(1 day, 4 hours ago)
Public Bill CommitteesCan 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.
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.
(3 days, 4 hours ago)
Public Bill CommitteesMy mother has some shareholdings in British American Tobacco, but that links to my parents’ having worked for Imperial Tobacco 50 years ago.
I am an officer of the responsible vaping all-party parliamentary group.
I declare an interest as an NHS transplant and vascular surgeon. My wife is a lung cancer doctor.
Q
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.
Q
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.
Q
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—
Q
“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.
Q
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.
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.
Q
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.
Q
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.
Q
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.
(3 days, 4 hours ago)
Public Bill CommitteesQ
David Fothergill: I will take the fines element first and then talk about the cost of licensing for those retailers. A fine of £200 is quite a low figure. I think it was £100 previously, so it has been increased. If you pay within 10 days, it goes from £200 to £100. If you sell 40 vapes in one day, you have paid your fine. Some retailers—very few, because the vast majority are scrupulous—will take the view that they could sell more vapes to under-age people and those they should not be selling to, and pay that £100 fine within 10 days. So yes, we view it as too low. We would like to see a review brought in within a year to see whether it should be increased.
If we can align the cost of licensing fees with alcohol licensing, that would enable us to find a way to reduce the burden, because the vast majority of people who are selling alcohol are also selling tobacco. We need to work with our businesses to reduce the cost of applying for those licences, which is why we need the consultation period over the next few months, before we bring in legislation, to ensure that we have worked with our retailers, the public and our communities in order to deliver a scheme that actually works.
Q
Alison Challenger: We are ultimately trying to reduce the harm caused by smoking—that is the big killer, and we really would not want to lose sight of that. The Bill also brings in elements around the second-hand smoke agenda. It is important to recognise that there are many vulnerable people who would potentially be harmed by breathing in second-hand smoke, so we welcome the fact that the Bill includes that element. As for whether it will increase vaping, it is really hard to know at the moment how that will work out. Potentially more people might switch to vaping, but ultimately, the Bill brings in a progressive approach to taking out smoking tobacco, which is to be welcomed.
Q
Alison Challenger: I do not have the actual figure, but it is significant. One of the early benefits of the Bill going through will be the impact on children, particularly around asthma. Obviously, second-hand smoke will be exacerbating some of those respiratory illnesses, particularly for children. There is a considerable burden on the NHS as a result of breathing in second-hand smoke. We must also consider those who have cardiovascular disease and those who have existing respiratory illness. It is not always evident that somebody is vulnerable, so it is really important that the measures in the Bill serve to protect those who are vulnerable from inhaling second- hand smoke.
Q
Secondly, in the United States, you can have products with up to 60 mg-worth of nicotine; that is a standard product in the United States. In the UK, it is 20 mg, or significantly less. Is there an awareness within trading standards of just how much we are potentially out of kilter with some of the key markets that we are aligned to? Our limit is significantly lower than those of other major economies, so do you think that we might therefore have a problem with products perhaps coming in from other sources that are not the same as tobacco? Is that a concern for your Department?
Lord Michael Bichard: I will pass that one to Wendy, if it is not unfair. On the first point, you are right that we think that that is going to make regulation enforcement easier but I will have to leave the second question to Wendy, I am afraid.
Wendy Martin: Just to reinforce Michael’s point around the digital stamps, I am not close to this myself, but I know that trading standards colleagues who are operational experts in this field are working in response to the various HMRC consultations about the implementation of excise and tax stamps, and those sorts of things. I know those conversations are happening, and I think the view is that that kind of simple identification is really important for trading standards.
In terms of the 60 mg versus 20 mg, I am afraid I do not have any detailed knowledge of that personally, but I would certainly anticipate that those kinds of challenges and issues would be built into the guidance and information being put to officers and any planned training programmes once we know the final form of the Bill, the excise duty and all the other changes coming over the next few years as the Bill and other legislation progress. I am sorry that I do not have a detailed answer.
Lord Michael Bichard: But we can get it for you.
Q
Lord Michael Bichard: I do not want to sound complacent, because I am not. But this is something we are used to doing, so we do not see that as a major issue or a major problem. That is what we do.
Q
Lord Michael Bichard: No, the point I was making was about enforcement.
Wendy Martin: To add to that, as part of the programme that DHSC has been funding for the last 18 months, we tested out a number of issues, and one was online under-age sales. I think we tested 312 purchases, and there was a 10% failure rate. That was significantly lower than premises-based sales. There was a lot in the platform’s corporate website design to try to ask the right questions and kick purchasers out. It is very much about who does it and who takes responsibility, rather than a major problem in itself.
We also work quite closely with the Advertising Standards Authority, and it does a lot around broadcast and published media, and website compliance and claims. That is quite a well-established mechanism for enforcement. It is about the structure of enforcement, as you have rightly identified.
Lord Michael Bichard: It is probably worth pointing out—it does not relate to the online point—that I said earlier that last year we carried out 4,000 test purchases, and 26% of those were failures. Compared to the 10% online, it is significantly higher. This is a very practical point, but some of the other changes that are going to happen will make it easier for us to do test purchasing. At the present moment, we can only use children or young people, so we have issues of safeguarding and we can only do it at certain times of the day. It should become easier, in that sense, for us to enforce the legislation.
Q
Lord Michael Bichard: It will be enforced in the same way we enforce it for tobacco and other things. This is not new. Trading standards officers employed by local authorities are constantly visiting premises, and they will therefore deal with any offences that are being committed. They also have their own local intelligence networks. We cannot afford, because we do not have enough staff, to just have a random system where we pop in every now and then. We depend on people giving us intelligence. Some of those people are members of the public, and some are from other agencies. We try to target what we do. When you visit a shop—there are something like 60,000 outlets—you can see whether the current legislation, or future legislation, is being implemented. We can take action against the retailer if it is not.
Q
Inga Becker-Hansen: Precisely. But then it should be up to the business or the retailer to decide that strategy for themselves rather than it being implemented.
Q
Inga Becker-Hansen: It is difficult for the BRC to comment on that, given that we are not public health experts or behavioural economics experts. I would therefore ask that you confirm that with public health experts, rather than the BRC.
Q
Inga Becker-Hansen: Some of the challenges with the restrictions on advertising will be at the point of sale of products for some retailers. There is also a query from retailers about how recycling schemes for vapes can be implemented if they cannot be advertised, and about how the Bill and the Government can support recycling initiatives alongside the reduction in advertising of vapes. Retailers appreciate the need to restrict advertising. Again, there is this idea of creating a level playing field among all retailers, rather than focusing on specific ones.
Q
Inga Becker-Hansen: Again, I do not have specific details, so I cannot comment. I am happy to follow up in writing.
Q
Matthew Shanks: Yes, but not on its own. It would help, but people will find a way to get something if they want it—we know that. The price hike without the education might increase other instances of unpleasantness between people, such as bullying, bribing, theft and so on. It has to come alongside education. The whole message needs to be that vaping is not something for children to engage in. It is something to help people to stop smoking. That is my view and the view of educators.
Q
Matthew Shanks: It is not that they are not an issue—
I meant that I was pretty surprised that they are such a predominant issue. I would have presumed that disposable vapes were the predominant issue.
Matthew Shanks: Oh yes, they are a huge issue.
Q
Matthew Shanks: The reason disposable, single-use vapes are more popular is that there is less to carry, so it is easier to secrete, hide and get rid of. Refillable vapes are fiddly to fill up, for a start. That is something that is not appealing, if you do not have that speed—I am conjecturing here around it. However, the flavours and colours are certainly something that influences and impacts children using vapes. As I say, I think the size of the single-use, disposable vapes is an issue. We have said, for example, that single-use vapes are banned anywhere on site, which means that parents cannot bring them in as well. What we have then seen in some of our schools is more children bringing in their parents’ vapes, and when you catch them with those, that brings conflict in. I was not trying to imply that people were not still using them, we just cannot necessarily know.
Q
Matthew Shanks: At the moment I would take anything that is not coloured and does not make it look like it is candy, to be honest, in the American version. They are like sweets, and when you walk in to shops, they are in your face with the way they are placed. They are not behind a screen shutter. Yes, the health benefits are not known in the same way, but I would like to see a move towards that for packaging. I would welcome anything that tells children that this is not something that is safe or recreational or a reward, and it will not help them to have a better life or to study better within school because it relaxes them—all those things.
Q
Matthew Shanks: No, with the refillable ones it is the way that the flavours are displayed, as well. It is not just the disposable vapes; it is all vaping. You can go into a shop with a refillable and buy four different flavours in four different colours to refill at a different time, and you all have a different toke of a different type of flavouring. That is exciting and different, because it is a reward and it is pleasant and it can help you to be calm.
I thank Matthew Shanks for his evidence today. It has been very interesting and stimulating for those of us who do not know much about vapes. I am sure we will take a lot of what he said into consideration in our deliberations.
Examination of Witness
Dr Laura Squire OBE gave evidence.