age-gating technology and wider measures can be supported in the United Kingdom to strengthen the shared aim we all have to stop bairns vaping.

The Bill grants the Secretary of State similar powers to bring in regulations relating to the display, packaging and flavours of vapes. On that, I will make a few brief points. The Bill should not deter smokers switching to vapes. Flavours are a huge reason why smokers quit and stick by quitting, and we should not regulate in any way that undermines the crucial message we must get to stick with adult smokers, which is that vaping has a far lower relative harm than continuing to smoke.

If we can, across this House, acknowledge the scientific consensus that there is no non-harmful consumption of tobacco, the Bill should be supported. It is time to take a step that will do a substantial amount to deter smoking, prevent nicotine addiction and secure a generation against smoking-related disease and premature death.

[Jack Rankin]

I hesitate to break up the consensus ever so slightly, but I do disagree fundamentally with the Bill. In my view, a generational smoking ban misrepresents the proper relationship between the state and the individual, and creates two tiers of adults. Members will be heartened to know that, recognising the will of the House on Second Reading, I do not intend to plough on with that argument too far. What I have tried to do with my amendments, however, is to genuinely improve the main aim of the Bill in a way that gets people off smoking in the interests of public health, which, whether we are for or against a generational ban on smoking, is something that we should all support. That is why I am grateful to Members from across this House—on the Government Benches, the Liberal Democrat Benches and the Democratic Unionist Benches, as well as some independent Members—for supporting the measures in my name, new clauses 8, 9 and 10 and amendment 46.

The message behind those measures is simple: let us ensure less harmful vapes and nicotine products get to the adult smokers who could benefit from them so that smoking rates continue to fall. In that regard, I associate myself with some of the remarks made by the hon. Members for Falkirk (Euan Stainbank) and for City of Durham (Mary Kelly Foy).

I feel the risk of the Bill is that Ministers may inadvertently weaken the decline in smoking in Britain somewhat. As the Minister and shadow Minister both said in their opening remarks, vaping is a legitimate and desirable smoking cessation tool for adults who currently smoke.

--- Later in debate ---

In the Bill Committee, many raised the issue that any advertising seen by adults would inevitably be seen by children. That is why I tabled amendment 46, which would avoid this problem by permitting advertising in adult-only environments such as pubs, bars and clubs. To me, that is just common sense. If we know that everyone is 18, is no good reason why advertising of these products should not be permitted. Further, we know that these night-time venues are often hotspots for smoking. These are the people who could benefit from tobacco-free products the most. If a vape or a nicotine pouch is advertised in this location, a smoker may well think twice before going to the local newsagent to buy cigarettes. This would work especially well if the same pubs were licensed to sell these products on the premises. I urge the Government, through these amendments, to reconsider their approach to advertising when it comes to legitimate smoking-cessation tools. My recent written question to the Department exposed that either no real assessment has been done in this area of policy or it has been obscured.

[Euan Stainbank]

Specifically on amendment 46, which I have a degree of sympathy for, who would be responsible for enforcing the advertisements and ensuring that it was only those over the age of 18 who were seeing them?

[Jack Rankin]

I am assuming, to be honest, that it would be the same people who are responsible for the licensing of alcohol advertising.

All my amendments speak to the principles that I have outlined, which I think are consistent with the aims of the Bill, and for which I have received support from across the House. I hope that Members both in here and in the other place will recognise the value of my amendments and that the Government will take these concerns seriously.

--- Later in debate ---

[Sir John Hayes]

What I am saying to the hon. Lady is that the Government—and the previous Government should have done the same—need to take concerted and decisive action to deal with the unintended consequence of well-meaning legislation that led to a huge growth in the illegal sale of tobacco and cigarettes. Rather than introducing a rolling age of consent, which, by the way, is entirely unenforceable, they ought to target their efforts, draw on their resources and seek the almost limitless expertise that is available to Government to deal with an issue that, frankly, is going largely unrestricted.

Good work is being done by trading standards in my constituency in Lincolnshire and by local police, but they struggle, because the legislation is inadequate. I would have supported a Bill, had it come to the House— I will not digress too much, Madam Deputy Speaker, because you will not allow me to do so—that licensed the sale of tobacco. Most tobacconists and most newsagents, I suspect, would welcome that measure. I know that police would like to see that kind of measure, which is rather like what we do with alcohol. There is a precedent there, but that is not what is before us today.

On the rolling age of consent, the right hon. Member for East Antrim (Sammy Wilson), who has tabled amendment 4, is right that it cannot be enforced. I am in favour, by the way, of raising the age of consent. To be honest, I am in favour of raising the age of consent to 21 for virtually everything. That could be enforced, although it would not be straightforward. But the idea that someone will go into a tobacconist or a newsagent and say, “I am 29” and the tobacconist will say, “Actually, I think you could be 28” or in years to come, “I am 57” and the tobacconist or newsagent will say, “No, no, I think you could be 55” is nonsense. It is never going to happen. No retailer is going to do that. Either the Bill will fail—I think the law would be broken daily—or we will devote undue resources to policing something that frankly does not warrant such attention. Let us recognise that this is a preposterous proposal. As the right hon. Member for East Antrim said, by and large we should not do things in this House that are preposterous.

[Euan Stainbank]

rose—

[Sir John Hayes]

I will give way to the hon. Gentleman, who is going to tell me why we should.

[Euan Stainbank]

I was a retail and hospitality worker myself in Scotland, and we applied “Check 25” regularly. Would the simple question not be, “Were you born before or after 1 January 2009?” Is that a complex question? I would appreciate an explanation of how it is.

Oral Answers to Questions

Euan Stainbank Excerpts

Tuesday 25th March 2025 Commons Chamber

[Wes Streeting]

It was thanks to the decisions taken by the Chancellor in the Budget that we were able to award £889 million for general practice. That is why the Minister for Care was able to get the GP contract agreed for the first time since the pandemic. Opposition Members cannot continue to welcome the investment and oppose the means. They have to spell out where they would cut services or raise taxes instead.

[Euan Stainbank (Falkirk) (Lab)]

Last year, my constituent Danielle was diagnosed with POTS—postural orthostatic tachycardia syndrome. She found herself unable to get out of bed and unable to speak for long periods. She could not receive care in Scotland. Specialist treatment does not seem to exist for POTS. What more can we do for people like Danielle, and what conversations has the Minister had with counterparts about establishing specialist treatment in Scotland?

[Ashley Dalton]

In England, it is the responsibility of local integrated care boards to work with clinicians, service users and patient groups to develop services and care pathways that are convenient and meet the needs of patients with POTS. NICE has published a clinical knowledge summary on the clinical management of blackouts and syncope, which provides advice for UK clinicians on best practice and the assessment and diagnosis of POTS.

Rare Cancers Bill

Euan Stainbank Excerpts

2nd reading
Friday 14th March 2025 Commons Chamber

[Euan Stainbank (Falkirk) (Lab)]

I thank my hon. Friend the Member for Edinburgh South West (Dr Arthur) for introducing the Bill. It may be the most repeated phrase in the Chamber, but politics is about choices and he, having ranked so highly in the private Member’s Bill ballot—an early accolade in this Parliament—chose a Bill that would put patients suffering from a rare cancer and their families higher up on the list of priorities. As my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn) so movingly put it, I hope that, in time, the Bill will mean that in some instances, my constituents in Falkirk and families across the United Kingdom will get precious extra hours, days, weeks and years to spend with our loved ones.

Every Member of the House and every constituent I have spoken to about this has a story of a loved one who has suffered through the heartbreaking cruelty of a cancer diagnosis. I lost two of my grandparents in their early 60s. I still remember the seven years of my life that I spent with my grandad Robin. We found plenty of time to exchange robust views on football, and I am sure that if he had more time with us, we would today be exchanging views on life and politics, too. He was lucky, though, to meet all four of his grandchildren, thanks to the immense care he received from his doctors and the support he got from his family.

I remember my granny Janet, who passed away in 2012 after a 10-month battle with a brain tumour. I remember most fondly her fussing over everyone in the house to make sure they had absolutely everything they needed at all times. I remember holding her hand in Strathcarron hospice, where she had volunteered for a number of years, and where she received care in her final days. One thing I have drawn from those experiences is the value of our NHS and hospice staff to those who have cancer and their families. Those staff, day in, day out, take the worst parts of life and allow us to endure them. We should arm them with the best possible tools for treating illness and disease.

Statistically, half of us in the Chamber will have to comprehend our own diagnosis of some type of cancer. The definition of “rare cancer” is, for the purposes of the Bill, one that affects fewer than one in 2,000 people. We must acknowledge that active intervention is required to ensure that research, treatment and clinical pathways for those cancers have parity with other cancer research. As has been mentioned, rare cancers account for about 47% of all cancer diagnoses.

I will go through the Bill and each of its clauses to show why I support it. Clause 1 and the statutory requirement for a review relating to orphan medicines will be an essential step to gaining a comprehensive understanding of the availability of medicines and how they can best be calibrated towards new treatments and new research. The comparative approach that the Bill puts forward for the review acknowledges that while we have a proud history of world-class research, other countries have been able to make substantial strides in this area in recent years when we have not. In the last six years, the UK has dropped from being ranked second for the availability of orphan medicines—behind only Germany—to England being 10th and Scotland being 13th among European countries. That does not necessarily look like regression, but it potentially exposes stagnation in advancing research that would benefit those suffering from a rare cancer. The British pharmaceutical industry has stated that it is increasingly challenging to develop medicine for rare diseases in this country, citing, among other things, the low prospect of NHS reimbursement for rare disease medicines.

Clause 2 gives the Secretary of State a duty to promote research on rare cancers, ensure that patients can be easily contacted about such research, and ensure appropriate oversight of rare cancers. That is a progressive move, as the duty to promote research will write into law that any Health Secretary must take a proactive approach to maintaining and promoting rare cancer research. It embeds in the Government’s job description a duty to ensure that ease of contact is properly facilitated, and that there is appropriate oversight. The Bill is not overreaching when it says that strategic co-ordination is key. The appointment of a national speciality lead for rare cancers will put into law the requirement for a champion who can cut through any silos that exist, or that start to develop as the Bill takes effect.

Clause 3 is a critical part of the framework. It will aid the building of a robust evidential basis for clinical trials by making a bespoke register for those with a rare cancer. The sharing of information from the national disease registration service by the NHS with the NIHR’s “Be Part of Research” registry, so that patients can be identified and contacted, will improve an issue that has come up several times when I have spoken to organisations in this space: there are not enough people available for clinical trials for rare cancers. Correspondingly, as has been mentioned by other Members, clearly there is a substantial barrier at the patient end. Cancer52 found that 82% of those with a rare cancer had not been offered a clinical trial. That evidences the clear case for the change proposed in the Bill.

With rapid advances in cancer treatment, there is a massive opportunity to take steps forward in increasing survivability after diagnosis. For all these new treatments to be effective, there needs to be corresponding clinical trials. Currently, connecting those with a rare cancer to clinical researchers involves an amount of luck that the information about the trial will make its way to the patient or that they will be aware of a clinical trial. Organising the register so that clinical trials can get in touch with patients will simplify and improve the efficiency and efficacy of the system, saving time and increasing the chance of successful trials. I give the Bill my full support.

Tobacco and Vapes Bill (Third sitting)

Euan Stainbank Excerpts

Committee stage
Thursday 9th January 2025 Public Bill Committees

The chief medical officer sounded a note of caution about the tobacco industry and the fact that it tends to move quickly to maintain its market when the law is changed. As I understood it from him at the beginning of the week, if we changed the age of sale to 25, people may be less prone to taking up tobacco products and less prone to addiction if they do, but the risk is that the industry would regroup around the new age of 25 and look instead at what advertising and promotion measures would most likely make 24, 25 or 26-year-olds—that generation—smoke or take up tobacco products. In a few years’ time, we would therefore be back saying, “Should we increase the age to 30?” In practice, that is what the Government propose to address by picking a defined date instead.

[Euan Stainbank (Falkirk) (Lab)]

Can we acknowledge that youth initiation often starts before the age of 18? Moving the age to 25, as this amendment proposes, would not automatically shift the dial on when youth initiation starts by seven years. The Bill permanently demarcates a smoke-free generation that we are specifically targeting.

[Dr Johnson]

When Parliament brings in any law of any kind, most people will follow it—the vast majority of the public are law-abiding citizens who want to know what the law is and obey it. However, whatever law we bring in, there will always be people who will disobey it. Even if cigarettes were completely banned, people would buy them. Many products—cocaine and heroin, for example—are banned, but some people still access and purchase them, so the Bill would not eliminate the issue completely.

Perhaps I could answer the hon. Gentleman with a couple of statistics. According to the Government impact assessment, 66% of smokers begin smoking before they are 18, and 83% before they are 20. Yet the research shows that three quarters of those smokers, were they to have their time again, would prefer never to have started smoking.

The hon. Gentleman may be aware that the age of sale for cigarettes was previously 16 and that a previous Government made it 18 instead. The effect was reviewed by scientists at University College London in 2010, and we saw a fall in smoking in all age groups. That is in line with what we have seen across a lot of the western world: smoking rates have declined. Actually, if we look at the difference between the younger and the older people, that fall was 11% in those in the 18 to 24 age group, but 30% in those aged 16 to 17. That meant that the age group targeted by the ban was much more likely not to start smoking. That is the start of the smoke-free generation, and we hope that a similar pattern will be seen and roll forwards.

Tobacco and Vapes Bill (First sitting)

Euan Stainbank Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Sarah Bool (South Northamptonshire) (Con)]

My mother has some shareholdings in British American Tobacco, but that links to my parents’ having worked for Imperial Tobacco 50 years ago.

[Euan Stainbank (Falkirk) (Lab)]

I am an officer of the responsible vaping all-party parliamentary group.

[Dr Zubir Ahmed (Glasgow South West) (Lab)]

I declare an interest as an NHS transplant and vascular surgeon. My wife is a lung cancer doctor.

--- Later in debate ---

[Sadik Al-Hassan]

Q Comparatively, how addictive is nicotine in tobacco and vapes compared with other products? I seem to remember that it is harder to get off nicotine than methadone. Is that true?

Professor Sir Gregor Ian Smith: I am not sure we have the data or the evidence to back that up, but I have certainly heard people claim that in the past about the addictive nature of nicotine. One of the important aspects of this issue is the very rapid re-emergence of that addiction by small exposures after people have managed to quit. Certainly we should be in no doubt about the addictive nature of nicotine and the risks—going back to the harmful effects of passive smoking or being in the company of people who smoke—associated with the re-emergence of that addiction and of people’s tobacco smoking habits. That is something very real. Therefore, the best protection is never to start in the first place. If we can prevent people from taking those first nicotine products and prevent the addiction from forming in the first place, there is obviously a much greater chance that they are not going to suffer the health consequences.

[Euan Stainbank]

Q It is clear, from the comments made about display and advertising, that child vaping is an issue that needs to be tackled; I think it is an issue that many of our constituents and many people in the country recognise. Especially for adult smokers, do you believe that there will be any impact from the display and packaging restrictions on the effectiveness of vapes as a tobacco cessation tool?

Professor Sir Chris Whitty: Our view is that the benefits of preventing people who are not currently vaping, particularly children, from vaping through what is proposed in this Bill significantly exceed that risk. However, that risk exists; we all accept that. To go back to a previous point I made, that is why having these powers gives us the advantage that if, as a result of where we get to—remembering that this change will come after consultation and there will be secondary legislation going through Parliament—it looks as though we have gone too far, it will be possible to ease back. Our view, though, is that at this point in time, and subject to what the consultation shows, the net benefit in public health terms is positive for the prevention of children starting smoking, over any risk for adults.

The area of greatest uncertainty is on flavours. There is some genuine debate around that, with a range of different views from people who are quite seriously trying to wrestle with this problem—rather than doing marketing masquerading as wrestling with this problem—but in all other areas, most people think that the benefit outweighs the risk.

[Dr Ahmed]

Q Thank you, Sir Chris—your anecdote about the vascular war resonates strongly with me as a practising vascular surgeon; many of my patients leave hospital with fewer legs than when they entered. The comment I want to make is on the chronic disease burden. As you all know, there is a rising epidemic of chronic disease in our country, and it will probably require various public health measures to get back under control. I wonder if I could ask you to comment on how you feel this legislation might impact on the chronic disease burden on the NHS going forward, not only in the short term but in the long term?

Professor Sir Chris Whitty: I will give a view, and I think Sir Gregor will want to add to it. It will make a very substantial difference. The thing to understand is that not only does cigarette smoking cause individual diseases, but many people as they go through life have multiple diseases from smoking. They will start off with heart disease, for example, as a result of smoking, and will go on to have a variety of possible cancers, and they might have chronic obstructive airway disease, and they will end up potentially with dementia. All of these would have not happened at all or would have been substantially delayed had they not smoked. Of course, this is heavily weighted towards areas of deprivation, people living with mental health conditions, and other areas where I think most people would consider it really unjust in society. All of us, and anybody who has looked at this in public health terms, would say that if you could remove smoking from the equation, the chronic disease burden would go down very substantially, and be delayed, and the inequalities of that burden of disease would also be eroded. The arguments for this are really clear.

To give some indication of the numbers involved, we have thousands of people every year—millions over time—going into hospitals and general practices only because they are smoking. Had they not smoked, they would not have to use the NHS, and they would not have the chronic disease burden that disbenefits themselves, disbenefits their families and, of course, because of the impact on wider society, disbenefits everyone else as well. Undoubtedly this Bill—if it is passed by Parliament—will reduce that burden and have an enormous impact.

Professor Sir Gregor Ian Smith: Thank you for raising this as a question, because it is a very important point to understand. I will speak to the experience in Scotland. The Scottish burden of disease study published by Public Health Scotland suggests that from now to 2043 we are going to see a rise of 21% in overall burden of disease across our society in Scotland. That burden of disease is very much weighted towards a number of conditions such as cancer, dementia including vascular dementia, cardiovascular disease, and others. There is no doubt in my mind that smoking contributes to those.

Chris’s point about the multimorbidity that people experience is really important in this context. There are more people in Scotland who experience multimorbidity under the age of 50 than those who do over the age of 50, and much of that is related to smoking. Anything that we can do to reduce that burden of disease on people will not only make their own lives so much better, but make them more productive—they will be able to spend more time with their families, they will be economically active for longer, and they will also use health services less. So there is both a compelling health argument and an economic argument here on the preventive nature of stopping smoking and stopping people from beginning to smoke, which is really important to understand in the context of that projected increase in the burden of disease.

The last thing to remember is that our experience of disease can sometimes be cumulative. As Sir Chris alluded to, people who have developed diabetes for other reasons but who smoke as well, will have accelerated disease as a consequence. Removing as much as we can, step by step, the risks that are associated with the development of that accelerated disease—you will have seen it very clearly in your role as a vascular surgeon—has to be a step that we take to maintain both the health and the economic prosperity of our nation.

Professor Sir Chris Whitty: The numbers that I was looking for—

--- Later in debate ---

[Mary Kelly Foy]

Q I notice in your submission that you have a recommendation:

“The government should make good on their pledge to publish a ‘roadmap to a smokefree country’…with a strong focus on tackling inequalities.”

I am from the north-east region, where we have high deprivation and high smoking prevalence. It is the only region that has a clear vision—if you like—and declaration from Fresh and the directors of public health for how to achieve a smoke-free country. Could you explain a bit more why we need that vision and that strategy going forward?

Hazel Cheeseman: The legislation is fantastic; it is world-leading and brilliant, and it will really set us on that path toward being a smoke-free country. However, it will not be the last word in how that is achieved. We have 6 million smokers across this country, and we need to ensure that all of our agencies are lined up to do the job that they need to do to help those people stop smoking—the NHS, local government and integrated care boards across the system need to have the right approach. We also need to ensure that the funding is there to do that too. The Government have committed to the funding in stop-smoking services in local government, but we also need to see funding in mass media campaigns. The chief medical officer was talking earlier about people’s waning understanding of the harms of second-hand smoke. One way to address that would be to go back on TV and radio and explain to people what the harms of second-hand smoke are. That package of measures alongside this legislation would really help us to accelerate progress.

The Bill will massively raise the saliency of the harms of smoking with the public—there is no doubt about that. There has been, and there will continue to be, a strong public debate on the measures in this Bill. By really riding the wave of that public understanding through that coherent strategy and that investment, we could really see smoking rates start to drop, particularly in those disadvantaged populations where we continue to have persistently high levels of smoking.

[Euan Stainbank]

Q By restricting vaping products in this Bill in the same ways that tobacco products are currently restricted—be that packaging, display or potentially flavourings, as we discussed with the CMOs earlier—do you think that this will lead to greater misconceptions by the public and, quite crucially, current smokers about the relative harm between the two products?

Suzanne Cass: We obviously have an issue when it comes to the understanding of and the misconceptions around the harms of vaping. In particular, the most worrying stats are among smokers considering them as harmful as or more harmful than tobacco. That is that a significant issue. This legislation allows us to reset the clock and promote these products as smoking cessation products, using health professionals to promote them and getting the right language around them. Rather than their being seen as a recreational toy, they can be seen as a product that is going to help people to quit smoking. When it comes to the positioning of these products, it is essential to readdress those misconceptions and re-place this product.

On standardised packaging, what we did with tobacco was put it in the ugliest packaging you could ever imagine. We are not talking about that when it comes to vaping products; we are talking about plain packaging—something that is informative but not necessarily attractive to young people. There is a big difference between something that is repulsive and something that is not attractive. That is where we see the difference, and that is where we see this legislation coming into its own and allowing us to reset and to have that different conversation.

Hazel Cheeseman: I am sure we will tease more of it out through the consultation process that will follow this legislation, but some of the early research that has been done has indicated that you can, to some extent, have your cake and eat it on this. If we remove some of the attractive branding elements on packaging, which we know appeal to children, that does reduce the products’ appeal to children, but it does not damage their appeal to adult smokers and it does not damage harm misperceptions. We can progress with this legislation, via the consultation and looking properly at the evidence, to make sure that we get the balance right.

There are also provisions in the Bill to allow public health bodies to do marketing and public health messages around vapes as a smoking cessation tool. It will be important that the Department of Health and Social Care and the Advertising Standards Authority work with public health bodies to make sure that they have the right guidance to be able to do that and to give smokers directly the right information about how vapes can be used as a cessation tool.

[The Chair]

Thank you. I am afraid this will probably be the last question before the next panel of witnesses. Tristan Osborne, we have about two and a half minutes left.

--- Later in debate ---

[Sadik Al-Hassan]

Q Is there any research into passive vaping risks to bystanders, who do not have a choice if someone is vaping next to them?

Sarah Sleet: As I said earlier, the research evidence around vaping harms is currently very poor. There has not been enough. It takes a long time to build up evidence of things that are generally very progressive rather than having an immediate impact, so we will have to wait. We need to put that in place, and we are going to have to wait to get that evidence back.

We have had anecdotal reports from our beneficiaries and those who contact the organisation about places—particularly in closed spaces, but sometimes outside—where there is a concentration of vaping. It is that classic thing where you go through a door and suddenly everybody around you is vaping immediately outside it. We get reports that that exacerbates people’s asthma and sometimes their COPD, but they are anecdotal. We really need the evidence base to support what is happening.

Dr Ian Walker: The only thing that I would add specifically from a cancer perspective is that although there is very little long-term evidence, because the products have not been around long enough and the cumulative effects have not been seen yet, what we do know, based on the current evidence, is that vapes are far less harmful than cigarettes. You heard the advice earlier that if you smoke it is better to vape or take other nicotine products, but if you do not smoke you should not vape, because we do not know yet what the long-term effects will be. In particular, we are very light on evidence on what the impact of vaping will be on bystanders.

[Euan Stainbank]

Q Do you believe that there is a substantial health impact on people working in certain sectors who unavoidably encounter second-hand smoke in the course of their employment? What impact will the measures in the Bill have on that?

Dr Ian Walker: The impact of the Bill will reach every sector, on the face of it. Obviously the aim of making a smoke-free UK will impact everybody in whichever sector, but I think you are probably referring specifically to increasing smoke-free places, or places where smoking is not allowed. For people who are exposed unavoidably by their working environment, of course this will be good news and a good expansion.

As you heard from Sarah, we did not quite get to hospitality in the Bill, but it will be interesting, as we go through consultation, to review the evidence and understand the sentiment. Clearly, people working in hospitality are likely to be exposed to smoke in their work environment, even if that is outside. The Bill makes important steps in increasing the number of smoke-free places and reducing exposure to tobacco smoke.

Sarah Sleet: As the CMO said earlier, it is about the duration as well as the density of smoking. If you work in hospitality in those outdoor spaces, the duration will clearly be longer; if you work on a coach concourse, you will be exposed for longer. It is really important to remember that.

Another issue is inequality. There is a concentration of working lives that are more exposed to second-hand smoking, which is exacerbated by inequality.

[Mr Barros-Curtis]

Q Some of the evidence that has been submitted referred to the gateway effect and how there is perhaps not the evidence to suggest that there is a transition from one to the other. Are your organisations still concerned about the increase in vaping among groups who have not previously smoked cigarettes?

Sarah Sleet: That is a tricky one. We know that a lot of people who use vaping to stop smoking end up dual-using for a while. Some then move on to just vaping, and some eventually move completely away from it. We seriously need a comprehensive programme for nicotine cessation and smoking cessation to support people on that journey and make sure that people who go on that journey do not come back in. We heard earlier from ASH Wales about some really good measures that have been put in place, but without that wider context it is hard to cement the behaviour needed to move completely away from it. We need to think broadly about the whole support structure to help people to get off smoking and eventually to move away from nicotine altogether.

Dr Ian Walker: I agree. The real killer in the room, if you like, is cigarettes and tobacco. There is no safe way of consuming tobacco. The alternative of smoking versus vaping is very clear; even though we do not know the long-term health implications of vapes, we know that you are much better off vaping than smoking. Having said that, of course we do not want young people and never-smokers to vape either.

The power of the legislation is its double-pronged approach: preventing people from ever smoking in the first place by raising the age of sale by one year every year, and putting in place a comprehensive package of measures alongside that to control vaping, particularly the access to vaping and the appeal of vaping for young people, to reduce uptake in those communities. All those things together, alongside—you will forgive me for saying this—the investment that will be required for smoking cessation services and to support enforcement by Border Force, HM Revenue and Customs and retailers, will be important components of the Bill’s ability to drive the change that it can make.