Tobacco Control Plan

Debate between Jim Shannon and Kevin Barron

Thursday 19th October 2017 Commons Chamber

[Sir Kevin Barron]

I will comment on that, but I think the hon. Gentleman ought to be happy that this is the first time in any tobacco control plan that e-cigarettes have been mentioned and there is some intent to do things with them.

I welcome the acknowledgment of the seriousness of the issue for people with long-standing mental health problems, as the smoking rate is a staggering 40% among those with a serious mental illness. That is another area that needs to be targeted and worked on. The control plan rightly states that joined-up working and integrated commissioning between local government and the NHS are very important. This is not just the case in hospitals when people are admitted; we must focus on prevention and early diagnosis. For example, dentists are the only healthcare professionals who frequently see healthy patients and so are in an excellent position to identify possible oral health problems early on.

[Jim Shannon (Strangford) (DUP)]

We welcome the tobacco plan and the reduction in the number of people who smoke from 20% to 16%, but there is one anomaly here, to which the right hon. Gentleman has referred. I refer to chewed tobacco, as it is not mentioned in this plan and there does not seem to be any plan to address this. Oral cancer is one of the major cancers across the UK, with some half a million people affected by it. Action on this was recommended 11 years ago. Does he feel, as many in this House feel, that chewed tobacco should be part of this tobacco plan and that there should be legislation to address this?

[Sir Kevin Barron]

I am going to go on to discuss some of the issues relating to that situation. As I said, dentists are the only ones who normally see healthy people. I am aware that some GPs—we have one sat here in the Chamber—talk to healthy people even though these people do not think they are healthy at the time, but the situation is a little different for dentists. This early identification is crucial, as mouth cancer patients have a 90% chance of survival if the condition is detected early, but that plummets to just 50% if their diagnosis is delayed.

I say to the hon. Gentleman that I worked in an industry where people used to chew tobacco because we could not smoke at work. I tried it once at the age of about 16 and I am pleased to say that I never went near it again, although I used to smoke cigarettes when I came up from underground—that is a long, long time ago now. The general health implications of smoking are well known and documented, but mouth cancer often gets overlooked. This is the point: despite its killing more people in the UK than cervical and testicular cancers combined, there is still an alarming lack of public awareness towards oral cancer. There are thousands of chemicals contained in a single cigarette, and their point of entry is the mouth. Smoking helps to transform saliva into a deadly cocktail that damages cells in the mouth and can turn them cancerous.

Pharmacy teams also have an important role to play in promoting and encouraging attempts to stop smoking; as Members will know, in Healthy Living pharmacies and others, this is part of the job they do in advising people. These teams can be trained to be very effective in that. This often occurs in the community, but hospital and GP-based pharmacists are also well placed to offer this support. They are well placed to offer stop-smoking interventions with behavioural support and medication. In fact, the National Pharmacy Association is re-evaluating its position on e-cigarettes. As frontline healthcare professionals, pharmacists and dentists are exquisitely positioned to make a difference to health outcomes.

The Government must look to protect public health funding for stop-smoking services in particular if their aims are to be achieved. A growing number of local authorities have already stopped providing stop-smoking services for general smokers. The King’s Fund also highlighted that in 2017-18 local authority funding for tobacco control faces cuts of more than 30%. We have seen the transfer of commissioning responsibilities for public health services to local authorities, and subsequent cuts to the public health grant. A study by Cancer Research UK and ASH—Action on Smoking and Health, an organisation I have been involved in for more than two decades—found that 39% of local authorities reduced their smoking cessation budgets, despite the public health budget being ring-fenced by central Government. These are the issues that are happening down below, but we need to be aware of them.

All this has led to a reduction in mass media campaigns to motivate quitting, which are so vital to direct people towards the services that are on offer. Only this morning, I saw that the British Lung Foundation has published a report showing, yet again, that stop-smoking support is one of the most cost-effective treatments for people with COPD—chronic obstructive pulmonary disease.

Recently, in my role as vice-chair of the all-party group on smoking and health, I visited a smoking-cessation service—the one led by Louise Ross in Leicester. The team in Leicester have been trailblazers in the use of e-cigarettes for cessation purposes. They told me that Leicester’s stop-smoking service was the first in the country to go “e-cig-friendly” on No Smoking Day 2014. Since then, the team has built up a comprehensive bank of knowledge and insights, developed from many discussions with both vapers and smokers, that can be drawn on to help people get the best advice when they decide they have had enough of smoking. I had a discussion with a nurse who works in that service and who was using e-cigarettes in working with pregnant women to try to address our awful statistics on the effect of smoking in pregnancy. Most smoking-cessation services could do worse than talk to the people in Leicester about exactly what they are doing on that.

There has clearly been an increase in e-cigarette usage since the publication of the previous strategy in 2011: in 2012, there were some 700,000 e-cigarette users, and that had risen to 2.8 million by 2016. There is growing evidence to support the successful use of e-cigarettes as a smoking cessation aid. The Office for National Statistics found that in 2016, some 470,000 people were using e-cigarettes as an aid to stop smoking, while an estimated 2 million people had used the products and completely stopped smoking. I believe that e-cigarettes played a huge part in the beating of the target in the previous tobacco control plan. It is clear that e-cigarettes do not suit everyone, though, so there still needs to be a wide range of licensed stop-smoking medication to use alongside much-needed behavioural support.

Tuberculosis

Debate between Jim Shannon and Kevin Barron

Wednesday 27th November 2013 Westminster Hall

[Mr Kevin Barron (Rother Valley) (Lab)]

I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on applying for and securing the debate. We have heard some of the dreadful statistics on TB throughout the world, and I want to spend a few minutes looking in detail at the cost of treating TB when it has not been caught first time round.

Last year, there were an estimated 450,000 cases of multi-drug-resistant TB. It is believed that 10% of those involve extensively drug-resistant TB and are, effectively, impossible to treat. Drug resistance is really a man-made problem resulting from the misuse of anti-TB drugs and the poor management of the disease. Drug-resistant TB can be passed from person to person in the same way as TB that is not drug-resistant. Clearly, early and rapid diagnosis and treatment completion are essential to control TB. As many Members, including my hon. Friend the Member for Scunthorpe, have said, TB is the leading killer of people living with HIV/AIDS and accounts for one in five AIDS-related deaths.

Drug-resistant TB develops primarily because it is treated with a number of drugs taken over six to nine months. If medication is taken incorrectly or stopped prematurely, the TB bacteria can re-emerge and become resistant to the drugs used to treat TB. That sometimes happens because of the provision of substandard drugs, because patients do not complete their treatment or because the drugs are available only intermittently.

Multi-drug-resistant TB is a form of TB that does not respond to the standard treatment using first-line drugs and that is extremely difficult and expensive to treat. As I suggested earlier, extensively drug-resistant TB occurs when resistance to second-line drugs develops on top of multi-drug resistance. Drug-resistant TB can take two years or more to treat with drugs that are less potent, more toxic and much more expensive than those used to treat a standard case of TB. The drugs are toxic and are commonly associated with severe side effects, of which permanent deafness is the most common. Almost all of them have limited effectiveness, and most are more than 40 years old, as the hon. Member for Mid Dorset and North Poole (Annette Brooke) said. Fewer than 50% of multi-drug-resistant TB cases are successfully treated and considered cured.

On costs, multi-drug-resistant TB can be up to 450 times as expensive to treat as a standard case of TB. In all 27 high-burden multi-drug-resistant TB countries, the treatment cost is greater than the annual average income. If multi-drug-resistant TB is not correctly treated and develops into extensively drug-resistant TB, the chances of someone being successfully cured are less than one in 10. The world needs to recognise that. Extensively drug-resistant TB patients are practically impossible to treat, but they often remain infectious and capable of transmitting the disease to others. That scenario is often described as a time bomb.

[Jim Shannon]

Everyone is aware of the high prices of the normal drugs, but a number of countries—India is one—can produce similar, effective drugs more cheaply. Should we source those similar, cheaper drugs to help spread the cost?

[Mr Barron]

I am sure that is the case; indeed, the global fund does do that. However, that does not prevent the supply of drugs, even if they are affordable in part, from becoming intermittent. As a consequence, we end up with the more extreme cases of TB.

The UK Government have played a leading role in the response to TB globally, investing in research and development on new tools to tackle TB, supporting efforts to increase the profile of the disease through the Stop TB Partnership and supporting key institutions such as the global fund, which accounts for more than 80% of donor funding to tackle TB in developing countries.

I mentioned in an intervention that I visited Ethiopia earlier this year. I went there with Results UK in the February recess, along with the hon. Member for South Derbyshire (Heather Wheeler), my hon. Friend the Member for Workington (Sir Tony Cunningham) and two Members of the other place. In Addis Ababa, we visited St Peter’s hospital, which is Ethiopia’s national TB referral hospital. With support from the global fund, St Peter’s provides care for TB referral cases and patients with multi-drug-resistant tuberculosis. It also provides care and treatment to people living with HIV/AIDS, which is of course closely linked to TB.

The hospital demonstrated that, with proper funding, low-income countries can use minimal resources efficiently and effectively to respond to the threat of drug-resistant TB. As I said in my intervention on the right hon. Member for Arundel and South Downs (Nick Herbert), we also visited Awasa and looked at the great work TB REACH was doing there to find the missing 3 million cases.

While we were in Ethiopia, we did not look just at TB, although that was our primary aim. We also looked at Ethiopia’s strong planning and innovative response to its human resource crisis. It is using its health extension programme, which quite a lot of our money has gone into developing. Funding to support such successful interventions has been provided by key multilateral organisations, including the global fund and TB REACH. I reiterate that, in addition to what they have done already, the UK Government have put £1 billion over three years into the global fund, and they are much to be credited for that.

Finally, I have travelled the Commonwealth on many occasions over the years. When we were out in Addis Ababa, we had a meeting with DFID—I say this because the Minister is here—and it was one of the most positive meetings I have ever had. The DFID people knew exactly where global fund money and our taxpayers’ money was going: to help people in dire need of an improvement in their health, as well as in their quality of life, through water supplies and things like that. We always hear negative views about what happens to taxpayers’ money when it goes to the developing world, so it is worth putting on record that that was the most positive experience I have had since becoming a Member of the House.