HIV Testing Week

Jim Dickson Excerpts

Thursday 13th February 2025 Westminster Hall

[Jim Dickson (Dartford) (Lab)]

It is a pleasure to serve under your chairship, Dr Allin-Khan. I pay tribute to the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) for securing this important debate and for his excellent speech.

We are here because of the work done by the excellence Terrence Higgins Trust, which, with the Department of Health and Social Care, runs the vital National HIV Testing Week campaign. It provides a vital staging post towards the goal, which we all share, of ending new HIV infections by 2030. This week, as the right hon. Member said, anyone can order a free postal HIV test, and I encourage anyone listening to do so. I was pleased to be able to take a test myself just next door, on Tuesday, at the excellent event run by the Terrence Higgins Trust.

I welcome the goal set by the last Government to end new HIV cases by 2030, and I am pleased that the new Labour Government have commissioned a new HIV action plan for England, which is expected to be published in the summer, to make that a real prospect as we approach 2030. As I am sure other hon. Members will agree, if we are to meet this ambitious target, it is crucial that we find the estimated 4,700 living with undiagnosed HIV in England, as well as those across the UK, and ensure that they are getting the lifesaving treatment they need and cannot inadvertently pass on the infection. It is clear that that will happen only through testing.

In my previous life as cabinet member for health in Lambeth, we worked very closely with the Elton John AIDS Foundation to introduce the world’s first social impact bond focused on bringing people living with HIV into care. We worked with a coalition of third-sector organisations across the three boroughs of Lambeth, Southwark and Lewisham to ensure that health settings earned outcome-based payments each time they identified someone either newly diagnosed with HIV or someone who had stopped treatment, and linked them back into care. Our brilliant GPs across the three boroughs carried out opt-out testing to accompany this set of changes. The results were dramatic: over three years, more than 265,000 people received HIV testing, and more than 460 south Londoners living with HIV entered treatment. More than 200 people received a new HIV diagnosis and attended their first treatment, and 250 who had stopped treatment returned to care.

I am proud of the work done across local government in the fight against HIV/AIDS. In Lambeth, for instance, the council has led London boroughs on commissioning of the London HIV prevention programme. We were in the forefront of the successful campaign to get PrEP provided free on the NHS for all those who needed it, and the council continues to jointly commission, with our neighbouring boroughs, work with marginalised groups to reduce stigma and thereby increase awareness of HIV and the need to take tests.

I support the Government’s aim of ending new HIV cases in England by 2030, supplemented, it needs to be said, by the Mayor of London’s great work in ensuring that the capital is a fast-track city. However, that date is only five years away and, like the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale, I worry that without a dramatic increase in testing, we will not get there. I was pleased therefore that last month the Government announced an expansion of the number of hospitals carrying out HIV opt-out testing, including Darent Valley hospital in Dartford, in my constituency. I welcome the service that will be made available to my residents as a result.

I hope that the new HIV plan for England, expected this summer, will build on that expansion and bring the increase in opt-out testing we need to find all those unknowingly living with HIV. The incredibly welcome 5.4% increase in the public health grant for 2024-25—that is £200 million, which is the biggest increase for many years—will strengthen this work, alongside so many other areas in which we need to tackle health inequalities.

I would like to end by paying tribute to all the charities working so hard to tackle this issue, including but not limited to the Terrence Higgins Trust, the Elton John AIDS Foundation and the National AIDS Trust.

National Cancer Plan

Jim Dickson Excerpts

Tuesday 4th February 2025 Commons Chamber

[Andrew Gwynne]

I congratulate the hon. Lady’s step-mum on ringing that bell, which is great news. The hon. Lady is absolutely right to raise the issue of inconsistency when it comes to the levels of service that different patients get. That will obviously be a major factor in the national cancer plan going forward, to ensure that all people diagnosed with cancer have the same levels of treatment and the same opportunities to survive.

[Jim Dickson (Dartford) (Lab)]

I warmly welcome the Minister’s statement. He will know as well as anybody else in this Chamber that smoking causes one in four cancers in this country, and that two out of three people who smoke will die as a result. He is assiduously moving the Tobacco and Vapes Bill through Parliament. Can he set out the likely effect that the Bill will have on those shocking statistics?

[Andrew Gwynne]

I am grateful to my hon. Friend for being a member of the Committee for that Bill, which ended its business last Thursday. The hon. Members for Sleaford and North Hykeham (Dr Johnson), and for Farnham and Bordon (Gregory Stafford), who are sitting on the Opposition Front Bench, were also members of that Committee. My hon. Friend is absolutely right, because the Bill will stop the conveyor belt that the tobacco industry has used to its advantage for decades. We are saying that we will not allow any more children and young people to become addicted to nicotine and tobacco, which, as he says, kills two out of every three users. It is uniquely the most harmful product, and we are making the next generation smoke-free for a reason.

Tobacco and Vapes Bill (Thirteenth sitting)

Jim Dickson Excerpts

Committee stage
Tuesday 28th January 2025 Public Bill Committees

[Andrew Gwynne]

I am very happy to answer the question posed by the shadow Minister. It is a simple answer: we need clause 133 to avoid loopholes. Otherwise, newer products such as heated tobacco—and those products that have not even been developed yet—are in scope of the restrictions, but devices used alongside them could still be used to promote tobacco consumption.

Question put and agreed to.

Clause 133 accordingly ordered to stand part of the Bill.

Clauses 134 and 135 ordered to stand part of the Bill.

Clause 136

Addition of smoke-free places in England

[Jim Dickson (Dartford) (Lab)]

I beg to move amendmentusb 11, in clause 136, page 77, line 8, after “regulations” insert

“and a local authority may (as respects its area) make byelaws”.

This amendment would extend the power to designate areas as smoke-free to certain local authorities, by making byelaws. Any byelaws so made would need to be confirmed by the Secretary of State by virtue of section 236 of the Local Government Act 1972.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 12, in clause 136, page 77, line 14, after “regulations” insert “or byelaws”.

This amendment is associated with amendment 11.

Amendment 13, in clause 136, page 77, line 16, after “regulations” insert “or byelaws”.

This amendment is associated with amendment 11.

Amendment 14, in clause 136, page 77, at the end of line 24, insert—

“(5) Before making byelaws under this section the local authority must consult any persons the local authority considers it appropriate to consult.

(6) In this section,

‘local authority’ means a county council in England, a district council, a London borough council, the Common Council of the City of London in its capacity as a local authority, the Council of the Isles of Scilly, a combined authority or a combined country authority.”

This amendment is associated with amendment 11.

[Jim Dickson]

It is a pleasure to serve under your chairship, Mr Pritchard. Amendments 11 to 14 are intended to extend the power to local authorities in England to designate areas as smoke-free by making byelaws. Any byelaws would need to be confirmed by the Secretary of State, by virtue of section 236 of the Local Government Act 1972.What the amendments seek to do is to bring the power to extend smoke-free places to a local level, as there are already a number of local authorities that have had success with that approach.

As we know, local authorities are responsible for public health and know their communities well. Eleven councils have introduced 100% smoke-free conditions in pavement seating, including in thriving cities such as Liverpool, Manchester and Newcastle. There are many more areas where that approach could have benefits: for instance, in my Dartford constituency, we have a high street with an area where an excellent market takes place every Thursday and Saturday. It is an area not covered by smoke-free legislation, but one that in my view could greatly benefit from smoke-free areas.

[Gregory Stafford]

We may come on to this point when we discuss the substantive part of clause 136, but does the hon. Member not see any potential difficulty where there are different local authorities with different regulations on smoke-free areas? One of the beneficial simplicities in the Bill is that it applies the same rules across all areas in all the different constituent parts of the United Kingdom. What he is suggesting could potentially add a level of complexity.

[Jim Dickson]

That is indeed a good question. Consistency is clearly desirable: it is easier for the public to understand and it makes enforcement easier. However, there are councils already leading the way in that area, and it is a question of the needs of the community covered by that local authority. We know that smoking is particularly concentrated in deprived communities. Local authorities are able to understand what areas are most at risk, work with those communities and arrive at solutions hand in hand with them. We know that public spaces facilitate quit attempts, so it is a great way to do this in areas where the communities consent to that approach. I still advocate the measure as a good way forward.

Obviously I would have liked to have seen outdoor hospitality settings included in the consultation for smoke-free extensions to this Bill; however, I know that many Members at the Second Reading expressed relief that that is not in scope for England. Other Members have sought to put the areas identified by the Government on the face of the Bill to rule this out in future, but I disagree with that approach, because we need flexibility.

[Gregory Stafford]

This is a point I will raise with the Minister as well—just to forewarn him—but, whereas I entirely agree with the future-proofing of this Bill in areas such as products and advertising where the market may move on, I do not fully understand why the regulations need to be so open on public places. Public places are not going to change over the next 100 years, so why not define them on the face of the Bill?

--- Later in debate ---

[Jim Dickson]

Certainly, public spaces are not going to change, but smoking prevalence is; it may be that as, a result of declines in smoking prevalence, the public acceptance of smoke-free areas may change. I am sure that the Minister will have a useful contribution to make in response to the hon. Gentleman’s point when he speaks. There is a discussion to be had.

I would be particularly interested to look at the data and modelling and the customer feedback that suggests that hospitality venues are economically dependent on the consumption of tobacco. As we have discussed, currently only 11% of the population smoke—granted, if we are talking about nightlife, that prevalence may be higher, but I certainly believe that families should be able to enjoy eating outside in the summer without being exposed to the risk of second-hand smoke. We have seen that smoke-free pavement licences are popular with businesses and with the public, particularly families with children.

Giving local authorities a say in how smoke-free laws are applied will align with the commitment in the recent English Devolution White Paper to shift any power

“away from Whitehall and into the hands of those who know their communities best”.

It is critical that local authorities consult fully on any measures, and particularly closely with the hospitality industry. As I say, there is a possibility that that industry, in specific parts of local authorities where the consultation takes place, may actually agree and feel that this is a sensible step. It is important that local authorities get this right with the right consultation, but they should have the powers to do it.

[The Chair]

I remind Members that we are at this point talking about amendments, so any comments should be restricted to those amendments. We can talk about the generalities of the clause later in the debate. It is always helpful to have a reminder of that—for myself as well.

[Gregory Stafford]

Looking at the amendments, I can see why the hon. Member for Dartford wants to do this. There clearly could be public health benefits and, as a localist myself, I am naturally sympathetic to having local decisions made as close to people as possible. I think the point I made during the intervention stands, however: the potential for confusion among people who are potentially not from the area, or who are from the area but do not understand the local byelaws, probably makes the amendments unworkable.

My hon. Friend the shadow Minister and the hon. Member for Dartford mentioned that smoking prevalence is higher in places of social deprivation. The hon. Member seemed to be suggesting it would therefore be better to enforce regulations, or byelaws for regulations, in those areas. I can see the public health impact, but we must not ghettoise people who are from lower socio-economic backgrounds and who are more likely to smoke, as seen in the evidence. The shadow Minister makes a good point that people who do not have outside space, and who may have children and not want to smoke and vape in their properties because they are rightly worrying about their children’s health, will find that difficult if there are local byelaws in place that prevent it. I think that is especially true with women who smoke.

[Jim Dickson]

I thank the hon. Gentleman for giving way. He is making a number of very good points, but will he respond to the notion that smoke-free areas are all about making smoking less attractive and so giving people incentives to quit? Does he accept that that might give people incentives to quit and therefore be a significant public health benefit, and worth considering as part of the legislation?

[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?

--- Later in debate ---

[Sarah Bool]

I absolutely agree, and my hon. Friend makes a powerful point. I would like us to consider this issue when we look at whether to take these proposals any further. I cannot see how we can ensure in practice that everyone knows what is happening without there being a national campaign.

[Jim Dickson]

Perhaps I can try to answer a couple of the questions from the hon. Lady and other hon. Members. If a byelaw were enacted, it would need to be well publicised, and there would need to be signage. Clearly, it would be impossible for a local authority to enforce a byelaw against which the defence was, “We had no knowledge of the fact that there was a byelaw.” Therefore, doing those things would be very important, and that would obviously be part of the consultation. The local authority would also have to set out a plan, and it would ultimately have to be approved by the Secretary of State, who I am sure would ensure that it was adequate. In terms of the penalties, the local authority has the power to set out its own penalties, but only within the quite tight legal framework set out in the Local Government Act. It would be for the local authority in this instance to define the level of penalty and what was proportionate.

[Sarah Bool]

I thank the hon. Member for clarifying that point. Many Members would prefer that local councils were dealing with potholes rather than advertising those different spaces, but I thank him for his amendment and his proposal.

--- Later in debate ---

[Andrew Gwynne]

Obviously, if a local authority introduces byelaws, as the City of Manchester has done in respect of pavement licensing, it is for that local authority to ensure that those byelaws are adhered to. Of course, in that case, the weights and measures authority is the City of Manchester, so I suppose that makes it easier.

These powers are already being used. Local authorities are already designating areas, whether it is for pavement licences, public space protection orders or just deeming that land within their own responsibility is smoke-free. We do not believe that the amendments are necessary. I kindly ask my hon. Friend the Member for Dartford to withdraw them.

[Jim Dickson]

The Minister has given a very comprehensive response. I suspect that the suggestion that this might be a way forward might come up in the consultation when that happens in the coming months. For the moment, I beg to ask leave to withdraw the amendment.

[The Chair]

Mary Kelly Foy, did you want to speak?

--- Later in debate ---

Division 25

Ayes: 4

Noes: 8

[Jim Dickson]

I beg to move amendment 10, in clause 136, page 77, leave out lines 26 to 29 and insert—

“(a) for subsection (1A) substitute—

‘(1A) The Secretary of State must, no later than the end of the period of 6 months beginning with the day on which the Tobacco and Vapes Act 2025 is passed, lay draft regulations to be made under this section which have the effect of providing for all enclosed vehicles to be smoke-free, other than vehicles of the type described in subsection (3).

(1B) Regulations may make provisions about the meaning of “enclosed vehicle”, which may include vehicles which are partially enclosed or enclosed (or capable of being enclosed) for some but not all of the time.’”.

This amendment requires the Secretary of State to make regulations which would extend the existing prohibition on smoking in vehicles to all enclosed vehicles except ships and hovercraft which are regulated under other legislation. The prohibition currently only applies to workplace vehicles and vehicles carrying under 18s.

Amendment 10 requires the Secretary of State to make regulations that would extend the existing prohibition on smoking in vehicles to all enclosed vehicles except ships and hovercraft, which are regulated under other legislation. As hon. Members will know, the prohibition currently applies only to workplace vehicles and vehicles carrying under-18s. The 2015 ban on smoking in cars that contained children was a really important moment in in public health. It raised awareness about the harms of second-hand smoking in enclosed spaces and protected many children from being exposed to those harms.

[Gregory Stafford]

I agree that the regulations on smoking in private vehicles with under-18s were symbolically the right thing to do. Is there evidence either that the ban was in any way enforceable, or that it had any impact on public health?

[Jim Dickson]

I thank the hon. Member for those comments; I will do my best to answer them. Compliance with the measure is still not where we would like it to be: the last survey undertaken by an independent company on behalf of Action on Smoking and Health indicates that 9% of 11 to 15-year-olds say that

“they travel in a car with someone smoking some days, most days or every day in 2024.”

The current law also does not protect those with clinical vulnerabilities. The smoke-free powers in this Bill are driven by a desire to protect people with clinical vulnerabilities from second-hand smoke. That includes pregnant women and those with asthma and lung conditions, among others. No smoker wants to harm their family, friends, pets or co-workers, so no smoker should smoke in an enclosed vehicle.

The evidence is clear: concentrations of smoke in vehicles where someone is smoking are greater than in any other small, enclosed space. If we are to be led by the evidence when extending smoke-free places, we have to consider vehicles. That would provide consistency in policy and raise awareness of the harms of second-hand smoke even further than they currently extend. It would be easier to enforce than the current law, where we have to check who else is in the vehicle, and would make the regulations on vehicles simpler and easier to understand—“It’s a straightforward ban; you can’t do it.” Finally, it is worth pointing out that it is supported by the public, with 67% of British adults saying they are in favour of an outright ban on smoking in vehicles.

[Dr Johnson]

I thank the hon. Gentleman for his clear explanation of what he wishes to achieve. I have great sympathy with it, because nobody wants to see people making their health worse by smoking in a car. However, his statistics are quite interesting. He said that 9% of children find themselves on a regular basis in a car where someone is smoking, yet the Minister has said already this morning that 11% of people smoke. Given that not all of the 11% of people who smoke have children with whom they travel in a car, that implies that the measure is pretty badly enforced and badly adhered to at the moment. He might argue that a complete ban in all vehicles would make it more uniform and easier to enforce, but I am not sure that that is the case.

I will be interested to hear from the Minister when he responds to the amendment whether he has any information or statistics on the number of prosecutions that have occurred under the current legislation. I support the legislation that prevents someone from smoking in a car with children, and I would support an extension of that to include vaping and other nicotine products. I would also support a ban on people smoking while driving; if someone is holding a lit cigarette in their hand, that will have an impact on their ability to manoeuvre the car, particularly in an emergency situation.

Essentially the hon. Member is proposing to say to someone in a parked-up vehicle, perhaps in someone’s drive, “Although you are in a private space, you are not able to smoke.” I understand what he said about no smoker wanting to hurt someone—I am sure that is true—but I cannot imagine that there is any adult smoker that does not realise that smoking in a car with children is bad for the children. I find it very difficult to believe that that would be the case. I invite him to consider whether he is trying to prevent what is a legal activity—even under this Bill, if someone is the right age—in a private space that is theirs and theirs alone?

--- Later in debate ---

As the shadow Minister said, if the Bill passes, smoking will not be illegal; smoking, and likewise vaping, will be illegal for certain people of a certain age. As I said previously, I support the ambitions of the Bill, but this is a massive overreach. If a person is legally allowed to smoke in their own home on their own—or indeed with others—then if they are in their own vehicle and their smoking is harming nobody other than themselves, I do not see that we should make that illegal.

[Jim Dickson]

The hon. Gentleman is making his point very articulately. The idea that smoking legislation is an overreach is not new. Just about every change over the last 30 years—changes that have helped to cut very significantly the number of people affected by smoking-related diseases—has been described as an overreach. A lot of this is about public acceptability, and nearly all the polling accepts that a great majority of adults would see this not as an overreach, but as a welcome change.

[Gregory Stafford]

I do not pretend to have deep wisdom and insight into the whole population’s view on this, and I have not seen the studies the hon. Gentleman talks about, but I accept them. My concern is the need to be careful about the balance between the stated ambitions of all of us—or certainly most of us—on the Committee to reduce smoking as much as possible, and the rights confined within the Bill. If someone is legally allowed to smoke—that is, they were born prior to 1 January 2009—or is over 18 in the case of vaping, and they are in the privacy of their own vehicle without harming anybody else in said vehicle, they can do so. The hon. Gentleman’s amendment is a step too far.

[Gregory Stafford]

I have much sympathy with my hon. Friend’s point of view. I must confess, I am not clear—I am sure the hon. Member for Dartford will be able to tell us—who will enforce this regulation. If it is the police, then I agree with my hon. Friend that it is an unnecessary burden.

[Jim Dickson]

The police currently have responsibility to enforce a whole range of activities that take place within a car, such as mobile phone use. It would in no way be a new concept for the police to enforce something of this nature. If they saw someone in a car with a cigarette, they would be able to stop the car and apply a penalty as they currently do with other types of behaviour within cars.

--- Later in debate ---

[Gregory Stafford]

I completely agree with the shadow Minister. I have two final points. Proposed new subsection (1B) makes reference to the meaning of an enclosed vehicle. I just want to clarify what that means. The amendment says:

“which may include vehicles which are partially enclosed or enclosed (or capable of being enclosed) for some but not all of the time.”

Is the amendment trying to capture convertible cars—someone driving with the top down on a sunny day?

[Jim Dickson]

The amendment is not intended to change the way that the current legislation relates to individual vehicles, merely the activity happening within them, and that currently permits smoking in open-top vehicles with the hood down, i.e. unenclosed. The amendment does not propose any change to that.

[Gregory Stafford]

That is a helpful clarification. Finally, in the explanatory statement, it says that enclosed vehicles account for everything “except ships and hovercraft” apparently because that is “regulated under other legislation”. Perhaps it is in a later amendment, but why did the hon. Member decide not to amend the regulations for ships and hovercraft? Is that because he is hoping to get a private Member’s Bill at some point to change whatever legislation governs hovercraft and ships—[Interruption.] My hon. Friend the shadow Minister whispers to me, “It’s further down,” so that clarifies the point for me.

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

Tobacco and Vapes Bill (Twelfth sitting)

Jim Dickson Excerpts

Committee stage
Thursday 23rd January 2025 Public Bill Committees

[Jim Dickson (Dartford) (Lab)]

We are straying from the point a little, but is the hon. Gentleman aware that the Premier League will shortly initiate a shirt front ban on gambling sponsors? His examples of free advertising and sponsorship of gambling will probably be out of date soon.

[Jack Rankin]

I am glad to hear that—it sounds like positive news, but I will finish my point and go down the list. Crystal Palace FC is sponsored by Net88, a Vietnamese betting company; Everton FC by Stake, an Australian online casino; Fulham FC by SBOBET, a Philippine gambling company; Leicester FC by BC.Game; Nottingham Forest FC is—

Obesity: Food and Diet

Jim Dickson Excerpts

Monday 20th January 2025 Commons Chamber

[Jim Dickson (Dartford) (Lab)]

I, too, thank my hon. Friend the Member for Stroud (Dr Opher) for securing this really important debate, and for his thoughtful and incredibly insightful speech on one of the biggest health challenges that our country faces, as many Members have said. After a week’s delay, I am glad that we are now able to have this debate, and it has been great to see how much consensus there is across the House on the need to act.

As we set out in our manifesto, and as the consultation on the 10-year plan for the NHS says, we must move towards having a much sharper focus on the prevention of ill health for the sake of the long-term viability of our NHS. As other Members have said, there is a huge crisis, with growing levels of obesity putting the nation’s health at risk. In my constituency, nearly 15,000 Dartford residents meet the definition of obese. Such statistics denote immense health inequalities, with those on low incomes far more likely to be obese, as other Members have pointed out.

There are plenty of reasons why we must take action in this area. We spend £6.5 billion annually on treating obesity-related ill health, and around £10 billion a year on diabetes, with the number of type 2 diabetes diagnoses doubling over the last 15 years. Aside from the financial cost, we should surely wish for people to live longer, healthier lives.

This month I am privileged to be spending my Tuesdays and Thursdays on the Public Bill Committee for the Tobacco and Vapes Bill, a landmark piece of legislation that we will go through line by line. Among other measures, it will prevent anyone born after 1 January 2009 from purchasing tobacco. I am very pleased to see in this Chamber a number of colleagues who are also on that journey with me, including the Minister and the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson). The arguments that we hear against obesity interventions today are the same ones that we heard about restricting smoking in days gone by: that it is “nanny state”, that regulatory approaches do not work, that the public will not stand for it, and that it makes things more expensive, which impacts on those who can least afford it.

One of the greatest public health legacies of the last Labour Government are their interventions on smoking. Smoking was to the last Labour Government what obesity can be to the current one. Obesity currently places a staggering burden on the NHS and the wider economy, but it will be one of the great legacies of this Government if we can turn things around and make our country healthier. Solutions are urgently needed.

I very much welcome the Government’s plans to review the sugar tax and to consider extending it to milk-based drinks. As many Members have said, however, we need to go so much further, including by taxing foods that are high in salt, fat and sugar, as recommended by the House of Lords inquiry. Manufacturers reformulated their products in the face of the soft drinks industry levy, and I see no reason why that cannot happen with a well-designed levy on foods high in fat, salt and sugar.

I very much welcome the Government’s commitment to banning advertisements for junk food aimed at children and the sale of high-caffeine energy drinks to under-16s, and I look forward to working with Members of different parties to tackle this crisis. In my time in local government, I have seen how supporting less well-off families to replace unhealthy foods in their diet with fresh fruit and vegetables—such as through the programme run by the Alexandra Rose Trust, which others have mentioned tonight—has had a transformative impact on families’ physical and mental health. I urge the Government to fund voucher schemes, introduce food ambassadors to improve cooking skills, and encourage food growing as part of the solution.

As we are in Veganuary, I commend the work to increase the level of plant-based food in people’s diets. I hasten to add that I am not a vegan myself, although I do aspire to eat more healthily. Veganuary and vegan diets are good for our health and good for the planet. That could be part of the solution, and I urge the Minister and others, particularly those in local government, to consider it too.

Tobacco and Vapes Bill (Seventh sitting)

Jim Dickson Excerpts

Committee stage
Thursday 16th January 2025 Public Bill Committees

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

It is a pleasure to serve under your chairmanship, Sir Roger. May I start by not only thanking the shadow Minister for her support, but congratulating my hon. Friend the Member for Dartford on his birthday? [Hon. Members: “Hear, hear!”] It is a real pleasure that we are able to provide him with a full day’s entertainment—better than Netflix.

[Jim Dickson (Dartford) (Lab)]

I thank the Minister very much for his birthday felicitations. There is nowhere I would rather be than here.

[The Chair]

I only hope that is not open to challenge.

Tobacco and Vapes Bill (Sixth sitting)

Jim Dickson Excerpts

Committee stage
Tuesday 14th January 2025 Public Bill Committees

Moving forward, nothing much changed until 1927 when a man called Joseph Robinson in New York filed a patent for a device he called a medical butane ignition vaporiser. That never really made it off the drawing board, but it shows how the early idea of an e-cigarette first came into play as an alternative to smoking. Numerous patents for nicotine inhaler devices were filed throughout the 20th century and early 2000s by tobacco companies and individual vendors, with a flurry of activity in the 1990s. But the first commercially successful e-cigarette was invented by a smoker who wanted to quit, so it was initially conceived as a device in that regard. In 2004, a pharmacist in China called Hon Lik invented—

[Jim Dickson (Dartford) (Lab)]

I applaud the hon. Lady for her admirable history lesson on the background of vaping. Can I ask how it is relevant to what we are discussing in terms of the penalties and the sale of products?

[Dr Johnson]

It is relevant because we are discussing a product in the UK that we are considering essentially doing away with, and banning completely for children. The hon. Gentleman may note that we discussed the history of tobacco when we debated clause 1, on tobacco, and no less than two Members of the hon. Gentleman’s own party talked about how interesting and relevant that was—[Interruption.] At least one of those individuals appeared very genuine.

Let me go back to Hon Lik, who invented the first e-cigarette as a way to cure his own smoking addiction and to try to prevent deaths such as his father’s from lung cancer—and we have talked much about the potential for smoking to cause lung cancer. The basic concept of mimicking smoking via vaporising liquids remains the same. The company he started was later bought as a subsidiary of Imperial Tobacco, which again demonstrates that the industry will continue to try, where it can, to be involved in nicotine addiction.

The World Health Organisation proclaims that it does not consider electronic cigarettes a legitimate smoking cessation aid. It demands that marketers immediately remove from their material any suggestion that it considers electronic cigarettes to be safe and effective. In 2011, the WHO released a report on e-cigarettes recommending that they be regulated in the same way as tobacco products. Clause 10 will do some of that, inasmuch as it will bring e-cigarettes in line with the legislation on tobacco products so that they cannot be sold to under-18s. However, it does not go so far as to bring it in line with the new smoke-free generation legislation. The Minister may wish to comment on why he has not done so.

In the last Bill, the hon. Member for York Central (Rachael Maskell) tabled an amendment that would have included nicotine products in the smoke-free generation legislation, banning them for those born after 1 January 2009 rather than just for under-18s. Her concern, as I understand it, was that the industry would pivot to other forms of nicotine that did not contain tobacco, hook a new generation on them and use similar marketing techniques to hook them on a lifetime of nicotine addiction, as it once did with tobacco. The Minister could seek to avoid that by preventing non-medicinal products containing nicotine from being used by anyone born after 1 January 2009. That power is within his grasp. On a personal level—this is not necessarily my party’s view—I would like him to seize that power.

The sale of vaping products to under-18s is addressed in clause 10. One of the reasons for restricting the sale is the range of pulmonary and coronary conditions—lung and heart conditions—that can occur for people who vape. To help us to understand why they are so damaging, it is important to understand what is in vapes per se. This is not just about nicotine products; it is also about vaping products.

As I say, nicotine is an extremely addictive substance that disrupts brain development in adolescence. Because adolescence is a critical time for neural development, it makes young people particularly vulnerable to the negative effects of nicotine. Adolescence is marked by substantial neurodevelopment, including synaptic pruning and the maturing of the pre-frontal cortex, the part of the brain that governs decision making, impulse control and emotional regulation. Nicotine exposure during this period can disrupt those processes, leading to lasting cognitive and behavioural impairment. Research indicates that nicotine alters the neurotransmitter systems, noticeably those using acetylcholine and glutamate receptors, affecting the neural pathways essential for learning and memory development. Nicotine exposure during adolescence has been linked to deficits in attention, learning and impulse control. Studies have shown that adolescents using nicotine products exhibit diminished cognitive performance and are more prone to mood disorders, including depression and anxiety.

Another reason to get rid of these products, which relates to the point made by the hon. Member for Winchester, is that they can lead, in and of themselves, to problems with mental health. As hon. Members will know, these issues can adversely affect academic achievement—as we have heard from teachers’ evidence in the past and evidence to this Committee—and social interactions, potentially leading to broader physical challenges.

Hospice and Palliative Care

Jim Dickson 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.

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[Jim Dickson (Dartford) (Lab)]

I thank the hon. Member for Wimbledon (Mr Kohler) for securing this debate and for his excellent and moving opening speech. Hospices across the country care for hundreds of thousands of people living with conditions that limit their lives or mean they face their lives coming to an end.

I wish to put on record my thanks to two hospices that provide crucial services for people in my area. Ellenor is a specialist palliative care provider for adults and children based in the constituency of my hon. Friend the Member for Gravesham (Dr Sullivan). Since 1985 it has been providing hospice care for those who need it most, and it recently opened a new wellbeing centre, which is a hugely welcome addition to its facilities. I also pay tribute to Demelza, which has children’s hospices in the constituencies of my hon. Friends the Members for Sittingbourne and Sheppey (Kevin McKenna) and for Eltham and Chislehurst (Clive Efford). Demelza supports families who are going through what I can only imagine are some of the most difficult circumstances I can possibly think of, where children are facing serious or life-limiting conditions.

Given the importance of such services, I understand the high degree of concern from the sector before the Government’s announcement of further funding last month, with the NHS England children’s hospice grant not having been confirmed at that point for 2024-25. I therefore join hon. Members who have welcomed the 19 December announcement by the Secretary of State for Health and Social Care of £100 million in funding improvements for hospices, such as updated IT and improved facilities for patients and visitors. I also very much welcome the news that hospices for children and young people will receive £26 million in revenue funding for the next financial year. Hospice UK has welcomed that funding, saying that it will

“bring clarity to critically important services for children with life-limiting illnesses.”

[Mr Angus MacDonald]

What does the hon. Member think about the many hospices that do not need the capital but are desperate for the income? I would be interested in his answer.

[Jim Dickson]

I thank the hon. Gentleman for his question. The capital funding will be of immense help to a wide variety of hospices in ensuring that they can upgrade their operation so that they are less reliant on revenue funding from the charity sector and from the NHS. We need a sustainable funding model, and I know the Minister will come back on that at the end of the debate. Finally, let us wish Hospice UK, individual hospices, and our NHS every success with their amazing care for all who need their services, and hope that they will be able to find a sustainable financial future as a result of the Government’s work.

Tobacco and Vapes Bill (Third sitting)

Jim Dickson Excerpts

Committee stage
Thursday 9th January 2025 Public Bill Committees

[Dr Johnson]

I merely make the point that ID is used for purposes other than to buy cigarettes and tobacco, Sir Roger.

I want to return to a point raised in an earlier intervention about the group of people who would be asked to carry ID. If somebody’s birthday is, like mine, in 1977, it is sadly unlikely that anyone will think that I was born in or after 2009. The cohort affected will be those born around 2006 or 2012. I do not see this as an ID for old people through the back door, because, as I view it, there will be a cohort of people within five or even 10 years on either side of the 2009 boundary who will find themselves required to carry ID if they wish to smoke. If they do not wish to smoke or use any tobacco, cigarettes or smoking products, they will not be affected.

[Jim Dickson (Dartford) (Lab)]

Will the right hon. Lady give way?

[Dr Johnson]

I keep getting promoted—that is fine.

[Jim Dickson]

Sorry. Does the hon. Lady accept that the changes that have resulted in significant decreases in smoking prevalence over the last 20 years have all been about imposing additional burdens on those who wish to smoke, such as on where they can smoke and how they can buy the products, which are now in lockable cupboards rather than out on display in shops? Asking someone who wishes to smoke to carry ID is an increased burden—a very small one, but an increased burden none the less—and it is all part of the policy family that has enabled us to reduce smoking prevalence from between 25% and 30% 20 or 30 years ago to 12% now, and that will hopefully help us reduce it to 5% or 0% in the future.

[Dr Johnson]

It is certainly the case, as I am sure we will come to when we discuss clause 1 itself in more detail, that where tobacco control measures have been brought in—on place, price, display or age group—they have led to a fall in smoking, which is a welcome and intended outcome.

I have been lumbered with a lot of interventions and I did not get to answer one point in full, which was on the issue of adult consistency. Amendment 17 would create two groups of adults—those aged between 18 and 25, who would be unable to smoke or use tobacco products, and those over 25, who would. The previous Government sought to say, “This is when you become an adult—when you turn 18. Before that, you are a child, and we will use child protection and safeguarding measures, so you cannot get married or buy a lottery ticket.” We sought to create consistency across the board, because consistency helps people to understand what the law is, which makes it easier for them to follow it and give a greater level of consent to it.

Let me turn back to the amendments. I cannot speak directly for the hon. Member for Epsom and Ewell, who tabled the amendments, but one of the reasons that has been given to me for increasing the age to 25 is that people normally begin smoking when they are young. Most people begin before they are 16, and many more before they are 21. That means that in principle, if we raised the age to 25, we would find that people did not start smoking in any great numbers, because their brain and their thinking process would be more mature, so they would be less likely to start. It is also the case that if someone starts smoking at a younger age, they are more vulnerable to the addictive properties of nicotine, as we heard in the impact assessment and in medical evidence.

--- Later in debate ---

[Jim Dickson]

On the point made the hon. Member for South Northamptonshire, a common maxim applied to our public policy on harmful substances is that we permit. Even having a permission to smoke and buy cigarettes after the age of 25 means that society is effectively saying that that is fine to do, albeit harmful. We do not do that with very many other harmful substances, so it would seem odd to do it with cigarettes.

[Dr Johnson]

I think this comes down to the libertarian argument. Someone can be an adult either because they are over the age of 25, as per amendment 17, or because they are born before 1 January 2009, as per clause 1, unamended by amendment 17. Essentially, whichever type of adult someone is, we would normally say, “If you are an adult, you make an informed choice about which substances to take and what risks you want to take with your life.” But two thirds of people who take cigarettes will die as a result.

There are other substances that we do ban, and there is a scale. There is the libertarian who would have us make all drugs—whether cannabis, cocaine or heroin—free for everyone to use and to buy as they choose. That is not a position I subscribe to, but it is a position that some subscribe to. There are also those who would go further and ban many more substances, such as certain foods that are particularly sweet or fatty but otherwise enjoyable. There is a spectrum, and I think—society probably agrees—that the judgment is that tobacco is very harmful to those who consume it, and potentially to those around them, in a way that does not offer them any significant benefit. I am a doctor, and when we prescribe medication, we look at the risk balance between the benefits of the substance that we are giving somebody and its potential harm. However, with smoking, as far as I can tell, there are no real benefits, other than an emptier pocket—because an individual has spent so much money—worse lungs and worse health.

Tobacco and Vapes Bill (First sitting)

Jim Dickson Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

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

I cannot hear everything because of that noise, but I am co-chair of the all-party parliamentary group on smoking and health.

[Jim Dickson (Dartford) (Lab)]

I declare an interest as vice chair of the APPG on smoking and health.

Examination of Witnesses

Professor Sir Chris Whitty, Sir Francis Atherton, Professor Sir Michael McBride and Professor Sir Gregor Ian Smith gave evidence.

--- Later in debate ---

[The Chair]

I am sorry, Sir Chris. Just for the purposes of timekeeping, which is my job, we have about 20 minutes left and five people wish to ask questions, so can we keep the questions as tight as possible, and within reason the answers as well?

Professor Sir Chris Whitty: I wanted to give the exact numbers, which I just found in my notes. Some 75,000 GP appointments a month are caused by smoking—just think of that when you phone up the GP—and 448,000 admissions to the NHS: again, think of that when you look at these areas. So the impact of this is really very substantial.

[Jim Dickson]

Q May I ask a question about some of the arguments from tobacco companies for heated products to be excluded from the tobacco regulations and the Bill—and presumably therefore the age of sale regulations. Would you have a view on whether that is a sensible proposal?

Professor Sir Chris Whitty: I have a very strong view. The tobacco industry is extraordinarily adept at pretending that it is on the side of the angels, and that it is trying to help with the problem. This goes along with slimline cigarettes, filters, low-tar cigarettes—many other marketing things, all of which claim to try and help with the health effects. Tobacco is extraordinarily dangerous, as well as being addictive. The heated tobacco products have probably slightly lower levels—they do have lower levels of the multiple chemicals that are toxic: multiple, not just one or two, but they are way away from safe levels. So heated tobacco products, while arguably being slightly lower in terms of the risk if someone had exactly the same amount, are a long way short of anywhere near safe, and they are still addictive. They also have some side-blow areas where they will have some issues for people around them as well. So the idea that this is some kind of solution only makes sense if you have shares in a company. So I would very strongly argue against trying to exclude these and carve these out.

Sir Francis Atherton: Nicotine is addictive however you take it—whether it is in heated tobacco, in cigarettes, in snus, in chewed tobacco or in shisha pipes—so in terms of protecting the next generation, the great value of this Bill is the flexibility to deal with not just the issues that we see in front of us, but the things that may well come down the pipeline in the future. I believe the Bill is flexible enough to allow us to protect the next generation from these terrible problems that flow from addiction.

[The Chair]

Sir Michael, you were nodding. Did you have any comment to make?

Professor Sir Michael McBride: I simply echo Sir Frank’s comments on the flexibility that the Bill affords us, and again confirm my agreement with Sir Chris’s comments. Let us be clear: there is no other product that causes life-limiting addiction, that kills two thirds—kills two thirds—of the people who use it. It is staggering, and this Bill provides us with an opportunity to address a scourge on our society. There is no safe tobacco product —none.

--- Later in debate ---

[Mr Barros-Curtis]

Q Some of the evidence that has been submitted referred to the gateway effect and how there is perhaps not the evidence to suggest that there is a transition from one to the other. Are your organisations still concerned about the increase in vaping among groups who have not previously smoked cigarettes?

Sarah Sleet: That is a tricky one. We know that a lot of people who use vaping to stop smoking end up dual-using for a while. Some then move on to just vaping, and some eventually move completely away from it. We seriously need a comprehensive programme for nicotine cessation and smoking cessation to support people on that journey and make sure that people who go on that journey do not come back in. We heard earlier from ASH Wales about some really good measures that have been put in place, but without that wider context it is hard to cement the behaviour needed to move completely away from it. We need to think broadly about the whole support structure to help people to get off smoking and eventually to move away from nicotine altogether.

Dr Ian Walker: I agree. The real killer in the room, if you like, is cigarettes and tobacco. There is no safe way of consuming tobacco. The alternative of smoking versus vaping is very clear; even though we do not know the long-term health implications of vapes, we know that you are much better off vaping than smoking. Having said that, of course we do not want young people and never-smokers to vape either.

The power of the legislation is its double-pronged approach: preventing people from ever smoking in the first place by raising the age of sale by one year every year, and putting in place a comprehensive package of measures alongside that to control vaping, particularly the access to vaping and the appeal of vaping for young people, to reduce uptake in those communities. All those things together, alongside—you will forgive me for saying this—the investment that will be required for smoking cessation services and to support enforcement by Border Force, HM Revenue and Customs and retailers, will be important components of the Bill’s ability to drive the change that it can make.

[Jim Dickson]

Q Thank you for all your work to advocate for smoke-free legislation. Can I ask you about differential smoking rates across the country? Which parts of the country are likely to benefit most from this legislation as we see a decline in smoking rates and in tobacco use more generally?

Sarah Sleet: Health inequalities relating to lung disease are profound. The three conditions with the biggest gap in health outcomes between rich and poor are lung conditions: asthma, COPD and lung cancer. All three are profoundly affected by smoking, and smoking is concentrated in socially and economically deprived areas. Those in the poorest part of the country are twice as likely to smoke as those in the richest part of the country.

It is even more profound in certain segments. We heard that young mothers are four times more likely to smoke in poorer parts of the country than in richer parts. If we can drive down smoking, particularly among young people, the impact will be greatest in those areas that are most in need of help and support. This is probably one of the biggest things that can be done to tackle health inequalities. For that reason, I think the Bill is probably the most important public health measure being passed through Parliament in a very, very long time.

Dr Ian Walker: Thank you for the question, which I think is a really critical one. At CRUK, we have done a lot of research and work on cancer inequalities, which are part of broader health inequalities and which generally mirror similar trends. We know that people in the most deprived communities have higher incidences of cancer. They typically present at a later stage, they typically engage less with screening, they typically have worse outcomes and they typically do not get optimal treatment —it is a pretty difficult story right along the pipeline. The reasons behind that can be very complex and involve lots of different things.

Despite all that, the one thing we do know is that higher smoking rates, particularly among children and young people in the most deprived communities, are a really significant contributor to health inequalities. It is very clear from the evidence that the most deprived communities across the UK are the ones that suffer most from the impacts of tobacco.

This Bill is clearly not a magic switch—it will not change those things overnight—but it sets us on the pathway to fundamentally reversing some of those inequalities and to reducing some of the cancer inequalities that we see across the UK. Alongside the important measures in the Bill, a really clear, targeted set of actions around health marketing interventions in those communities and the effective funding of cessation services where we need them most will contribute to reducing health inequalities much more quickly and much more effectively. Again, it is a very positive story in terms of the potential impact on health inequalities.

[The Chair]

Thank you very much. As there are no other questions from Members, let me thank the witnesses, Ian Walker from Cancer Research UK and Sarah Sleet from Asthma and Lung UK.

Ordered, That further consideration be now adjourned. —(Taiwo Owatemi.)