Tobacco Control Strategy

Jane Ellison Excerpts

Thursday 17th December 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Betts. What an excellent and extremely well-informed debate we have had. I thank the right hon. Member for Rother Valley (Kevin Barron) for raising this important issue for debate. In a way, the timing is more helpful for me than for right hon. and hon. Members, inasmuch as this is a piece of work to which we in the Department of Health are turning our minds, so it has been enormously helpful to hear the views of colleagues from across the House on how we go forward. There are some areas of the topic on which I can respond, but some on which Members might have to wait until a little way into the new year.

The Government have a very clear position on tobacco control, recognising that smoking is and remains one of the most significant challenges for public health, with all the devastating social and personal consequences that Members have outlined. The Government have been proactive and, I think, ambitious in their approach to tobacco control. That was reflected in the comments made by both Government and Opposition Members, for which I thank them. It is also reflected by the fact that many other countries approach us for advice on tobacco control matters. Over the time I have been in this post, it has been a pleasure to attend a number of international events at which we were asked to provide a leadership role. I will say a little more about international matters before I finish.

Our efforts are paying off, and have paid off. As the shadow Minister said, they build on the good work done by previous Governments in previous Parliaments, and we continue to see year on year reductions in smoking. Since 2010, its prevalence has decreased by almost 3%, saving thousands of lives and, of course, countless families from the pain and harm caused by smoking. At various events in the past I have been open about discussing my experience of that harm in my own family. I know that I speak for other Members who have seen that as well.

Before I talk about the new strategy, it is worth reflecting on progress against the current tobacco control plan. We have met, or are on track to meet, the three national ambitions. Adult smoking prevalence is now at 18%, which is the lowest rate since records began; only 8% of 15-year-olds smoke, which is also an all-time low; and rates of smoking in pregnancy are falling, with the most recent figures showing a rate of 10.5%, so we have a high degree of confidence that we will meet that national target as well. On 1 October, it became an offence to smoke in a car carrying children and for adults to buy tobacco for those aged under 18. Making the latter—also known as proxy purchasing—an offence has been called for a great deal in the past. As has been noted, we have also passed legislation to introduce standardised packaging and consulted on how we intend to transpose the revised EU tobacco products directive into UK law.

Despite those achievements, smoking is still the leading cause of premature death and health inequality, and Members have rightly focused on that throughout the debate. About 8 million people still smoke, and the resulting number of premature deaths has been recorded. There continues to be enormous regional variation, which weighs heavily on me—I know that the right hon. Member for Rother Valley is very conscious of that as well. In some areas the prevalence rate is as high as 29%. With that backdrop, we can by no means think that the battle is won.

There is similar variation in ill health and death rates associated with smoking, as the hon. Member for Central Ayrshire (Dr Whitford) eloquently outlined. That variation means that there can be 472 deaths per 100,000 people in one area and fewer than 200 deaths in the same population in others. Throughout the country, we see variation in rates of smoking by pregnant women from more than 25% to about 2%. I know that some areas are working really hard to address that variation. I pay tribute to the people working in places that, despite the high rates that they battle, have seen encouraging results, such as the public health and NHS teams in Blackpool. They are bearing down on their high rates with some success and have done very well.

While we are discussing the ill health caused by smoking, perhaps this is a useful moment to give the shadow Minister a little reassurance in two regards. He made a good point about oral cancer, and I can confirm that one of the pictures in the new library of photographs being introduced with the tobacco products directive will feature throat cancer, so that will draw attention to it. Also, we received welcome information today from the British Dental Association setting out how dentists can help with smoking reduction and the identification of oral cancer. We will consider that further as we develop the strategy. That is welcome and timely news.

As we are talking about the work that people have done in different areas, such as the efforts to bear down on smoking in pregnancy, which have seen some welcome drops, I want to mention the role of health professionals. Their role has run as a thread through the debate, and I suppose it will be ever more relevant as some services look to integrate more with health professionals in the NHS and elsewhere. The movement of health visiting into local government in October—it is now commissioned through local government, as are public health services—offers a welcome opportunity to get some really close working between those two functions in local government right across the board.

As we look at the new tobacco strategy, we are working with Health Education England to identify how NHS health professionals can be further supported to act on smoking. Nevertheless, progress has been made, and I congratulate the midwives and health visitors who have done such good work to identify women who smoke during pregnancy. We have seen their work reflected in the ongoing reductions in the level of smoking during pregnancy, but there is more to do, so we are looking to build on that success.

As I have said, the Government remain committed to tobacco control, and our goal is to drive down the prevalence of smoking in England. At this point, I should say that we are working very closely and constructively with colleagues in the devolved Administrations on that shared objective. Our officials speak to each other regularly, and we are always interested to look at what measures are introduced. As always, it was good to hear the contribution from the hon. Member for Central Ayrshire. Tobacco-related deaths are avoidable, so we want to do more to avoid them.

Although I have said this in an event in the Palace of Westminster, I have not yet confirmed it in the Chamber, but I can confirm that the Government will publish a new tobacco control strategy for England next summer, which I think is a sensible timetable. I hope Members agree that, given the significant measures coming into force in the spring and the fact that we want a little time to reflect on the current strategy, that strikes the right balance. The work is under way already, which is why this debate is a timely opportunity to hear Members’ thoughts. I will ensure, throughout the timetable for developing and producing a new strategy, that there are ample opportunities for Members on both sides of the House to contribute to the strategy development. Important stakeholders, such as those who contributed through Members’ speeches today and supplied useful briefing materials ahead of the debate, will have important and regular opportunities to influence the strategy and have input into it.

In developing the strategy, we will review the current national ambitions, and we will further empower local areas and support action within them, particularly where tobacco control strategies can be tailored to the unique needs of local populations. We cannot ignore the stark differences in the results of different areas across our country, so the new strategy has to focus on those discrepancies. Robust activity at that level is vital if we are to tackle the impact of health inequalities in England and ensure that smoking prevalence continues to decline in all communities. We will, of course, need to support local authorities in pursuing collaborative partnerships and securing a high return on investment as they prioritise and streamline their budgets.

A number of questions were asked about funding, and we will give careful attention to it. I am not in a position to comment in detail on the funding of the strategy itself, about which hon. Members made a number of points and expressed concerns. It was made clear in the spending review that the public health budgets are to be ring-fenced for the next couple of years and protected, with conditions stipulating that the whole budget must be spent on public health duties.

If any right hon. or hon. Members are concerned about what is happening in a particular area, I ask them to please speak to me. The chief executive of Public Health England remains the accounting officer for how the ring-fenced public health grant is spent, and I am always extremely happy to ask him to speak to Members about their concerns about what is happening in their own areas. Manchester was mentioned specifically. I can confirm that we are aware of Manchester City Council’s decision, and Public Health England is currently working with it to identify how it can provide cost-effective support to local people who want to stop smoking. The new control strategy has not been finalised, so we cannot commit to the level of funding that will be needed, but Members have made their views on that extremely clear.

I gently say to my hon. Friend the Member for Harrow East (Bob Blackman) in particular that we have championed the way in which, over the past five years, local government has done extremely well in providing excellent services for less cost. It has focused far more on outcomes than on the money spent. It is relevant to bear that in mind, given that Members have expressed reasonable concerns about the local government spending landscape.

[Kevin Barron]

rose—

[Jane Ellison]

I sense an intervention coming.

[Kevin Barron]

I entirely accept that there are regional variations. We must all accept that, but the mass media—the news and the national media—cut across all regions. Will an evidence-based mass media campaign be part of the strategy that will be published in the summer?

[Jane Ellison]

I can give the right hon. Gentleman a broader assurance than that. Our approach to the subject has at all times been evidence-led, so the new tobacco strategy will clearly encompass a range of evidence-led activities. I hope that reassures him more broadly than just on that point. We must at all times be led by the evidence, as those who contributed today highlighted.

The new strategy is an opportunity to shine a spotlight on what local councils are doing locally, and to learn from innovative work. We cannot stand still in that regard. We must be open to evolving the way we do things, and that is already happening. The new devolution deals are an opportunity to focus on the exciting new ways in which local areas are reimagining the way they do things, and we have seen councils of all colours doing that. We must be optimistic in that regard and pay tribute to the innovation of local government across a range of areas. I have seen that in a host of different public health areas in the two-plus years that I have been doing this job.

But the picture in some communities and areas is not positive. Smoking rates vary across social groups—those from poorer communities and backgrounds experience higher tobacco use and much greater health burdens, as the right hon. Member for Rother Valley and others said in their speeches. Although the right hon. Member for North Norfolk (Norman Lamb) has left, I want to put it on the record—I am sure he will follow this up after the debate—that a particular focus of the new strategy will be on reducing health inequalities and their impact on people who suffer from a mental health condition. We are conscious of the great differences in smoking rates, so that will be a focus of what we do. A quarter of cigarettes are smoked by people with mental health conditions, so I can confirm that that group will be a key priority for the new strategy. We seek to embed the importance of tackling health inequalities both in the new strategy and locally, to cement the national gains that we have made.

We have introduced a significant tranche of legislation, some of which is still to come into force, so we are unlikely to commit in the strategy to a package of legislative interventions. I think colleagues appreciate the reasons for that. Rather, we will set out what we must do to identify and develop new and more effective measures for reducing smoking and smoking harm.

It might be useful to update the House on prisons, which hon. Members mentioned. We are conscious of the great differences in the rates for prisoners and non-prisoners. The Ministry of Justice has announced a programme to make prisons smoke-free, which will be implemented in stages, and prisoners will be given support to stop smoking. Public Health England continues to improve the support that it offers to prisoners who quit in prison to stay smoke-free when they leave.

Of course, tobacco control is not a matter just for legislation or for the Department for Health. There are a range of measures that can choke off the supply of new smokers and help those already addicted to quit. We will work with Her Majesty’s Treasury on tax, as Members would expect; with Her Majesty’s Revenue and Customs on the illicit trade; with local authorities, as I have already said; and, of course, with the NHS on smoking cessation services. I am conscious, as we look at the preventive landscape, that there has rightly been a focus on the five-year forward view. I am looking at several strands of that key piece of work, and this strategy is part of it. Our colleagues in trading standards, who do so much great work on enforcement, are also part of the solution. We will work with academia, the royal colleges and the wider tobacco control community to look at what works and how the Government can play their part.

Next year, in addition to publishing the new tobacco control strategy, we will introduce the stricter packaging requirements, and the revised EU tobacco products directive will come into force. The directive sets out harmonised rules on the composition and labelling of tobacco products that will apply from May 2016, and it will strengthen the functioning of the EU internal market. We look forward to its helping to improve public health. Examples of the impact of the directive are that the minimum pack size for cigarettes will increase to 20, and all flavours, including menthol, will be banned by 2020.

I will come to e-cigarettes in a moment, as I want to respond to the right hon. Member for Rother Valley and others and hopefully give them some helpful updates. First, on the international element, which was rightly raised, I can confirm that the UK has a significant role to play. The UK Government have signed the framework convention on tobacco control, and are now working in the UK and with the Commission to ensure that everything is in place to ratify that protocol. That is something we are committed to doing. The Department for Health has been awarded an overseas development assistance fund to assist other countries with developing their tobacco control policies. That funding will be used to protect people from the harms of tobacco internationally and to tackle the problem of health inequalities globally. A dedicated team will be established to deliver that work. I look forward to updating the House on that in due course.

I turn to e-cigarettes. Of course, the best thing a smoker can do for their health is to quit smoking, and to quit for good. There are now more than 1 million ex-smokers who have used e-cigarettes to help them to quit smoking completely. The evidence indicates that e-cigarettes are significantly less harmful to health than smoking tobacco. I thank Public Health England for the important piece of work it provided to advise us in the summer.

However, the quality of products on the market remains variable. It is therefore important that we have regulation that is proportionate—that is exactly the right word, and I echo that view—to ensure that we have minimum safety requirements and that the information provided to consumers allows them to make informed choices. That is exactly the aim of the regulatory framework set out in the revised directive.

In implementing the new EU rules, we intend to work towards regulation that will permit a range of products, which people want to use, to remain on the market, but with those products positioned as alternatives to smoking, not as products that introduce children to vaping or smoking.

I join the right hon. Member for Rother Valley in welcoming the arrival of licensed products that can be prescribed alongside existing nicotine replacement therapies. The Government had full support from both sides of the House when we took through precautionary legislative measures on the issue of children and e-cigarettes; indeed, most parts of the industry welcomed and supported the uncontentious approach of adopting the precautionary principle with regard to children.

We will continue to take a pragmatic approach to e-cigarettes, and we will be guided by the evidence. The right hon. Gentleman was right that, in a fast-evolving marketplace, we must be guided by the evidence. To that end, we have commissioned a comprehensive review of the impact of e-cigarettes to ensure that future policy decisions continue to be supported by a robust and published evidence base. That will build on the PHE review of evidence on e-cigarettes, which was published in August.

It might be helpful if I update right hon. and hon. Members on some relevant research projects. The National Institute for Health Research is funding a randomised controlled trial to examine the efficacy of e-cigarettes, compared with that of nicotine replacement therapy, when they are used in the UK stop smoking service. I spoke earlier of the evolving world of smoking cessation services and of understanding what works, and that will be an important piece of research. The report of the trial is expected to be published in 2018.

The Department—I hope this speaks to the watching brief that the shadow Minister asked that we keep—is commissioning work through the Public Health Research Consortium to identify whether there are any early signals of e-cigarettes having the potential to renormalise use of tobacco products. That work is expected to report in summer 2016. Again, we will look to update the House when we have the results—I know there will be interest in them on both sides.

I congratulate the right hon. Gentleman on securing a debate on this important issue. As I said, it comes at a really timely moment. When I come back in the new year, I and my officials will certainly turn considerable attention to this important strategy. As I hope I have made clear, none of us can rest on our laurels. We have made some good progress, but the Government will continue to develop support and new measures to reduce the prevalence of smoking further and faster in England. We will, I hope, continue to work constructively with colleagues in the devolved Administrations, with the objective of preventing more people—more of our constituents—from dying prematurely as a result of smoking.

I am acutely conscious of the fact that the burden of disease and harm associated with smoking falls most heavily on the most disadvantaged. Addressing that will be right at the heart of our new strategy. Like all those who have contributed to this excellent debate, I look forward to our first smoke-free generation.

In closing, I echo the words of the shadow Public Health Minister. I wish colleagues and the staff of the House a very happy Christmas, and I thank all those who have contributed to this excellent debate.