Department of Health and Social Care

Debate between Gregory Stafford and Sarah Bool

Wednesday 5th March 2025 Commons Chamber

[Sarah Bool (South Northamptonshire) (Con)]

The Government came into office making all the right noises about tackling waiting lists and delivering a better healthcare service, which all our constituents want to see. However, since their election, I am concerned that Ministers are giving out more money—about £22.6 billion —for the day-to-day running of the NHS, without plans about how that may be spent to reform our health service, make it more efficient and support priority areas, such as dentistry, general practice or hospice care.

The Government are seemingly giving with one hand but taking with the other. No one should overestimate the impact of the increase of the employer national insurance contribution on our GP surgeries. Both Towcester and Brackley medical centres in my constituency have said that that increase will cost at least £40,000 to £50,000 and may result in redundancies, stopping the growth of their practices. Our surgeries are not here to make profit, but to deliver care, and attacks like this make care unsustainable.

The Darzi report said:

“The NHS budget is not being spent where it should be—too great a share is being spent in hospitals, too little in the community, and productivity is too low.”

[Gregory Stafford]

I agree entirely with what my hon. Friend says, but has she seen anything from this Government that suggests that there will be a significant shift from acute care in hospitals to community care, despite the rhetoric that we have heard from the Government Benches?

[Sarah Bool]

I concur that I have not seen anything, which is why today’s debate is so important. My GPs tell me that more attention needs to be given to GP practices: they are the praetorian guard who can ultimately protect the NHS. Access to timely appointments is crucial, as is rebuilding the key relationship and contact between a GP and their patient.

Tobacco and Vapes Bill (Thirteenth sitting)

Debate between Gregory Stafford and Sarah Bool

Committee stage
Tuesday 28th January 2025 Public Bill Committees

[Gregory Stafford]

I completely agree that we could very easily ban tobacco and vaping for everybody at every age. That would be the biggest incentive for people to quit. The Government—I think rightly—are not doing that, because they are not looking to criminalise people who are currently addicted to tobacco and vapes. If we are allowing people to do something legally, there should be places where they can do so safely and not harm others, such as their own children. I am sympathetic to the public health argument that the hon. Gentleman makes but, in practical terms, there may be areas where this is a problem.

My final point is really a question for the hon. Gentleman: under what regulations would the local authority be enforcing such byelaws? Would it be through the penalties and enforcement activities in this Act itself —if it becomes law—or would there be some sort of fine or penalty system that the local authority could use? While there are potential fines and enforcement activities on the face of this Bill, if there were local regulations, would these be in line with what is in the Bill, or would there be some other fining system that a local authority could dream up itself?

[Sarah Bool (South Northamptonshire) (Con)]

Taking on board what you said, Mr Pritchard, I just want to build on the point that my hon. Friend made about enforcement—I always talk about enforcement in practice. I want to know how rules will be advertised between different jurisdictions. I think we will end up spending an inordinate amount of money on trying to run a campaign that could have been better spent on helping with smoking cessation or on more practical measures.

Tobacco and Vapes Bill (Tenth sitting)

Debate between Gregory Stafford and Sarah Bool

Committee stage
Tuesday 21st January 2025 Public Bill Committees

[Gregory Stafford]

My hon. Friend makes a good point, which she has already made during her interventions on this clause. It is vital to understand what is in the chemical make-up of the different flavours when the Minister is making those decisions.

That brings me neatly on to my next point, which is about the flavours themselves. I know that the Minister and the shadow Minister have raised unicorn milk, tutti-frutti and bubble gum flavours and all those kinds of things. I suggest to the Minister that it is less the flavour itself that appeals to children—as my hon. Friend the shadow Minister said, I do not know what unicorn milk tastes like, and I doubt any child does either—but that the phraseology “unicorn milk” sounds exciting and appealing to a child, whereas orange or banana may be less exciting.

When the Minister looks at this issue, I suggest that he looks not necessarily to ban a flavour, but to ban the naming and descriptions of those flavours, which are clearly appealing to children. If someone is looking to stop smoking and is using a vape to do so, it is not unreasonable that they should know whether what they are buying is orange, blackberry or strawberry-flavoured, whereas the terminology being used, which we have discussed in this debate already, appeals to children.

I will bring my remarks to a close. I obviously agree with the Government’s intention to target specific flavours that appeal to young people to preserve harm reduction, but we need to monitor and assess the impact of that regulation over time. When the Minister winds up the debate on the clause, will he give some indication of how that analysis and the impact assessment of the bans on specific flavours has impacted on smoking cessation, hopefully stopping children being dragged into vaping?

[Sarah Bool]

I want to build on the points my hon. Friends have made. As we have said, clause 92 relates to the flavouring of vapes. In the future, we will have to be incredibly agile in regulating in this area. It clearly needs further investigation, because different bodies are all disagreeing on whether we should limit the number of vapes, the flavours or the range and on what is going on. In the written evidence provided to Members, Cancer Research UK, which the shadow Minister mentioned, made some interesting observations, which I will put on record. It says that:

“Current evidence seems to suggest that e-cigarette flavours influence vaping initiation in both young people and adults who smoke. We know that the range of flavours of e-cigarettes are a large part of the appeal for both young people and adults. When taking action on e-cigarette flavours, a balance needs to be struck between dissuading uptake in young people and maintaining an appeal to those who use vapes to quit smoking, so they are not deterred from transitioning away from tobacco”.

I think we all agree with that. It further goes on to say:

“Although we believe there is currently insufficient evidence to justify banning specific e-liquid flavours, as the evidence base related to the role of flavours in youth and adult vaping increases, powers to regulate flavours will be an important lever for Government to use to reduce youth vaping.”

It then says:

“It is important that there is a holistic approach to flavours. If the UK Government is changing the packaging and display of vapes…this will go a long way to reduce the appeal of vapes. Therefore, the Government may not need to go as far when restricting flavours. We believe that restricting the way flavours are described”—

which is the point that my hon. Friend the Member for Farnham and Bordon made—

“rather than banning actual flavours could help reduce the appeal to young people with limited negative impact on adults who smoke. At the very least, CRUK believes that mint, menthol and fruit should remain available as there is evidence that these help adults quit smoking.”

If we go on the basis that, actually, we should limit the way the flavours are described, perhaps one day we will know what unicorn milk actually tastes like.

Tobacco and Vapes Bill (Seventh sitting)

Debate between Gregory Stafford and Sarah Bool

Committee stage
Thursday 16th January 2025 Public Bill Committees

[Gregory Stafford]

My hon. Friend is making an interesting point. What does she think about the idea of having a single licence? If a shop—for example, a small convenience store—is selling alcohol, tobacco, where it is still permitted under the regulation, and vapes for those over 18, would a single regulatory process and licensing scheme be more efficient and more beneficial both to the customer and the retailer?

[Sarah Bool]

My hon. Friend makes a valid point. We do not want the introduction of this legislation to lead to any overburdening. We do not want the smaller convenience stores that are trying to operate to be challenged and put out of business. We want this to be a very practical measure so I agree that would be something to look into. I wonder whether the Minister might offer any further thoughts on that.

Tobacco and Vapes Bill (Sixth sitting)

Debate between Gregory Stafford and Sarah Bool

Committee stage
Tuesday 14th January 2025 Public Bill Committees

[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.

--- Later in debate ---

[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?

Tobacco and Vapes Bill (Fourth sitting)

Debate between Gregory Stafford and Sarah Bool

Committee stage
Thursday 9th January 2025 Public Bill Committees

[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 ---

[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.