Tobacco and Vapes Bill (Eighth sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 16th January 2025 Public Bill Committees

[Andrew Gwynne]

The clause places the duty to enforce the tobacco and vaping measures in part 1 of the Bill and any display regulations in England and Wales on local weights and measures authorities. It provides local weights and measures authorities—meaning local authority trading standards in England and Wales—with the power to use the investigatory powers under the Consumer Rights Act 2015 to conduct their enforcement activity.

Those investigatory powers are comprehensive and include the power to purchase products, observe a business, enter premises with or without a warrant, inspect products, test equipment, require the production of documents, seize goods, seize documents as evidence, break open containers and require assistance from persons on the premises. Trading standards officers are experts in enforcement, and it is vital that we provide them with the appropriate powers to perform their duty. The clause ensures that local authority trading standards can use the same investigatory powers that are used now, and known to be effective, to enable successful enforcement of the new legislation.

Clause 33 provides a requirement for local weights and measures authorities in England, meaning local authority trading standards, to consider a programme of enforcement action and the potential design of such a programme of enforcement for offences under part 1 of the Bill and display regulations, on a yearly basis. The clause is important to the Bill as it reconfirms what local authority trading standards should consider appropriate action to enforce tobacco, vapes and nicotine product regulations in their local area.

[Gregory Stafford (Farnham and Bordon) (Con)]

The Minister is outlining clause 33. Under subsection (2), it is clear what the programme of enforcement action might involve, but what is not clear is what the consideration means in this case. In the local authority, is that decision made by a certain department, by the cabinet or, if a combined authority, by the mayor? What is due consideration under the Bill?

[Andrew Gwynne]

The hon. Gentleman has answered his own question, because that very much depends on the constitutional make-up of the local authority. The governance of that local authority will determine the way in which that is considered. As licensing functions tend to be quasi-judicial in their nature, enforcement required to ensure that those licensing conditions are met means that, in effect, elected members across the authority have some role in and responsibility for giving consideration to those points. I hope that clarifies the matter for him.

[Gregory Stafford]

It does in the most general sense, but I am trying to get to the specifics of this, if the Minister does not mind. The clause is very clear. It says in subsection (1) of clause 33,

“Each local weights and measures authority in England must, at least once a year, consider”

and so on. Presumably, the Department has some idea of what that consideration would look like, and it is presumably the Department’s job to enforce that the local authority has made some consideration. It must have some benchmark as to what that consideration would be, otherwise how on earth will it enforce that part of the Act once passed?

[Andrew Gwynne]

Look, the clause merely reaffirms the current case, which is that local trading standards and weights and measures authorities must consider certain things. The hon. Gentleman is right that on the enforcement regime for tobacco and vaping products, the Bill extends the consideration that local members should give. It is very clear, with the set of measures we are dealing with in this Bill, what those considerations should be and what local councillors and the executive or the mayor should consider on behalf of the local authority. Every local authority trading standards has a programme of enforcement that is approved by that local authority; this Bill will request of them that that is extended, within the scope of the measures in the Bill—hopefully to be an Act—to include what we expect for the enforcement of tobacco and vape regulations.

The Bill will also ensure that they continue to review the action they take on a regular basis. It is really important to ensure that the enforcement regime in any particular local authority area is as robust as it can be and that, where there are deficiencies, the local authority and the members constituting it have the opportunity to put things right. Clause 34 makes the same provision for programmes of enforcement action in Wales as is made for England under clause 33, and clause 81 makes similar provision for district councils in Northern Ireland. I therefore commend these clauses to the Committee.

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[Liz Jarvis]

It is a pleasure to serve under your chairship, Mr Dowd, and to speak to these amendments.

The UK should be one of the healthiest countries in the world, with our long history of grassroots sports, high-quality food production and world-leading medical research. However, under the previous Government the UK only became sicker, and now lags far behind its international peers. That is why the Liberal Democrats want to see the new Government take urgent action to support people to live healthier lives. The previous Government squandered numerous opportunities to make the UK a healthier place to live and failed to take easy steps to improve the nation’s health. The Liberal Democrats have welcomed the new Government’s early steps to tackle ill health. We believe that supporting people to lead healthier lives should be a priority for the Government.

[Gregory Stafford]

As all Liberal Democrats do whenever they stand up, the hon. Lady has just castigated the previous Government for everything they did. Did she not welcome the fact that the previous Conservative Administration brought in a Bill very similar to this one to improve the nation’s health? Is there nothing she can find to praise the previous Government for?

[The Chair]

Order. I ask that we stick to the amendment.

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[Gregory Stafford]

I do not want to repeat too many points that other people have made. This a well-meaning, but ill thought-through amendment, as has been highlighted by the two hon. Members who spoke before me.

I was a local government councillor for 17 years, and served on many health and wellbeing boards. I do not recall them ever having a separate fund, so this would be a new innovation. It would not necessarily be an innovation without good intention, but using central Government legislation to enforce a completely new set of financial arrangements on local authorities could have a wider impact than those who have tabled these amendments have anticipated. The Minister, either in his summary or on Report, might find a way of achieving what those hon. Members want via other means, because clearly we would all want the moneys from continued enforcement to be used for things as close to health and public health improvements as possible. Will the Minister address that in his response?

[Andrew Gwynne]

I will first discuss the clause and then move on to the amendments. Clause 38 sets out how proceeds from the new fixed penalty notices in England and Wales must be used. I will also discuss the amendments that the hon. Member for Eastleigh has tabled on behalf of the Liberal Democrats.

The clause states that funds received from fixed penalty notices issues in relation to the licensing offences in the Bill must be returned to the relevant Consolidated Fund once the costs of investigating the offences and issuing the notice have been deducted. That will ensure that these fixed penalty notices remain cost-neutral and will not cause local authorities to incur additional cost burdens for enforcing a future licensing scheme. For all other offences, which carry a fixed penalty notice of £200, proceeds will be retained by local authorities and must be used in connection with their functions under this Bill, part 1 of the Health Act 2006, part 3 of the Public Health (Wales) Act 2017 and the Tobacco and Related Product Regulations 2016. That means that if local authority trading standards issue a fixed penalty notice—for example, to a retailer selling to someone under age—the local authority may retain the funds from the fixed penalty notice, and those funds must be used by the local authority to support the enforcement of tobacco and vape legislation. That will allow local authorities to cover the enforcement costs for issuing fixed penalty notices and to reinvest any remaining funds into their enforcement regimes.

The amendments to the clause proposed by the hon. Member for Eastleigh seek to ringfence the proceeds from the £2,500 fixed penalty notice for licensing offences for public health projects. They would achieve that by making it mandatory for any proceeds received by local authority trading standards from these fixed penalty notices to be allocated by local health and wellbeing boards to public health projects. Although I admire the hon. Lady’s ambition to further support public health—and who would not?—it would not be appropriate to enable local authorities to retain the fixed penalty notice proceeds in that way.

Councils already have a ringfenced budget for public health in England. The proceeds from the £2,500 fixed penalty notices for licensing offences were never intended as a revenue-generation mechanism. The fixed penalty notice is introduced to support the enforcement of the future licensing scheme and tobacco and vape sales regulations. It should continue to be the choice of trading standards officers to determine the appropriate enforcement action to take in a given case to achieve compliance. Enabling retention of fixed penalty notice proceeds for a different purpose risks distorting the operational priorities of the licensing scheme.

The £200 fixed penalty notice introduced by the Bill for offences such as under age sales are an exception. We worked carefully with His Majesty’s Treasury during the development of the Bill to enable trading standards to retain that relatively small value in order to support their procedures. To ensure that the future licensing scheme can be sustainably implemented, we have established that local authorities will be able to use the licensing fee to support them in covering the costs of administering and enforcing the licensing scheme, and that trading standards can deduct the costs of investigation and issuing fines from the FPN proceeds before returning the remainder to the Consolidated Fund.

My hon. Friend the Member for Cardiff West also mentioned the fact that the provision is not compliant with the reality of seeking to apply to both England and Wales, in that it makes specific reference to bodies that do not exist in Wales, namely the health and wellbeing boards, which only appertain to local authorities in England. I want to be clear that local authorities are receiving not just their public health grant but, in the financial year 2025-26, an additional £70 million from central Government and the Department of Health and Social Care to support local authority-led stop smoking services in England. We expect that investment will support our aim to help around 360,000 people to make quit attempts, and up to 198,000 successful quits a year.

Decisions for future years are subject to the spending review process, but that money, as the shadow Minister rightly pointed out, in part comes from the Consolidated Fund. So there is a virtuous circle of the kind that the hon. Member for Eastleigh rightly wants to see, in that there are direct correlations between money that my Department gets from His Majesty’s Treasury and money that the Treasury will get from not just those fixed penalty notices in the future, but other sources of income generation, including fines and penalties.

That money, in one form or another, almost certainly will be recycled into public health measures determined by Ministers and by Parliament and given to local authorities to determine how to spend at their local level. That could be through the public health grants, or through direct grants such as the smoking cessation or the drugs and alcohol grants that we make available to local authorities. But rest assured, there will be investment in public health, and that will come from money that my Department receives from His Majesty’s Treasury through the usual routes. With that, I ask the hon. Member for Eastleigh to withdraw her amendment.

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[Dr Johnson]

Clause 46 provides the legal framework for the power to amend the definition of the identity documents in clauses 1 and 10. There has been some debate about the list of identity documents, which is quite short. I know that the Minister has described the list of identity of documents for voting as too short, for example, but that is a much longer list than this one, with a much broader scope.

I understand the need to provide a legal framework to increase the number of identity documents and amend the list as required, so I support clause 46. I am sure that the Minister will be under pressure from the Chancellor to find efficiencies in his Department. Rather than saying, “We have the power to amend it, so let’s do that later,” and instead of using civil servants’, Members’, Ministers’ and the House’s time to amend it by regulations later, might it not be more efficient to add to this list now? He could add things like veteran cards and other pieces of ID currently available for those wishing to vote. He could do it now with a stroke of his pen.

[Gregory Stafford]

I have a simple question. Obviously, “amend” can mean either “increase” or “decrease”. The Bill lists the following ID cards:

“(a) a passport,

(b) a UK driving licence,

(c) a driving licence issued by any of the Channel Islands or the Isle of Man,

(d) a European Union photocard driving licence, or

(e) an identity card issued by the Proof of Age Standards Scheme”.

I assume that a passport, a UK driving licence, or a driving licence issued by the Channel Islands or the Isle of Man is unlikely to disappear. I have no idea, but I suspect that a European Union photocard driving licence is not going to disappear.

[Jack Rankin (Windsor) (Con)]

Shame!

[Gregory Stafford]

My hon. Friend tempts me, but I am not going to respond. I suppose the only one that the Minister would consider removing would be the proof of age standards scheme card, if it were somehow changed or amended. Will he confirm that he is not looking to reduce the numbers?

[Dr Johnson]

One point to add is that individuals with certain disabilities may not have a driving licence, because their disability makes them ineligible to drive. The options available to them are quite substantially restricted, because most of the options on the list are forms of driving licence. Has the Minister assessed whether those with disabilities are more or less likely to have the documents listed, and is he happy that those with disabilities who wish to buy age-restricted products can do so?

Tobacco and Vapes Bill (Sixth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 14th January 2025 Public Bill Committees

[Dr Johnson]

Clauses 1 to 9 of the Bill have predominantly dealt with tobacco products of varying kinds. Clause 10 moves on to the sale of vaping or nicotine products to under-18s, distinct from the measures on a smoke-free generation and the date of birth of 1 January 2009.

The first question is what are the vaping products of which we speak. Clause 48 deals with the interpretation and definitions within part 1. It defines a vape as

“a device which…vaporises substances, other than tobacco, for the purpose of inhalation through a mouthpiece”.

That applies whether it vaporises tobacco as well or not. It excludes medical devices, although we heard in evidence that no vapes are medically approved in the United Kingdom, and medicinal products that vaporise, including any aerosolisers. The clause also refers to an item that is intended to form part of a device, including anything to be attached to a vaping device with a view to imparting flavour. As the Government have already brought forward legislation to ban single-use vapes, it is important that individual components of reusable vapes are covered by the Bill.

A “vaping product” itself means a vape or vaping substance. A vaping substance means a substance other than tobacco that is intended to be vaporised by a vape. Vapes themselves can either contain nicotine or not and work essentially by heating up a liquid that creates a vapour to be inhaled. A nicotine vape typically contains nicotine, propylene glycol or vegetable glycerin, and flavourings, which we will come to discuss because of their importance in enticing children.

Nicotine products are also relevant to clause 10, on the sale of vaping or nicotine products. Clause 49 defines nicotine products as

“a device which is intended to enable nicotine to be delivered into the human body”,

part of a device that does that, or anything that contains nicotine. That is important because we have heard again and again how the industry will continually evolve to entrap people in a lifetime of nicotine addiction. This wide definition of anything containing nicotine helps to future-proof this legislation such that it does not have to be revisited again and again as the industry continues to evolve.

The main type of nicotine product currently on the market, other than vapes, is oral nicotine pouches from brands such as Velo and White Fox. These are a tobacco-free product placed between the lip and the gum for oral nicotine absorption. They are similar to Swedish snus, which we have discussed; they are pre-portioned pouches and they are produced in a variety of flavours. We have seen flavours such as lemonade razz and others that are designed with childlike descriptions, perhaps to influence children to use them. Certainly, when I talk to teachers, they say that they starting to see them used in the classroom. They look to parents very much like a small square of chewing gum, and some parents may not be aware of the hazards that these items pose.

The nicotine content within oral nicotine pouches can vary and is typically between 4 mg and 18 mg of oral nicotine per pouch. That is important; I have seen amendments suggesting that they should be limited 20 mg, but 20 mg is a lot. When we look at the amount of nicotine in a cigarette, we have to look not at the amount contained within it in its packet, but at how much is absorbed by the end user, the customer, when actually smoking it. The amount absorbed by the end user is much smaller than the amount in the cigarette. When brands imply that the amount within a pouch is similar to what is in a cigarette, they are talking about the amount within the cigarette itself, not how much the person smoking it will absorb from the cigarette.

The difference is quite marked: people may only take 1.2 mg from a cigarette when they smoke it in the usual way, so 18 mg in an oral nicotine pouch is an awful lot of nicotine. Some online retailers will sell products containing up to 150 mg of nicotine per pouch, with examples of flavours including black cherry, citrus and coffee. The release of nicotine from oral pouches is similar to, or faster than, from smokeless tobacco products and, given the Minister’s robust approach to snus and novel products designed to create addiction, I hope he will take a strong approach to these too.

Oral nicotine pouches sit alongside other novel nicotine products such as nicotine toothpicks and nicotine toothpaste that have emerged on the market. They are regulated under the General Product Safety Regulations 2005. Under those regulations, there is no age of sale requirement for retailers to impose. As such, individuals aged under 18 can legally purchase nicotine pouches, as opposed to tobacco and vaping products, which require all purchasers to be aged over 18. Clause 10 will help to deal with that.

Furthermore, oral nicotine pouches are not regulated by the Medicines and Healthcare products Regulatory Agency, since no medical claims are made, and they are not an alternative to an authorised medicinal nicotine product—something like Nicorette gum, for example. I should note that some supermarkets have a voluntary age of sale; some supermarkets and larger retailers, or even smaller retailers, will voluntarily not sell these products to under-18s, but there currently is no legal requirement for them not to do it.

There is also no restriction on the amount of nicotine contained in an oral nicotine pouch under the current legislation, as such new products sold within the UK can contain levels of nicotine exceeding other nicotine or tobacco-based products such as cigarettes. We have heard about the addictive nature of nicotine; the higher amount transmitted so rapidly into the bloodstream is clearly stronger in its effect and therefore undesirable because it will remove people’s choice not to have those products.

What about the health impact? The health impact of nicotine is another reason why we need to invoke clause 10. Some people say, “If you take the nicotine out of the tobacco, maybe that will be safer.” However, it is safer but not safe. According to the impact assessment produced by the Government in response to the Bill, a recent scoping review found that oral nicotine pouches claimed to be less toxic than cigarettes and that they deliver comparable amounts of nicotine. However, the data for that review was mainly available from industry-funded studies. Despite potentially lower toxicity than cigarettes, oral nicotine pouches still contain nicotine, and that still has harmful effects.

[Gregory Stafford (Farnham and Bordon) (Con)]

My hon. Friend is right to highlight all the problems of vapes, especially for children, and the lack of evidence out there, other than that produced by the industry itself. Is she aware of any independent studies, either in the UK or abroad, that have done any substantive investigation into how harmful vapes are, either for adults or for children?

[Dr Johnson]

I thank my hon. Friend for his intervention. Last Tuesday, we heard in evidence from various medical sources, and both the Select Committee and our processor Bill Committee heard in evidence that nicotine is, of itself, harmful, and that the chemicals added to vapes are harmful. In some cases, they are extremely harmful. I will talk more about vaping chemicals later. Indeed, sometimes the products do not contain what they are expected to contain, and that can be worse still. I will return to that subject later, too.

Nicotine is highly addictive and can permanently affect the development of the adolescent brain. We have heard how the industry targets young people, and that is because the adolescent brain is particularly vulnerable. Nicotine can permanently affect its development. Nicotine also fulfils all the criteria for drug dependence. Giving it up is very difficult, and withdrawal symptoms can include cravings, irritability, anxiety, trouble concentrating, headaches and other mental symptoms. Symptoms associated with nicotine and dependence are often not recognised by novice smokers, particularly if they are young.

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[Sarah Bool]

Absolutely. Unlike my hon. Friend, I am not a medical professional, but I wholeheartedly agree that it is a self-perpetuating cycle, and we need to stop it as soon as possible to protect children.

[Gregory Stafford]

It is a pleasure to serve under your chairmanship, Sir Roger. I want to make two points about this part of the Bill. First, I support new clause 10, in the name of my hon. Friend the Member for Sleaford and North Hykeham. It is essential that we close off all avenues for children to purchase vapes. In the Bill, the Government have done a very good job of dealing with physical retailers, but there is a gap in relation to online retailers. I hope the Minister is minded to support the new clause, either when we come to a vote on it in a few moments, or by inserting something similar into the Bill on Report to ensure we close off online retailers.

In my opinion, online retailers are more dangerous than physical shops. A child—especially a very young child—has to depart from their guardian or their adult to go and buy something in a shop, whereas they can purchase products online on their phone or computer in the comfort of their own home, and it is very difficult for a parent or a senior person in their family to spot that. We know that that is where a number of children and young people are getting these products, so we have to close off that avenue.

My second point is about a more fundamental issue with the clause itself. My hon. Friend the shadow Minister has said this quite extensively, but it bears repeating so that we get some answers from the Minister. It does not seem obvious why the Government decided to ban vapes for anyone under the age of 18, whereas for other tobacco products it is for anyone born on or after 1 January 2009. I completely accept that vapes can be used as a smoking cessation tool; it is important that they are used in that way.

When we come on to vending machines, there are medical settings in which people require some form of intervention to help to stop smoking, and we should be looking at that. However, it is not beyond the wit of the Bill’s drafting to apply 1 January 2009 to tobacco products, and then to create an exemption specifically for smoking cessation. I want to understand why the Minister has decided to make this distinction. Does he not see the potential risks in doing so? Hopefully, we all want people not to be addicted to any products that are harmful to them, but both retailers and consumers, when faced with two sets of rules for very similar products, could become confused and accidently fall foul of the law. Because of that confusion, the law might not be enforced as the Minister would like it to be. I very much hope the Minister addresses those two points in his closing remarks on these clauses.

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[Andrew Gwynne]

I will come to that; I am just spelling out why I am concerned about the consequences of the shadow Minister’s proposals in the amendment, because they would lead to more lenient penalties for those committing an offence for the first time than they are liable to under the current legislation. Again, like the amendments that we have already discussed, the effect would be to create a first-time offence, and if the Committee is content, I will not repeat myself, as the rationale for my asking the shadow Minister to withdraw the amendment remains the same.

The shadow Minister’s new clause 10 would introduce an offence in England and Wales for businesses selling vaping products online without applying an age verification policy. It would therefore create a requirement for businesses selling vaping products online to take steps to establish and ensure that any customer attempting to purchase those products online was above the age of 18.

Although I am incredibly sympathetic to the shadow Minister’s intentions, as I said earlier, the Bill already makes it an offence in England and Wales to sell a vaping or nicotine product to anyone under the age of 18. As with in-person retail, online retailers must take all reasonable steps to avoid selling vaping products to anyone under age. Alongside the Bill, we are exploring how we can enhance online age verification to further tackle online under-age sales. The office for digital identities and attributes, which sits within the Department for Science, Innovation and Technology, is creating a framework of standards and governance, underpinned by legislation, which will enable the widespread use of trusted digital identity services. We are working closely with DSIT to consider how its work to enable the use of digital identities can best support retailers selling tobacco and vapes, whether online or in-person. It is for those reasons that I commend clauses 10, 59 and 76.

[Gregory Stafford]

I may have missed the Minister’s explanation, but why has he decided not to have the incremental increase for vapes when he has it for smoking? Does he feel that there is something fundamentally different about vapes, beyond the smoking cessation element, that could have been an exemption from the progressive age range that he has for tobacco?

[Andrew Gwynne]

The hon. Gentleman should panic not; I had not quite come to the end of my contribution. I was merely saying that it is for those reasons that I commend clause 10, clause 59 and clause 76 to the Committee.

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[Sarah Bool]

This amendment states:

“The offence set out in subsection (1) does not apply to vending machines that are located within specialised mental health units that provide care for mental health patients.”

I tabled this amendment on the basis of the evidence provided to us. I put on record that the Committee received a letter by Peter Terry, a

“Smoke Free lead in a large Mental Health Trust in the North West of England”.

In his letter, he says,

“As you may be aware the success of hospitals and Trusts becoming smokefree environments (especially Mental Health units) is particularly challenging. Mental Health service users due to their conditions have little or no motivation to stop smoking. On the units of my trust the prevalence of smoking is consistently between 70-77%.”

He goes on to say:

“To ensure we allow service users who are hospitalized a safer way to manage their nicotine addiction...my Trust would require Vending machines. These would allow service users to purchase a closed pod system device, which is a lot less harmful than tobacco smoking. On admission they would be offered either free NRT products or to purchase a vape as described above.”

He is asking that we make an exemption.

The exemption was also supported in another submission from the Cambridgeshire and Peterborough NHS foundation trust. Ben Kingsbury, the tobacco dependency lead in that trust, wrote to express his concerns over the ban on the sale of vapes from vending machines. He indicated that his trust had installed vending machines back in May 2024

“to ensure that vapes are available to staff and patients at all times.”

He stated:

“Since installation of the vending machines in our Trust we have had over 2400 individual vends. Each vend represents a staff or service user making a positive decision to improve their health. 2400 individual vends in just 6 months represents a saving to the Trust of around £12,000.”

He argued:

“Removing the machines will reduce patients’ independence in buying their own devices while in hospital and will have a financial implication to our Trust, as wards would be expected to fund more vapes.”

He was also concerned that

“a lack of vape provision on our Trust premises may result in patients returning to smoking”,

which I am sure we all agree we do not wish to be the result. He also asked that we consider the financial implications, as well as health and wellbeing of service users, by implementing the exemption.

We can all empathise with those who are admitted to mental health units. They may have difficult and complex conditions that they need to work through, and coping with a potential addiction may be too much for them. There may be a logic to listen to the voices of the experts—especially if we end up having smoke-free places around hospitals and how that will work out—asking us to allow a mechanism to help someone with smoking cessation.

The Minister himself has just said that vaping can be good to help someone quit, but if they do not have access to a vape they may face difficulties such as cravings, anxiety, trouble concentrating and all the other elements that go with it, including potentially going back to smoking tobacco in its pure form. Taking away the option from those in mental health units will only make their recovery harder, longer and more expensive for the NHS. I heartedly commend to all members of the Committee that we all consider this amendment thoroughly, to ensure that we are not doing additional harm by taking an aggressive approach in this regard.

[Gregory Stafford]

I thank my hon. Friend the Member for South Northamptonshire for moving the amendment. One thing we have seen across the debate thus far, and indeed during oral evidence, is that we have been led by the evidence—the Minister has clearly said that. The evidence that my hon. Friend has provided is from medical experts. These are not vape peddlers or people from the industry, or people who want to make a quick buck out of those who are addicted to nicotine. These are health professionals who are trying to ensure that there is a balance between what is absolutely right—we do not want to see people vaping—and the reality of the situation in medical settings, especially in mental health settings, where the ability for patients to have a certain amount of autonomy is often vital to their mental recovery.

My hon. Friend also made the valid point that if we remove smoking and tobacco products from in and around hospitals, which is a suggestion in the Bill that I think I support, we must ensure that those who are addicted—and we accept that it is an addiction—are dealt with appropriately. Obviously, in most regular acute trusts, that would be dealt with through a nicotine patch, but for mental health services, as I said, the requirement for autonomy should sometimes outweigh the functional nature of a nicotine patch. Indeed, my understanding is that nicotine patches do not work for everyone, because some of the addiction is in the holding as well as the imbibing.

I welcome the Minister’s response. As I have said to him on previous amendments, even if he is not happy with the precise wording my hon. Friend the Member for South Northamptonshire has put forward, I hope that he can bring in some kind of exemption on Report, so that the medical professionals who have written to us are satisfied that their concerns have been heard?

[Dr Johnson]

Amendment 96 and clause 12 relate to vaping and nicotine product vending machines. I support the clause; indeed, if one looks at proceedings on the previous, Conservative iteration of the Bill from earlier this year, one will see that new clause 4, which was signed by just under 40 Members proposed a ban on vaping product vending machines, and the lead name was mine. I was concerned that vending machines would be used by children to obtain vaping and nicotine products. That loophole in the law that would make it easy—as we have seen with cigarettes in the past—for youngsters to circumvent the age-restricted product legislation designed to protect them, by allowing them to buy things from a machine that was not checking how old they were. I am therefore clearly supportive of this legislation.

Clause 12 makes it an offence for a person who manages or controls a premises to have a vending machine that sells vaping or nicotine products—

“an automatic machine from which”

vaping or nicotine products “may be bought”. Again, I ask the Minister to look at the principle of machines “from which” these products “may be bought” and to reconsider the wording to ensure that the industry cannot sell products using an app or online platform that can then be collected from a dispensing machine, in the same way as someone might buy something off a retailer and collect it from another retailer or a lock box collection point.

Banning the sale of vaping products, nicotine products and cigarette papers from vending machines would, by virtue of the various clauses in the Bill, including clauses 12 and 17, be a UK-wide provision. That would be beneficial because it would have consistency across the UK in a positive direction. The clause introduces a new offence, as there are currently no restrictions on the use of vaping or nicotine product vending machines in the UK, in the way that there is with tobacco vending machines. This is a new offence, and in my view a welcome one.

Self-service vending machines provide an anonymous, unregulated environment where individuals under the legal age could otherwise purchase vaping or nicotine products without any face-to-face interaction with a retailer, clearly increasing the risk of under-age sales. The offence will come into force six months after Royal Assent, which means that premises that currently contain a vape or nicotine product vending machine will have time to remove it or to stock it with a product that can legitimately be sold to younger people.

The primary rationale behind the restriction on vape vending machines is to reduce vaping rates, particularly among minors and children. The Government’s aims, as I understand them, are to protect young people from the harmful effects of vaping by limiting their access to vaping and nicotine products. Vape or nicotine product vending machines, which may also be used for pouches, are seen as a mechanism to bypass the responsibility of retail staff in ensuring that restrictions are met, contributing to increased sales.

The fine is level 4 on the standard scale, which is similar to that for selling over the counter. That makes sense to me, but I want to ask the Minister who qualifies as a person who manages or controls a premises? If it is a tenanted property, does that mean the landlord or the tenant who has control of the premises? If it is a larger retailer, such as a large supermarket, who controls those premises? Who takes the blame there? Is it the person who was on shift as the supervisor? Is it the store manager? On a more general basis, is it the regional manager or the managing director of the company? Who is responsible for managing and controlling those premises? The Minister needs to provide guidance on that so that people understand their responsibilities and so that, in the event a crime is committed and a vending machine is put in place, fingers are not pointed in every direction, making it impossible to work out whose responsibility and fault it was, such that nobody is held to account for the breach.

The Department of Health and Social Care has produced an impact assessment for the Bill, and paragraph 477 says:

“Regulating vape flavours, packaging, and presentation, as well as point of sale displays, and banning vending machines which sell vapes and nicotine products is expected to reduce the number of people taking up vaping, and therefore it is expected that there will be environmental benefits from reduced litter from vaping products.”

The clause will therefore benefit the health of not just our children but the environment in which they live and grow.

Paragraph 781 of the impact assessment highlights the following information about vending machines and under-age sales:

“A survey conducted by ASH”—

which gave evidence to our Committee last week—

“found that 6.6% of 11–17-year-olds who currently vape used machines as a source of vapes.”

Given that vaping vending machines are not currently that common, that seems quite a high figure. Without a ban and the implementation of the clause, that figure will surely increase.

--- Later in debate ---

[Jack Rankin]

I have supported the Government so far on the principle of not allowing under-18s to vape, but I am concerned that, as we get to these clauses relating to distribution and discount—we have just talked about display, and I will not talk about flavours and marketing in depth, because I know they will come later—we are at risk of moving away from the evidence, and from the balanced approach that the Minister talked about when he delineated between vaping and tobacco.

These clauses give quite wide scope to Ministers on all of these products together, but I think the products should be treated differently. There should be scope for legitimate, responsible vaping companies to offer free distribution and discount of products, in aid of the Government’s stated aim. We do not want to create new vapers, but vaping is a powerful tool to realise the aim of a smoke-free generation. As with most products, it is possible to promote price savings in a responsible way.

We have received a huge weight of correspondence on this topic and I cannot say that I have had the time to read everything that has come across our desks, but I read the letter from VPZ, which I understand is a vaping company. It talked about its partnership with the NHS in Essex, which had put out to tender for a process to help people successfully quit. There was a £55 voucher from the NHS associated with that partnership. As I understand the letter—perhaps the Minister knows more about this than I do—VPZ used that voucher to offer a cashback scheme such that that money came off the price of vapes. VPZ did not benefit directly, because it did not think it should be doing so from a public source, but it passed that saving on, and I suppose that counts as a discount on a product.

I might contend to the Minister that that is exactly the kind of thing we want responsible, legitimate vaping companies to do. I understand that he wants, through this mechanism, to strictly limit advertising to, and targeting of, children and new vapers, but—

[Gregory Stafford]

I accept the point that my hon. Friend is making: there might be an argument for some kind of promotion around the use of a vape for cessation from tobacco products. However, the reality is that there are thousands, if not tens of thousands, of medicines that we do not advertise in this country, because they are generally prescribed by a medical professional, and those that are not—those that can be bought over the counter—are generally harmless so long as they are taken according to the instructions. We would not want a situation like that in America, where specific drugs are promoted to the general public, because I think that would send us down a very difficult route. Does my hon. Friend not think that what he is suggesting on vapes is something like that, and that for products prescribed by a doctor for smoking cessation, or at least for over-the-counter products, we should not have advertising, marketing or promotional products?

Tobacco and Vapes Bill (Fifth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 14th January 2025 Public Bill Committees

[Andrew Gwynne]

These clauses make it an offence in England, Wales and Northern Ireland for someone over the age of 18 to buy or attempt to buy tobacco products, herbal smoking products or cigarette papers for someone born on or after 1 January 2009. That is called proxy purchasing. Clause 2 replaces the current offence under the Children and Families Act 2014 of someone aged 18 or over buying or attempting to buy tobacco products or cigarette papers on behalf of someone who is under 18 in England and Wales.

Clause 69 amends the offence of proxy purchasing in Northern Ireland to align to the change in the age of sale. That applies to tobacco products, herbal smoking products and cigarette papers.

[Gregory Stafford (Farnham and Bordon) (Con)]

The Minister said that this measure was to prevent people from buying cigarettes, cigarette papers or tobacco products for people under the age of 18. Obviously, when the Bill is first passed, that will be true, but with every progressive year, it will prevent buying for people aged 19, 20, 21 and 22. Why has the Minister not made a differential in law to ensure that, once the Bill is in place, there is a separate and more serious offence of buying tobacco products for someone under 18, however far in the future, and a separate offence of buying them for an adult who is ineligible to have them?

--- Later in debate ---

[Dr Johnson]

Clause 2 makes it an offence for a person aged 18 or over to make a proxy purchase of tobacco products, herbal smoking products or cigarette papers for a person born on or after 1 January 2009. It essentially stops an older person going in and buying those products for a younger person, which we are aware has been happening for many years with both tobacco and alcohol. If found guilty, the person committing the offence faces a level 4 fine on the standard scale, which hon. Members will recall is £2,500.

The clause replaces the current offence under section 91 of the Children and Families Act of someone aged over 18 buying or attempting to buy tobacco products or cigarette papers on behalf of someone aged under 18 in England and Wales. In many ways, that seems a sensible consequence to clause 1. If we want it to be illegal for people born after a set date to have tobacco, it makes sense to ensure that people cannot buy it for them.

However, I have some questions, particularly in relation to cigarette papers. I did not particularly talk about cigarette papers in our discussion of clause 1 because they are more rightly talked about in relation to clause 2, which treats cigarette papers differently, in so far as it makes them illegal unless a person can prove that they are using them for something else. I looked into what that something else might be. I naively thought that cigarette papers were essentially just bits of paper of a particular thinness that could be rolled up and stuck together with a little gum arabic once somebody had rolled whatever they wanted to roll inside them; in fact, that turns out not to be the case because of the law.

The papers contain ethylene-vinyl acetate, which makes them more fire-resistant. The sad situation is that every year people smoke in bed or in their armchair, fall asleep and cause themselves burns, and sometimes even cause death or house fires. The ethylene-vinyl acetate—a sort of plastic—added to cigarette papers helps them to self-extinguish and reduces the risk of fires; we know that some particularly dreadful fires, such as the Kings Cross fire, are believed to have been caused by loose cigarettes.

The cigarette papers are essentially made from plant fibre, such as bamboo flax and rice, but they can be flavoured and coloured. In the evidence given to the Committee last Tuesday, we heard about the tobacco industry’s aim of ensuring that younger people are enticed by colours and flavours. A quick look at Amazon—other sellers are, of course, available—reveals that people can buy cigarette papers in a whole range of bright colours. People can also buy cigarette papers with pictures of cherries, apricots, bubbles and all sorts of things on them. I thought it was interesting that that has not been covered in relation to cigarette papers. Why give an exemption allowing them to continue to be sold when the reality is that they will continue to be used for rolling either illegal tobacco or other forms of illegal drug?

[Gregory Stafford]

Is my hon. Friend saying that cigarette papers have a specific definition in law and therefore that the papers she talks about, which have chemicals to make them fire-resistant and so on, will be banned, or is she saying that the clause will ban anything that could be used as a cigarette paper within the law? If she does not know the answer, perhaps the Minister can pick that up when he responds.

[Dr Johnson]

Clause 48, which we obviously have not come on to yet, gives the interpretation of part 1 and all the definitions. The definition of cigarette papers in the Bill includes

“anything…to be used for encasing tobacco products or herbal smoking products for the purpose of enabling them to be smoked”.

Different chemicals are put in, believe it or not, to make the ash whiter—people are concerned, when they have burnt their cigarette, with the colour of the ash that has fallen from it, which seems remarkable to me. Calcium carbonate, magnesium carbonate and titanium oxide can be added to affect the colour of not just the paper, but the ash produced. Seignette salts—sodium potassium tartrate and sodium citrate—are also added to make it burn faster, so that people go through cigarettes slightly more quickly. Then there is the glue of the acacia gum.

As far as I can tell, it is impossible to find out what is in the cigarette papers that one might wish to purchase; if one looks online, it is very hard to work out what is in them. I have seen medical reports of people allergic to the ingredients having: cheilitis, or inflammation of the lips; circumoral—around the mouth—inflammation; and finger dermatitis. If one is selling a ham sandwich, it is important to include the ingredients so that people know what it is in it, but it seems that for cigarette papers that is not the case and I am not entirely sure why. It is also the case that some commercially available papers contain copper, chromium and vanadium. As they burn, the pigments can lead to very high levels of exposure. These are not inexpensive; Amazon sells a random choice of eight flavours for £9.99. The issues are worth considering. It has been proposed that individual cigarette papers have on them a message saying “Smoking is bad for you” or something along those lines, but does that not involve adding further chemicals to the paper and therefore further risk?

Clause 2(3) states:

“It is a defence for a person charged with an offence”

of proxy purchasing

“to prove that they had no reason to suspect that the other person intended to use the papers for smoking”,

To which the somewhat obvious question is, “What on earth else would one use cigarette papers for?” With some trepidation, I asked Mr Google. Initially, all I could find was that they are used for smoking joints of cannabis, which did not seem to me a particularly good reason—the smoking of another illegal substance—for the Government to exclude them. Then I found out that some people use them for woodwind instruments. They place them underneath the key and press the key down, which allows extraneous water to be soaked up. They then release the key and pull the paper out. That helps to dry the instrument, prolong its life and prevent damage. Clarinet players—I did learn the clarinet but I did not know this; maybe that is why I was not so good at it—or players of the oboe, bassoon, flute or saxophone can buy cigarettes papers for that purpose.

The question of whether the Government need to provide an exemption for cigarette papers hinges on whether there is an alternative for the public to use for their woodwind instruments—and there is, of course. It is obvious in some respects that the market would provide one were cigarette papers banned. Connoisseurs of such instruments tell me that cigarette papers are not ideal to use for this purpose because of the additional, potentially toxic chemicals they contain—one is potentially inhaling bits of the chemicals back in—and because it is not ideal to get traces of the gum on one’s instrument. It is possible buy Superslick Pad and Yamaha cleaning papers. As far as I can tell, they do not contain toxic chemicals, because nobody would be interested in whether the ash burnt from them was white or otherwise since no one is going to set fire to them. Is it therefore really necessary to have a specific exemption for the use of cigarette papers for instruments, when in practice that is unlikely to be what they will be used for? There is an alternative and the most likely use—I think the Minister will understand this—is that they will be used for smoking joints.

--- Later in debate ---

[Dr Caroline Johnson]

I searched quite extensively for other uses of cigarette papers and had not come across that one; that is very interesting. I do not know whether the hon. Gentleman thinks they need to have pictures on them—perhaps that helps with the art. I think there is still a difference in a cigarette paper that contains extra toxic chemicals to help it burn a particular colour, for example. I am not sure whether there is any particular art or model making application for having the cigarette paper with all the chemicals in, as opposed to any other type of paper that is produced for the purpose. Inevitably, the market would produce a non-cigarette paper for the purpose, which would reduce the amount of toxic chemicals that are used and therefore also the amount of toxic chemicals in our environment—given that, inevitably, once they finish being used, they get wasted.

The point stands that the papers themselves contain toxins that would not be required for any other uses, whether that be for models, art or music. Therefore, since such products are available on the market to buy separately from cigarette papers, though they may currently be slightly more expensive, the Minister may want to consider removing that exemption, because it inevitably creates a loophole for these products to be used for the smoking of illegal tobacco or a joint.

[Gregory Stafford]

It is interesting—now that we have moved on to the alternative uses—to note that anyone who has ever had children knows that pipe cleaners are an essential part of any craft kit. Obviously, they can be used for cleaning a pipe, as well as making a spider or whatever else. The Minister has not sought to ban pipe cleaners in the same way. I wonder why he has picked out cigarette papers, which have alternative uses, but not pipe cleaners, which clearly have alternative uses as well.

[Dr Johnson]

The hon. Gentleman is bringing back painful memories of trying to create things with pipe cleaners for my children, and trying to make them stand up straight when they simply are not quite that stiff—but some fun memories, too. Yes, I do see that they are used in art. That suggests another question. The Minister can correct me if I am wrong, but I presume that the Government have chosen to ban cigarette papers because they want to reduce the amount of people smoking illegal tobacco; it is also an opportunity to reduce the amount of availability of papers for smoking cannabis and other illegal products, but why have they not included filters?

For many years, the tobacco industry has implied that smoking through a filter is safer and many in the population believe that smoking through a filter is safer, but it is a single-use plastic—and I am sure the Minister is very worried about the environment and the use of single-use plastics. The previous Government banned quite a lot of single-use plastic items to reduce waste. The cigarette filter is the most littered item globally every year and it is a single-use plastic. It contains a cellulose acetate filter, which I am told is a plastic pollution. It also increases the risk of a particular form of lung cancer, because the tiny little itty bits of plastic are inhaled into the individual who is smoking. They also increase the way that people draw on a cigarette, which means they could take in more of the toxins when there is a filter than when there is not. Will the Minister discuss whether he plans to include filters on Report?

Let us look at international examples. In 2011, the United States said that all cigarette papers should have Food and Drug Administration approval for their ingredients. Is the Minister considering publishing the ingredients on the packet here in the UK, so that if they are to continue to be sold, people are aware of the toxins they contain? Further, where these products are being used for modelling or art purposes, perhaps such steps will start to reduce the number of toxins contained in them.

As part of clause 2 we are also going to discuss clause 69 stand part. Clause 69 substitutes for article 4A of the Health and Personal Social Services (Northern Ireland) Order 1978. That is, essentially, identical to clause 2, except for the fact that subsection (4) states someone guilty of an offence under the article is liable to a fine “not exceeding level 5”, whereas clause 2 says “not exceedingly level 4.” As the Minister is looking for consistency across the four countries of the United Kingdom, could he explain why he has chosen to have a lower level of fine for the proxy sales offence here than he has in Northern Ireland?

It should be noted that, although we have already discussed clause 50, that part of the Bill provides for legislation for proxy sales in Scotland, where the fine threshold is also set at level 5. I understand that the Minister is a fan of devolution, and wants devolved nations to be able to have different fines, so why has he chosen the fine level for this particular part of the country to be at level 4, which is lower than in Scotland and Northern Ireland? Additionally, section 5 of the Tobacco and Primary Medical Services (Scotland) Act 2010 says that it is illegal to buy, or attempt to buy, for oneself if under 18. Is it the Minister’s intention to amend that? That is my final question on clause 2.

--- Later in debate ---

[Dr Johnson]

I thank the hon. Lady for that.

[Gregory Stafford]

My hon. Friend is making, I think, an important point about whether Ministers, either in England or in the devolved Administrations, can put signs together in order to reduce the burden on a business of having multiple, potentially confusing signs. I understand the point about devolution, but most ordinary people will look for a single regulated sign for this. I wonder whether there is any discussion—even if the Minister cannot legally enforce it within the Bill—about working in tandem with the relevant Ministers in Scotland, Wales and Northern Ireland, so that there can be a standardised sign, so that it is abundantly clear, whether someone is in England, Wales, Scotland or Northern Ireland, that that is the sign, and that it is both clear to consumers and it is clear to businesses what they are supposed to be displaying.

[Dr Johnson]

I thank my hon. Friend for his intervention. It is of course correct that we have devolution, and the hon. Member for Worthing West is of course right that Welsh Ministers—in the same way as Scottish Ministers, and, as I will come to, Northern Irish Ministers—have the capacity to deal with changes to the signs, but it will be easier to have clarity. I am merely suggesting that the Minister could discuss these details with his devolved counterparts and put such measures on the face of the Bill now, rather than not do so and then require, for example, as I said before, the Scottish Ministers to then introduce an SI for something that could be changed much more cheaply with drafting now. It would require much less time and energy from the civil service in Scotland—and spend less taxpayers’ money—to achieve that.

I am interested by the comment from my hon. Friend the Member for Farnham and Bordon about joint signs. The point I was making was about the display space: if someone has to put a lot of different signs up—particularly given that the Minister has shown reluctance on the principle of a nicotine-free generation, which I suspect is where we will end up—and we need to do that at a later date, we will end up with yet another sign with yet another date on it. There comes a point at which the amount of display space available to retailers starts to become smaller, given the required font size.

Before I finish, I have one more quick point, which is just to note that clause 72 is the Northern Irish equivalent added to the Health and Personal Social Services (Northern Ireland) Order 1978, so it is the same as clause 5, with the same effect.

Ordered, That the debate be now adjourned.—(Taiwo Owatemi.)

Hospice and Palliative Care

Gregory Stafford Excerpts

Monday 13th January 2025 Commons Chamber

[Gregory Stafford (Farnham and Bordon) (Con)]

Hospices provide vital care for adults and children with life-limiting conditions, offering end of life care, pain management and bereavement support to families, but despite being this essential part of healthcare, the hospice sector has challenges due to inadequate Government funding and the taxes that they are putting on it, and to workforce shortages. That is all compounded by rising costs and economic uncertainty.

Before I became a Member of Parliament, I have to confess that I had, perhaps fortunately, very little contact with the hospice sector, despite having worked in health and social care for the majority of my career and being a local government councillor for 17 years. During the election campaign, I was invited to the Shooting Star children’s hospice, which has been mentioned by numerous Members across the House. I visited Christopher’s, which is its in-house care facility in Guildford. I think it is actually in the constituency of my right hon. Friend the Member for Godalming and Ash (Jeremy Hunt)—I am sure that the hon. Member for Guildford (Zöe Franklin) will correct me if I am wrong. There I saw the true meaning of selfless day-to-day acts of kindness and care, with people looking after some of the most vulnerable children and their families. They are the absolute exemplar of people providing dying well.

I also have the Phyllis Tuckwell hospice in my constituency, which is currently going through a multimillion-pound rebuild funded by donations from people who have either used or care for our hospice in Farnham. When it is open—hopefully by the end of the year—it will provide 18 new palliative care beds alongside rehabilitation and services for the families as well, along with therapy sessions. Both are shining examples of what dying well should look like.

As other hon. Members have mentioned, the one good thing to come out of the assisted dying debate has been a much greater focus in this House, and indeed across the country, on what it means to die well. I echo some of the comments we have heard: let us get palliative care and hospice care right first, before we start thinking about whether or not we should be allowing people to kill themselves.

Despite the Government’s announcement just after Christmas, which I would be churlish not to welcome, the reality is that adult hospices and children’s hospices are almost totally reliant on charitable donations. The rest comes through the integrated care boards and, as the hon. Member for Scarborough and Whitby (Alison Hume) just mentioned, it is a complete postcode lottery.

I am grateful to the hon. Member for Wimbledon (Mr Kohler) for securing the debate, and he mentioned the significant variation in per person funding depending on where they are in the country and at which hospice they are being treated. The children’s hospice sector is the starkest example, with some places funding just under £30 a head, whereas others fund over £500 a head. This inequity in care clearly leaves some families worse off.

The Government really have not made it easy for the hospice sector. It is still not clear to me that the Health Secretary and the Department of Health had any clue that the national insurance contribution changes were coming down the line. If they were aware, had they allocated this funding beforehand? Was this in their plan, or have they been scrabbling to try to make up the difference since they heard this announcement? Despite asking questions, I have not heard an answer.

We also have not heard whether the Government will cover the costs of the national insurance contribution rise. My personal view is that they must, because the hospice sector, alongside so much of the care sector, is vital not just to the people who use it, but to the wider health economy. Underfunding and taking money from hospice care will have a significant cost impact on other parts of the health service.

[Jim Dickson (Dartford) (Lab)]

The hon. Member seems to welcome the additional £100 million for the hospice sector and, indeed, the additional investment in the NHS that have come out of the Budget, but he seems not to welcome the way in which that revenue is being raised. How would his party raise the revenue needed for the NHS and the hospice sector?

[Gregory Stafford]

Well, the simple fact is that what the hon. Members and his Front-Bench team are doing is ensuring that the NHS is worse off, because raising the money will have a greater impact on the rest of the service. [Interruption.] The Minister for Care is shouting at me from the Front Bench, and I am sure that, in his response to the debate, he can outline whether he and his team knew about the national insurance contribution rises and whether they planned for them.

The other part of this is the workforce, who have been touched on briefly. There is a real shortage of qualified healthcare professionals. Vacancy rates for hospice nurses have risen to nearly 19%, and the corollary is that staff morale is low. Again, the Government need to make sure that the long-term workforce plan that they and the NHS are rolling out includes how we will ensure that hospice staff are part of the long-term funding. Hospice UK has warned, seriously, that without urgent action, some, indeed many, hospices may be forced to close their doors in the next 12 months.

I have some requests of the Government. First, as the hon. Member for Birmingham Erdington (Paulette Hamilton) said, we need them to commit to a long-term sustainable funding model for hospices. That is not to say that hospices should be brought into the central NHS—I personally believe that the innovation of the hospice sector is down to its independence from the NHS—but they need multi-year funding to understand where they stand.

Secondly, as has been mentioned, we need to scrap the postcode lottery that comes from the integrated care boards. Some kind of ringfenced funding, particularly for children’s hospice grants, would prevent a lot of the delays and inequities in the service. As I said, we need to make sure that hospice staff are integrated into the NHS long-term workforce plan and are paid in parity with similar NHS roles.

[Dr Al Pinkerton (Surrey Heath) (LD)]

Will the hon. Gentleman join me in paying tribute to the Phyllis Tuckwell hospice, which does great work in his constituency and mine? I have been speaking to the hospice over the last few days, and it requires £25,000 a day to maintain its services. The hospice has told me that it desperately needs multi-year funding settlements to offer a guarantee of future financial security, as well as a clearly articulated workforce plan to ensure continuity of high-quality staff.

[Gregory Stafford]

I think I mentioned Phyllis Tuckwell at the beginning of my speech, so I entirely agree with the hon. Gentleman. It does fantastic work in Farnham and across Surrey and Hampshire. I am sure like all hospices around the country, it relies on donations but requires secure funding from the Government.

I welcome the £100 million of capital investment. We need to remember that hospices and palliative care are not a “nice to have.” They are absolutely essential charitable services, and they must be fully integrated into the funding and planning frameworks of the Department of Health and the NHS. They provide compassionate, life-changing care to thousands of adults and children every year. However, this vital work is being undermined by short-sighted Government policies.

If the Government are serious about improving end of life care and reducing hospital pressures, they must deliver fair funding, address workforce challenges and ensure that no family are left without the care they need, regardless of where they live. This is not just about numbers—the Minister might listen to this. It is about dignity, it is about compassion and it is about humanity at the most vulnerable time in people’s lives.

[Several hon. Members rose—]

--- Later in debate ---

[Stephen Kinnock]

The hon. Gentleman will not be surprised to know that I have a section in my speech on employer national insurance contributions. I will get to it.

A number of colleagues raised concerns about regional variations. Facts and evidence are very important in that context. To address that issue, NHS England has developed a palliative and end of life care dashboard, which brings together all the relevant local data in one place. The dashboard helps commissioners to understand the palliative and end of life care needs of their local population, enabling ICBs to put plans in place to address, and track the improvement of, health inequalities, and to ensure that funding is distributed fairly, based on prevalence.

[Gregory Stafford]

Will the Minister give way?

[Stephen Kinnock]

I will, but I have to finish at 9.58 pm, so there is only about five minutes left of my contribution.

[Gregory Stafford]

It is generous of the Minister to give way, so I shall be brief. Would funding continue to be produced through ICBs, or will the system be funded centrally?

[Stephen Kinnock]

That is precisely the topic of conversation for officials in my Department and NHS England, who are looking at this issue in the round and deciding how we will work. We need a system that empowers ICBs to deliver at the coalface, but we also need accountability from the centre to ensure that things are delivered. Getting the balance right is never easy, as I am sure the hon. Gentleman will understand; that is what we are trying to navigate.

Alongside NHS England, my officials and I will continue to proactively engage with our stakeholders, including the voluntary sector and independent hospices, to understand the issues that they face. In fact, I will meet the major hospices and palliative care stakeholders, including Hospice UK, early next month to discuss potential solutions for longer-term sector sustainability. That will inform our 10-year health plan.

Tobacco and Vapes Bill (Fourth sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 9th January 2025 Public Bill Committees

[Dr Johnson]

I thank my hon. Friend for making that point. It brings us to the heart of the next part of my speech, which is the inconsistency between different parts of the United Kingdom. We will come on to other inconsistencies in further amendments to clause 1 relating to age verification processes. As for why there are differences in the legislation as drafted, I am afraid I did not draft it; the Minister did. Perhaps he will say whether that was intentional or whether he wishes to amend it later.

[Gregory Stafford (Farnham and Bordon) (Con)]

I just want to clarify the intention of my hon. Friend’s amendments, not to resile in any way from her clear point that she supports the Bill, but to clarify her feeling that the current level of fines and punishments within it are disproportionate, especially if they are going to be levied on a part-time junior shop worker, or perhaps even a Saturday person who is a minor themselves. I want to clarify for the record that she does not in any way feel that the offence should carry a lesser punishment, but believes that first-time offenders should be educated rather than castigated.

[Dr Johnson]

I am grateful to my hon. Friend for making that point. Those who know me or who have listened to my speeches on tobacco and vaping will be in no doubt of my support for the Bill, and I believe that the criminal justice system has its part to play in ensuring compliance, particularly where people recklessly or even deliberately sell products to children. If one talks to children at local schools, one will repeatedly be told which shops they know they can get particular products from.

You were not here this morning, Mr Dowd, but I talked about the last time I was carded when purchasing alcohol. A junior shopkeeper was selling it under the supervision of an adult, and when the adult had walked away, the young chap actually said to me, “Now if you go to the corner shop round there, they will sell you it.” That shop might not have sold me what I was trying to buy, but a different form of alcohol. It is certainly the case that some shopkeepers sell age-restricted products to children with some impunity, and it is important that we catch them and ensure that they are punished appropriately.

--- Later in debate ---

However, one reason we have new smokers is because people, particularly children, start smoking; again, clause 1 will help in that regard. The other reason is because people who smoke come here, either as tourists or migrants, whether regularly or irregularly. How the Minister tackles that group will be interesting. What will happen with tourists to the UK who are legal smokers in their own country? Will they be expected to bring tobacco with them? Presumably, they will. Does that have an effect on imported volumes and how will border control manage that situation?

[Gregory Stafford]

My hon. Friend is making a very interesting point that I personally had not considered before. We need to know more from the Minister, and the point will potentially come up again when we consider smoking in the grounds of a hospital. The Minister has quite rightly pointed out that smoking is a terrible addiction, but if we have people coming to this country—tourists or migrants—who are addicted to smoking, but who are also under the age of sale here in this country, how will we be dealing with them?

--- Later in debate ---

[Mary Kelly Foy (City of Durham) (Lab)]

I wish to speak to new clause 3, which is in my name. I do not intend to press it to a vote, and I will be very brief because there has been a lot of discussion—about three and a half hours—on this part of the Bill already, and I hope it will answer some of those points. I am introducing it because I think it would enhance the Bill’s consistency with the Government’s four-nations approach. New clause 3 would apply to all the nations of the United Kingdom mandatory age verification for purchasing tobacco, vapes and non-medicinal nicotine products, in line with the provisions set out for Scotland in the Bill.

Scotland has had mandatory age verification for anyone who looks under 20 as a legal requirement for purchasing tobacco and vapes since 2017. In lay terms, there is a legal underpinning for Challenge 25, which is voluntary in the rest of the UK. The Bill amends the Scottish system so that from 2033, it will be a legal requirement to verify the age of anyone trying to purchase tobacco who looks like they were born on or after 1 January 2009. My new clause would simply extend that beyond Scotland to ensure consistency for retailers, customers and enforcement agencies.

[Gregory Stafford]

Just for clarification, is the hon. Lady doing this simply to make it equitable across the United Kingdom, or is there something specific in the policy that she thinks will strengthen the Bill or add to it parts that are not covered currently?

[Mary Kelly Foy]

The new clause will make the policy consistent across the nations and simplify the process. If I can carry on, I will expand on those points. The new clause will extend the policy further than Scotland and simplify the process for retailers, customers and enforcement agencies. There has already been a lot of discussion about the implementation of a smoke-free generation, and about trying to make it simple and easy to understand. We heard in oral evidence concerns about the difficulty, when the policy has been in place for some decades, in telling the difference between two individuals in their forties who fall on either side of the policy. While that is likely to be a marginal issue in practice, the new clause will further help to resolve it.

Mandatory age verification currently exists in Scotland and is supported by retailers here. In response to the Minister’s point about it possibly being a burden on businesses, a survey of independent UK tobacco retailers by Action on Smoking and Health in 2024 found that more than seven out of 10 retailers—71%—in England and Wales supported this.

--- Later in debate ---

[Sarah Bool]

I want to take a step back and look again at clause 1 itself. Enforceability has to be considered as an important element of achieving the smoke-free generation. As I keep stating, as a former lawyer, I want to be absolutely sure before I can give further support.

I seek assurances from the Minister on the implementation of the policy with regard to Northern Ireland, if it is truly to be a smoke-free nation. One of the provisions of EU law in the Windsor framework is the EU’s second tobacco products directive—TPD2—which applies to Northern Ireland. It lays down various requirements that must be satisfied for tobacco products and vapes to be marketed in the EU—for example, on ingredients, emission levels and packaging. Most crucially, it also states that member states, which include Northern Ireland for these purposes,

“may not...prohibit or restrict the placing on the market of tobacco or related products which comply with this Directive.”

So a generational smoking ban may be incompatible with TPD2.

Similar plans for generational bans in Denmark and the Republic of Ireland were ditched in 2022 and 2024, respectively, because of TPD2. I ask the Minister whether the Department of Health and Social Care has any plans for this issue, and whether the Attorney General has formed a view that can be shared with us. I think we have learned over the years that it is imperative that we do not jeopardise our Northern Irish friends.

[Gregory Stafford]

It is a pleasure to serve under your chairmanship, Mr Dowd. I thank the shadow Minister for her comprehensive look at the clause, and the amendments and new clauses that go with it. I look forward to similar in-depth discussion on the rest of the Bill over the coming sittings.

I will state at the outset that I have never smoked a cigarette or tobacco-based product, or indeed any other product—legal or illegal—and I come with a background of being vehemently anti-smoking, so it may surprise some Members that I abstained on Second Reading. I did so for two reasons, really.

I support entirely the vapes element of the Bill, and had the Bill contained just that, I would have supported it wholeheartedly. I will not talk about vapes now, because that is a separate part of the Bill. My concern is with the enforceability of the tobacco element of the Bill, and indeed about some of the civil liberties that I outlined earlier. That said, I hope that hon. Members take my comments as helpful, supportive and inquisitorial rather than critical of the principle of the Bill. I entirely support the idea that we must have a smoke-free generation, as outlined in clause 1.

I abstained for two reasons. The first was personal. My paternal grandparents were both chain smokers. I do not have medical evidence of this, but I would say that both died because of that chain smoking. My grandfather died when I was three months old, so I do not have any recollection of meeting him. Having heard from people in Haslemere who did know him since becoming the Member of Parliament for the area where he lived, I feel that I am definitely the poorer for having not had the chance to meet him. My grandmother lived a lot longer; I knew her very well and loved her very much. But I have to say that the smell of tobacco and smoke in her house was not something I looked forward to as a child; in fact, I dreaded it. When I went back to visit that property, which is now in the hands of a lovely woman in Haslemere, it was refreshing that it did not have the pervasive smell of smoke and, to be frank, decay that went with it.

--- Later in debate ---

[Mary Kelly Foy]

As I pointed out, surveys of retailers in Scotland show that 83% of them do not think it is a burden. As things are, there are fewer tobacco sales year on year, and as we progress, the sale of tobacco will phase out anyway; it will not be a thing of the future for businesses. In the meantime, they have pointed out that this measure aids them.

[Gregory Stafford]

I am interested to hear those facts. I know the hon. Lady will not press her new clause to a vote, and given that the Government do not support it, as far as I can tell, it is probably not going to be part of the law, but perhaps we can have a further discussion on Report.

[Sarah Bool]

On that point, the concept of having an age verification policy so that all retailers know what to do in these situations is not necessarily a bad thing in itself, but the difficulty perhaps lies in making it an offence not to have one, because it will be in-built as part of that process.

[Gregory Stafford]

My hon. Friend makes a good point. We in this Committee want to ensure that nobody who does not have to dies of smoking or tobacco-related issues, but we do not want to make the regulations so tight that they make things more complicated than necessary for business.

[Dr Johnson]

I do not want to put words into the mouth of the hon. Member for City of Durham, but I think she is trying to fill a gap with her new clause. The Government have said that businesses need to take reasonable steps and people need to take reasonable steps, but they have not defined those reasonable steps. Even today, it does not seem clear what they might be, although we know what they are not.

[Gregory Stafford]

I thank the shadow Minister for her intervention. She made that point powerfully during her speech. It is vital that we in this Committee, people listening to at home and those who will have to implement or abide by this legislation are really clear what those steps are. I hope the Minister is able to give us some surety on that.

We must ensure that we expand the acceptable forms of identification as much as possible, especially in clause 1, as the shadow Minister said. We have seen this in all sorts of walks of life, and she made the reasonable comparison with voter ID laws. Even if it is not something that the Minister can guarantee today, I hope that further forms of ID, such as veterans’ cards, will be inserted on Report, because as the age of people who are still allowed to smoke increases, they will have different forms of ID from younger people.

I will finish with a personal comment, if you will indulge me, Mr Dowd. I have two daughters, one of whom is nearly seven and one who is eight, and I find it fascinating that they find the idea of people smoking both bizarre and abhorrent. When we drive along in the car or walk along the street and they spot someone who is smoking, they rather loudly, and perhaps slightly to my embarrassment, point it out and say, “Daddy, that man”—or woman—“is smoking. Isn’t it awful?” Although the steps in the Bill are necessary and useful, I think that we as a nation, and Governments of all different colours, have done a good job in dealing with this. What worries me more for our young children is vapes, which we will discuss in future sittings. I will be happy to support clause 1 if it comes to a vote.

[Jack Rankin]

Judging from the tone of debate so far, I might be the most sceptical about the principle of clauses 1, 50 and 68, and I appreciate that perhaps I am in the minority. I will talk to what I see as the principle of those clauses and put on the record where I agree with the Minister and the shadow Minister. I will also give international examples that we should bear in mind, particularly in relation to the scope of “tobacco products”, which I think is wrong in these clauses.

We talk about a smoke-free generation. If we were to tweak that slightly and call it a “cigarette-free generation”, I would share the aim of the Government and the previous Government; that is laudable pretty much every which way. The Minister, the shadow Minister and Members from across the Committee have made eloquent contributions about the damage that smoking cigarettes does to people over many years. It clearly should be a priority of a Government of any colour to reduce cigarette smoking significantly. As my hon. Friend the Member for Farnham and Bordon eloquently said, we have made significant progress on that. Yes, there has been legislation, but the change has also been cultural. The legislation has been important. Government Members made the point to me earlier that some of the arguments I have used I might have used against previous legislation that sought to put barriers between people and smoking. But the cultural element that my hon. Friend the Member for Farnham and Bordon talked about is deeply embedded in most young people today.

That is why, despite sharing with the Government the aim of moving to a cigarette-free generation, I do not think I can quite get over the principle of what they are doing to civil liberties in this Bill. We are on the journey to a cigarette-free generation anyway, so why would they need to use—I do not mean this in an incendiary way, although they might take it that way—quite draconian powers? I would say that that is what this is.

Tobacco and Vapes Bill (Third sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 9th January 2025 Public Bill Committees

[Dr Johnson]

I thank my hon. Friend for his helpful intervention. I do not know whether any Member present has worked in a small corner shop and could tell us whether they have the same level of technology. Perhaps the Minister or his officials know whether the same level of technology is used in shops across the board. I am afraid that I do not know the answer to that.

[Gregory Stafford (Farnham and Bordon) (Con)]

On that point, will my hon. Friend give way?

[Dr Johnson]

Yes; if my hon. Friend knows the answer, I would be delighted to hear it.

[Gregory Stafford]

I do not know the answer to that question, although I suspect that many such shops do not. Although I agree with my hon. Friend about the thrust of the Bill, something that does concern me comes not from the retailer point of view but the consumer point of view. At the moment—please do not disabuse me of this view—when I go and buy a bottle of wine or a pint of beer, I am very rarely, if ever, IDed. But I accept that if, on the rare occasion that I am IDed, I do not have a form of identification, it is not the biggest problem in the world. Most of the time, however, people can see that I am over the age of 25 or over the age of 18, so it does not happen.

If the Bill were to go forward in its current form, every smoker would essentially have to carry a form of ID all the time. Some, especially the older generation, might not have a suitable form of identification and some—if they are, like me, a civil libertarian—might not want to carry ID, so how do we get around that point in the Bill to ensure that we do not end up having ID cards for older people by the back door?

--- Later in debate ---

[Dr Johnson]

I thank the Minister for his intervention, although I am not sure what he is implying about the age of my hon. Friend the Member for Windsor—

[Gregory Stafford]

Wisdom!

[Dr Johnson]

Wisdom or age, but I shall be cautious not to answer too closely.

--- Later in debate ---

[Dr Johnson]

The hon. Gentleman is exactly right, in my personal view, to say that. As we heard before, the previous Government wanted to ensure that in bringing forward a Bill, they were not going to criminalise people with an addiction to a product that they could not quit, and therefore leave them in a situation where they could no longer buy the product they needed to feed that addiction. Obviously, we want them to stop, but we do not want to make them stop by making them criminals. So, yes, I would be concerned that sticking in a sudden increase to 25 would mean that any smokers legally accessing tobacco products between the ages of 18 and 25 would find themselves somewhat stuck. That is not something I would wish to see.

[Gregory Stafford]

As a point of clarification, what the proposals in the Bill, and indeed the amendment, deal with is the selling of tobacco products, not the consumption. So when we are talking people not being able to smoke, they would be able to, but a retailer would not be able to sell them tobacco products. I say that just so we are clear what we are talking about.

[Dr Johnson]

According to clause 1, my hon. Friend is right.

[Gregory Stafford]

Yes, under this clause.

[Dr Johnson]

Under this clause, it is true that somebody would not be able to purchase tobacco, but clause 2 means that somebody cannot purchase tobacco on behalf of somebody else. It would not be possible legally for somebody under the age of 25, if the clause was amended, or somebody born after 1 January 2009, if it was not, to buy tobacco, but it would also be illegal for them to use it because, under clause 2, which provides for proxy purchase, the person who gave the younger individual tobacco would themselves have broken the law.

Tobacco and Vapes Bill (First sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[The Chair]

I will go to Gregory Stafford first, and then I will move over to the Government side.

[Gregory Stafford (Farnham and Bordon) (Con)]

Q Do you have any concerns about the impact of the Bill on vapes as a smoking cessation tool? As my hon. Friend the Member for Sleaford and North Hykeham said, vaping in children is abhorrent, and I am glad that the Bill is addressing that, but how can we ensure that, as a cessation tool, vapes remain part of the panoply of options for smokers who are trying to give up?

Professor Sir Chris Whitty: That is a very important question. I think everybody would agree on two things, and then there is a way of making sure that we get to the exact middle point of this argument.

First, as you imply, in this country—it is not universally true—there is a strong view that we should try to continue our support to allow current smokers who are finding it very difficult to get off because of their addiction, which has taken away their choice, to move to vaping as a step in the right direction. I think that is broadly accepted in this country. As I say, there are some countries where that is not accepted so, to be clear, that is not a universal view.

At the other extreme, as you imply—or state directly, actually—I think everybody would agree that the marketing of vapes to children is utterly abhorrent. I think almost everybody would agree that marketing vapes to people who are current non-smokers, given that we do not know the long-term effects of vapes because we have not had them for long enough, is a big mistake. We should not allow ourselves to get into a position where, in 20 years, we regret not having taken action on them.

The question then is: how do you get the balance? In my view, this is sometimes made more complicated than it needs to be. I think it can be very simply summarised: “If you smoke, vaping is safer; if you don’t smoke, don’t vape; and marketing to children is utterly abhorrent.” That is it, although it is sometimes made a lot more convoluted. Our view is that the Bill gets that balance right.

In general, if people’s profession is getting people who are current smokers off, they tend to be more at the pro-vaping end, because they see the dangers for current smokers. People who deal with children, such as Dr Johnson, who has taken great leadership in this area and is very much in the centre of her profession, and the Royal College of Paediatrics and Child Health take a very strong anti-vape view, because they have seen the effects on children. It is getting the balance between those two, and I think that the Bill does that.

But—and it is an important but—the Bill takes powers in this area, and that means that if we go too far in one direction or the other, there is the ability to adjust that with consultation and with parliamentary secondary legislation. That allows for the ability to move that point around if it looks as if we have not got it exactly right. It may also change over time as the evidence evolves.

[Dr Cooper]

Q My question is around inequalities. How effective or otherwise do you think the Bill will be in reducing inequalities? Are there any areas of the UK that have specific challenges related to tackling smoking prevalence that you would like to highlight?

Professor Sir Michael McBride: That is a really important question. We talked before about the blatant marketing of tobacco and vapes. There is also the preying of the industry on those more socioeconomically deprived areas.

If we look at smoking rates in those more socio- economically deprived areas, they are two to three times higher than in less socioeconomically deprived areas. If we consider the death rate from smoking-related conditions, it is twice as high. If we look at lung cancer rates, they are two and a half times as high in those areas. That is a direct consequence of the smoking incidence in more socioeconomically deprived areas. The health inequalities associated with the consumption of tobacco are significant and great.

If we look at smoking in pregnancy and all its consequences in terms of premature birth, stillbirth and low birthweight, we see that smoking among women from more socioeconomically deprived areas is four and a half times higher than among those in less socioeconomically deprived areas. The health inequalities argument and the case to be made for addressing that within the Bill is huge. This is an opportunity that we must not pass up to narrow the adverse health consequences.

Professor Sir Gregor Ian Smith: It is my very clear view that the provisions within the Bill will help us to tackle some of the inequalities associated particularly with tobacco smoking. If I look at the situation in Scotland, 26% of our lowest socioeconomic group are smokers, compared with 6% of our highest socio- economic group.

The gradient that Sir Michael has spoken about in terms of the subsequent tobacco-related disease that those groups then experience is really quite marked, whether that be cardiovascular disease or the numerous cancers associated with smoking. All of those can be addressed by trying to tackle the scourge of these tobacco companies preying on more vulnerable groups within our society, whether that be those who experience socioeconomic circumstances that are much more difficult and challenging for them, or whether that be particular groups that are more likely to experience mental health conditions.

All of these must be tackled; people must be assisted not to develop addictions that lead to lifelong smoking and problems with their health thereafter. I am very clearly of the view, both in terms of smoking and, it is important to say, of vaping, that the targeting of those groups that creates those inequalities within our society is something that this Bill can address.

Oral Answers to Questions

Gregory Stafford Excerpts

Tuesday 7th January 2025 Commons Chamber

[Andrew Gwynne]

Local authorities were pre-selected using the income deprivation affecting children index average rank scores, with a rural and urban weighting applied. Tackling child inequalities in health and outcomes is crucial. As resources allow, it is the ambition of the Government to ensure that Start for Life services reach every child.

[Gregory Stafford (Farnham and Bordon) (Con)]

15. What steps he is taking to ensure that brain tumours are included in the national cancer plan.

[The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)]

Let me start by commending the hon. Gentleman for his fundraising efforts to fight cancer in Surrey and his support for the Brain Tumour Charity. We are committed to ensuring that people with brain tumours have access to more effective treatments and excellent care through, for instance, our national cancer plan, and we will give more details shortly.

[Gregory Stafford]

I thank the Minister for his answer, and for his googling of my background! Early detection is essential in ensuring that brain tumours do not fall further behind other cancers in priority. Will the Minister update us on the Government’s progress to ensure that screening is prioritised?

[Andrew Gwynne]

We absolutely want to ensure early detection of these cancers, and I recently met representatives of the Brain Tumour Charity to discuss how we can roll that out. The Government are investing an awful lot of money in tackling cancers, but there is a great deal more that we can do on brain cancer.

NHS Backlog

Gregory Stafford Excerpts

Monday 6th January 2025 Commons Chamber

[Gregory Stafford (Farnham and Bordon) (Con)]

I welcome this debate, although we have had a number of health debates over the past few sitting days that have crystallised the real problem that we see in the NHS. It is stark that none of the Government Members have mentioned covid thus far and its massive impact. [Interruption.] The hon. Member for Carlisle (Ms Minns) is pointing at herself; she might have mentioned it, but she did not set out the absolute devastation that covid wreaked on our services.

Before I came to the House, I worked for the Getting It Right First Time programme, an NHS England programme that was initially funded by my right hon. Friend the Member for Godalming and Ash (Jeremy Hunt) when he was Health Secretary, and again when he was Chancellor of the Exchequer. The programme made a significant difference in getting rid of “unwarranted variation” within the NHS, because while there is some amazing service, treatment and patient care in the NHS, we have to admit that there is also some poor and inefficient patient care.

The Getting It Right First Time programme tried to improve patient care and ensure that the worst-performing trusts were brought up to the level of the best-performing trusts; I hope that the programme will continue to try to achieve that under the current Government. Areas for improvement include high-volume, low-complexity work, such as cataract, hip and knee operations. There are massive backlogs of such procedures in the NHS that could be cleared if some failing trusts reached the level not of the top-performing trusts, but of the top quartile, or the top 10%.

[Lewis Atkinson (Sunderland Central) (Lab)]

The hon. Gentleman worked in the NHS before covid, as did I. He mentions the impact of covid, but does he not recall that in December 2019, before covid hit, standards had already fallen, and only 84% of patients were being treated within the 18 week target? Why was that allowed to happen under the previous Government?

[Gregory Stafford]

I accept that the pressure on the NHS went way beyond covid, as the hon. Gentleman will remember, but to use the Secretary of State’s term, covid was the point at which the NHS was “broken”, and it is taking a long time to recover.

The Government are right to push for more localised services, and to bring services closer to the patient. Access to GPs is a fundamental part of that, but we know that GPs are overstretched. The previous Government really pushed Pharmacy First, which was a superb programme. This Government want to go further with it, but there are disincentives for general practitioners to embrace Pharmacy First. What will Ministers do to ensure that there is no financial disincentive to work with pharmacies? If we are to deal with the backlog, there has to be a financial incentive.

What was concerning about today’s statement from the Secretary of State was the lack of genuine reform. There was a lot of rehashing of previous policies, perhaps eking them out a tad further than the previous Conservative Government did, but I think the Secretary of State himself said that if anyone is able to reform the NHS, it is a Labour Government. While I was quite interested in what he was saying as shadow Secretary of State, I have been deeply disappointed by what he has said since. It appears to me that unfortunately the union paymasters and the inertia in the NHS have captured him and his Front Bench. I hope that I am wrong, and that the Minister will tell me differently this evening, but that is what I have seen.

Locally, the reality is that there is a problem with being able to bring services closer to home. My hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) mentioned the problem of accountability for ICBs. I have the fortune, or misfortune, depending on how one looks at it, of having three ICBs in my constituency. To use a previously mentioned term, there is a lot of unwarranted variation in how they deal with my constituents, and with me as a Member of Parliament. A big issue in Bordon is that we want a brand new surgery in the area, but there has been no conversation with the ICB about how that might go ahead. Likewise, we are really keen for Haslemere hospital to move from being a district hospital to having an urgent treatment centre. It is vital that we get that moving. The community hospital in Farnham could also be somewhere treatment is done closer to home. I urge the Government not to sit back, but to use their majority and reform the NHS for the benefit of all our constituents.

--- Later in debate ---

[Gregory Stafford]

Will the hon. Gentleman give way?

[Peter Prinsley]

May I carry on, as I have very little time?

I am glad that the Prime Minister has made general practice and care in the community a central part of his plan. General practice is the front door to the NHS. Patients who have a genuine connection with one or two GPs are less ill and live longer.

There is an illuminating article entitled “Closer to home” in this month’s Fabian Review by my Suffolk GP colleagues Drs Reed and Havard, who reimagine GP as a comprehensive community health service close to the patient, with multiprofessional teams of health workers and with mental health services and district nursing all in one place. Patients know who their doctors are and know that the community health centre is the place to go. Let us call them Bevan community health centres. We really can manage most clinical problems in the community, and investing in our brilliant GPs is truly the key to the crisis. Community hubs with diagnostic capabilities for larger populations would send to hospital only people who need to go to hospital.

We must do something about productivity. I started my career with four workers in the theatre operating on eight children, only to reach a situation today of operating on four children with eight workers. As we reform and rebuild our NHS, let us bring the 1.5 million staff members with us on this great journey, for it is on them that we and the NHS depend. The measures announced today will surely help, but only if we find enough staff and invest in training. Let us look after those who look after us, with fair pay, fair conditions and a great deal of respect. That must be our mission.

Healthcare: Hampshire

Gregory Stafford Excerpts

Wednesday 20th November 2024 Commons Chamber

[Dr Chambers]

I completely agree with the hon. Gentleman. As a vet who has worked in public health programmes around the world, I know that it has been proven time and again that it is always more cost effective to treat people in their communities and keep them healthy, than to treat them in hospital when they get sick. We need to focus on that. I know the Government have said that they want to move treatment from hospitals into the community.

[Gregory Stafford (Farnham and Bordon) (Con)]

I suspect the hon. Member understands that I probably will not agree with him on the thrust of his argument about Basingstoke hospital. However, on the point about local community services, in my seat, in Whitehill and Bordon, there is a debate about whether we should keep the old Chase community hospital or build a new health hub. There are arguments on both sides, but the one thing that unites the two is the lack of communication from the Hampshire and Isle of Wight integrated care board. Does the hon. Gentleman find it as frustrating as I do that that ICB seems to not want to communicate with residents across the county?

[Dr Chambers]

I agree with the hon. Gentleman; when there is a lack of communication with residents, decision makers and any other interested stakeholders, that is when there are difficulties, such as rumours and unnecessary anxiety. Improved communication, whether in healthcare or in any Government Department, solves a huge number of problems.

On the point made by the hon. Member for Strangford (Jim Shannon) about accessing healthcare when people live in rural areas, I have a story about Margaret, who lives just south of Winchester and who wrote to me saying that she had been given an appointment at Basingstoke for a particular type of X-ray. Her journey to Basingstoke hospital took well over an hour and involved multiple buses and a train, plus considerable walking time. Margaret has chronic obstructive pulmonary disease and gets exhausted walking long distances, and she cannot easily afford a taxi all the way from Basingstoke back to Winchester. She asked me whether people without cars were to become second-class citizens and be denied access to decent healthcare options. We have to look at individuals’ situations, and that can include needing really good public transport. The more community care we have in people’s towns and villages, the quicker they can get there from their homes.

The other side of emergency care and A&E departments is social care. We have said many times that we cannot fix the NHS without fixing social care. We know that in the Hampshire hospitals NHS foundation trust, there are between 160 and 200 people at any given point who are well enough to be discharged and more appropriately cared for in the community with social care packages, but who are currently stuck in a hospital bed and cannot be discharged. That means that patients cannot be moved out of A&E and people cannot be removed from ambulances as quickly as they could be, which means that ambulance waiting times are longer.

When I spoke to the CEO of Winchester hospital, he said that the single biggest help they could get from Government would be another 160 social care packages. Although people ask where the money will come from, we know it is more expensive to keep someone in a hospital bed than to give them a social care package. We have winter pressures coming up—indeed, winter has already started—and the CEO has told me on more than one occasion that, to help with those winter pressures, more social care packages would probably be the single biggest intervention that would make a huge difference. Local authorities struggle to afford social care packages and the NHS trusts have to fund some of those packages out of their NHS budget, which is primarily meant for treating people in hospital.

One of the biggest concerns raised by Winchester residents is the potential removal of consultant-led maternity services at Winchester hospital. That means that if a woman were to haemorrhage or require an emergency C-section during labour, she would need to be transferred. To put that into perspective, in April 2024, 22.7% of births were performed via emergency C-section at Winchester hospital. It is clear that surgical interventions are not an unusual eventuality, but something that will affect more than one in five mothers.

An emergency transfer in such a situation would inevitably put the lives of some women and babies at serious risk and, tragically, some could be lost. A constituent wrote to me about her daughter, who had recently haemorrhaged badly after giving birth to a baby who was in a breech position. The blood transfusion and lifesaving surgery to remove her placenta needed to happen within minutes, and it is unthinkable what would have happened had there been no consultants on hand. As someone who has performed many emergency caesareans—on animals rather than on humans—I know that time is of the essence, and anything that delays surgical intervention can make a huge difference, not just to whether the person and the baby survive but to whether the baby has potential brain damage and other life-changing complications.

As the Liberal Democrat mental health spokesperson, I see this debate as a chance to highlight how desperately we need more resources put into mental health, alongside a more holistic approach to treatment. When speaking to residents in Winchester, one of the most common concerns is the difficulty in accessing mental healthcare, and that is especially true for parents who are struggling to access mental healthcare for their children.

I spoke to a constituent near Swanmore who was struggling to access the mental healthcare and support they needed for their child who was anorexic and had an eating disorder. They had been informed that their child had to reach a lower BMI to qualify for the threshold to get treatment, because resources are so stretched. That would not be considered even remotely acceptable for any other disease. A person with cancer would never be told that they needed to reach stage 4 before they qualified for treatment. We know that outcomes with delayed treatment for mental and physical health disorders, of which eating disorders are a combination of both, will be much less successful and much less cost-effective, requiring longer and less successful treatment the longer that the condition is left. I urge the Minister to look with particular concern at the mental health of young people and children. Delays in mental health treatment for anyone can be catastrophic, but a three-year delay for someone who is only 13, 14, or 15 is a huge chunk of their life.

As part of that, we urgently need to invest in primary care. Failing to address this will only place greater pressure on our already overstretched hospitals. I have spoken to people who have spent extended amounts of time in hospital beds, because they cannot get the mental healthcare that they need.

Similarly, the lack of NHS dentists often forces patients to turn up to hospital, sometimes needing a general anaesthetic, to sort out tooth root abscesses, which costs more than providing NHS dental care. It seems as though all the dentists I speak to say that their current contract for performing NHS care is not fit for purpose. I urge the Minister to look at this as an urgent priority, because so many people are not receiving the dental care that they need. It seems as though this whole issue will not be resolved until the NHS contract is looked at.

The other issue that affects people getting healthcare in their communities, especially around Hampshire, Winchester and the Meon Valley, relates to struggling pharmacies. The situation for pharmacies seems to be very similar to that of the dentists in that their arrangement with the Government for providing prescription services does not seem to be fit for purpose. It seems to be costing pharmacies money to provide prescription drugs, and they are telling me that their businesses are no longer viable. The more pharmacies that we lose, the further people will have to travel to not only collect drugs, but get medical advice and vaccines.

In conclusion, I wish to pay tribute to NHS staff. I imagine that they dread the winter coming up. Every year, it is a stress for them. Every year, they are overworked. And every year, we know that both clinical and non-clinical staff will work longer hours than they are contracted to do. I know that they will be bracing themselves right now. They will be busier, and they will be putting themselves at risk from getting things such as flu, covid and the other respiratory diseases that we see in the winter. One thing that we can all do, both as the public and the Government, is to encourage everyone to get vaccinated ahead of these winter pressures. Anything we can do to prevent a trip to hospital will make their job easier and make it less likely that they will get sick.

--- Later in debate ---

[Andrew Gwynne]

As I said before the hon. Gentleman’s intervention, ultimately these are local decisions, and they must be clinically led. If the trust has decided that certain outcomes that he would like to see are out of scope of the consultation, we must take it as read that there are sound clinical reasons for that. If he thinks otherwise, I am sure that he can bring that up with my hon. Friend the Minister for Secondary Care, but ultimately we must be guided by the clinicians. They know, more than we Ministers in Whitehall will ever know, what the better outcomes for their areas are.

The hon. Gentleman mentioned primary and community care. We know that patients nationally and in Hampshire find it increasingly difficult to see a GP. We are committed as a Government to fixing the front door to the NHS, to ensure that patients receive the care that they deserve. If patients cannot get a GP appointment, they end up at accident and emergency, which is worse for them and more expensive for the taxpayer. That is why we will shift the focus of the NHS out of hospitals and into community. One of our three big shifts is from hospital to community; the others are from analogue to digital, and from sickness to prevention. Those three things, taken as a whole, could be quite transformative in how we deliver primary care.

[Gregory Stafford]

I agree entirely with the Minister on the shift from hospital to community. I do not want to labour the point that I made when I intervened on the hon. Member for Winchester (Dr Chambers), but in the Hampshire part of my seat, we have a debate about whether we will still have Chase community hospital or a new health hub there. They are both essentially local services. The ICB is dragging its feet and will not make a decision on which it will be. Local people do not know what will happen, and decisions are being kicked down the road by the ICB. As my hon. Friend the Member for Hamble Valley (Paul Holmes) said, the leadership of the Hampshire and Isle of Wight ICB is not fit for purpose. Will the Minister meet us and them to ensure that we can get this moving?

[Andrew Gwynne]

I hear loud and clear what Conservative Members say about the leadership of their ICB. I hope that the ICB management will obtain a copy of today’s Hansard and read not only those comments, but the Minister’s reply. I expect them to make decisions in a timely fashion, so that there is some certainty for the local population about the new make-up of health and care services in that area—not just for the sake of patients and the local population, but staff. As we redesign services and change towards more preventive, community-focused care, some parts may become obsolete, and it is absolutely crucial that we take the workforce, as well as the population, on that journey of change in services. I very much hope that the hon. Gentleman’s ICB leadership will have heard the message from the Minister at the Dispatch Box, which is that they really need to crack on, make a decision, communicate it and work with Members of Parliament, the public and staff on whichever changes they propose.

I return to primary and community care. As I said, our manifesto commits to moving towards a neighbourhood health service, with more care delivered in local communities, so that problems are spotted earlier. We will bring back the family doctor by incentivising GPs to see the same patient, so that ongoing or complex conditions are dealt with effectively. In doing so, we will improve continuity of care, which is associated with better health outcomes for patients, and our plan will guarantee a face-to-face appointment for all those who want one; we will deliver a modern booking system that will end the 8 am scramble. That is crucial in improving access to general practice.

The hon. Member for Winchester rightly raised the huge problems with dentistry in his area, which are not that uncommon across the whole country. I do not believe that the previous Government’s dentistry recovery plan went far enough; too many people were still struggling to find an NHS appointment. We are working to ensure that patients can start to access additional urgent dental appointments as soon as possible, and we will target the areas that need the most—the so-called dental deserts. Integrated care boards have started to advertise posts through the golden hello scheme. This recruitment incentive will see up to 240 dentists receive payments of £20,000 to work in the areas that need them most for three years. The common reason why children aged five to nine are admitted to hospital—this is absolutely shocking in the year 2024—is tooth decay. We will work with local authorities to introduce supervised toothbrushing for three to five-year-olds in the most deprived communities. These programmes are proven to reduce tooth decay and boost good practice at home.

To rebuild dentistry in the long term, we will reform the dental contract with the sector, with a shift to focusing on prevention and the retention of NHS dentists. To be fair, this has been an issue for all Governments, going back to the Labour Government who introduced the dental contract. They did so for the right reasons, but in 2010, we recognised that the dental contract was not working in the way we envisaged, and that it had to change. It is shocking that 14 years have passed since then with no real action having been taken—we are determined to fix that. At the same time, we will not wait to make improvements to the system to increase access and incentivise the workforce to deliver more NHS care. We are continuing to meet the British Dental Association and other representatives of the dental sector to discuss how we can best deliver our shared ambition of improving access for NHS dental patients.

I have to say that the statistics for Hampshire and Isle of Wight integrated care board make sorry reading. Only 36% of adults were seen by an NHS dentist in the 24 months to June 2024, compared with 40.3% across England, and 54% of children were seen by an NHS dentist in the 12 months to June 2024, compared with 56% across England. In 2023-24, there were 46 dentists for every 100,000 people in the hon. Gentleman’s trust, whereas the national average across all ICBs in the same year was just under 50 dentists, and in 2024, the general practice patient survey success rate for getting an NHS dental appointment in the past two years in the Hampshire and Isle of Wight ICB area was 72%, compared with 76% nationally. They are not great statistics nationwide, but they are certainly not brilliant in the ICB of hon. Members present, and we look for real improvements there.

Turning to the pharmacy sector, we want to take pressure off GPs by increasing the services offered in community pharmacies. There is so much more that our pharmacists could and should be doing to deliver basic healthcare services on the high street and in the community, as part of the shift from hospital to community. That would free up thousands of GP appointments in cases where people do not really need to see a general practitioner for their condition. We are committed to looking at how we can further expand the role of pharmacies and better use the clinical skills of pharmacists as more become independent prescribers—that is where the potential gets really exciting. Now that the budget for Government has been set, we will resume our consultation with Community Pharmacy England shortly. I hope Members will understand that I am unable to say more until that consultation has concluded. Suffice it to say that Pharmacy First and community pharmacies have a huge role to play in improving health outcomes in the community.