Smoking Cessation: Prescription of E-cigarettes

Debate between Jonathan Ashworth and Maggie Throup

Monday 1st November 2021 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement to the House on the Government’s announcement that e-cigarettes will be available on prescription.

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

I am grateful to the right hon. Gentleman for his question. Covid has been a stark reminder that our underlying health and lifestyle determine how resilient we are to new risks and diseases. Covid did not strike evenly. People who smoked, were overweight, or struggled with chronic conditions fared worse. We are determined to level up health for a society that is not just healthier but fairer.

Smoking rates are down to 13.9%—the lowest on record—but tobacco continues to account for the biggest share of avoidable premature death in this country. It contributes half the difference in life expectancy between richest and poorest. Action against smoking is therefore at the heart of our mission to level up. Our goal is for England to be smoke free by 2030. To support this goal, we have an ambitious tobacco control plan, and will soon publish a new plan with an even sharper focus on tackling health disparities. Our new Office for Health Improvement and Disparities will support this vital mission nationally and locally.

Ministers from my Department have long been clear, including in this place, that we support e-cigarettes as part of a gateway process for stopping smoking. Last week, the Medicines and Healthcare Products Regulatory Agency updated its guidance on licensing as medicines e-cigarettes and other inhaled nicotine-containing products. The updated guidance sets out the steps needed to license an e-cigarette as a medicinal product, as well as quality, safety and efficacy standards.

Having e-cigarettes as a licensed product will enable them to be available on prescription, which I know will give health professionals greater confidence in their use. I am happy to update the House further when we are closer to having a licensed product. We will continue to consider e-cigarettes, and indeed any other innovative ways of improving the health of our nation, so that we can end disparities and level up to a healthier and fairer country.

[Jonathan Ashworth]

We welcome the announcement that e-cigarettes will be available on prescription. It should be a really significant step in helping 7 million smokers to quit. As the Minister says, smoking kills; it leads to 90,000 deaths and 500,000 hospital admissions every year across the UK. I think she will find broad support for what she has announced, but the House would have preferred to have heard this first, rather than via a press release issued by the Secretary of State on Thursday evening.

The Minister says that she will return to the House when she has more detail. What is the timeframe for that, and when does she expect the first prescriptions for e-cigarettes to be issued? She will know that to those who find it hardest to quit, the offer of e-cigarettes will be important, but it would be much better if it were backed up with access to specialist support services. However, smoking cessation services have been cut by over £22 million in the last five years. Indeed, areas with high levels of heart disease, cancer and stroke are among those hit hardest by the cuts. For example, Dudley has had a 17% cut. Derbyshire, which is where her constituency is, has had a 20% cut. Hartlepool and Wolverhampton have had cuts of 81% to their smoking cessation services.

To be frank, there will be no levelling up unless health inequalities are tackled, and unless we prevent cancer, heart disease, stroke, chronic obstructive pulmonary disease and diabetes where we can, but that demands fully funded local public health services, whereas in recent years, the public health grant has been cut by £1 billion in real terms, and in the Budget last week, it was just maintained at present levels. As the Association of Directors of Public Health has warned, this will mean further

“significant… reductions in public health services and capacity across the country.”

Will the Minister guarantee no further cuts to smoking cessation services? She mentioned the tobacco control plan, which is supposed to be published this year. Can she tell us at what point in the next two months that will happen?

[Maggie Throup]

I welcome the right hon. Gentleman’s support on the issue we are talking about and on our ambitions to make this country smoke free by 2030.

On the MHRA, the updated guidance provided further details on the steps required to license an e-cigarette as a medicinal product. To achieve a licence, a product would need to meet the standards of quality, safety and efficacy expected of a medicinal product. If successful, that would potentially allow safe and effective products to be made available for prescription for tobacco smokers who wish to quit. The update provides clarification and gives more guidance to potential providers on that issue.

The right hon. Gentleman asked about timescales. We anticipate that if a product was put to the MHRA today, for example, there could be an 18 to 24-month process for that product to be licensed. At this stage, we could not say anything further than that, so we are quite a long way from any e-cigarette being licensed and provided as a prescription medicine.

The public health grant increased by £135 million in 2020-21 and by £55 million in 2021-22. With regard specifically to the public health grant for smoking services, it is up to the local authority to decide how it spends its allocation of funding, but in addition, in our long-term plan, we have committed to helping to drive smoking cessation for a number of different groups. We want to provide help with cessation plans for in-patients and pregnant women, and to provide support for those with mental health and learning disabilities to tackle their smoking addictions. All in all, a lot of money is being spent both at the public health level and at the NHS level. We will continue to make sure that we do whatever we can in our power to make England smoke free by 2030.

Covid-19 Update

Debate between Jonathan Ashworth and Maggie Throup

Thursday 21st October 2021 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I often have a sense of déjà vu when responding to these covid statements, but I feel it particularly acutely today. I thank the Minister for advance sight of her statement. She, of course, has had advance sight of my questions. May I put to her again some of the questions that she did not have—or perhaps did not take—the opportunity to answer earlier? Perhaps she can tell the House the answers now.

Are Ministers ruling out a so-called plan C, where household mixing is banned? Are they ruling out lockdowns such as those we saw in Leicester, Bolton and so on? And are they ruling out a return to regional tiers? Is the Department looking at plans to introduce regional tiers? Will she also now tell us the criteria that trigger plan B? We did not get an answer to that question earlier either. Why not just make mask wearing—on public transport, for example—mandatory now? Yesterday, the Secretary of State talked about the importance of mask wearing. Why do we not just get on with it?

I am afraid that the vaccination programme is stalling. On current trends, the booster programme will not be completed until March next year. At one point back in the spring, we were doing about 800,000 vaccines a day. Why does the Minister not now set a target of 500,000 booster jabs a day so that we can complete the programme by Christmas? We are currently only doing about 165,000 jabs a day. Instead of blaming people for not coming forward, will she not only make sure that everyone eligible is invited and has a letter, but allow those who need a booster—or, indeed, the immunosuppressed who need the third dose—to go to a walk-in centre or a pop-up centre, rather than making them book online as they have to at the moment?

Children’s vaccination rates are also low, at only about 17%. Of course, we have seen years of cuts to numbers of school nurses and health visitors, who help with the children’s vaccination programme. The rate of infection among children is running at about 10,000 a day. Will the Minister mobilise retired medics and school nurses to return to schools and carry out vaccinations?

The Minister talked about the importance of the flu jab, but people’s flu jabs are getting cancelled. Will she guarantee a flu jab to all those who need and want one before December?

Let me put a question to the Minister that I did not put to her earlier. About 20% of covid patients in hospital—or one in six, actually, on the latest figures—are unvaccinated pregnant women. Will she guarantee a helpline so that expectant mothers can access proper advice? Will she deal with some of the anti-vax nonsense that we sometimes see spread on social media? Will she establish a target for driving up vaccination rates, including priority access for expectant mothers?

Ministers can have plan A, they can have plan B and they can have plans C, D, E and F, but infectious people cannot afford to isolate and transmission will not be broken until we fix sick pay as well. Indeed, there will be those who will fear that getting their booster or their second or third dose could lead to a couple of days of feeling unwell because of the side effects and will not take it because they will not be able to afford two or three days off work as a consequence. We really need to fix sick pay as we go into this next stage of dealing with covid.

There we have it: those were six straightforward questions for the Minister, and I am looking forward to six straightforward answers—because the wall of defence, I am afraid, is crumbling; vaccination is stalling; and we are heading into a winter of misery. This vaccination programme needs fixing now.

[Maggie Throup]

I would like to reassure the House and anybody who is listening that our wall of defence is extremely strong. I am really proud of all the scientists who developed the vaccines that helped to build our wall of defence, and all the NHS workers and volunteers who have helped to deliver it and are continuing to develop it.

The right hon. Gentleman talked about whether people can access booster jabs. Comparing the number of community pharmacies, for example, there were 1,032 in phase 1 and there are now 1,049 taking part in our activities to provide the booster jab. It is a bit disingenuous of him to say that we are not going fast enough, as there are actually plenty of opportunities for people to get their booster jab.

The right hon. Gentleman asked what would trigger plan B. As I said earlier, we are on plan A. There are numerous factors that we could go into about triggering plan B, but we are still on plan A, and we can still go further with plan A.

The right hon. Gentleman rightly mentions the importance of pregnant women getting the jab. Only last week there was a big push from the NHS to get the message out that it is extremely safe for pregnant women to get a covid vaccine—encouraging them to do that, because it is protecting them from getting this deadly disease. There has been a high rate of hospitalisation for those who are pregnant and have not been vaccinated, and we need to encourage more pregnant women to get the jab.

The right hon. Gentleman mentions plan C. I saw that story earlier and checked it out, and it does not have any foundation. We are always open to alternatives, and quite rightly so, because as a Government it would be irresponsible of us not to be looking at every alternative. I hope he is reassured that, as I said earlier, we are still on plan A. By encouraging everybody who has not already had their booster jab to come forward, we want plan A to be successful.

The right hon. Gentleman mentioned statutory sick pay. I am extremely proud that this Government, through the Coronavirus Act 2020, introduced statutory sick pay throughout this emergency from day one, alongside many other measures that were put in place to support people, whether businesses or individuals, throughout this global pandemic.

Covid-19: Government Response

Debate between Jonathan Ashworth and Maggie Throup

Thursday 21st October 2021 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health and Social Care, if he will make a statement on the Government’s response to covid-19.

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

I am grateful to the right hon. Member for his question and for the opportunity to answer questions from across the House in addition to my oral statement later this morning. Before I do so, I want to underline our commitment to keeping the House informed.

Yesterday’s announcement on the procurement of new antiviral treatments was made to Parliament via a written ministerial statement. The purpose of the Secretary of State’s press conference was to appeal directly to the public to come forward for their vaccines, including the 4.7 million people over the age of 18 in England who have not accepted the vaccine. We need those who are eligible to do so to take up the offer of a booster jab as we pursue plan A to its full extent.

[Jonathan Ashworth]

I thank the Minister for that answer.

Yesterday the Secretary of State said that the pressures on the NHS were sustainable, but we are seeing ambulances backed up outside hospitals, patients waiting hour upon hour in A&E, cancer operations cancelled, and NHS staff exhausted. Has there ever been, in the history of the NHS, a more complacent attitude on the part of a Secretary of State as we head into winter? Yesterday the Secretary of State refused to trigger plan B. Can the Minister tell us what is the criterion for triggering it?

Newspapers report today that a plan C—no household mixing—is being considered: a lockdown by the back door. When the Business Secretary ruled out a lockdown yesterday, was that just another example of his making things up as he goes along in interviews? The Minister for Health, the hon. Member for Charnwood (Edward Argar), said on the radio today that that plan was not

“something that is being actively considered.”

Members should note the qualifying adverb “actively”. We do not want a return to the dark days of lockdown; nor do we want to see regional lockdowns, or local lockdowns like those that we saw in Leicester, Bolton and Burnley. Can the Minister rule out such lockdowns?

Is the truth not that we are in this situation because the vaccination programme is now stalling? Ministers cannot blame the public when 2 million people have not even been invited for a booster jab, and on current trends we will not complete the booster programme until March 2022. There are currently just 165,000 jabs a day; will the Minister make a commitment to 500,000 a day, and ensure that the programme is completed by Christmas?

The Minister will know that the highest concentration of infections is among children, but only 17% of children have been vaccinated. This is a stuttering roll-out of the children’s vaccination programme—and does it not expose the folly of cutting the number of school nurses and health visitors who support these immunisation programmes in our communities?

Only 36% of over-65s have been vaccinated against flu. We hear stories of cancelled flu jabs at GPs’ surgeries, and of pharmacists saying that they do not have enough supplies. Why are supplies apparently running so low? With infections, meanwhile, running so high, Ministers need to stop vacillating and get vaccinating.

The wall of defence is crumbling. We know that we have to get ahead of this virus, because otherwise it gets ahead of us. How will the Minister fix this stalling vaccination programme?

[Maggie Throup]

Let me first thank the right hon. Gentleman for his co-operation throughout the pandemic. However, I am a bit disappointed with his tone today. What we are seeing is the Government carrying out the plans that have been laid before Parliament—the autumn and winter plans involving plan A and plan B—and as the Secretary of State rightly said yesterday, plan A is still what we are working to.

Our vaccines have created a wall of defence. It is incredible how many people have taken up the offer, not just for the first jab but for the second, and are now coming forward for their boosters. In fact, at the start of the week 5.4 million people were eligible for their booster jabs, and 4 million people had taken up that opportunity: 4 million arms had been jabbed.

The right hon. Gentleman talked about 12 to 15-year-olds. We are now able to offer more choice to parents wanting to take their children to vaccination centres. I am sure the right hon. Gentleman will agree that it is important for the choice of where children get their jabs to be as wide as possible to ensure that everyone has that opportunity. It is also important to ensure that the 4.7 million people who have not yet taken up the offer of the first jab are encouraged to come forward, because, as the right hon. Gentleman said, the vaccines are our wall of defence.

The flu vaccine programme, too, is extremely important, and people are now being called forward for the flu jab that is helping to protect us throughout the winter months. My message is this: if you receive a call for a flu jab, do not wait to receive a call for your booster jab, and vice versa. Get whichever jab you are invited for first, and that will help to protect you, your family and the people around you.