E-cigarettes

Debate between Graham Stringer and Norman Lamb

Thursday 31st October 2019 Westminster Hall

[Graham Stringer (Blackley and Broughton) (Lab)]

I put on record my thanks to the right hon. Gentleman for his time chairing the Select Committee on Science and Technology. It has been an interesting period, in which we have gone into great detail—effectively, I think—on many subjects. I was annoyed that NHS England, which has the time to put out often crass and obvious statements on health, did not have the time to come and give us advice on e-cigarettes, the use of which, as he says, is one way get people to stop smoking.

[Norman Lamb]

I thank the hon. Gentleman for that. I will call him my hon. Friend, because I am demob-happy and I do not care about the normal rules. It has been a great pleasure to work with him on the Committee. I share his concern. Given that the Government’s own tobacco control plan describes tobacco as

“the deadliest commercially available product in England”,

one would have hoped that the body that runs the NHS in England would show a strong commitment to confronting that clear risk. Despite it being very clear from all the available evidence that vaping is significantly less harmful than smoking, I none the less absolutely encourage continued research in this area. We should always be alert to anything that indicates a potential risk; that is exactly what our Committee recommends.

E-cigarettes are not only less harmful than smoking, but appear to be an effective tool for stopping smoking, as the hon. Gentleman made clear. A study published earlier this year in the New England Journal of Medicine randomly assigned adults attending UK NHS stop smoking services either nicotine replacement products of their choice, including product combinations, for up to three months, or an e-cigarette starter pack. That study of 886 participants found that the one-year abstinence rate was 18% in the e-cigarette group, compared with 9.9% in the nicotine replacement group. That is a significant difference, and we need to make sure that we act on that difference now that we have knowledge of the effectiveness of e-cigarettes as a stop smoking tool.

Results from a 2019 survey carried out by YouGov for Action on Smoking and Health—ASH—found that

“the three main reasons for vaping remain as an aid to quitting (22%)…preventing relapse (16%) and to save money (14%)”,

because people who vape spend much less money than people who smoke. That demonstrates that users perceive e-cigarettes as a stop smoking tool. E-cigarettes are therefore likely to help the Government to meet their ambition, announced in the prevention Green Paper, for England to be smoke-free by 2030. None the less, I accept that further research is needed on the effectiveness of e-cigarettes as a stop smoking tool. Will the Government or one of their agencies request further independent research on the effectiveness of e-cigarettes as a stop smoking tool?

Our report highlights the issue of what the NHS does on smoking cessation. Cancer Research UK recently pointed out that primary care clinicians face barriers to discussing e-cigarettes with patients who smoke; one in three clinicians is unsure whether e-cigarettes are safe enough to recommend. Given the death toll from smoking, it is extraordinary that it appears that clinicians are unaware of the clear advice from Public Health England in that regard.

--- Later in debate ---

[Norman Lamb]

I suspect that the right hon. Gentleman knows better than I do, but I note the point that he makes. My view, based on the evidence that the Committee heard, is that the action taken by India is not based on evidence and is likely to result in more people dying of lung cancer. I think that is shameful.

I encourage all right hon. and hon. Members to read the helpful and comprehensive reply that we received from Public Health England on these issues and others, and which we have published so that anyone can delve into the detail. I am reassured that Public Health England is in “close dialogue” with a range of international partners, and I agree with Public Health England when it says:

“It is no exaggeration to say that inflating fears about e-cigarettes could cost lives.”

Incidentally, I have concerns about the attitude at the World Health Organisation, which does not take the same evidence-based approach, as far as I can see, as this country has done. Again, that has implications through the potential loss of life for millions of people across the globe.

It seems to me that people often conflate the fact that we do not have all the long-term evidence on vaping impact with an assertion that that should lead us to conclude that we should not be recommending vaping as an alternative to smoking. Frankly, that is stupid as a public policy approach, because we know that smoking is killing—I think—more than 70,000 people in England every year, and all the evidence so far shows that nothing like that is happening from vaping. According to Public Health England, it is 95% less dangerous than smoking. Therefore, the clear public health advice has to be that vaping is an appropriate way to help people give up smoking. Of course, the best thing of all is not to vape and not to smoke, but if that is not possible for someone, the clear public health advice needs to be that vaping is better than smoking.

Will the Minister set out what contact the Government —she or other Ministers—have had with other countries on international approaches to e-cigarettes? In particular, what are they doing at the World Health Organisation to encourage a more enlightened approach? What assessment have the Government made of the effects of those international approaches on public perception of e-cigarettes in the UK? What steps will the Minister take to ensure that this misinformation on e-cigarettes is challenged?

[Graham Stringer]

It is not only the World Health Organisation that is not using evidence for its advice, but the EU. The EU’s directive on the size of the bowls used and the amount of substance put in is not based on evidence. It is likely to mean that those people getting a nicotine kick—much less dangerous than cigarettes—will not find the products satisfactory and will go back to smoking.

[Norman Lamb]

I share the hon. Gentleman’s concern about the directive and the proscriptive rules relating to vaping, which do not appear to be sufficiently evidence-based.

E-cigarettes are positive in helping current smokers to stop smoking, and they are significantly less harmful than smoking conventional cigarettes. Yes, there are unknowns about long-term risks, and we need to maintain research on e-cigarettes, but doing nothing is not an option when people’s wellbeing and lives are at risk. I look forward to the contributions of other right hon. and hon. Members, and to the Minister’s reply.

Brexit, Science and Innovation

Debate between Graham Stringer and Norman Lamb

Thursday 6th September 2018 Commons Chamber

[Norman Lamb]

I thank the hon. Gentleman. In a sense, these reports are all about seeking to ensure that collaboration does continue beyond March next year, and I of course completely accept that fact about collaboration, not just across Europe, but across the world.

My Committee has produced two reports this year looking at the impact of Brexit on science and innovation. They build on work undertaken by my two predecessor Committee Chairs and their Committees in the 2015 Parliament. One of those Chairs was the hon. Member for South Basildon and East Thurrock (Stephen Metcalfe), who continues to be a member of the Science and Technology Committee. I pay tribute to him for his work and note that he is in his seat for this debate. The first of this year’s two reports, as referenced on the Order Paper, was published in March following a summit with more than 50 representatives of the science and innovation community. We are grateful for the community’s willingness both to respond quickly to our call for evidence and to participate in that event.

The report recognises the current strength of British science on the world stage and the Government’s commitment to science and research through a range of policies. For instance, the Government have made science a key pillar of the industrial strategy, and they have also committed to increase R&D spending further to the OECD average of 2.4% of GDP by 2027.

Those commitments are very welcome, but the shadow of whether the UK will participate in all aspects of EU schemes such as Horizon 2020 and its successor programme after March 2019 looms large. Whatever form of Brexit we end up with, there is a need to make sure that the international standing of UK research is protected, and indeed strengthened, following March next year.

A key recommendation of our report is that the Government should explicitly commit to seeking associated country status for Horizon 2020’s successor programme, now known as Horizon Europe. The UK has received €4.73 billion from Horizon 2020 to date, and Horizon Europe is set to be a huge increase in ambition, and the pot of money available will total €100 billion from 2021 to 2027.

Since our report, the Government’s no deal technical note on Horizon 2020 funding has underlined the importance of such close association. The note confirms that, without a deal that secures associated country status, we will not be eligible to participate in some very important elements of Horizon 2020 during its remaining years, including European Research Council funds. The campaign group Scientists for EU has calculated that we stand to lose around £0.5 billion each year in the event of no deal by not being eligible to access those funds, although it is important to say that presumably we would not be paying in during that period either.

The plans for Horizon Europe set out an enhanced role for third countries—in other words, countries outside the EU—in the new scheme when Horizon 2020 has run its course. The Government have played their part in shaping the programme for Horizon Europe, but the Minister has said that participation is contingent on three things.

First, it is contingent on the programme’s continued focus on excellence. I think we have reassurance, but it would be helpful if the Minister updated us. Secondly, it is contingent on agreeing a suitable participation fee. The Minister has said that he supports participation but “not at any price”. Thirdly, it is contingent on securing a suitable level of influence on the programme.

The last point remains a challenging issue. We are likely to be one of the biggest contributors to the programme if we do participate, but the proposed rules for Horizon Europe prevent third countries from having “decisional powers” over the programme. In financial terms, it appears that we will not be allowed to get more out than we put in, as we have been able to do in the past.

The Minister will need to be able to sell the idea of participation to the Treasury, which on the face of it is made more challenging by there being no voting rights, according to the EU’s current position. On the other hand, formal voting is rarely, if ever, necessary, and there may be other ways in which the UK could have influence over the programme if the EU will not shift on formal voting rights. Either way, the science community takes the view that striking an agreement is vital, as this international funding programme is so important and so highly regarded.

Incidentally, I also urge the EU negotiators to demonstrate some flexibility, because if the UK is to be one of the largest contributors to the programme, it does not seem unreasonable that we should be given decision-making powers as a third country.

[Graham Stringer (Blackley and Broughton) (Lab)]

The right hon. Gentleman is making some sound and sensible points about the negotiations on the future of Horizon 2020. We have been a net beneficiary of those funds. Does he accept not only that, overall, as the House of Lords Science and Technology Committee said, we contribute a great deal more than that to the EU budget but that Horizon 2020, which deals with elite science, is not the only source of science funding? Taking into account the regional funds that go into science, we are actually a major net contributor to the science budget, not a gainer.

[Norman Lamb]

I accept the hon. Gentleman’s point, but it is also important to say that, internationally, the Horizon 2020 funding scheme is regarded as the best in class. There are those, among both Brexiteers and remainers, who support participation in the scheme because it just makes sense for science. I would be grateful if the Minister updated us on progress on the critical issue of negotiating a satisfactory way for this country to participate.

Shortly before our report was published, the Prime Minister’s Mansion House speech set out the Government’s intention to secure

“a far-reaching science and innovation pact with the EU”.

That would, in principle, address such concerns about our future relationship. A key recommendation of our report back in March was that the Government should therefore seek to agree such a pact as soon as possible. We argued that, because co-operation in science and innovation is a win-win for both the UK and the EU, getting an early agreement could set a positive tone for the rest of the negotiations. Sadly, that particular opportunity has now all but evaporated and discussions on the high-profile political issues are, of course, intensifying against a backdrop of red lines and deadlines, which are getting ever closer.

We see a need for urgency on this. Ongoing uncertainty is damaging to future collaborations, as partnerships and bids take time to develop. At the moment, no one who is considering bids for funding under the successor programme has any idea whether we will be part of it or not.

Cities and Local Government Devolution Bill [Lords]

Debate between Graham Stringer and Norman Lamb

Tuesday 17th November 2015 Commons Chamber

[Norman Lamb]

I agree with the right hon. Gentleman that this is an important issue, but I hope he will understand that those of us who are convinced of the case for change should take every opportunity to argue that case, and this is one such opportunity. Because we recognise that the world will not cave in, and that many positive consequences will flow from the measure, we see no difficulty in including it in the Bill.

The hon. Member for Heywood and Middleton (Liz McInnes) referred to the Scottish referendum, which engendered an extraordinary level of engagement among young people. I do not think that any Conservative Member suggested that the young people who voted in that referendum did not know what they were talking about, or that they ought not to have the right to a say. If Conservative Members believe, on reflection—given what happened in the Scottish referendum—that it was right for those young people to have a say, they should stick with the logic of that, and accept the case for including the measure in the Bill.

It is interesting to note that the turnout among people between the ages of 16 and 18 was very high in Scotland. I understand that, according to an Electoral Commission report that was published in December 2014, the turnout among 16 and 17-year-olds was 75%, as opposed to 54% among 18 to 24-year-olds. Given the opportunity, they engaged in the democratic process very readily, and I think we should all welcome that.

[Graham Stringer (Blackley and Broughton) (Lab)]

The right hon. Gentleman has made some fair points about the analysis of participation in the Scottish referendum, but does he not agree that that referendum was an almost unique event in terms of the enthusiasm that it engendered among all age groups throughout Scotland’s population, and that there is no immediate read-across from it to other elections and referendums?

[Norman Lamb]

I accept that it was a highly unusual event in terms of the degree of excitement and enthusiasm that it engendered across the population. I am simply making the point that the world did not cave in because 16 and 17-year-olds had had a vote in that referendum, and I do not think it would cave in if we gave people in the same age group the right to a say in who becomes their local representative on their local authority.

Regulatory Reform

Debate between Graham Stringer and Norman Lamb

Tuesday 9th September 2014 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I beg to move,

That the draft Legislative Reform (Clinical Commissioning Groups) order 2014, which was laid before this House on 13 March 2014, in the last Session of Parliament, be approved.

The draft legislative reform order seeks to amend the National Health Service Act 2006 in two ways. First, it will allow clinical commissioning groups to form a joint committee when exercising their commissioning functions jointly. The 2006 Act already allows two or more CCGs to exercise their commissioning functions jointly, but makes no provision for them to do so via a joint committee. Secondly, it will allow CCGs to exercise their commissioning functions jointly with NHS England and to form a joint committee when doing so. The Act already allows NHS England and CCGs jointly to exercise an NHS England function and to do so by way of a joint committee, but it makes no provision for them jointly to exercise a CCG function.

This draft order has already been scrutinised by the Regulatory Reform Committee, and I was pleased with its recommendation that it be approved under the affirmative resolution procedure.

I should say from the outset that the proposed arrangements are voluntary. One party cannot impose the arrangements on another. This allows CCGs to retain their autonomy and to continue to make decisions that are in the best interests of their local populations. They can decide whether to enter a joint committee arrangement with other CCGs. At the moment, the lack of provision for CCGs to form joint committees is placing a burden on CCGs and preventing them from working in the most effective and efficient way. Without the power to form joint committees, CCGs have had to find other means of reaching joint decisions that are binding. That means that they often end up seeking legal advice to ensure that they are on a firm footing, and that adds to cost and complexity without a proper process in place.

As an interim measure, therefore, some CCGs are forming committees in common whereby a number of CCGs may each appoint a representative to such a committee. Those representatives then meet, and any decisions reached are taken back to their respective CCGs for ratification. This leads to additional costs in terms of people’s time in sitting on multiple committees, administrative resources, and extra financial cost. Clearly, such arrangements are burdensome, particularly when compared with the simplicity of a joint committee. Primary care trusts, the predecessors of CCGs, were able to form joint committees at which all participating PCTs were bound by the decisions reached, subject to the terms of reference of that committee.

[Graham Stringer (Blackley and Broughton) (Lab)]

The Minister’s advice that all the members of a committee acting in common have to report back is at odds with the letter from the Department of Health to a committee dated 8 April 2014, where part of its case is that decisions have to be taken unanimously. That is quite different from having to report back, and it undermines his case about the administrative burden.

Healthier Together Programme (Greater Manchester)

Debate between Graham Stringer and Norman Lamb

Tuesday 22nd July 2014 Westminster Hall

[Norman Lamb]

To be fair, when I indicated earlier that the issue is about process, the hon. Lady came back at me—as is her right—to say that it is not just about process but about the model of separating specialisms from general hospitals. I therefore quoted what the shadow Secretary of State for Health had said in that regard.

I turn to the specific case raised by the hon. Member for Blackley and Broughton in this debate. Healthier Together was launched by the NHS in Manchester in February 2012 and is part of the Greater Manchester programme for health and social care reform, which seeks to improve outcomes for all Greater Manchester residents. The scheme is substantial, involving 12 CCGs and 12 hospital sites across Greater Manchester. As the consultation sets out, the case for change aims to improve access to integrated care and primary care, community-based care and in-hospital care services, including urgent and emergency care, acute medicine, general surgery and children’s and women’s services.

The House should appreciate that although those are the services being looked at, there are interdependencies with the core in-hospital services, including anaesthetics, critical care, neonatal services and clinical support such as diagnostic services. Changes in one area might have consequential effects elsewhere, as hon. Members have pointed out, and those effects have to be fully understood.

I should also repeat that the proposed changes are not a top-down restructuring. They are led by local clinicians who know the needs of their patients better than anyone. They believe that the clinical case for change—

[Graham Stringer]

Will the Minister give way?

[Norman Lamb]

I am conscious that I have only three minutes left. I have tried to be generous.

Local clinicians estimate that across Greater Manchester around 1,500 lives could be saved over five years as a result of implementing the proposed changes; that is not my assessment, but that of local clinicians. That would be an impressive improvement in health care, touching and affecting the lives of thousands of ordinary people—not only the individuals concerned, but their families and friends. It is because of the area’s current performance: if all trusts in Greater Manchester achieved the lowest mortality rates in the country, the CCGs believe that the number of deaths in Manchester could reduce by some 300 per year, equating to saving 1,500 lives over five years. That is an objective that we should all sign up to.

I am sure hon. Members will agree that it is not an unrealistic aim for hospitals in Greater Manchester to want to be the very best in the country. I am also sure all hon. Members want the very best for their constituents. Greater Manchester has some of the best hospitals in the country. However, not all patients experience the best care all of the time. In particular, the consultation sets out evidence that suggests that for the sickest patients who need emergency general surgery, the risk of dying at some Greater Manchester hospitals might be twice that at the best hospitals. That is simply not acceptable.

There is a shortage of the most experienced doctors in services such as A and E and general surgery, leaving some hospitals without enough staff. Only a third of Greater Manchester hospitals can ensure a consultant surgeon operates on the sickest patients every time; similarly, only a third can ensure a consultant is present in A and E 16 hours a day, seven days a week.

Healthier Together aims to ensure that all patients receive reliable and effective care every time. The programme is endorsed by the independent National Clinical Advisory Team, which offered strong support for the programme’s ambition, vision and scope, as well as its impressive public and clinician engagement. The NCAT felt that the programme’s approach was an exemplar of how the NHS should try to improve safety, value and sustainability.

I have not had time to say everything that I wanted to. I am conscious that hon. Members raised specific issues that I should respond to and am happy to write to all Members who have taken part in the debate. I hope my remarks have been of some help.

Oral Answers to Questions

Debate between Graham Stringer and Norman Lamb

Tuesday 27th November 2012 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I thank my hon. Friend for that question. The NHS outcomes framework includes an indicator on the quality of end-of-life care as it is experienced by patients and carers, which is based on the VOICES survey of bereaved relatives. The proposals for reform to the NHS constitution include a right for patients and families to be involved fully in discussions, including at the end of life.

[Graham Stringer (Blackley and Broughton) (Lab)]

T3. What action does the Minister intend to take to reduce the number of unplanned emergency admissions to hospital by sufferers of muscular dystrophy and other neuromuscular conditions?